In collaboration with the Jordanian Ministries of Health (MoH) and Agriculture (MoA), EMPHNET implemented a series of workshops during July and August 2016 on brucellosis surveillance, diagnosis, and control. Held in Mafraq, Jordan, these workshops formed part of a project funded by the U.S. Centers for Disease Control and Prevention (CDC). They were designed to help prevent the spread of brucellosis in the Kingdom’s most vulnerable governorates.
Brucellosis is a zoonotic disease that is endemic to Jordan, and it is especially a public health concern in Mafraq. This governorate covers a wide geographical area that includes a number of Syrian refugees and a high animal population density, and it is an area known for its large production of animal products. According to the MoH, there has been an increase in the number of reported human cases of brucellosis in recent years attributed to the low vaccination coverage for animals in the governorate and inadequate knowledge of the disease’s modes of transmission in both human and animal population.
In response to this condition, the first workshop in the series was designed to train clinicians working at MoH Comprehensive Health Centers (CHC) in Mafraq. During this workshop, the clinicians were updated on topics specific to human brucellosis, such as the epidemiology of brucellosis in Jordan, especially focusing on Mafraq. They were also trained in topics related to case definition of the disease according to the MoH surveillance guide; MoH investigation form for reporting cases to the surveillance unit at the MoH; diagnosis of human brucellosis and determining the recommended course of treatment; and the role of clinicians in samples collection, and referral of patients from the CHCs to Mafraq’s Central Laboratory.
The second workshop in the series was attended by laboratory technicians from Mafraq’s CHCs. The technicians received training in the principles of serological tests and laboratory tests used for diagnosis of brucellosis. Their training also covered topics relevant to laboratory safety measures, sample collection, documentation, and follow-up with Mafraq’s central laboratory. During this workshop, the technicians also sat through a demonstration of the Rose Bengal, a brucellosis screening test, and were trained on how to conduct the test according to the instructions written in the test leaflet.
While the first two workshops focused on human brucellosis, the third focused on cases of brucellosis in animals. Its participants were veterinarians and para-veterinarians from the Agricultural Directorate in Mafraq. They were trained in brucellosis case definition, the epidemiology of brucellosis in animals, field and laboratory diagnosis using the Rose Bengal test, and sample collection, preservation and transportation to the central veterinary laboratory (CVL). During this workshop, they also sat through a demonstration of the Rose Bengal and were trained on how to conduct the test according to the instructions written in the test leaflet.
The fourth workshop was designed to help strengthen collaboration between human and animal health sectors in the detection, diagnosis and reporting of brucellosis cases. The sessions discussed the epidemiology, diagnosis, treatment and control of human and animal brucellosis, with emphasis on the importance of inter-sectorial collaborations between human and animal health sectors in matters related to surveillance, diagnosis, and management of brucellosis. The participants were clinicians, laboratory technicians, and veterinarians who work at Mafraq’s Health Directorate and the governorate’s Agricultural Directorate, respectively.
These four workshops were followed by two more sophisticated training sessions focusing on the laboratory techniques used to diagnose brucellosis, namely the Enzyme-Linked Immunosorbent Assay (ELISA) and the Polymerase Chain Reaction (PCR) techniques.
The ELISA training, the fifth training in the series, consisted of three days of theoretical and hands-on training conducted at Mafraq Central Laboratory (MCL). There were five participants -three participants from MCL, one veterinarian from Mafraq Veterinary Laboratory and one technician from CVL. The ELISA technique is used to determine the antibody response against the Brucella infection (IgM in acute cases and IgG in chronic cases). The first day of training covered the principles of the serological test, laboratory diagnosis of brucellosis, samples separation, preservation and transportation to CPHL in Amman. For the second and third days, the training covered ELISA assay principles and application, ELISA test performance initiation, hands-on training on ELISA testing (IgM & IgG) with positive and negative samples, as well as the reading, documentation and interpretation of lab results. ELISA has been newly introduced for the first time to PHL in Mafraq by EMPHNET.
The PCR training was the sixth training in the series, and it consisted of three days of theoretical and hands on training conducted at Princess Haya Biotechnology Center (PHBC) at Jordan University of Science and Technology (JUST). There were six participants – four technicians from CPHL and one technician and one veterinarian from CVL. The PCR technique is highly sensitive and specific and can also differentiate between both subtypes of brucellosis: B. abortus and B. melitensis. The first day of training was theoretical and focused on new molecular based methods of diagnosis, real time PCR, diagnosis of animal and human brucellosis, all in preparation for practical training the next day. On the second and third days, Qiagen DNeasy blood and tissue extraction protocol, biosafety consideration when working with infectious samples, DNA extraction procedures, primers, probes, control DNA and data analysis were completed through group work.
EMPHNET introduced PCR for the first time to CPHL and to CVL in Amman. Additionally, EMPHNET will provide the MoA and MOH with Rose Bengal kits, ELISA kits, PCR reagents— all of which are usable for one year. It is worth mentioning that EMPHNET has a vision to expand the project to include more than one governorate and to introduce more sophisticated tests to CPHL and CVL (for example, the Multiple Locus VNTR Analysis (MLVA) for genotyping) and will also provide the veterinary clinics with fluorescence polarization assay (FPA) to facilitate the work.