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MECIDS Annual Meeting Amman January 16-18, 2007. Jordan Salmonella Report. Disease Control Directorate Ministry of Health, Jordan. Outline. Background: Jordan Burden of Illness Study MECIDS objectives Methods Results Conclusions & Recommendations. Jordan Burden of Illness Study.

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Jordan salmonella report

MECIDS Annual Meeting

Amman January 16-18, 2007

Jordan Salmonella Report

Disease Control Directorate

Ministry of Health, Jordan


Outline
Outline

  • Background: Jordan Burden of Illness Study

  • MECIDS objectives

  • Methods

  • Results

  • Conclusions & Recommendations


Jordan burden of illness study
Jordan Burden of Illness Study

  • Jordan first site in Eastern Mediterranean

  • Burden of Salmonella, Shigella, Brucella

  • Burden of illness study

    • Population survey

    • Laboratory survey

  • Validation study



Cases of salmonella and shigella in stool cultures
Cases of Salmonella and Shigella in stool cultures*

*In 24 MOH lab


Comparison of laboratory survey results moh reports
Comparison of laboratory survey results & MOH Reports

* cultured

† tested: food handlers probably included, unknown procedures



Measuring the burden of foodborne illnesses

273 infected persons

in the community


Estimated burden of foodborne pathogens jordan 03 04
Estimated Burden of Foodborne Pathogens Jordan 03-04*

*Only 50% of Jordan’s population seeks care in MOH facilities.


Comparison of isolation rates of foodborne pathogens between lab survey validation study
Comparison of Isolation Rates of Foodborne Pathogens between Lab. Survey & Validation Study*

* Jordan Aug—Sep 2003


Mecids objectives
MECIDS objectives Lab. Survey & Validation Study*

  • Establish sentinel laboratory-based surveillance in Israel, Jordan, and PA

  • Enhance laboratory capabilities to identify Salmonella

  • Strengthen existing capabilities and develop new ones for characterization of Salmonella using phenotypic and genotypic markers


Methods
Methods Lab. Survey & Validation Study*

  • Meetings at national and regional levels

  • Sentinel sites

  • Study population

  • SOPs

  • Training (local & regional)

  • Data collection forms (lab. logbooks, reporting forms)


Data flow chart
Data flow chart Lab. Survey & Validation Study*


Training
Training Lab. Survey & Validation Study*

MoH Lab. Training Center, Amman, Sept 2006


Data collection forms
Data collection forms Lab. Survey & Validation Study*


Methods1
Methods Lab. Survey & Validation Study*

  • Data collection started in July 2005

  • Information on specimens tested recorded routinely

  • Aggregated numbers sent monthly by fax to Lab. Directorate & DDC*

  • Data entered and analyzed at DDC using Microsoft Excel

  • Monthly reports sent to CMC Amman

*Disease Control Directorate


Specimens tested jordan jul 05 nov 06
Specimens Tested Lab. Survey & Validation Study* Jordan Jul 05-Nov 06


Food items tested jordan jul 05 nov 06
Food Items Tested Lab. Survey & Validation Study* Jordan Jul 05-Nov 06


Blood specimens tested jordan jul 05 nov 06
Blood Specimens Tested Lab. Survey & Validation Study* Jordan Jul 05-Nov 06


Patients stool specimens tested jordan jul 05 nov 06
Patients Stool Specimens Tested Lab. Survey & Validation Study* Jordan Jul 05-Nov 06


Food handlers stool specimens tested jordan jul 05 nov 06
Food handlers Stool Specimens Tested Lab. Survey & Validation Study* Jordan Jul 05-Nov 06


Isolation rate of salmonella by type of specimen jordan july 05 nov 06
Isolation Rate of Lab. Survey & Validation Study* Salmonella by Type of Specimen Jordan July 05-Nov 06


Isolation rate of salmonella by type of specimen jordan july 2005 june 2006
Isolation Rate of Lab. Survey & Validation Study* Salmonella by Type of Specimen Jordan July 2005-June 2006


Isolation rate of salmonella by month jordan july 2005 june 2006
Isolation Rate of Lab. Survey & Validation Study* Salmonella by MonthJordan July 2005-June 2006


Isolation rate of salmonella by sentinel laboratory jordan july 2005 june 2006
Isolation Rate of Lab. Survey & Validation Study* Salmonella by Sentinel LaboratoryJordan July 2005-June 2006


Percentage of salmonella isolates by serogroupe
Percentage of Lab. Survey & Validation Study* Salmonella Isolates by Serogroupe

S. typhimurium 5%

S. enteritidis 15%


Conclusions
Conclusions Lab. Survey & Validation Study*

  • System is useful and operates efficiently

  • Similar Salmonella rates in stools from patients (1.54%) & food handlers (1.53%)

  • Overall Salmonella rate in stool: 1.5%

  • Rates comparable to those of developing countries (1.8%) and tenfold lower than rates in developed countries (0.15%)*

*Chaker & Baker, 1988. A review of human salmonellosis


Conclusions1
Conclusions Lab. Survey & Validation Study*

  • Higher than rates laboratory survey (0.3%), lower than rates in validation study (2.5%)*

  • High Salmonella burden ([64+74]*273~38,000 cases in 18 months)

  • High % of S. enteritidis

*Jordan Burden of Illness Study


Recommendations
Recommendations Lab. Survey & Validation Study*

  • At sentinel lab level

    • Continue Salmonella surveillance system

    • Add Shigella using same diagnostic procedures and mechanisms of reporting

    • Test for other entero-pathogens (Campylobacter, E. coli, etc.)

    • Establish electronic reporting from sentinel labs


Recommendations1
Recommendations Lab. Survey & Validation Study*

  • At reference lab level

    • Use PFGE

    • Establish electronic reporting from reference lab

  • At regional level

    • Training?

    • Compare & publish data


Acknowledgements
Acknowledgements Lab. Survey & Validation Study*


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