Date: Tue 26 Sep 2017
Source: GIDEON (Global Infectious Disease Epidemiology Network) [edited]

re: ProMED-mail Hepatitis A - Jordan: (MA)
http://promedmail.org/post/20170925.5338989
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The potential benefit for hepatitis A vaccination in Jordan is illustrated by the chart at
<https://www.gideononline.com/wp/wp-content/uploads/HepAIsrael.png>.

In 1999, Israel became the world's 1st country to institute routine hepatitis A immunization (blue arrow), and has since largely eradicated the disease [1].

Reference
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1. Chart generated by a Gideon multi-graph tool, see
<https://www.youtube.com/watch?v=q1vlA_wi2xo>
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Communicated by:
Stephen Berger
Geographic Medicine
Tel Aviv Medical Center
Tel Aviv, Israel
steve@gideononline.com
=========================
[ProMED thanks Dr Berger for his continued contributions. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/63190>.]
Date: Sun 24 Sep 2017
Source: Arab Jordan [in Arabic, trans. ProMED Mod.NS, edited]
<http://www.arabjo.net/?p=18290>

A total of 27 children suffered from hepatitis A in Al-Akaider area, 30 km (18 mi) northeast of Al-Mafraq city within Hosha district [Mafraq province]. This prompted the Ministry of Health to send a specialized epidemiological team to determine the causes of the outbreak. According to information received from the people, the disease has reached an epidemic level as the infection has spread among children, especially schoolchildren. This required closing the 2 schools located in the area to maintain the health and safety of children and stop the transmission of the disease.

The Director of Health of Al-Mafraq, Hani Alimat, stated that the disease is endemic in the region, reducing the negative effect on children because the recovery from the infection gives immunity throughout life.

Alimat said that the ministry had sent a specialized epidemiological team to take samples and examine them in laboratories. He indicated that the tests proved that the children are infected with hepatitis A, which is often caused by the use of unclean toilet facilities. He confirmed that the laboratory tests of the water lines in the houses showed that the water is clean.

Alimat stressed that during visiting the 2 schools that have 280 students, they found that the health environment is poor due to having poor toilet facilities and drinking water, in addition to the absence of walls to protect these facilities and the presence of dead animals around the area. He explained that the increased number of cases made the Directorate of Health allocating a doctor to the health center throughout the day hours to receive patients. There are also field visits to the schools in addition to providing a health educator to give lectures on awareness of how to deal with the infection. Alimat also pointed out that the field visits of the health monitors in the area closed a shop for not complying with health requirements.
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[The age-specific seroprevalence rates for hepatitis A antibody as reflected in the citation below supports, in the absence of widespread hepatitis A vaccine use, almost universal hepatitis A infection in Jordan occurring in childhood or adolescence.

Hayajneh WA, Balbeesi A, Faouri S: Hepatitis A virus age-specific sero-prevalence and risk factors among Jordanian children. J Med Virol. 2015; 87: 569-74;
<http://onlinelibrary.wiley.com/doi/10.1002/jmv.24137/full>

Abstract
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Hepatitis A virus (HAV) has been a significant cause of infections among the children and adolescents of Jordan. Availability of safe vaccines made it necessary to identify the ill-defined temporal immunity trends for HAV and possible age-specific prevalence transitions. This community-based cross sectional study was conducted during the period July-August 2008 on 3066 recruited subjects from the 12 governorates of Jordan, with predefined criteria. Several households were chosen at random within each selected block to enrol the subjects. They were interviewed and data were collected. Their sera were tested for total antibodies against HAV. A multivariate model was then performed to identify the possible risk factors.

The HAV seroprevalence rates among the age categories-second year, 2-4 years, 5-9 years, 10-14 years, 15-19 years, and those above 20 years were 26 percent, 32 percent, 44 percent, 63 percent, 78 percent, and 94 percent, respectively. The model revealed the association of several risk factors for higher HAV seroprevalence rates: (i) older age groups; (ii) lower maternal education levels; (iii) residing in certain governorates; (iv) using public net drinking water; and (v) avoiding use of public net sewage system.

This study provided strong evidence for continuous transition of HAV epidemiology towards intermediate endemicity in Jordan, with more susceptible adolescents and adults. Following the World Health Organization (WHO) recommendations for countries with intermediate endemicity, large-scale hepatitis A vaccination is recommended for children in Jordan. This is strengthened by the availability of effective and safe HAV vaccines, improving the socio-economic status of the Jordanians, and increasing life expectancy among Jordanians. - ProMED Mod.LL]

[Maps of Jordan can be seen at
<http://www.lib.utexas.edu/maps/atlas_middle_east/jordan_divisions.jpg>
and <http://healthmap.org/promed/p/63190>. - ProMED Sr.Tech.Ed.MJ]
Date: Mon, 19 Dec 2016 00:17:43 +0100
By Kamal Taha

Amman, Dec 18, 2016 (AFP) - Gunmen killed 10 people including a Canadian tourist and police officers on Sunday in southern Jordan, before security forces killed four attackers in a siege lasting several hours.   The shootings took place in Karak, a tourist destination known for one of the biggest Crusader castles in the region, around 120 kilometres (70 miles) south of the capital Amman.   Jordan's general security department said seven policemen, a female Canadian tourist and two Jordanian civilians were killed in a series of shootings.

It said that 27 others, including policemen and civilians, were wounded.   Four attackers who had taken refuge in the castle were killed later Sunday by security forces who had besieged them amid exchanges fire lasting several hours, a security source said.   The Canadian foreign ministry confirmed that one of its nationals had been killed in the attack and another injured in "the heinous attack."   Canadian officials in Amman are "actively working with local authorities to gather additional information and are providing consular assistance to Canadians at this difficult time," a foreign ministry official said.   "The government of Canada stands ready to assist Jordan in bringing the perpetrators of this attack to justice," a statement added.

- 'Five or six gunmen' -
Earlier, the prime minister said 10 gunmen were holed up in the fortress, while the general security department spoke of "five or six gunmen" who were thought to be involved in the shootings.   The first attack took place early in the afternoon when a police patrol went to check on a house fire in Karak, the department said in a statement carried by the official Petra news agency.

"As soon as they reached the area, unknown gunmen who were inside the house opened fire on the patrol, wounding a policeman, and then fled by car," the statement said.   Gunmen later fired on another patrol while more shots rang out from inside the Crusader castle, aimed at the Karak police station and "wounding several policemen and passersby," it said.   "Police and security forces have surrounded the castle and its vicinity and launched an operation to hunt down the gunmen."

- People trapped -
A senior security source said some people had been trapped in part of the citadel when the gunmen took shelter there, but denied media reports that they were being held hostage.   "There are no hostages. But some people who were on a lower floor were afraid of leaving as the gunmen traded fire with the security forces," the source said, speaking on condition of anonymity.   He said that the gunmen were on a higher level inside the fortress.   The Jordan Tourism Board describes the Karak citadel, which dates back to the 12th century and has withstood many sieges, as a "maze of stone-vaulted halls and endless passageways."

Prime Minister Hani al-Malki, who was addressing parliament at the time of the shootings, said that "special forces and policemen are surrounding 10 gunmen holed up inside the Karak citadel."   It was not immediately clear who was behind the shootings, but Jordan has been hit by Islamist attacks in the past.   Jordan is a leading member of the US-led coalition fighting the Islamic State group in neighbouring Iraq and Syria.   It has carried out air strikes targeting IS, and also hosts coalition troops on its territory.

Maaz al-Kassasbeh, a Jordanian fighter pilot, was captured by the jihadists when his plane went down in Syria in December 2014, and he was later burned alive in a cage.   Karak is Kassasbeh's hometown.   In June, a suicide bombing claimed by IS killed seven border guards near the Syrian frontier.   According to sources close to Islamists, almost 4,000 Jordanians have joined jihadist groups in Iraq and Syria, and an estimated 420 have been killed since 2011.
Date: Tue, 10 May 2016 21:26:00 +0200

Petra, Jordan, May 10, 2016 (AFP) - Stables and a clinic have been installed at Jordan's famous Petra tourist site for overworked and sometimes mistreated horses and donkeys used to transport visitors.   Under new regulations seen by AFP on Tuesday, any owner who exhausts or mistreats animals in future faces having permission to work at the site withdrawn.   More than 1,300 horses and donkeys work at the fabled rose-red city hewn from rock, an attraction which also provides a living for some 8,000 people.

Owners who make animals gallop or bear too heavy a weight now face being sanctioned under the new measures.   In March last year, the Vienna-based international animal charity Four Paws and Jordan's Princess Alia Foundation began a project aimed at improving the lives of the working animals at Petra.

Stables and shaded rest areas were created at the entrance to the huge site, and a clinic to treat injured horses and donkeys was renovated and equipped.   "A lot of people in Europe called us and complained about the situation here in Petra with horses. Two years ago, more or less, it was a disaster," said Four Paws president Heli Dungler, who visited the site along with Princess Alia to inspect the changes.

The animals now have somewhere to rest, eat and drink.   "Here they can recover and regain their strength," he said.   "Along with the new regulations, this has allowed us to take the first steps to improving conditions for the horses working in Petra."   Princess Alia, who has a keen interest in animal welfare, said she hoped the animal owners would cooperate and respect the new rules.   "There will be no results if they don't," she said.

The changes at Petra should help to improve the image of the site, where the number of visitors has dropped by a third in five years.   According to tourism ministry figures, there were 900,000 visits to Petra in 2010 and 315,000 last year.   Despite its abundance of natural wonders, Jordan's tourism industry has been hard hit by the country's proximity to regional conflicts in two of its neighbours, Iraq and Syria.
Date: Sun 20 Sep 2015
Source: Petra News Agency [in Arabic, machine trans., edited]
<http://www.petra.gov.jo/public_news/Nws_NewsDetails.aspx?Menu_ID=&Site_Id=2&lang=1&NewsID=215454&CatID=14>

On [Sun 20 Sep 2015], the Ministry of Health reported 2 cases of MERS-CoV infection bringing the total number of casualties for the current year to 13 cases -- including 6 clinically ill and 5 deaths [presumably this includes 2 asymptomatic infections as well]. According to the Director of Communicable Disease, Dr Mohammed Abdullat, in a statement issued by the Ministry this evening [20 Sep 2015], the 1st case is a 29-year-old healthcare worker, and the 2nd case has high blood pressure and diabetes. Both cases are currently under treatment.
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[From the report above, it appears as though the nosocomial outbreak in Amman is most likely continuing, with the addition of a healthcare worker and another case with known chronic disease -- (although the geographic locations of these 2 newly confirmed cases are not specified in the above report). Hopefully more details will be available in the coming days.

The HealthMap/ProMED map of Jordan can be found at
<http://healthmap.org/promed/p/91>. - ProMED Mod.MPP]
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