Jordan/H5N1: First Human Case Arrives by Ferry from

UNCLAS AMMAN 002358 SIPDIS SIPDIS STATE PASS USAID FOR GLOBAL HEALTH/K HILL, D CARROLL USDA FOR APHIS STATE FOR M/MED DASHO DR. TRIPLET GENEVA FOR WHO REPRESENTATIVE ROME PASS US MISSION FAO OES FOR SINGER, DALEY NEA FOR RA/LAWSON STATE FOR CA/OCS/ACS/NESA E.O. 12958: N/A TAGS: TBIO CASC KFLU JO SUBJECT: Jordan/H5N1: First Human Case Arrives by Ferry from Egypt REF: A) Amman 2326, B) Amman 2176, C) Amman 2156 ¶1. Summary: A 31 year-old Egyptian who arrived on March 27 in Jordan already sick from H5N1 avian flu is Jordan's first human case. The man raises poultry at his home in Egypt, the presumed source of the infection. The man's medical condition on April 2 is stable. No other human cases are reported, and no new cases in poultry in Jordan have been reported since the March 23 poultry outbreak. End summary. -------------- -------------- Initial Test Negative; Followup PCR Confirms H5N1 -------------- -------------- ¶2. Jordan's Minister of HEALTH Saeed Darwazeh said in a Friday, March 31 press conference that a 31 year-old Egyptian man arrived in Aqaba on Monday, March 27 by ferry from Nuweiba, Egypt, apparently already sick from H5N1 avian flu. The man, who works in Jordan's construction industry and has a home in Kerak, Jordan (one hour south of Amman by car),checked himself into a Ministry of HEALTH hospital in Kerak on Thursday, March 30. He told HEALTH workers that he has chickens at his home in Fayyoum, Egypt, and this fact - combined with his symptoms - made him and hospital workers suspicious that he might have avian flu. An initial "rapid" test was negative, but because of the strong clinical symptoms and the history of exposure to poultry, a second test by PCR was done, which confirmed H5N1. Samples have been sent to the USG's NAMRU-3 lab in Cairo for further testing. -------------- Patient Had Clear Symptoms - Tamiflu Given -------------- ¶3. AID FSN participated in the GOJ's Avian Flu Technical Committee meeting on Sunday, April 2. The meeting was chaired by Ministry of HEALTH (MOH) Secretary General for Technical Affairs Dr. Ali As'ad. As of 1300 local time, the patient's medical condition was stable, although doctors are watching carefully as the patient reaches what they feel is a critical stage at 5-7 days after becoming symptomatic. Doctors reported at the meeting that the patient had symptoms of cough, high fever, congestion in the upper respiratory tract and around the eyes, and that his chest x- ray clearly showed evidence of disease in the lower lungs. ¶4. The MOH hospital in Kerak has put the man and a traveling companion in isolation, and is treating both with double dosages of Tamiflu. HEALTH authorities haven also given Tamiflu to eleven HEALTH workers with whom the Egyptian man had direct contact at the hospital. HEALTH authorities are monitoring the temperature and symptoms of the people at the patient's home in Kerak. The HEALTH Subcommittee of Jordan's Avian Flu Technical Committee has developed protocols for use of Tamiflu and is sticking with them, despite pressure for wider use of Tamiflu. The GOJ's "golden rule" is direct exposure to confirmed cases in either birds or people. No further human or avian cases of H5N1 in Jordan have been reported, and officials said that the situation in Ajloun in northern Jordan, where there were confirmed cases in turkeys in March, is under control (ref C). ¶5. GOJ officials are investigating why the initial "rapid" test was negative. Three possible scenarios were discussed at the April 2 meeting: a bad or inadequate sample, poor lab procedures, or a bad test kit. For the time being, GOJ protocols are that if the history and symptoms are strong indicators of avian flu, they will immediately do a PCR test. -------------- Fine-tuning the Response -------------- ¶6. The AI Technical Committee meeting gathered representatives from the Agriculture Ministry, the HEALTH Ministry, Royal Medical Services and universities. Chairman As'ad noted to attendees that the human case in Kerak is a "real test" of Jordan's capacity, and that the committee should use the opportunity to address the inevitable shortcomings and problems that emerge. ONE such shortcoming was a delay in getting Tamiflu to Kerak; supplies are now being distributed around the country. Another mid-course correction is to minimize the number of HEALTH workers (such as lab technicians) with direct exposure to H5N1. There was discussion about continuing with plans to cull all backyard flocks around Jordan, and the decision was ultimately made to stand by that decision (ref B). Compensation to farmers (ref A) is still an evolving issue, but the latest information from the Ministry of Agriculture is that the GOJ will compensate for all poultry that the GOJ itself culls, but not for any culling done by farmers themselves. -------------- Industrial Poultry Operations Continuing -------------- ¶7. On the economic side, the committee agreed not to close Amman's large central slaughterhouse to poultry. MOA and MOH officials agreed that closing the slaughterhouse would be a tacit admission that sick birds could get through their screening procedures. They feel that their monitoring and other food safety procedures ensure that this will not happen. Due to a drop in demand for chicken, big industrial poultry producers are freezing their product in preparation for a rebound in demand. -------------- Public Outreach Campaign Shifting Gears -------------- ¶8. The press has covered the Egyptian's case widely in a straight-forward and factual manner. Although the GOJ's initial press strategy focused on agriculture, it is now shifting gears to get out the message on human health. USAID is working with Johns Hopkins University to release immediately some television announcements, originally done for Egypt, on avian flu. The GOJ's public affairs program on avian flu is also on a fast track, but may require a week or two to get its television announcements off the ground. Press placements are being done already. -------------- Embassy Outreach and Response -------------- ¶9. The Embassy's Avian Influenza Task Force met on April 2 to discuss the case, review the tripwires and plan the next steps. The Task Force agreed to take the following actions: the Ambassador will lead a discussion of avian flu at Town Hall meetings on the morning of April 6 for American staff, family members and locally-engaged staff. A Management Notice will be circulated to all staff on April 2, and a warden message following similar lines will be distributed shortly after that. A public informational event on avian flu for all concerned members of the larger Embassy community, including DOD contractors, AID contractors and staff at the American Language Center will be held on the afternoon of April 6. Embassy ESTH Officer will participate in a webchat about avian flu on Tuesday, April 4. HALE