A Middle East subregional laboratory-based surveillance network on foodborne diseases established by Jordan, Israel, and the Palestinian Authority.

In late 2002, health professionals from the ministries of health and academia of Jordan, the Palestinian Authority and Israel formed the Middle East Consortium on Infectious Disease Surveillance (MECIDS) to facilitate trans-border cooperation in response to infectious disease outbreaks. The first mission of MECIDS was to establish a regional, laboratory-based surveillance network on foodborne diseases. The development of harmonized methodologies and laboratory capacities, the establishment of a common platform of communication, data sharing and analysis and coordination of intervention steps when needed were agreed upon. Each of the three parties selected the microbiological laboratories that would form the network of sentinel laboratories and cover the different districts of each country and also designated one laboratory as the National Reference Laboratory (NRL). Data analysis units have been established to manage the data and serve as a central point of contact in each country. The MECIDS also selected a regional data analysis unit, the Cooperative Monitoring Centre (CMC) located in Amman, Jordan, and established a mechanism for sharing data from the national systems. Joint training courses were held on interventional epidemiology and laboratory technologies. Data collection started in July 2005 with surveillance of salmonellosis as the first target. This network of collaboration and communication established in an area of continuous dispute represents an important step towards assessing the burden of foodborne diseases in the region and is expected to be fundamental for coordination of public health interventions and prevention strategies.

Goiter prevalence and urinary iodine excretion in schoolchildren of Jordan.

Iodine deficiency disorders (IDD) are considered a major health problem in the eastern Mediterranean region. In Jordan, an IDD assessment was performed in 1993 following which, a salt iodization and consumption program was implemented and a monitoring survey performed in 2000. In schoolchildren 8 to 10 years of age (2457 in 1993 and 2601 in 2000) goiter was graded according to WHO classification. Urinary iodine was measured in 10% of the children in 1993 and in all of them in 2000. Percent of iodine consumption in households was assessed by rapid kit test in 2000. Prevalence of goiter was 37.7 and 32.1 % and median urinary iodine was 40 and 154 microg/L, in 1993 and 2000, respectively. Before salt iodization, the prevalence of goiter and severity of iodine deficiency was more pronounced in rural regions and in the southern part of Jordan. In 2000, all but one governorate had a median urinary iodine (MUI) of above 100 microg/L. The percentage of urinary iodine levels < 50 microg in two governorates was > 20%. Iodine consumption rate of households was 88.3% throughout the country, but was < 70% in three governorates. It is concluded that moderate and severe IDD existed before 1993 in Jordan. Although the iodized salt program has been successful in optimizing MUI, the program for the control of IDD needs further improvement.

Mass psychogenic illness following tetanus-diphtheria toxoid vaccination in Jordan.

In September 1998, more than 800 young people in Jordan believed they had suffered from the side-effects of tetanus-diphtheria toxoid vaccine administered at school; 122 of them were admitted to hospital. For the vast majority, their symptoms did not result from the vaccine but arose from mass psychogenic illness. The role played by the media, the children's parents, and the medical profession in the escalation of this mass reaction appeared, at first sight, to be unusual and even unique to the circumstances in Jordan at the time. A review of the literature showed, however, that this mass reaction was similar in many ways to previous outbreaks, even though the underlying causes varied. There are about 200 published accounts of mass responses to situations involving suspected poisoning or other events. Because such mass reactions are relatively rare and the triggers so diverse, individuals faced with responding to them are unlikely to have prior experience in how to handle them and are unlikely to take bold steps to prevent their escalation. Indeed they may be unaware that such events have been recorded before. The lessons learned from this incident in Jordan may help other immunization programme managers to handle crisis situations elsewhere.