US embassy cable - 06AMMAN905

Jordan Adds Muscle to Avian Flu Preparedness

Identifier: 06AMMAN905
Wikileaks: View 06AMMAN905 at
Origin: Embassy Amman
Created: 2006-02-08 11:07:00
Redacted: This cable was not redacted by Wikileaks.
This record is a partial extract of the original cable. The full text of the original cable is not available.

E.O. 12958: N/A 
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 
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 
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 
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 
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. 

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