Jordan Adds Muscle to Avian Flu Preparedness

UNCLAS SECTION 01 OF 03 AMMAN 000905 SIPDIS STATE PASS USAID FOR GLOBAL HEALTH/K HILL, D CARROLL USDA FOR APHIS STATE FOR M/MED DASHO DR. TRIPLET, NEA/ELA, NEA/EX SENSITIVE E.O. 12958: N/A TAGS: TBIO KFLU EAID AMED EAGR PGOV JO SUBJECT: Jordan Adds Muscle to Avian Flu Preparedness REFTELS: A) 05 AMMAN 9093, B) 05 AMMAN 8696 ¶1. (SBU) Summary: Jordan continues to develop its resources in preparation for avian influenza (AI). It now has rapid testing capability in labs around the country, an inclusive interagency committee, a public outreach plan, professional training programs for the agricultural and medical communities, and enough money to buy testing kits and 300,000 courses of Tamiflu (enough for 5% of Jordan's population). End summary. GOJ and Embassy AI Committees Meet -------------- ¶2. (U) Representatives of post's Avian Influenza Task Force and the GOJ's Technical Committee for Avian Influenza Preparedness met on February 5 for a wide-ranging, detailed discussion that focused on the GOJ's lab capacity and surveillance capacity. Participants represented expertise in human health, animal health, agriculture, and public affairs. USAID/Jordan's population and family health office coordinated USG participation. Ministry of Health Assistant Secretary General for Primary Health Dr. Ali As'ad was the SIPDIS senior representative for the GOJ. During the meeting, As'ad said that the GOJ's work on AI is coordinated by a National Technical Committee, which he chairs, and which has created an AI Preparedness Plan. The GOJ plan has undergone only minor changes since the version given to the Embassy in September (Ref A). (As'ad will provide a copy of the latest version to Post.) Rapid Testing at Local Labs - First Line of Defense -------------- -------------- ¶3. (U) Dr. As'ad said that the Ministry of Health (MOH) has expanded to sixteen the number of labs that can do rapid testing for H5N1, a test which he said is very specific and sensitive. The MOH just ran a training course for lab technicians on H5N1 testing during the week of January 29, and has a second course scheduled for the week of February ¶11. When these courses are completed, As'ad said, the MOH will have two persons at each of the MOH's sixteen governorate-level labs who are trained to do the rapid test for H5N1. As'ad expects that five thousand test kits will be delivered next week and distributed to the labs. ¶4. (U) According to Minister of Agriculture (MOA) Assistant Secretary General for Animal Health Dr. Faisal Awawdeh, the SIPDIS Ministry of Agriculture has trained personnel in all of its eleven local labs, but only three of the labs are currently equipped to do the rapid testing. When more test kits are available, they will be distributed to each of the labs, Awawdeh said. PCR Testing at Three Labs - Two in Amman, One at University -------------- -------------- ¶5. (U) Dr. As'ad said that Jordan's plan is to use the simple rapid test of possible H5N1 cases at the local labs for initial detection of either avian or human cases. This takes fifteen minutes, he said. Dr. Gharaibeh from Jordan University of Science and Technology JUST compared it to a home pregnancy test. Any positives would then immediately be sent for confirmation with the more sophisticated PCR testing at the central labs at the Ministry of Health, Ministry of Agriculture, or Jordan University of Science and Technology (JUST). The initial PCR test for the "H5" component takes about 4 hours to run, and the additional test for the "N1" component takes an additional hour. Any PCR tests that come back positive must be sent to a WHO reference lab for further verification. The USG's NAMRU-3 lab in Cairo is the GoJ's first choice for reference lab. ¶6. (U) Dr. Mansour Al-Hadidi, head of the Ministry of Agriculture's central lab, said that Jordan does not have labs rated at biosafety level three, and thus cannot isolate strains of the virus. Also, Jordan does not have the capability of "subtyping" H5N1 samples, Hadidi said, to get the sequencing of the virus. The Health Ministry's As'ad noted, however, that a positive result from the PCR test would be sufficient to trigger immediate medical intervention, including Tamiflu treatment. The subtyping would be useful for vaccines and epidemiology, but not necessary for medically managing a potential outbreak, As'ad said. Dr. Akthem Hadadeen from the Ministry of Health's central lab said that positive lab results would always be interpreted in light of the observed clinical situation. ¶7. (U) Dr. Al-Hadidi commented that Jordan's lab capacity is still limited by human resources, materials and equipment. His comments were echoed by JUST Vet School Assistant Dean Dr. Saad Gharaibeh, who said that his small staff worked "until midnight" on occasion to test dead birds brought in by worried local residents. Tamiflu - 600 Courses in Hand, 5,000 by End of February -------------- -------------- ¶8. (SBU) Dr. As'ad said that the GOJ has budgeted $3.7 million for the purchase of Tamiflu. The MOH has 6,000 capsules (600 courses of two capsules per day for ten days) in stock now, with a further 50,000 capsules (5,000 courses) expected by the end of February. The balance of Jordan's order for 3 million capsules (300,000 courses) is due in August 2006. Dr. As'ad said that some Tamiflu might be used as prophylaxis for medical staff and ambulance crews. The rest would go for treatment, including some in powder form for children. He also kindly offered to provide the diplomatic community, which he referred to as "part of our MOH responsibility," with Tamiflu if necessary. ¶9. (U) When asked about Jordan's treatment protocol for utilizing Tamiflu, Dr. As'ad said that this is being considered by the medical treatment subcommittee of the National Technical Committee on AI. That subcommittee, he said, has met with hospital directors and has trained doctors on the symptoms and management of AI. Each hospital has a "focal point" contact for AI, and there are joint Ag/Health ministry surveillance teams in each governorate. President of the Jordanian Veterinary Association Dr. Abdel Kilani added that his association has posted AI information on their website, and works closely with the National Technical Committee and the local Ag and Health Ministry surveillance teams on AI. Surveillance Systems and Reporting - District Level -------------- -------------- ¶10. (U) Minister of Agriculture (MOA) Assistant Secretary General for Animal Health Dr. Faisal Awawdeh described Jordan's structure for AI surveillance, reporting and testing. He said that there is an AI committee at each governorate. MOA teams go out to take fecal samples from farms and samples from dead birds, generating weekly reports and about 750 samples per month. They focus on farms near water bodies, which are seen as magnets for migratory birds carrying AI. People also bring dead birds for testing, and the Royal Society for the Conservation of Nature brings in dead wild birds for testing. The MOA does PCR follow-up tests for roughly 2-3% of the initial rapid tests. No cases of H5N1 have been detected yet in Jordan, he said. ¶11. (U) Dr. As'ad said that Jordan has six well-trained epidemiologists working at the central level trained by CDC's Field Epidemiology Training Program and funded by USAID/Jordan. That core group supports eighteen teams at the district level that do the initial surveillance reporting. The core group also has communication lines open to CDC and to WHO. Compensation Scheme for Culling Up for Cabinet Approval -------------- -------------- ¶12. (U) When asked about compensation schemes for culled birds, Dr. Awawdeh said that there are no compensation funds available, but a proposal jointly drafted by the Ministries of Health and Agriculture is now before the Cabinet for approval. He noted that the compensation levels would have to be adjusted to match the scope of the problem. Jordan might not be able to pay full price for each bird under some scenarios, he said, noting that the total cost might run to $35 million. Outreach Strategy: Reach Medical Professionals, Allay Fears -------------- -------------- ¶13. (U) National AI Technical Committee Spokesman and Director of the MOH's Chest Disease Directorate Dr. Khaled Rumman outlined the GOJ's communication and public outreach strategy. Driving the strategy is a collaboration of the USAID-funded Health Communication Partnership and Johns Hopkins University. Dr. Soliman Farah, Chief of the Health Communication Partnership, gave hard copies in English of the draft communication strategy. These include plans for web resources on the Ministry's website at http://www.healthcomm.gov.jo/aindex.asp. ¶14. (U) To date, Jordan's outreach consists of distributing brochures on AI prevention to schools, health professionals, and agricultural workers. Other mass media tools have included regular television spots and newspaper articles. Senior ministry officials have also maintained a high media profile on the subject of avian flu preparedness, although few Jordanian newspapers have journalists specialized in health and disease issues. Efforts to reach out to the general public, according to Dr. As'ad, will come later. He blamed existing outreach efforts for increasing public anxiety rather than decreasing them. Dr. Farah, when asked by Emboff, said that person-to-person outreach, such as physician-patient communications, as well as message impact assessment mechanisms, are included in the government's plans. Dead Birds Spark Rumors -------------- ¶15. (U) JUST veterinarian Dr. Gharaibeh said that the level of public anxiety about AI is high, and that people immediately suspect AI now when dead birds are found. He speculated that rumors about AI are being sparked by bird deaths from Newcastle disease, another highly pathogenic avian disease unrelated to H5N1. After the meeting, several GOJ officials complained to Emboff that the Jordanian public tends to distrust government statements in general, further complicating rumor-control efforts. Embassy Focusing on Practical Steps, Sheltering in Place -------------- -------------- ¶16. (U) ESTH Officer sketched the Embassy's preparedness planning. He said there were three principal aspects: educating staff about practical measures to stay healthy, building the staff's ability to shelter in place, and discussion of staff drawdown scenarios. AID Support Appreciated - More is Better -------------- ¶17. (U) In summing up, Dr. As'ad noted that the current meeting was only the latest in a series of US-GOJ consultations on AI. He expressed the GOJ's appreciation for USG support on AI programs, and said further support to fill gaps would be welcome. He and the other participants matter-of-factly endorsed the concept of regional cooperation on AI, saying it is a necessity. RUBINSTEIN