Social and economic impacts...………………………………………………....61
Members of National committees ……………………………………………...63
National Media Committee…………. ………………………………………....64
Telephone Number Directors of Agriculture …….………………………….....65
A list of labs approved by ministry of health.......................................................67
A list of approved hospital to encounter birds influenza…………. …….…......68
A list of names to inform at the directorate of disease control............................69
Telephones and fax numbers of directorates of health .……………………......70
Telephone numbers of directors of health ..…………………………………....71
Informing form ..…………………………………………………………….....72
Sample form …………………………………………………………………...73
Birds Influenza investigation form .…………………………………………...74
Chick form for RT-PCR .……………………………………………………..76
Field visitation table for poultry farms…..………………………………….....77
Influenza is a very infections viral disease which affects the respiratory system and spread by cough and sneeze droplets. This Virus belongs to the Orthomy- xovirus group. It is divided into three kinds: "A" "B" and "C". B and C affect humans only, while A affects birds, and rarely pigs and humans. A virus is distinguished by the ability to change its genes continuously through Mutation or Genetic reassortment, which enables it to avoid the human immunity system.
Influenza Pandemic is the World spread of the pandemic which happens suddenly every 10-40 years in which a high percentage of people are affected leaving millions of. death as shown in table 1.
Table 1.Previous Pandemic in the World
Number of deaths
Hong Kong flu
The risk of Influenza Pandemic begins when a new Strain of the virus:
People have no immunity for it
Emergence of a novel virus to which all are susceptible
New virus is able to replicate in humans and cause disease
New virus is transmitted efficiently from human to human
Fears of Spread of Influenza pandemic, as a result of H5N1 which infects people and birds really existed now, for the first in the Hong Kong in 1997 it caused about 260 cases, 60% of them died..
All the conditions to start an Influenza Pandemic now except for the virus is transmitted efficiently from human to human.
The World Health Organization invites, the world countries to put plans to encounter the new pandemic it is expected to infect 25% of the world population and to cause death from .,06 - 2,2% of the infected. Upon the these givens, 1,8 million Jordanians are expected to catch disease and 8000 of them are expected to die.
The Pandemic may cause parallel in social, political and economic life because of the great numbers of the infected people and the burden of the health institutes, and the lack of enough Vaccine, ant viruses and antibiotics.
In preparation to encounter the pandemic in Jordan, a plan was prepared to clarify the strategic procedure, to control it in Jordan.
The plan is divided into two phases:
This plan aims at:
Forming national committees
Reducing the possibility of human infection
Surveillance early Warning
Providing a strategic supplies of ant viruses and antibiotics
Containing and limit the spread of Virus
Decreasing of Morbidity and Morbidity
Reducing social and economic impacts of the Pandemic.
Forming National committees
A number of National committees have been formed in order to put down a comprehensive national plan to control the pandemic in Jordan, among these the supreme guidance national committee (headed by the minister of health and general secretary) and the national technical committee. It has sub-committees, The management committee, the media committee, and the sub committees in governments and districts.
A number of representative contributed to updating the national plan. These representatives Ministries were from: Ministry of health, Agriculture, Education, Awqaf, Finance, Royal medical services, public security, Civil defense, the public institute for food and medicine, Amman greater municipalityUuniversities, Unions, Royal society for conservation of nature, Petra news Agency, Institute of Radio and television. Private sector and international organizations.
Reducing the possibility of human infection: Ministry of Agriculture enhanced, early surveillance system concerning birds influenza among poultry and wild birds through:
Forming Co-committees from Ministry of Agriculture and Ministry of health, and condensing surveillance on poultry farms in different area of the kingdom in order to follow up the number of increasing dead birds, which is an indicator for the existence of H5N1.
Training people who work in poultry farms to deal with infected birds that emerge.
providing veterans, agricultural engineers and technicians with the needed equipments to deal with any cares.
providing veterans, and technicians with influenza vaccination.
Permanent coordination and cooperation with adjacent countries.
providing vaccinations for poultry in case of any emergence of Infected birds.
Reinforcing Surveillance and early alarm system among humans the Ministry of health reinforced the early alarm system for H5N1 among humans through:
Improve labs Capacity of Ministry of health to diagnose H5N1 and providing them with the needed substances , and training them in Rt-PCR technique in reference lab..
Published the case definition of Avian Flu for all Doctors in the Kingdom so that they can inform about any suspected cases.
Forming small task forces in all hospitals, in order to evaluate the suspected cases and reported them, these groups consist of in addition to public health doctor in the each Health Directorate, and at least two doctors specialist in the following specializations Infectious, chest, internal, and Pediatric, they must write their names and phone numbers in a clear place in the emergency room.
Selecting a number of Credited hospitals that represent the kingdom and the different health sectors to diagnose and treat H5N1 among people and deal with the patients and identify the health workers who will deal with the patients and providing them with Personal Protective Equipment.
Developed a guideline for the case definition and practical procedures to deal with the cases, instructions for Laboratory specimens and practices , Management protocols and instructions for personal safety for the workers and infection control in hospitals.
Developed investigation form the cases and putting down guiding principles to investigate the cases and specially the group case to identify the transmitted from human to human.(see appendix investigation form)
Training the Health workers in hospitals and directorates of health to perform these activities.
Providing a strategic supply of anti viruses and antibiotics.
The Ministry of health provided a strategic supply of antibiotic and anti viruses to treat the expected cases among population in additional to the prophylactic dose for the Health workers, doctors, nurses, lab technicians, general health doctor, field workers, veterans, and workers in disposing infected birds and workers in other sectors who grant services (police, civil defenses, transportation …. etc, in case of pandemic Phase.
The Ministry of health and National Management committee developed a protocol to treat and deal with cases and prepare hospitals to admitted and treat them and provide the personal Protective Equipment.
The Ministry of health provides health workers who deal with cases with Seasonal influenza vaccination and high risk group to protect them from infection.
The media committee designed a plan to reach precise information concerning bird influenza to people without provoking their fears.
The plan targets different members of the society "children, housewives, farmers, vets, health workers members of national committees" to "
Improve Awareness about the disease and the situation in Jordan for each phase of the disease.
Strengthening the healthy behaviors to prevent infections, especially with poultry farmers and people who keep domestic poultry.
Improving the health workers’ knowledge, attiude about the disease in order to prevent and control infection.
Grant peoples a safe and healthy food.
Exchanging information between public, NGOs and international organizations.
The media plan is executed through the following communication means:
Visual media: films, TV sketches, which target school children, universities, housewives and farmers.
Posters: targets children, students, farmers, veterans and health worker.
Face to face meeting likes meetings, seminars, lectures workshops, Friday preaches target the community.
Communication means: phones, faxes, E-mails of the :
Members of committee, and decision markers
SMS: citizens and committee members
Telephone:( hotline:) all society classes through doctors in Ministry of health and vets in Ministry of Agriculture.
The following are the most important messages to be reached to people:
No H5N1 cases among people in Jordan.
Measures and procedure were taken by Ministry of health, Ministry of Agriculture and other public institutions to control the cases when it appears.
- No transmitted efficiently from human to human
Hand washing, especially after dealing with poultry, after eating and after leaving lavatory.
Cooking poultry products well at 70c
Avoiding direct contact between humans and birds.
Aviculture must be done away from living areas and keeping them away from wild birds.
Vaccinating poultry and bird pets.
Notify Ministry of health and Ministry of Agriculture when poultry is suspected to have infected, and dispose them safely.
Similarity between H5N1 and the seasonal influenza in symptoms.
Pandemic phase among poultry
Isolating infected areas, and preventing poultry, vehicles, equipments, and workers’ movement.
Healthy disposal of infected flocks and the whole leftover
Disinfecting and sterilizing the infected farms and their surroundings.
Vaccinating the adjacent farms
Detecting the workers in infected farms.
Asking for help from international organizations.
Practical procedure in case of Infected and death occurrence among poultry and wild birds
Inform Ministry of Agriculture at the center or the govern rates (see appendix 1).
Director of Agriculture informs the Ministry of Agriculture /the veterinarian department to identify the degree of danger.
If the suspicion degree is high, the veteran rain has to perform a field visit using the available vehicle and safe equipment. .
Collect sample from the live or dead birds following the instructions in the given form (see appendex2).
Transport the sample to an approved Regional lab to conduct a rapid test(see appendex3 list of credit lab).
If the test is negative, another samples must be taken to confirm the test, considering the concerned experts estimations at the Ministry of Agriculture.
If the rapid test was positive to H5A, two more samples are to be tested using RT-PCR technology one at the lab department of animal fortune and the other to the lab of Jordan University of Science and Technology/ Faculty of veterinarian science.
If the result of RT- PCR was positive in any of the two labs, the result is approved and a confirmatory sample is to be sent to international referential lab. The national technical committee is invited do meet in the control room at the Ministry of Agriculture.
The instructions of the executive plan at the Ministry of Agriculture and the public security to be followed( see appendix ) .
In case of infected wild birds the following is to be done:
Spraying the places where they stay.
Checking the surrounding farms.
Poisoning the birds if possible.
In case of poultry infection, instructions of Ministry of Agriculture are to be followed(see appendix)..
Coordination between the directorate of disease control and directorate of health in the govern rate to investigate suspected cases.
Emergency plan to encounter birds’ influenza
The plan represents a brief for the procedures to be taken against birds’ influenza. Specialists at the Ministry of Agriculture designed the plan, to provide the veterans with the necessary practical information to manage any out break of the influenza.
1. Arriving to the suspected farms:
In case of the suspicion of infection in a farm the veteran has to know the person who informed, and if he was a farmer, the veteran has to collect the following data:
The location of the farm, the kind of birds, and the number of workers and their equipments.
The movements of the workers, the animals and the equipments from and to the farm.
The number of spraying pumps and the availability of disinfectants in the farm.
Informing the veterans of the infected cases is obligatory in private companies or sectors, and if information is concealed about the disease, the company or the vet hold the full responsibility.
If an infection is confirmed in the lab of any poultry companies, the company has to take all safety measures before the public veteran arrives, to prevent the disease from spreading out of the company surrounding..
All the transport media of the company have to stay away from the farm and even the public veteran must not enter the place.
The veteran must do the following to avoid moving equipments, animals, or molders from the farm:.
Informing the directorate of animal labs/ Ministry of Agriculture of the suspected animals..
Informing veterinary directorate / Ministry of Agriculture of the suspected animals.
Informing the directorate of Agriculture, where the suspected farm is located.
Finding the closest disinfecting spraying car and driving it to the location.
Providing the car with box No.1
2-1 Entering the farm
In case of entering an infected farm, all clothes must be changed out of the farm.
Disposable gear must be worn and they include over whole, a head cover, foot cover and that include all the people who enter the farm..
A dressing room has to be appointed in which, a big plastic bag, latex gloves and sufficient disinfectant have to be available.
The rest of the contents of box No.1 are to be used inside the barracks.
The main tasks of public vet are:
Quarantining the farm
Workers and the veteran must sign an obligation not to visit any farm that has live birds for three days.
Appointing a place in the farm for washing the equipments that leave the farm.
Organizing the washing and disinfecting process for the workers and the equipments that will leave the farm.
Preventing the used materials from going out of the dressing room.
Equipments have to be washed and disinfected when entering or leaving the farm, and they mustn't leave unless it is necessary.
Check the water sources in the area for fear of pollution.
The public lab doctor must reach the farm, holding box No.2 in a car with a driver, and must stay outside the farm, in order to carry samples from the farm to the lab.
The lab doctor must wear the Personal Protective Equipment dress in the dressing room and leave the following, items in box No.2 :
Water proof containersز
An ice box.
Four pairs of latex gloves.
Autoclaveble plastic bags.
The rest of objects in box No.2 must be used in the bariks.
2. Introductory procedures:
The public veteran and lab doctor do the following:
Identifying the barracks or brakes in the farm and problem and why they are suspected and if possible marker it. .
Identifying the workers who work in directly in these barracks.
Writing case history report
1-2 Clinical Procedures:
-These procedures aim at studying the situation directly in the farm and they include the infected and suspected birds.
- These procedures must begin with the surroundings or the far buildings from the suspected ones
- Check whether the Influenza vaccination was used in the farm or not.
In case of bird influenza infection suspicion, the following samples must be sent to the directorate of animal fortune lab:
At least 5 birds that revealed disease symptoms.
A number of pharynxes and lungs of at least 5 birds.
The complete guts of at least 5 birds.
Samples of pharyngeal swabs of at least 5 birds.
10 Acute sera blood samples.
Samples from different kinds must be identified individually.
Samples must be kept well, put in a water proof container, tied well in two bags of plastic to prevent spreading of infection and must be transported in an ice box to the directorate of animal fortune lab.
The 5 birds must be transported in 2 plastic Autoclavable bags.
All the samples must be sent to the lab in a polystyrene container full of ice packs. The container must be disinfected before and after taking it out of the farm with an effective disinfectant.
Sample and informing forms must be enclosed with the samples.
Samples must be delivered to the lab without delay.
The lab doctor and the public veteran must conduct a direct epidemiological investigation to know the following important things:
Bird movement: movements of birds in or out of the farm must be recorded as from 20 days before of the first clinical symptoms.
People movement including workers, veterans, engineers and farmers must be recorded.
Vehicle movements that entered or left the farms and especially those that had direct contact with the birds.
Data must be sent to the sub-committee in the govern rate and to the operation room in the Ministry of Agriculture.
3. Leaving the farm
After the field clinical visit and sample collection and sending them to the lab, the following must be done:
Put the disposable dress in Autoclavable bags, and must stay at the farm..
Keeping the equipment used in anatomy and sample taking in Autoclavable bags.
Close the bags tightly and put them in other. Autoclavable bags.
Bags must be disinfected well from the outside by an effective disinfectant..
Papers and pens used must remain in the farm and put in bags.
4. Objects to be used
4-1 Box No.1
Suspected case reporting form
Materials for the field visits including:
3 cover all disposable dresses
5pairs of shoe cover
5 pairs of latex gloves
A pair of rubber gloves
5 head covers
5anti leak containers
hand torch with batteries
100 syringes 2,5 ml
a pair of scissors
a pair of tweezers
Polystyrene ice box
Notes.: 2 boxes at least must be prepared in each governorate
if birds are little in number, they can be injected with Anesthetic drug.
If birds are more Gas in closed containers. 150 bird for each gas cubic meter with average weight at 1,8 kg
Carbon dioxide 17,5 kgs/1000 m3, kills within 15 minutes
Carbon mono oxide gas : 8 kg/1000m3 kills within 15 minutes
Drugs to use for killing birds: sodium Phenobarbital dissolves in water. 80 mg/55ml. kills within 4 hours can be used if the suspected birds clinically infected and have a good appetite.
6-3 Disposing infected birds
burial: the hole must be at least 2 m wide, 2m depth
this depth takes only 300 birds with average weight of 1,8 kg, birds can be doubled with each extra depth ,birds must be covered with calcium Hydroxide then 40 cm3 of soil.
Transporting and disposing infects bird a way.
Bird must be transported in closed lorries. They must be disposed in especially prepared places for such infectious materials.
7. disposing infected materials.
Trash and organic remains that cannot be disinfected, must be destroyed especially the bird remains, eggs, straw, fodder and feathers.
Trash and remains: must be buried with the birds or piled in heaps and covered with plastic cover till they yeast.
Eggs: must be buried with the birds
Straw: can be disinfected by spraying its surface with effective disinfectant and be kept for 42 days, but because of the long time needed it will be better to burn it in the farm.
Fodder: must be disinfected by steaming then burning.
8. Disinfecting polluted farms
There are many things to be considered when disinfecting a farm.
All the farm units must be disinfected.
All vehicles used in transporting birds, fodder and eggs must be disinfected completely.
Washing and disinfecting walls, floors, ceilings of all barracks to guarantee removing all organic remains.
Iron objects like cages, can be disinfected by burning
All objects inside the barracks used for feeding birds, must be washed and disinfected for 48 hours.
Water wells of the farm must be emptied, washed and disinfected.
Stores must be emptied, washed with pressured hot water and steamed.
After washing and disinfected all units must be steamed twice within two weeks.
9. Disinfectants be used
Sodium Hypochlorite 2%for objects and Instruments.
Quarterly Ammonium 4% for walls and floor.
Sodium + sulphanic Acid+ potassium peroxomono sulphate alky Benzene sulphate for cerhys, flowers walls and objects.
Calcium Hydroxide for walls and floors 3%
Cresolic Acid for floors 2,2%
Synthetic phenols 2% for floors
Formalin and potassium permanganates for steaming.
10. Pharyngeal and rectal swabs
These samples must be taken from 30 birds at least, this will help detect infection with a confidence level of 95% if the percentage of disease spreading through remains may reach .,1%. The sample must be at least 1g. It must be put in a special viral media to be transported to the labs.
The national plan for testing plan in simulation (a practical exercise) .
10-1 Reported infection
When suspecting infections a among birds or poultry a rapid test must be conducted in Ministry of Agriculture lab.
if the result is positive, the lab director informs Dr Faisal A waw -deh the secretary general assistant for animal fortune on phone No 0777781170, Dr Awawdeh informs Dr Ali Asa'ad the chairman of national technical committee for bird influenza phone No 0745492931.
if infection was proved by PCR test, information is passed to
The lab of Ministry of Agriculture prepares and sends samples of the infected birds to a referential lab to confirm infection and identify viral pathogenecity.
2. Executive procedures
The central operation room is opened, and a sub operation room is opened in the govern rate where infection is registered.
The central operation room is in Amman at the Ministry of Interior. The chairman of the of supreme guidance committee addresses the Minister of Interior.
Other operation rooms are to be opened at Ministry of Health and Ministry of agriculture at the central operation room in Amman, the following people attend::
Minister of agriculture or a representative .
-Minister of Health or a representative
Minister of Interior or a representative
The director of civil defense or a representative
secretary general of Ministry of municipalities
Deputy mayor of Greater Amman municipalities
Manger of royal Medical Services
Sub-operation room in the govern rate:
The governor of the concerned area
Director of Agriculture
Director of health
Director of public works
Director of municipalities
Director of police
Director of civil defense
The farm is secured by public security in order to prevent movement from and to farm
No birds are to be moved from the farm without order from the governor
The surrounding area of the farm is to be closed with a diameter of 3 km by the police.
A control evaluation and support team is to be formed in order to evaluate the taken procedures in the concerned goverrate and offer consultant and support for the local team. The team are:
Department of veterinary service/ Ministry of Agriculture
Department of disease control /MOH
Department of labs/MOH
Directorate of civil defense
Directorate of public security/Department of operations.
Field teams are formed as follows:
Ministry of Agriculture forms this team. Their task is to get rid of the infected poultry by the mechanisms agreed up on and they are: breaking necks, burning and burial. The veterinary department is assigned to offer alternatives. The team is headed by a vet from the directorate of the concerned govern rate and it includes:
-An animal production engineer.
-10 workers for each farm with 10000 birds in it. The number of workers is 1 for each 1000 birds.
-Selecting those workers, recording their names and phone numbers and informing the technical committee is the responsibility of the governor.
-The team must be provided with the personal prophylaxis materials which include :
-Over whole dress
N95 mask for disinfections and disposing team.
-plastic gloves of good quality
-The team must be provided with manual equipments and other needs like:
Enough and strong plastic bags to fill them with the dead poultry.
100m plastic sheet to cover the holes which are expected to be 4m length 2m width and 3m depth .The hole must be within the boundary of the infected area.
Carts, shovels, and other digging equipments are 20 ones for each govern rate.
These equipment are to be bought by Ministry of agriculture within the formal ways. They are to be kept in stores and used when necessary.
Plastic bags and prophylaxis kits are to be bought immediately.
The govern rate is to be provided with:
An overthrow truck.
Dead and killed poultry are to be collected in plastic bags and transported by carts to the trucks which will be unloaded in the approved load.
A hole is to be prepared to bury poultry and it must be3m in depth, length and width are determined by the size of the farm, the bags of dead poultry are to be buried in the hole and then to be covered with calcium and half meter depth of soil.
Another hole is prepared in the same way to bury or burn the poultry remains.
The head of the team supervises the record of the numbers of dead and killed poultry for the purposes for compensation.
Finding the sold birds 72 hours before emergence of infected and check whether there are dead ones or not.
If the farmer transported poultry to another farm the farm put under Quarantine till it has to check it for infections.
After completing the procedure above, workers are to dispose and burn the dresses and equipments in the same way done for the dead poultry, civil defense team are to help in handling pollution and disinfecting workers
The team is consisted of police and Royal force their task is:
Closing the roads from and to the farm.
Securing the farm within a 3km diameter circle from the center of infection to prevent entering or leaving from the Quarantine zone.
Maintaining security in the area.
It is the responsibility of the Ministry of Health and agriculture. The Ministry of Agriculture handles disinfecting farms and the equipments in them, tractors and sprayers are provided.
Names of teams are recorded in each govern rate and sent to the technical committee.
Ministry of Agriculture must enclose an appendix containing names of disinfectants, their concentration and how to use.
Ministry of Health is responsible for assuring the use of personal protective kits before entering the farm and disposing dresses after exiting the farm and washing hands well using soap and disinfectant.
At the closure points of the Quarantined area, entering and learning vehicles and to be disinfected using manual spraying pumps.
Team of directorate of water.
Formed by director of water in the area. Their task is to provide other teams with water for spraying and disinfecting.
General health team.
Headed by the general health doctor in the govern rate and the members are:
Civil defense rescue team.
The general health team are assigned the following:
Recording the names of the form workers, their families and the visitors.
Recording the names of people who entered the farm within the previous 48 hours.
Conducting interview, clinical history, clinical examination if necessary for all workers in the farm and their families.
Conducting Rapid test for the suspected workers.
Giving all the team members chemoprophylaxis Tamiflu tab, once daily for 10 for ten days.
Follow up the workers and their families by the doctor for 10 days.
If any symptoms were recorded for any one, a rapid test is conducted, if the result was positive he/she must be hospitalized and treated according to the designed plan.
Poultry vaccination team:
Formed of Ministry of Agriculture, farm owners, private veterans and veterinarian urine. They are assigned the following:
Vaccinating poultry within a circle of 8 Km diameter.
Applying safety precautions and infection control..
If infection appeared among domestic poultry, infections are dealt with as if they are in the farm and the instructions are applied precisely.
Team of media
Assigned the task preparing guidance messages and posters for all the phases of infection
Obtaining financial funds to provide the teams with:
Food and water.
Juice and hot drinks.
Means of transport.
Communication means: 400 cell phones - prepaid cards- commutation companies can be addressed to contribute in this national effort.
4. Incase infections among domestic poultry the following instructions are to be taken:
Applying quarantine on an area of 3km diameter.
Executing domestic poultry in the area.
Checking the surrounding farms within the quarantined area and to be watched carefully.
Vaccinating the surrounding farms within the distances of 3-7km.
5. In case of infection among wild birds, the following procedures are to be taken:
Identifying the infected bird.
Requesting the Royal Society for conservation of nature to provide Ministry of agriculture with immigration track and the numbers of the targeted kind.
Conducting checking procedure on the farms within the given track, and in case of infection, the procedures mentioned above are to be applied (quarantine, execution, disinfecting and vaccination).
If domestic poultry were found within the track, the previous item must be applied to them.