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THE HASHEMITE KINGDOM OF JORDAN
THE NATIONAL PLAN FOR INFLUENZA PREPAREDNESS
Seventh Version
Last saved:2/11/2013
TABLE OF CONTENTS
Introduction….…………………………………………………………………3
Pre-Pandemic Phase….……………….……………………………………..…6
Pre- Pandemic Phase in Jordan ……..………………………………………….6
Formation of National committees …………………………………………....6
Reducing chances of human infections……………………………………......6
Enhancing early alarm system among people………………………………...7
Providing strategic reserves of anti viruses and antibiotics …………………8
Preparing hospitals ……………………………………………...………….….9
Seasonal Influenza vaccination ………………...………….………………….9
Media ……………………………………………….…………………...………9
The pandemic phase of Influenza among poultry .………………...……….......1
The pandemic phase of Influenza among people ………………………..….….31
Case definition of H5N1 ……………………………………………………….31
Practical procedures for dealing H5N1 patients ……………………………….33
Infection –control recommendations …………………………………………..39
Recommendation for Pneumonia treatment..…………………………………..54
Recommendations for specimen collection …………………………………....57
Pandemic Phase ………………………………………………………………..60
Containment and delaying virus deployment…………………………………..60
Decrease morbidity &mortality ..……………………………………………..60
Social and economic impacts...………………………………………………....61
Appendix .……………………………………………………………………....62
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
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Introduction
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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
year name cause Number of deaths
1918 Spanish flu H1N1 50 millions
1957 Asian flu H2N2 millions
1968 Hong Kong flu H3N2 million
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
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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:
Pre-Pandemic phase
Pandemic phase
This plan aims at:
Pre-Pandemic phase
1. Forming national committees
2. Reducing the possibility of human infection
3. Surveillance early Warning
4. Providing a strategic supplies of ant viruses and antibiotics
5. Preparing hospitals
6. Influenza vaccination
7. Media
Pandemic phases
1. Containing and limit the spread of Virus
2. Decreasing of Morbidity and Morbidity
3. Reducing social and economic impacts of the Pandemic.
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Pre-Pandemic phase
1- 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.
2- 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.
Following up the immigrant birds
Preventing hunting wild birds
Banning importing birds
Condensing monitor on bird shops and zoos.
Training people who work in poultry farms to deal with infected birds
that emerge.
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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.
3- 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..
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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.
4- 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
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workers in other sectors who grant services (police, civil defenses, transportation
…. etc, in case of pandemic Phase.
5- Preparing hospitals:
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.
6- Influenza vaccination.
The Ministry of health provides health workers who deal with cases with
Seasonal influenza vaccination and high risk group to protect them from infection.
7- Media
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 :
Media mean:
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Visual media: films, TV sketches, which target school children,
universities, housewives and farmers.
Audio:( radio) targets students, housewives and farmers
Posters: targets children, students, farmers, veterans and health worker.
Newspaper articles
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.
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- Similarity between H5N1 and the seasonal influenza in symptoms.
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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
1. Inform Ministry of Agriculture at the center or the govern rates (see
appendix 1).
2. Director of Agriculture informs the Ministry of Agriculture /the
veterinarian department to identify the degree of danger.
3. If the suspicion degree is high, the veteran rain has to perform a field visit
using the available vehicle and safe equipment ..
4. Collect sample from the live or dead birds following the instructions in the
given form (see appendex2).
5. Transport the sample to an approved Regional lab to conduct a rapid
test(see appendex3 list of credit lab).
6. If the test is negative, another samples must be taken to confirm the test,
considering the concerned experts estimations at the Ministry of
Agriculture.
7. 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
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the other to the lab of Jordan University of Science and Technology/
Faculty of veterinarian science.
8. 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.
9. The instructions of the executive plan at the Ministry of Agriculture and
the public security to be followed( see appendix ).
10. 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.
11. In case of poultry infection, instructions of Ministry of Agriculture are to
be followed(see appendix)..
12. Coordination between the directorate of disease control and directorate of
health in the govern rate to investigate suspected cases.
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Emergency plan to encounter birds’ influenza
Introduction
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:
1-1 Suspicion
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:.
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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.
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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 containers ز
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.
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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.
- All-important notes about the kind of birds, date of onset, clinical
symptoms, and percentage of death, have to be written down.
2-2-sample collection
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
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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.
3-2:Epidemic procedures:
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.
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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
Stationary
Sample form
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
5 masks
tissues
5anti leak containers
hand torch with batteries
Effective disinfectant
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100 syringes 2,5 ml
a pair of scissors
a pair of tweezers
sticking plaster
Polystyrene ice box
5 Icepack
Notes.: 2 boxes at least must be prepared in each governorate
4-2 Box No. 2
Polystyrene heat resistance ice box
pairs of tweezers
a pair of scissors
a knife
sticking plaster
100 syringes 2,5 ml
100 disinfected swabs
50 blood tubes
10 anti leak containers to transport samples
5 disposable dresses
10 foot cover
10 latex gloves
10 head covers
10 mouth masks
10 black garbage bags
disinfectant with a sprayer
cartoon container
5. Infection confirmation
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As soon as the lab confirms the infection, all the necessary procedure must
be applied in the farm. The public veteran must do the following::
spraying the farm with disinfectants.
Reducing the number of vehicles and workers who work in the farm.
Workers who enter the farm, can leave if they changed their dress and
had a bath and must not contact with birds for 3 days at least.
contacting the crews needed for transporting birds, the diggers, and the
ones to disinfect the farm.
6. Transporting dead birds and disposing them
Birds must be transported and disposed as fast as possible to prevent
spreading of the disease and must be done with the regulations and
standards of Ministry of Agriculture.
Wild birds and animals must be prevented from entering or leaving the
farm to prevent them from spreading the virus mechanically.
Birds are advised to be buried in the farm, to prevent infection by organic
materials.
6-1 The crew and the vehicle needed to transport and dispose birds .
Disaffection tank.
A public veteran for each infected farm at least.
Enough workers to replace the tired ones.
A proper number of vehicles that will transport the birds
Identifying the source of vehicles
Police patrol must accompany the bird transportation
proper containers to dispose the infected materials
6-2 Killing birds
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birds can be killed using one of the following ways:
drinking water
breaking the necks
carbon Dioxide gas
a vacuum tank
Mechanical killing for fertilized eggs
other ways to be used:-
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.
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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
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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
Dr Faisal Awawdeh, who informs
- Minister of Agriculture.
- the governor of the infected area.
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- The chairman of National technical Committee/Dr Ali Asa'ad, who in
return informs
- Minister of health.
- Minister of Interior by Minister of Agriculture
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
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- 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.
3-Working teams
Field teams are formed as follows:
Disposing team
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:
-A veteran.
-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
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N95 mask for disinfections and disposing team.
-plastic gloves of good quality
-Head cover
-long boots
-eye glasses
-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:
A bulldozer.
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.
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- 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
- security team:.
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.
Disinfection’s team:
- 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.
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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:
Doctors
Nurses.
Lab technicians.
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..
29
- 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
Logistic needs.
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.
30
- 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.
31
1-The Pandemic Phase of H5N1
1-Suspected case: Acute lower respiratory illness with fever (>38°C) and cough,
shortness of breath, or difficulty breathing;
AND
1 or more of the following exposures in the 7 days prior to symptom ones:.
A. Close contact (within 1 meter) with a person (e.g. caring for, speaking with,
or touching) who is a suspected, probable, or confirmed H5N1 case;
B. Exposure (e.g. handling, slaughtering, defeathering, butchering, preparation
for consumption) to poultry or wild birds or their remains or to
environments contaminated by their faeces in an area where H5N1
infections in animals or humans have been suspected or confirmed in the
last month;
C. Consumption of raw or undercooked poultry products in an area where
H5N1 infections in animals or humans have been suspected or confirmed in
the last month;
D. Close contact with a confirmed H5N1 infected animal other than poultry or
wild birds (e.g. cat or pig);
E. Handling samples (animal or human) suspected of containing H5N1 virus in a
laboratory or other set.
2- Probable Case
Probable definition 1:
A person meeting the criteria for a suspected case
AND one of the following additional criteria:
A. infiltrates or evidence of an acute pneumonia on chest radiograph plus
evidence of respiratory failure (hypoxemia, severe tachypnea)
OR
32
B. positive laboratory confirmation of an influenza A infection but
insufficient laboratory evidence for H5N1 infection.
C.
Probable definition 2:
A person dying of an unexplained acute respiratory illness who is
considered to be epidemiologically linked by time, place, and exposure to a
probable or confirmed H5N1 case.
3-Confirmed case: A person meeting the criteria for a suspected or probable
case
AND
one of the following positive results conducted in a national, regional or
international influenza laboratory whose H5N1 test results are accepted by
WHO as confirmatory:
A. Isolation of an H5N1 virus;
B. Positive H5 PCR results from tests using two different PCR targets, e.g.
primers specific for influenza A and H5 HA;
C. A fourfold or greater rise in neutralization antibody titer for H5N1 based on
testing of an acute serum specimen (collected 7 days or less after symptom
onset) and a convalescent serum specimen. The convalescent neutralizing
antibody titer must also be 1:80 or higher;
D. A microneutralization antibody titer for H5N1 of 1:80 or greater in a single
serum specimen collected at day 14 or later after symptom onset and a
positive result using a different serological assay, for example, a horse red
blood cell Haemaglutination inhibition titer of 1:160 or greater or an H5-
specific western blot positive result.
33
Practical procedures for dealing with H5N1 suspected case:
1. If A suspected case visits a medical center, an out patient clinic, a private
clinic or unaccredited hospital.
Follow infection control recommendations.
transfer the case immediately to the closest approved hospital after calling
the emergency doctor in that hospital with coordination with civil
defense (199) or public security (196).
2. If a suspected case virus approved hospital.
Isolating the patient in quarantine.
Following infection control recommendations.
Immediately infer the small task force in the hospital to evaluate the case
and make sure it is meeting with the case definition.
Informing the Directorate of disease control (5607144) and taking
directorate of health in the concerned govern rate.
Taking 3 samples: 2 nasal swabs and nasopharyngeal wash.
Conducting a rapid test on one of the nasal swabs in the hospital.
Sending the rest of sample to PCR lab in Al Bashir Hospital after calling
and coordinating with the lab.
X-ray the patient in the hospital.
Classifying the case according to age, history, clinical examination, x-ray
and lab test.
Start treating the patient with the evaluation like community acquired
pneumonia in addition to Tamiflu capsules 75mg twice daily for 5
days.
Two of the national management committee members at least must visit
the patient within 24 hours of informing to evaluate treatment,
procedure and give advice doctors and nurse in the hospital.
34
The patient must stay in hospital till he get cured.
Infection control recommendation must be followed for seven days at
least after the fever gets normal with the grown ups and 21 days with
children.
If the patient dies the body must be dealt with according to the infection
control recommendation.
Cheoprophlaxysis must be given to medical a staff who contacts the
patient (closed contact) with the patient.
The public health doctor quarantines and follows up the people who are
exposed to patients for 10 days and daily to assure that they are free.
If a contact person showed symptoms, it should be considered as
suspected case.
Only hospital director in coordination with the Ministry of health allows
press statement about patient.
35
The Pandemic Phase of H5N1
F. Suspected case: a person who suffers a sever breathing hazards of breathing in
addition to one or more of the following:
A. Close socializing to some one suspected or proved to have H5N1
infection.
B. Exposure to poultry or wide bird or their remains in an area
suspected or proved to have H5N1 infections.
C. Eating raw or uncooked well poultry meat in areas where
suspected or confirmed infection are recorded among humans or
poultry.
D. Coming close to wild birds with confirmed H5N1 infection.
E. Handling human or animal sample suspected to have H5N1
infection.
G. Probable cases:
1-2 The first problem case: the suspected case in addition to one of the
following:
D. Infiltrates or evidence in the chest X-ray of lung
infection accompanied with symptoms of breath
hazards, like: hypoxemia and sever tachypnea.
E. Positive result of lab check-influenza A.
2-2 The second probable case: a death because of a severe respiratory disease
connected a time and place of H5N1 infection.
H. Confirmed case: the suspected or the probable case in addition to the positive
lab test conducted in a national regional, for international approved lab.
A. Isolating H5N1 virus.
B. Positive test of H5N1.
C. Four doubles rise or more in Neutralization antibody titer for H5N1
upon a sample test collected within 7 days from the beginning of
36
symptoms and post healing sample with neutralization antibody
titer for H5N1 > 1:80.
D. Micro neutralization antibody titer for H5N1 1:80 in a sample
collected after 14 from the beginning of symptoms in addition to
another positive test in a different way.
37
Practical procedures for dealing with H5N1 suspected case:
3. If A suspected case virus it’s a health center, an out door clinic a private
clinic or unapproved hospital.
Follow infection control instructions
Sending the case immediately to the closest approved hospital after
calling the emergency doctor in that hospital with coordination with
civil defense (199) or public security (196).
4. If a suspected case virus approved hospital.
Isolating the patient in quarantine.
Following infection control instructions.
Immediately infer the small task force in the hospital to evaluate the case
and make sure it is identical with the practical definition.
Informing the department of disease control (5607144) and taking
directorate of health in the concerned govern rate.
Taking 3 samples: 2 nasal swabs and nasopharyngeal wash.
Conducting a rapid test on one of the nasal swabs in the hospital.
Sending the rest of sample to PCR lab in Al Bashire Hospital after calling
and coordinating with the lab.
X-ray the patient in the hospital.
Classifying the case according to age, history, clinical test, x-ray and lab
test.
Start treating the patient with the evaluation like community acquired
pneumonia in addition to Tamiflu capsules 75mg twice daily for 5
days.
Two of the national treat mental committee members at least must visit
the patient within 24 hours of informing to evaluate treatment,
procedure and give advice doctors and nurse in the hospital.
38
The patient must stay in hospital till he get cured.
Infection control instructions must be followed for seven days at least
after the fever gets normal with the grown ups and 21 days with
children.
If the patient dies the body must be dealt with according to the infection
control instruction.
Preventive treatment must be given to medical teams who worded with
the patient.
The general health doctor quarantines and follows up the people who are
exposed to patients for 10 days and daily to assure that they are not
infected.
If a case showed symptoms of infection, it should be treated as suspected
case.
39
Infection control Recommendations
Patient
Place patient in a negative pressure room (airborne infection
placement
isolation room) or area, if available .
If a negative pressure room is not available , place patient in a single
room.
If a single room is not available, suspected and confirmed AI-
infected patients may be cohorted separately in designated multi-bed
rooms or wards.
Doors to any room or area housing suspected or confirmed AI-
infected patients must be kept closed, when not being used for entry
or egress.
To facilitate cleaning and to reduce the potential for virus
aerosolisation via vacuuming, house AI-infected patients in
uncarpeted rooms/areas, if possible.
When possible, isolation rooms should have their own hand washing
sink, toilet, and bath facilities.
The number of persons entering the isolation room should be limited
to the minimum number necessary for patient care .
A list of the medical team that supervise the case must be recorded .
The patient file must be kept out of the room
The mattress and pillows must have non-permeable, intact covers
Disposable paper towels and an antiseptic/detergent hand cleanser in
an elbow operated pump dispenser must be provided
Staff Minimize the number of personnel needed for care and assure
those assigned are immune to the disease for which the patient is
isolated, if applicable
A list of the medical team that supervise the case must be recorded
Seasonal Vaccination must be provided to the Staff
Anti Viral drug must be provided to the staff
Screen all health workers providing care AI-patient for ILS and
symptomatic excluded from duty.
Work team The medical team must be reduced as much as possible.
Vaccinating the medical team and providing them with the necessary
40
medicine.
Personal Gloves, Masks, Aprons, Gowns and Goggles.
Protective
Equipments
Gloves Sterile gloves:
Mostly used for surgery. They are disposable, sterile, and individually
wrapped items. They are used whenever there will be a percutaneous or
permucosal contact with tissues (e.g. surgical procedures, insertion of
central venous catheter and urinary catheter.
Latex gloves:
When starting intravenous (I.V.) lines or performing phlebotomy.
When changing dressings or handling soiled dressings.
When cleaning or handling soiled equipment, instruments, or
other items that may be contaminated with blood, urine, feces, or
drainage.
When handling specimens and their containers.
When suctioning the respiratory tract of a patient or
performing oral care in which fingers need to be placed inside
the patient’s mouth
Heavy Duty gloves
When handling medical waste (red bag trash).
When cleaning up spills of blood or body fluids (As they are
difficult to be cleaned, it is preferable to use double non-sterile
disposable glove
When using chemicals such as cleaning products and disinfectants
41
Masks A high efficiency mask (N95), if available, should be
worn when entering the room of a patient with known
or suspected tuberculosis.
The same mask must be worn during the procedures
that might cause blood or body fluids pollution.
Aprons procedures that are likely to generate splashes of
(Surgical blood or body fluids.
gowns) during activities that may contaminate clothing or
uniforms with microorganisms or infectious material.
The neck strap and the waist tie should be torn and the
apron should be discarded into a clinical waste bag
before it is carried out of the room.
gowns worn for such purposes should be fluid
resistance.
Goggles when there is risk of splashes or sprays of blood or
body fluids into the face and eyes of Health Workers.
Foot Cover Shoe cover is not recommended because it is an
ideal way of transferring microorganisms from floor
and shoes to hands
Washing Hands must be washed and disinfected in the following
hands cases:
After touching inanimate sources that are likely to be
contaminated with virulent or epidemiologically
important microorganisms; these sources include urine-
measuring devices or secretions collection apparatuses.
Before and after contact with patients.
after using the toilet or latrine.
42
after removing gloves.
before serving meals or drinks.
before leaving work.
Decontamina Non-disposable items should be sent to Sterile Service
Department (SSD) for disinfection/sterilization.
tion and
Waste: Contaminated waste is disposed of as
Waste
clinical waste according to local policy.
Disposal
Use standard precautions when working with
solid waste that may be contaminated with AI viru.
All waste generated in the isolation room/area
should be removed from the room/area in suitable
containers or bags that do not allow for spillage or
leakage of contents.
Waste should be classified as directed by the
national laws or regulations. If waste from Infected
patients is classified as infectious, then all waste
from an isolation room/area should be treated as
clinical waste and should be treated and disposed
of as per facility policy and in accordance with
national regulations pertaining to such waste
One waste disposal bag is usually adequate, providing waste
can be placed in the bag without contaminating the outside
of the bag. If the outside of the bag is contaminated, two
bags should be used (double bagging). If additional bags are
not available, clean and and
disinfect the outside of the bag before removing it from
room.
• Liquid waste such as urine or faeces can be flushed into the
sewer system if there is an
adequate sewage system in place. Close toilet cover when
flushing faeces
43
Laundry Place soiled linen directly into a laundry bag in
the isolation room/area.
Contain linen in a manner that prevents the linen
bag from opening or bursting during transport
and while in the soiled linen holding area.
Heavily soiled linen should be rolled or folded to
contain the heaviest soil in the centre of the
bundle. Large amounts of solid material (e.g.,
faeces) should be removed from linen with a
gloved hand and toilet tissue and then placed into
a toilet for disposal (close toilet lid when
flushing), before linen is placed into the laundry
bag.
When transporting soiled linen and laundry
outside the isolation room/area, use gloves
followed by hand hygiene.
Soiled linen and laundry should not be shaken or
otherwise handled in a manner that might create
an opportunity for contamination of the
environment or reaerosolisation of virus
Laundry personnel should use standard
precautions and perform hand hygiene after
removing
Specimen
sealable pocket for the specimen (i.e., a plastic
collection biohazard specimen bag).
Personnel who transport specimens should be
trained in safe handling practices
,decontamination procedures in case of a spill.
Specimens should be hand delivered where
possible.
HCWs who collect specimens from AI-infected
patients should wear full barrier PPE.
The accompanying request form should be
clearly labeled as “(suspected) AI” and the
laboratory notified by telephone that the
specimen is “on its way.”
Visitors Visitors should be strictly limited to those
necessary for the patient’s well-being and care
and should be advised about the possible risk of
AI transmission.
44
• Visitors should be provided PPE for full barrier
precautions and should be instructed in these of
PPE and hand hygiene practices prior to entry to
the patient isolation room/area.
• Parents/relatives/legal guardians may assist in
providing care to AI-infected patients in special
situations (e.g., lack of resources, pediatric
patients, etc.) if adequate training and supervision
of PPE use and hand hygiene is ensured.
• Because family members may have been
exposed to AI via the patient or similar
environmental exposures, all family members
and visitors should be screened for symptoms of
respiratory illness at entry to the facility.
• Symptomatic family members or visitors should
be considered possible AI cases and should be
evaluated for AI infection.
Transportation Limit the movement and transport of patients
from the isolation room/area for essential
Within health purposes only and inform the receiving area as
care facilities soon as possible prior to the patient’s arrival of
the patient's diagnosis and of the precautions that
are indicated.
If transport outside the isolation room/area is
required, the patient should wear a surgical mask
and perform hand hygiene after contact with
respiratory secretions.
If there is patient contact with surfaces, these
surfaces should be cleaned and disinfected
afterwards.
If patient cannot tolerate a mask (e.g., due to the
patient’s age or deteriorating respiratory status)
instruct patient (or parent of pediatric patient) to
cover nose/mouth with tissue during
coughing/sneezing or use the most practical
alternative to contain respiratory secretions. If
possible, instruct the patient to perform hand
hygiene after respiratory hygiene.
Surgical and procedure masks are appropriate
for use by AI-infected patients to contain
respiratory droplets and should be worn by
suspected or confirmed AI-infected patients
45
during transport or when care is necessary
outside of the isolation room/area.
HCWs transporting AI-infected patients should
use PPE as per standard precautions.
Pre-hospital care If tolerated by the patients, place a procedure or
surgical mask on all patients with respiratory
and transport
illness to contain droplets expelled during
outside health coughing. .
care facilities Screen patients with severe acute febrile
respiratory illness for AI risk factors.
HCWs should use full barrier precautions if pre-
hospital care is being provided for a suspected or
confirmed AI-infected patient.
Unless medically necessary to support life,
aerosol-generating procedures (e.g., mechanical
ventilation) should be avoided during pre-
hospital care or during transport.
Optimize the vehicle’s ventilation to increase the
volume of air exchange during transport. When
possible, use vehicles that have separate driver
and patient compartments that can provide
separate ventilation to each area. In this situation,
drivers do not require particulate respirators.
Notify the receiving facility as soon as possible
prior to arrival that a patient with suspected I
infection is being transported to the facility and
of the precautions that are indicated.
Use gloves for direct patient contact followed by
hand hygiene.
46
Care of the • Use standard precautions for routine care of the body
• PPE to be used by HCWs:
deceased
Particulate respirator, if HCWs remove the body
immediately after the patients' death.
Surgical or procedure mask is sufficient, if air in
the isolation room/area has been exchanged.
Disposable long-sleeved, cuffed gown, (waterproof
if outside of body is visibly contaminated with
potentially infectious excretions or secretions).
Alternatively,
if no waterproof gown is available, a waterproof
apron can be used.
Nonsterile, ambidextrous gloves (single layer):
should cover cuffs of gown.
• If splashing of body fluids is anticipated:
Balaclava-type cap (disposable).
Face shield (preferably) or goggles.
• The body should be fully sealed in an impermeable
body bag prior to removal from the isolation room/area
and prior to transfer to pathology or to the mortuary.
• No leaking of body fluids should occur and the outside
bag should be kept clean.
• After removing PPE, perform hand hygiene.
• If the family of the patient wishes to view the body,
they may be allowed to do so. If the patient died in the
infectious period, the family should wear gloves and
gowns and perform hand hygiene.
• Transfer to pathology or to mortuary should occur as
soon as possible after death.
• Cultural sensitivity should be practiced when an AI
patient dies.
47
Practical Issues and Considerations
To prevent infection hospitals, the following aspects must be considered:
1. Hand Washing
The most important procedure to decrease infection in hospitals. The following
conditions must be considered:
A special part of the room must be specified for washing hands. Hand
washing material such as plain soap or antiseptic soap must be provided..
Providing paper tissues for drying hands..
Forced air driers are not recommended in clinical areas
2.PPE placement and removal procedures
A. Entering the isolation room/area
1. Collect all equipment needed.
2. Perform hand hygiene with an alcohol-based hand rub (preferably) or
soap and
water.
3. Put on PPE:
Put on fluid-resistant gown.
Put on disposable particulate respirator.
Perform user seal check of particulate respirator.
Put on hair cover (if used, e.g. during an aerosol generating procedure).
Put on face shield or goggles.
Put on gloves (make sure gloves cover cuff of gown sleeves)
4. Enter the room and shut the door.
B- Leaving the isolation room/area
1. Remove PPE in a manner that prevents self-contamination or self-inoculation with
contaminated PPE or hands. The procedure listed below is suggested to remove PPE (if
possible, have an observer monitor PPE removal to minimize the risks further):
Leave the isolation room/area
Remove PPE either in the anteroom or if there is no anteroom make sure that
neither the environment outside the isolation room/area nor other persons
can get contaminated.
Remove protective eyewear and discard in rubbish bin. If reusable, place
face shield in container for decontamination.
If worn, remove hair cover and discard in rubbish bin.
Remove gown and discard in rubbish bin.
48
Remove gloves and discard in rubbish bin (gloves may be peeled when
gown is removed).
Perform hand hygiene with an alcohol-based hand rub (preferably) or soap
and water.
Remove particulate respirator by grasping elastic bands, do not touch front
of particulate respirator (front of particulate respirator may be
contaminated) and discard in rubbish bin.
2. Perform hand hygiene with an alcohol-based hand rub
3. Occupational Health:
• Vaccinate HCWs against seasonal influenza .
• Keep a register of HCWs who have provided care for AI-infected patients.
• Develop a HCW influenza-like illness surveillance system in the health care
facility ,including self-reporting and self-isolating by symptomatic HCWs.
• Develop a system to monitor work absenteeism for health reasons, especially in
HCWsproviding care for AI-infected patients.
• Screen all HCWs providing care AI-infected patients for influenza-like
symptoms before each time they start duty. Symptomatic HCWs should be
evaluated and excluded from duty.
• Contact public health officials for local policy on antiviral prophylaxis of HCWs
and assistance for obtaining adequate supplies of neuraminidase inhibitors for
prophylaxis of HCWs providing care for AI-infected patient.
• Develop a system to provide neuraminidase inhibitors to HCWs exposed to AI
infected patients according to local/national policies..
4. Removing the blood or body fluids drops.
- These drops must be cleaned carefully and while wearing the complete
safety dress.
- Wet corers and sheets must be folded, so that the wet part be inside to
decrease the infection probability.
- Heavy utility gloves must be worn when start cleaning.
- These fluids must be swept with a piece of cloth and then disinfected by
another cloth coming disinfectant liquid.
49
- If the quantity of liquid to be cleaned is big a dry cloth is put on it to
absorb it then spill the disinfectant on it.
5. Environmental Cleaning:
- The room must be cleaned when a patient learns and another gets in.
- All dirty walls must be cleaned with water and cleaning fluids.
- Start cleaning from the dirty to the dirtiest and from up to down.
- Use disinfectants according to instructions the degree of the right
concentration.
- The disinfectant must remain for the time enlisted in the instructions.
6. Dishes and eating utensils
Use standard precautions for handling dishes and eating utensils used by
suspected or confirmed AI-infected patients outside of the isolation
room/area:
Wash reusable items in a dishwasher with detergent at the recommended
water temperature, when possible. If dishwashers are not available,
detergent and hot water should be used to wash items. Rubber gloves
should be used if washing items by hand.
If family members are providing care for patient, they should provide
designated and eating utensils for the patient’s use only.
Disposable items should be discarded with other general waste.
7. Linen and laundry
The use of standard precautions is recommended for linen and other
laundry that may be
contaminated with blood, body fluids, secretions, or excretions from
suspected or confirmed AIinfected
patients outside of the isolation room/area.
Place soiled linen directly into a laundry bag in the isolation
room/area.
Contain linen in a manner that prevents the linen bag from opening or
bursting during transport and while in the soiled linen holding area.
Heavily soiled linen should be rolled or folded to contain the heaviest
soil in the centre of the bundle. Large amounts of solid material (e.g.,
50
faeces) should be removed from linen with a gloved hand and toilet
tissue and then placed into a toilet for disposal (close toilet lid when
flushing), before linen is placed into the laundry bag.
When transporting soiled linen and laundry outside the isolation
room/area, use gloves followed by hand hygiene.
Soiled linen and laundry should not be shaken or otherwise handled
in a manner that might create an opportunity for contamination of the
environment or reaerosolisation of virus.
8. Emergency Health Workers:
Standard Precaution must be followed when caring patients with ILI.
Enough space around every bed must be available to allow easy
movement and good care for the patient.
A mask be worn when contacting confirmed or suspected cases.
Alcohol must be available the for all the team members.
All polluted surfaces must be cleaned and disinfected using the proper
disinfectants.
9. Cohort isolation:
Infected patients can be isolated in a separate restricted area from other
patients.
Confirmed cases must be separated from suspected ones in cohort
isolation.
Distance between beds must be more than one meter, and the bigger the
distant is, it will be better.
Medical team must be well experienced.
The medical team must be within the minimum numbers.
Medical procedures must be considered to protect patients from hospital
infections.
51
Appendex(1): Suggested checklist for isolation room/area trolley/table
Checklist for isolation room /area trolley / table in Hospitals
Yes No
N95
Surgical mask
Surgical gloves-sterile
Disposable gloves (latex)
Aprons-disposable
Utility gloves
Gowns-disposable
Surgical gowns
Head cap
Eye protection
Biohazard bag
Antiseptics: Alcohol based hand
Other antiseptics (Iodine )
Disinfectant: Appropriate for environmental cleaning
52
Figure(1):Infection Control precaution Health Care Facilities.
Patient Infection Control precaution
Follow standard and droplet
precautions
HCWs should use facial protection
(surgical/procedure mask, goggles /
Acute face shield)
Place a surgical/procedure mask on
Respiratory the patient when in the waiting
Illness room; if no masks are available, ask
the patient to cover mouth and nose
with a tissue when sneezing or
coughing
If possible, place patient in a place
Plus exposure history that is Separate patients from other
patients.
Single room accommodation - with
negative pressure, if possible
If single room is not possible,
Patient admitted for cohort patients
investigation H5N1 Staff should use full barrier
precautions
Other diagnosis Reassess
precautions
Patient Confirmed
H5N1
Negative H5N1
Apply Infection Control Precaution
during isolation period.
Reassess
precaution
53
Using different choler concentrations
Cleaning Disinfectant Disinfectant
infectious blood and
fluid
0.5% 0. 5% 1%
Rules of using environment disinfecting:
Read the label and follow the manufacturer’s instructions.
Check the expiration date of the solution.
Ensure that the correct dilution is used– more is not more effective.
Always wash and clean articles before disinfection.
Do not refill disinfectant containers without cleaning and drying the
container between each use – topping off a partially filled container is not
permitted.
Disinfectants should be supplied in a ready-for-use dilution from the
pharmacy.
Empty containers should be returned to the pharmacy. Do not use empty
containers to store any other solutions – this is dangerous as the wrong solution
might be used in the wrong situation.
Open containers of disinfectant should not be tolerated in any hospital
environment as there is a serious risk of contamination with multiply-
antimicrobial-resistant bacteria, such as Pseudomonas species and spores.
Where disinfectants are indicated for use on surfaces allow the disinfectant
to remain on the surface for a sufficient amount of time to inactivate microbes.
The instructions for use on the label of the disinfectant usually specify the
contact time..
54
1-Instructions for Management of pneumonia cases for patients less than
13 years
The case is evaluated by medical doctors according to patients age , medical history ,
clinical diagnosis , X-ray or any other lab test
A. Neonates / 0-20 days old
The patient gets treatment at a hospital
The simple case : no changes in the X ray
Ampicillin IV 200 mg/kg/day in 2 divided doses every 12 hours
+
Gentamycin IV 5-7 mg/kg/day in 2 divided doses every 12 hours
OR
Ampicillin IV 200 mg/kg/day in 2 divided doses every 12 hours
+
Amikacin IV 15-20 mg/kg/day in 2 divided doses every 12 hours
Moderate to severe case: there are changes in the X-ray & other clinical
symptoms such as severe dyspnea .
Ampicillin IV 200 mg/kg/day in 2 divided doses every 12 hours
+
Gentamycin IV 5-7 mg/kg/day in 2 divided doses every 12 hours
Blood culture or Pleural fluid culture is advised to be conducted .If the a test reveals S.
aureus infection the following medication should be added :
Vancomycin IV 30 mg/kg/day in 2 divided doses every 12 hours
(Slow release for an hour )
B. Infants / 3wks – 3 months
Mild case : in the absence of fever ( below 38ºC ) the patients are treated in the
outpatient clinics .
Erythromycin syrup 30-40 mg/kg/day in 3 divided doses every 8 hours
Vancomycin is usually administered as follows :
Neonates less than 7 days
Weight < 2kg:15 mg*1/day Weight > 2kg 15 mg*2/day
Ages 8-28 days
Weight < 2kg:15 mg*1/day Weight > 2kg 15 mg*3/day
55
OR
Azithromycin syrup 10 mg/kg/day in 1 dose 1st day, then 5 mg/kg/day in 1 dose for 4
days
Moderate to Severe cases: If fever(higher than 38) & severe dyspnea or X-
rays changes are present : patients are admitted to hospitals
Cefotaxime IV 200 mg/kg/day in 3 divided doses every 8 hours
C. Infants & Children ( 4 months – 4 years )
Mild cases : patients is treated in outpatients clinics:
Ampicillin syrup 80-100 mg/kg/day in 3 divided doses every 8 hours
Moderate to severe cases: X-ray changes & clinical symptoms such as
severe dyspnea : patients are admitted to hospital.
Cefotaxime IV 200 mg/kg/day in 3 divided doses every 8 hours
OR
Cefuroxime IV 150 mg/kg/day in 3 divided doses every 8 hours
D. Children ( 5-13 years)
Mild cases : patients is treated in outpatients clinics:
Erythromycin syrup 30-40 mg/kg/day in 3 divided doses every 8 hours
OR
Clarythromycin syrup 5 mg/kg/day in 2 divided doses every 12 hours
OR
Azithromycin syrup 10 mg/kg/day in 1 dose 1st day, then 5 mg/kg/day in 1 dose for 4
days
If the child is more than 8 years old , the following drugs may be used :
Doxycyclin 1 capsule 100 mg/day
Doxycyclin is usually administered as follows:4 mg/kg/day in 2 divided doses every 12
hours
Moderate to severe cases: X-ray changes & clinical symptoms such as
severe dyspnea : patients are admitted to hospital.
Cefotaxime IV 200 mg/kg/day in 3 divided doses every 8 hours
OR
Cefuroxime IV 150 mg/kg/day in 3 divided doses every 8 hours
If there is no clinical improvement within 48 hours, the following medications
56
Azithromycin syrup 10 mg/kg/day in 1 dose
2-Instructions for treatment of pneumonia cases for patients more than 13 .2
years
The case is evaluated by medical doctors according to patients age , medical history ,
clinical diagnosis , X-ray or any other lab tests.
Mild cases : no X-ray changes , patient is treated in the outpatient clinic
(1) Cefuroxime tablet 500 mg twice daily
+
Macrolide (Azithromycin, Clarythromycin) tablet 500 mg twice daily
OR
(2) Macrolide + Clavulanic acid 125 mg-Amoxicillin tablet 500 mg twice daily
OR
(3) Macrolide + Ciprofloxacin tablet 500 mg twice daily
(4) Levofloxacin tablet 500 mg once daily
Moderate to severe case : X-ray changes & other clinical symptoms
such as severe dyspnea , & according to laboratory tests if available :
CBC, blood chemistry oxygen sat, blood culture, sputum stain & culture
- Moderate case : patient is treated in the ward
Ceftriaxon 1g twice daily + Macrolide
OR
Ceftriaxon 1g twice daily + Ciprofloxacin 500 mg twice daily
OR
Levofloxacin IV
- Severe case : patient is referred to ICU
Cefuroxime + Ciprofloxacin IV or Levofloxacin IV
(-Lactame + macrolide IV)
If there is no clinical improvement within 48 hours, the following medications
Vancomycin 500 mg IV in 2 divided doses every 12 hours
(slow release for an hour)
OR
Other anti-pseudomonal therapy e.g. Ceftazidime or Cefepime
57
Recommendations of Specimen Collection
1. Bio Safety:
H5N1 is severe viral disease, so personal safety precautions must be
applied when dealing with Suspected cases:
Vaccinate technicians with Seasonal influenza vaccination.
Wear a surgical disposable gown.
Wear N95 mask.
Wear protective goggles.
Wear disposable head cover and foot cover.
Wash hand before and after conducting lab analysis (use alcohol get if
there was no sink in isolation room).
2. The samples:
A nasal swab for rapid test.
A nasal swab for RT-PCR test kept in a special medium for keeping
viruses.
Nasopharyngeal was for RT-PCR test.
3. Specimen Collection:
Samples are taken within 48 hours after the symptoms or in no more than
5 days for grown ups (and for a longer period for children).
Nasal swab sample is taken by a lab technician.
Nasopharyngeal wash sample is taken by ENT doctors or resident.
Nasopharyngeal wash sample size is 2-4ml., divided into two halves. It
must be kept in sterile cry tubes RNA and DNA free.
A label must be stuck on the tube on which the word (suspected is
written).
58
RT-PCR sample are kept in 2-8ْC and must be sent in no more than 12
hours from collecting time, to the PCR lab in an ice box after calling the
lab on the following phone number.
Direct (06477411) Dr. Islam Saleh (0796999553)
Dr. Mohmoud Al Ghazou (0777348091).
4. Sample Test:
A. Rapid Test:
The nasal swab sample is subjected to immoral test to check for anti
bodies for influenza virus H5A by rapid test in isolation room in
approved hospitals if requested by task force in the hospital.
The test is conducted by the trained lab technician according to
instruction of use with the test fluid.
The surface of test table is covered with drying paper. It must be changed
if the sample misspelled and use sodium heptachlor fluid with 1%
concentration to disinfect the place.
The director and the lab technician are responsible following up the safe
disposal of the lab medical trash by the rules.
B-RT-PCR test:
The test is conducted in the PCR lab in a Bio safety level 11 room.
Nasopharyngeal wash sample or nasal swab sample is tested by chain
polymerization interaction to reveal the target virus. (RT-PCR for H5N1).
The second sample is kept in –70ْ or less.
If the RT-PCR test is positive, the kept sample is to be sent the lab of the
American research center in Egypt, which is approved by International
Health Organization to confirm the diagnosis.
59
Naval Medical Research Unit 3:
Cairo/Egypt PSC452, Box 128
Tel.: 00202684505 Fax: 00202347121
5. Conditions of sample shipment:
The sample is kept in three containers (primary container, second
container and external container) according to the International Health
Organization Instructions.
The task of shipping sample is assigned to Dr. Ali Muhaidat/ Head of
Vaccination Department in Ministry of Health (0745442032).
60
Pandemic Phase
* Containment and delaying Pandemic:
As soon ad the International Health Organization declares the Pandemic
Influenza Phase, and before cases appear in Jordan, the Ministry of
Health will announce precaution procedures to reduce of viral exposure
and spread like instructions of travel, and local, regional and international
meetings where participate form infected countries might attend. All
Ministries and sectors must abide to recommendations of Ministry of
Health, which are derived from the recommendations of International
Health Organization.
If suspected or confirmed cases are found in Jordan Quarantine for
patient will be applied and the area will be isolated. Anti viruses
(Oseltamivir) (Tamiflu) will be given for the cases and for the team who
have controlling infections and deaths.
Vaccinations and anti viruses are the most important procedure to control
infections and deaths during the pandemic phase. Vaccines the first
defense line, but because they are not available at the beginning of the
pest, anti viruses play a major role.
It is important to focus on non medical Intervention like closing schools
and imposing Quarantine, banning public assemblies, controlling travel,
and using personal prophylaxis means to control infections and deaths.
61
3. Social and economic impacts:
The government must be ready to encounter social and economic impacts
and to provide health services to economic with any sudden demands. All
health sectors must be ready to meet any increase in health service
demands.
To control the expected social impacts in the pandemic phase, the
government must be ready to deal with the public, keep them acquainted
with the dangers, handle the lake of vaccinations and medication, and
justify the selecting groups of priority them.
62
Appendix
63
Members of National Committees
The National Technical Committee
Name Institute Phone No
Dr. Ali Asa’ad /chairman Ministry of Health 0745492931
Dr. Adel Belbaisy Ministry of Health 0745432047
Dr. Bassam El Hijawi Ministry of Health 0745433516
Dr. Rafiq Saleh Ministry of Health 0795164027
Dr. Khalid Abu Rumman Ministry of Health 0795580267
Dr. Hisham El Ma’aytah Ministry of Agriculture 0799816064
Dr. Mansour El Hadidi Ministry of Agriculture 0777775537
Dr. Ziad Moumani Ministry of Agriculture 0795549067
Dr. Malik El Dabbas Royal Medical Services 0777741522
Dr.Abdulfattah Elkeelani Veterinarian Union 0795230854
Dr. Najwa Baulus Jordan University 0795547611
Dr. Azmi Mahafza Jordan University 0777352233
Dr. Nazeer Obeidat Jordan University 0795178552
Jordan University of Science and
Dr. Sai’d Gharaybeh Technology
0795212487
Dr. Lutfi El Jazzed U.N.R.W.A 0795334211
Hani Ertaimeh Public Security 0777997355
Awad Abu Darweesh Civil Defense 0795967878
Laith Mughraby Royal Society for Conservation of Nature 0777422078
Dr. Fuad Da’as Public Institute for Food and Medicine 0777163237
E. Bakir El Abbadi Amman Greater Municipality 0795715972
Mousa Wakilah Al Ahlyah Poultry co 0795558384
Fakhry Abu Salim Al Watanya Poultry co 0795587703
64
National Media Committee
Dr. Bassam El Hijawi Ministry of Health 0745433516
Dr. Mohammad Abdallat Ministry of Health 0795552009
Engineer. Basema Estatyah Ministry of Health 5684370
Eman Al Shwayky Ministry of Health 5684370
Dr. Ziad Moumani Ministry of Agriculture 0795549067
Hani Ertaimeh Public Security 0777997355
Awad Abu Darweesh Civil Defence 0795967878
Public Institute for Food
Abeer Al Hwaydy 0777163232
and Medicine
Public Institute for Food
Maha Al Mo’aqet 0795294111
and Medicine
Dr. Sulayman Farah Media Partners Prog 0795542993
Karen Agha Janian Media Partners Prog 0795631700
Amal Al Tameemi Petra News Agency 0796601762
Ziad Omar Al E’es Radio &TV Institute 0795507166
Hind Lara Mango UNECEF 0796926180
Dr.Abdulfattah Elkeelani Veterinarian Union 0795230854
Agricultural Engineer
Engineer.Adulshakor Jamjom 0795537909
Union
Engineer. Khitam Hattar Ministry of Education 0795200137
Yousef Al Shibly Ministry of Awqaf 0777423063
Amman Greater
Engineer. Shtoura Al Adwan 0777722217
Municipality
Mousa Wakilah Al Ahlyah Poultry co 0795558384
Fakhry Abu Salim Al Watanya Poultry co 0795587703
65
Telephone numbers directors of Agriculture
No Directorate Director Work Tele House Tele Mobile
1 Capital Eng. Mohamed Fare’ 065624392 / 0777495560
2 Wadi sair Eng. Karim Rabadi 065856978 065342315 /
3 Na’our Eng. Amjad Qtaishat 065856978 0563551455 /
4 Jezeh Eng.Bader Saa’ydeh 064460170 064121389 0777372353
5 Muwaker Eng. Mohamed 064050785 065861838 0777407580
Nawayeseh
6 Irbid Eng. Qasim Mamdoh 027272345 027360616 0777494967
7 Bani Eng. Ali Shboul 027585492 027359778 0777488724
Kenanh
8 Kourah Eng. Ahmed Khazaleh 026521661 027518569 0777326961
9 Taybeh Eng. Nazmi Mahafzah 027339654 027585797 0777403615
10 Wastyah Eng. Ali Noktah 027300195 027575224 0795443570
11 North Eng. Ghazi Obeidalla 027031128 023781082 0777782801
Mazar
12 Ramtha Eng. Abdulra’ouf 027382269 027505605 0777341008
Malkawi 0
13 Ajloun Eng. Tawfiq Momani 026420043 027278215 0795853397
14 Jerash Eng. Mohamed 026338764 026342178 0777416220
Shurman
15 Mafraq Eng. Faisal Arqan 026232997 026210714 0777488738
16 North Eng. Ryad Bqa’in 026282025 026230677 0795646022
Badya
17 Zarqa Eng. Rita Sawaqid 053964072 053863299 0796220499
18 Azraq Eng. Mohamed Ghwari 053335004 053852619 0777748514
19 Balqa Eng. Ja’far Arabyat 053555552 053557720 0777331468
20 Ein Abasha Eng. Salem Dra’in 064726681 065533627 0795508440
21 Fhais & Eng. Awni Kloub 064720992 065852521 0777995565
Mahes
22 Wadi Eng. Najah Masalha 053573071 053571729 0777656683
Alordon
23 North Eng. Rateb Abu Rnameh 026587406 053576350 079522296
Aghwar
24 South Eng. Sami Al Adwan 053581010 053590088 0777329723
Shouna
25 Madaba Eng. Ahmed Foqaha 053252218 053252501 0777656684
26 Thiban Eng. Mahmod Abu 053206249 053206142 0777405989
Rbaiha
27 Kerak Eng. Khalid Nawayseh 032386107 032372294 0777488734
28 Qaser Eng. Issa Ja’afreh 032315121 032340256 0795532980
29 Almazar Eng. Khalid 032371303 032340789 0795569385
Alhabashneh
66
30 A’ay Eng. Mazin Mansour 032365731 032387222 0795861402
31 South Eng. Aktham Mdanat 032302696 032380722 0795506891
Aghwar
32 Tafila Eng. Ahmed Madaha 032242046 032354144 0777298361
33 Ma’an Eng. Suhyla Abu 032131992 032131080 0777488739
Darwish
34 Shoubak Eng. Mohamed 032164005 032164384 0777411065
Abdulsalam
35 Petra Eng. Hassan Hilalat 032156130 032157153 0777746175
36 Aqaba Eng. Sulaiman Ma’aytah 032012082 03234631 -
032013732
67
A List of labs approved by Ministry of Agriculture
Doctor Cell phone Telephone Directorate of
No. lab phones
Dr Hisham 0799816064 4730460 4771115/11
Mayta
Dr Ruba 0777436096 7103215 4771115/11
Omary
Dr Nadim 0795348817 - 4771115/11
Amarin
Dr Dyala Azer 0796994420 - 4771115/11
Lab Name Phone No.
Salt Dr Shorouq Arabyat 053552922
Yousef Khrays
Irbid Dr Ja’far Obeidat 0777314762
Dr Tharwat Batayneh 02/7225208
Jerash - Dr Abdulla Ajlouny 03/3251065
Dair Alah Dr Wafa’ Ramadneh 05/3573306
Fakhry HamaMashahreh
Tafila Dr Ziad Almuhtaseb ---------
Saqer Al Sqour
Kerak Dr Mariana Alzayadin 03/2351065
Suhayla Halaseh
Aqaba Dr Abdulla Alaween 032013904
Mayson Alshareef
Zarqa Dr Kafa Assaf -
Najeh Alqasim
Ajloun Dr Malik Almazaherh 02/6420028
Muneer Almoumani
Mafraq Dr Ina’am Almashaqbeh 02/6231062
Mohamed Inad Khazaleh
North Shouna Dr Mohamed Arsalan
Wadi Alrayan Abdulra’ouf Alkhateeb 02/6570008
68
A list of approved hospitals to encounter birds’Influenza
Region Hospital Hospital phone No Directors’ names Cell phone No.
Prince Hamzeh 5053814 Dr.Abduhadi Braizat 0795565732
Jamil
4020093 Dr Mohamed Asfour 0745432072
Towtanji/Sahab
Jordan
5353666 Dr Abdulkarim Alqdah 0796161414
Uni./Amman
Middle
Queen Alia 5157100 Gen. Hassan Malkawi -----------
Prince Faisal 053740251 Dr Raja’e Fares 0777465488
Prince Hashim 053962006 Gen. Sulaiman Abadi 0795558588
Al Hussein/Salt 053552957 Dr Ali Hyasat 0777635444
Al Nadim/Madaba 053241700 Dr Mahmood khraisat 0777497931
Princess
027275555 Dr Ahmed Alshagran 0745431177
Basma/Irbid
Almalik Almoa’sis 027200600 Dr Mahmood Alshyab 0796200555
Princess Rahma 027102985 Dr Qasim Batayneh 0745432063
North
Edoun Militar/Irbid 027100891 Dr Imad Alqdah 0795524478
Matrinity/Mafraq 026231176 Dr Yousef Tahat 0745431242
Jerash 026352581 Dr Yousef Qoqazeh 0745431302
Ajloun 026421914 Dr Ahmed Alzghool 0795896144
Kerak public 032386190 Dr Saleh Alqatarneh 0777772200
Prince Zaid 032242982 Col Mahmood Yamani 0777412122
South Princess
032014111 Dr Abduljalil Majali 0795877882
Haya/Aqaba
Ma’an public 032131565 Dr Abdullah Dawarage 0745431315
69
Name Phone No.
Director of disease control: 0745433516
Dr. Bassam Hijawi 0795600201
Director assistant Dr. Saif Eldin Saleh 0777403282
Dr. Mohammad Abdallat 0795552009
A list of
Dr. Mohamed Al rashdan 5680940
names Dr.Ali Mhaidat 0745442032
and Dr. Najwa Ja’arour 07955602952
addresse Dr Mohamed Alsuouf 0777411620
s of Dr.Kariman Alzain 0777333203
people Dr.Sami Al 0777741648
to
inform
;at the
director
ate of
disease
control.
70
71
72
73
74
75
Telephone and Fax numbers of Health Directorate
Health
Phone Fax
Directorate
The capital 06-5661171 06-5606029
East Amman 06-4120053 06-4128044
Alzarqa 05-3986205 05-3933827
Madaba 05-3244008 05-3244921
Balqa’ 05-3555741 05-3556093
Dair Alla 05-3571845 05-3571853
South Alshouna 05-3581363 05-3581467
Irbid 02-7271141 02-7257689
Al Ramtha 02-7383114 02-7382943
Ajloun 02-6420761 02-6420738
Jerash 02-6351290 02-6340769
North Badia 02-6282023 02-6282022
Alkura 02-6521300 02-5621379
Bani kenana 02-7525436 02-7525439
North Aghwar 02-6587419 02-6340769
Mafraq 02-6231057 02-6231557
Al Kerak 03-2341908 03-2341902
Al Tafilah 03-2241117 03-2241954
Ma’an 03-2132136 03-2130171
Aqaba 03-2013713 03-2018365
Ruwaished 02-6295135 02-6292182
Ghour Alsafi 03-2302181 03-2302182
76
Phone Numbers of directors of health
No. Directorate of Name No.
Bani kenanah
1. Dr.Yahya Obeidat 0745442741
Ramtha
2. Dr. Fuad Ala’bid 0745433527
3. Irbid Dr. Jamal Alshurman 0745431332
Kourah
4. Dr. Ahmed Al Omari 0745433524
North Shouneh
5. Dr.Najeh Alghazawi 0745433512
6.
Mafraq Dr.Sulaiman Afash Kassab 0745431310
North Badya
7. Dr. Hazzoum Al Baggoum 0745433525
Ajloun
8. Dr.Ali Sa’id Bani Naser 0745431236
Jerash
9. Dr.Haider Al Otoum 0745432037
Zarqa
10. Dr. Dafala Al-dughmy 0745497901
Capital
11. Dr. Ghasan Fakhouri 0745432046
East Amman
12. Dr. Lail Al Fayez 0745441156
Madaba
13. Dr. Adam Alabdalat 0745431313
Balqa
14. Dr. Kalid Al Hyari 0745431318
Deir Alla
15. Dr. Ahmed Alhawarat 0745441153
South Shouneh
16. Dr. Ali Aldirgham 0745433514
Kerak
17. Dr. Sultan Tarawneh 0745432040
Tafila
18. Dr. Ahmed Alsabayleh 0745551505
Ma’an
19. Dr. Abdulrahman 0745432053
Alma’ani
South Aghwar
20. Dr. Adel Khatatneh 0745432050
Aqaba
21. Dr. Damen Fahed Alabadi 0745432065
77
Reporting Form
Governorate ------------------- District ------------------- Village ----------------
Vet’s name ----------------------- Address -------------------Tele------------------
Name of the farm ----------------------------- Address ----------------------------
Farmer’s name ------------------------------- Tele ----------------------------------
Date -----------------------------------
Kind of birds in the farm:
Turkey. No. ----- Age ------- Hatchers No. ----- Age -------
Ducks. No. ----- Age ------- Hatchers (carnivorous) No. ----- Age -------
Ostriches. No. ----- Age ------- Hatchers No. ----- Age -------
Carnivorous mothers No. ----- Age ------- Others No. ----- Age -------
Hatchers No. ----- Age -------
Carnivorous No. ----- Age -------
Type Of breeding in the farm ---------------- No. of barracks ------------------
No. of workers ------------------- Nearest farm is -------------------
Does the farmer own other farms ------------- Source of fodder----------------
Exchanged materials with other farms------------ Date ------------Address----
Vaccinations used and time of use ------------------------------------------------
NB : Fill & enclose the sample form with this form if any samples are sent
to lab.
78
Sample Form
Kind of bird................
The sent sample: a whole bird, a lung, a pharynx, liver, blood
Clinical symptoms
Lethargy
Mild respiratory symptoms
Severe respiratory symptoms
Low egg production
No egg production
Skin Idima
Skin bleeding
Blue aroma and ?????????
????????? idima
diarrhea
Neuro symptoms
Other symptoms -------------------------------------------------------------------
Anatomical features
Sinusitis and rhinorria
Bronchitis
التهاب األكياس الهوائية
Epicardium
Endocardium
Proventriculus
Ovary bleeding.
Enteritis
Pancreatistis
Other symptoms -------------------------------------------------------------------
Notes
...............................................................................................................................
...........................................................................
Name & signature of vet Tele.
79
نموذج استقصاء مرض إنفلونزا الطيور
08
81
RT-PCR test sample delivery form
Delivering lab Tele/fax No.
Patient’s name
Sex Male Female Age
National number
Date of sample Taking Time of sample taking
Result of test positive negative Didn’t work
Date of sample Date of receiving
delivering sample
Nature of sample
Result of RT-PCR test
Dr/ lab technician
At the central lab
82
A table of field visits to poultry farms
Data of field visits to poultry farms Month ------------- Year --------------- Governorate ------------
*Per.
**Way of
No. of *Type of No of Of No of Available Source
No farm owner area tele * disposing
barraks breeding birds dead workers disinfectants of water
trash
birds
Write the type bred birds ( mothers, Carnivorous , or hatchers) ¹*
How many birds can the farm reside ²*
No. of dead birds within breeding period/No. of all birds 100% ³*
Disposing dead birds and trash (burning, burial, other ways) **
Last saved:2/11/2013
