A one health approach to the investigation and control of MERS-CoV among camel and human populations in Jordan as a potential model for the region

Lead Research Organisation: Royal Veterinary College
Department Name: Pathobiology and Population Sciences

Abstract

Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is an emerging infectious disease that was first identified in Jordan and Saudi Arabia in 2012. Clinical cases present as an acute respiratory infection with rapid onset pneumonia and in many cases death. To date there have been over 1800 laboratory confirmed cases, with 643 deaths (as 2nd October 2016) spanning 27 countries. Camels have been identified as the primary viral host reservoir for infection in humans (although infection in camels is largely asymptomatic) with secondary human-to-human transmission also occurring. Individuals with co-morbidities (pre-existing medical conditions) are at particular risk of infection, with the majority of outbreaks occurring in hospital settings. Over 90% of confirmed cases have been in Saudi Arabia.

There are current key knowledge gaps in the understanding of MERS-CoV - particularly the nature of disease transmission from camels-to-humans - that this project seeks to address. Through identifying specific risk factors for camel-to-human transmission the project aims to develop control measures to mitigate these risks. Such control measures must be culturally appropriate and developed in direct collaboration with high risk groups, to ensure they can be effectively implemented at a grassroots level. In addition the project seeks to identify key knowledge gaps in the understanding of MERS-CoV camel-to-human transmission that can form the target research efforts in the future. The project also seeks to establish Jordan, through Jordan University of Science and Technology (JUST), as a regional leader in international MERS-CoV research, surveillance, training and control.

With this in mind the project will adopt a 'One Health' approach to achieving these aims, drawing on the expertise of a number of world expert from various fields including; veterinary public, human public health, epidemiology, virology and anthropology. The project will be coordinated by the Royal Veterinary College (RVC), London, working in strategic partnership with the London School of Hygiene and Tropical Medicine (LSHTM), JUST and the US National Institute of Health. Studies already conducted by the RVC in partnership with JUST and US NIH have already identified high levels of MERS-CoV infection among camels in the south of Jordan.

Project field work will involve random sampling of high risk Bedouin communities in the south of Jordan, collecting blood samples, nasal swabs and sputum samples alongside a questionnaire to assess risk factors for infection. A routine health check will also be performed at this time. Where selected individuals are camel owners nasal swabs will be collected from these camels. All samples collected will be analysed for evidence of MERS-CoV infection, and this data then combined with the data collected from the questionnaires in order to identify risk factors for MERS-CoV infection. In addition an ethnographic study w
ill be conducted to examine the role of camels in Bedouin Arab society and understand how potential control methods for MERS-CoV exposure can most effectively be implemented. Community health workshops will also be run among high risk Bedouin communities regarding the risk of zoonotic (animal-to-human) infections, including MERS-CoV, and give training and advice on how to reduce these risk.

Technical Summary

A stratified multi-stage cross-sectional survey will be conducted among Bedouin communities and their camels in the southern governorates of Jordan (Aqaba & Ma'an) during the period April 2017 to April 2018. These governorates have been selected due to their high number of camel owners, long porous border with Saudi Arabia to the south and already established RVC relationships. Camel owning households and and non-camel owning households will be randomly selected in a 4:1 ratio using local government data of registered livestock owners. Blood samples and oral and nasal swabs will be collected from all family members and a physical examination performed. A pre-tested, structured questionnaire to identify risk factors for MERS-CoV infection will also be administered at this time. Based on an expected prevalence of 4% MERS-CoV seroprevalence among camel owning households and a 0.5% expected seroprevalence among non-camel owners (a risk ratio of 8) a 1:4 ratio of camel herders to non-camel herders and an 80% power, with a 90% confidence interval and a design effect of 1.25 to account for clustering - sample size has been calculated as 946 individuals, with 757 camel herders and 189 non-camel herders. Nasal swabs will also be taken from those camels belonging to selected owners. The number of camels to be randomly sampled per herd has been calculated as 11, using an expected prevalence of 15% and a confidence level of 80% and a mean herd size of 12. In herds of less than 11 camels all camels will be tested. Human serum samples will be screened using anti-MERS coronavirus ELISA (IgG) with microneutralization assay performed as confirmatory test. Human nasal and oral swabs, and camel nasal swabs will be tested by PCR to identify MERS-CoV viral RNA. All samples will be shipped to the US and diagnostics performed at NIAD/NIH Virus Ecology Group, Rocky Mountains Laboratories, Montana. Laboratory and risk factor data will then be subject to multivariate statistical analysis.

Planned Impact

The existing RVC / JUST twinning initiative, with additional input from LSHTM, represents an ideal vehicle for regional capacity building with the project seeking to establish Jordan, through JUST, as a centre of excellence for MERS-CoV surveillance, control, research and training - able to serve the entire region. With this in mind beneficiaries of the research would include the Jordanian governmental medical and veterinary services responsible for overseeing the surveillance and control of MERS-CoV. Due to the One Health nature of this study its findings will add to the research endeavours of those working in a number of different aspects of current MERS-CoV research. In particular, the work on identifying asymptomatic carriers will aid those researchers working on an improved understanding of MERS-CoV human-to-human transmission. Camel seroprevalence and virus isolation studies will help inform the development of vaccines and vaccination protocols and combined with the work on risk factor analysis for camel-to-human infection, will help inform researchers developing integrated MERS-CoV disease control strategies. The qualitative study will help towards informing researchers working in the important emerging discipline of zoonotic medical anthropology, along with more conventional ethnographic Bedouin research studies. In addition, this work will help inform future MERS-CoV disease control strategies with regard to culturally appropriate and effective interventions and the culturally appropriate implementation of future camel vaccination strategies.

The main impact of this research however will be to safeguard the regional security and stability of Jordan and the Middle East. MERS-CoV represents an important biological threat to Jordan, which in the event of a large scale clinical outbreak could threaten to destabilise the already severely overstretched health infrastructures. Jordan is of paramount strategic importance to the fragile stability that still remains in the Middle East region, and is home to well over a million displaced people from neighbouring Syria and Iraq. For this reason effective monitoring and control of MERS-CoV in Jordan is in the national interest of both the UK and the wider global community. In addition MERS-CoV represents an important biological threat to global health services, as illustrated by the 2015 outbreak in South Korea with 36 deaths. With this is mind the impact of this research will also be its significant contribution to the current worldwide research effort directed at the control of this important emerging infectious disease.

Communication Plan:
This study will result in the publication of a number of research articles in appropriate, high impact, peer-reviewed academic journals. In addition, this research and its associated publications will be presented at appropriate international conferences to maximise scientific impact. Consultation and training workshops will also be conducted in Jordan among relevant stakeholders, including camel owners, governmental and private veterinary surgeons, medical, university and governmental staff. For participating camel owners these will take the form of community development workshops, with a focus on zoonotic diseases and potential control measures to minimise risk of exposure. These workshops will build on a series of four previous Bedouin public health workshops conducted by RVC among Bedouin communities in the south of Jordan on the subject of zoonoses. The workshops will also form an opportunity for participatory appraisal, in the design of potential control measures for MERS-CoV, as well as an opportunity for qualitative, ethnographic analyses through group discussion.

Publications

10 25 50
 
Title Audio recordings - A series of field ethnographic interviews of Bedouin camel owners across the southern Badia of Jordan 
Description A series of 10 semi-structured interviews have been conducted among a diverse and representative group of camel owners living within the southern governorates of Jordan. These interviews have been digitally recorded and then transcribed into Arabic, before translation into English for detailed ethnographic analysis. In addition a series of focus group interviews are currently being conducted, which will also become available in a digital format, (audio and transcribed into Arabic and English). 
Type Of Art Artefact (including digital) 
Year Produced 2019 
Impact These resources form a valuable repository of ethnographic data regarding the role and place of camels within Bedouin Arab culture across the Badia of southern Jordan, and reflect attitudes and practices also found within the wider Arabian Peninsular. These data represents some of the first of its kind within the region and contributes to the growing body of ethnographic data currently being collected, examining the role of camels within Arabian culture. As such it represents a key resource in the development of culturally appropriate disease control measures for MERS-CoV, one of the four objectives of the current MRC GRCF funded project. 
 
Description This award has successfully identified significant MERS-CoV viral transmission routes both camel-to-camel and camel-to-human, knowledge of which is essential for the development of effective control measures. The cultural context of these transmission pathways has been examined and culturally appropriate control measures identified, including any potential challenges to future vaccine uptake. Key knowledge gaps to be addressed by future research studies have been identified and key data generated that can be used to inform future disease transmission models.
The planning, preparation and implantation of the field work (both quantitative and qualitative) were successfully completed within the allocated time frame. This first project phase has provided a unique platform for a potential second phase of research where the findings of this first phase (i.e, human and camel seroprevalence and appropriate disease control strategies, including vaccination) are implemented among these same populations, with any changes to the baseline seroprevalence resulting from these interventions closely monitored. If these interventions are found to be effective in reducing the prevalence of MERS-CoV among these at-risk populations it would be of global significance, with the potential mitigating and even preventing a further global coronavirus outbreak with the devastating economic consequences this would entail.
Important transmission routes for MERS-CoV from camels to humans have been identified, alongside potential control measures (e.g. for example the significant risks posed by; kissing camels, restraining camels by the nose, some traditional medicines practices involving camel oral and nasal mucosal treatments and training camels for racing).
Exploitation Route We have established a very unique platform to carry out work with the Bedouin communities of Southern Jordan where MERS-CoV is endemic and baseline data are currently being generated. We expect this study will provide ideal conditions for further work addressing the global MERS-CoV challenge, potentially including the formal testing of interventions.
Sectors Agriculture, Food and Drink,Healthcare

 
Description Data generated regarding MERS-CoV infection rates and risk factors for infection have been used in Covid-19 disease modelling\ Study findings are currently being published and will support the global effort to control and prevent MERS-CoV (including epidemioloigcal data being used in to inform vaccine development strategies)
First Year Of Impact 2020
 
Description Interdisciplinary MERS-CoV Stakeholder Focal Point Committee meetings
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
Impact These regular meetings include relevant stake holders from across the spectrum of MERS-CoV related activities in Jordan, including key representatives and policy makers from within the Ministry of Agriculture and Ministry of Health responsible for designing, co-ordinating and overseeing surveillance and control activities within Jordan.
 
Description Ministry of Agriculture and Ministry of Health
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact Initial meetings with the Ministries of Agriculture and Health at a local, regional and national levels have raised awareness of the need for increased surveillance in the field of camel zoonoses, with MERS-CoV in particular, though other important camel zoonoses also, including Brucellosis.
 
Description The successful hand-over of the 'Focal Points One Health Committee' to the Ministry of Health and Ministry of Agriculture for future joint oversight
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
Impact The 'Focal Points One Health committee' was established in 2017 and chaired by Prof Ehab Abu-Basha (Co-I, JUST), constituting partners from the Ministry of Agriculture (MOA), Ministry of Health (MOH), Ministry of Environment (MOE), World Health Organization (WHO), Food and Agriculture Organization (FAO), World Health Organization (OIE) and Royal Scientific Society (RRS). This committee has met regularly (quarterly) since its inauguration to promote knowledge dissemination between partners and promote a one health approach to disease surveillance, prevention and control ion Jordan. It represented the first national One Health committee of its kind in Jordan. In March 27, 2019, oversight of this committee was successfully handed over to the Ministry of Health and Ministry of Agriculture.
 
Description Training and development of field veterinary epidemiologists
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Within the context of this project (as well as the OIE twinning between JUST and RVC) field veterinary epidemiology training has been conducted in Amman among one third of the total state veterinary service (over 40 participants), through a 2 days workshop delivered in Amman, October 2018, with the aim of building capacity within Jordan to respond to the threat posed by emerging infectious disease such as MERS-CoV, as well as move toward the reduction and elimination of long-standing, intransigent zoonotic infections such as B. mellitensis brucellosis. This training has been augmented by the development of a bespoke smart phone application specifically designed for the Jordanian context. This application will be made available to both the state and public veterinary sectors, with the capacity for on-going feedback, development and software updates.
 
Title Field procedures including protocols and SOP to work among the Bedouin 
Description Random sampling (whole blood, serum, oral swabs and nasal swabs) of Bedouin populations in their tents and homes across the deserts of southern Jordan, combined with livestock sampling, has not been attempted before and thus the development of unique protocols and SOPs sufficient to meet this challenge were required - and have since been designed and successfully implemented. 
Type Of Material Biological samples 
Year Produced 2017 
Provided To Others? No  
Impact Despite the considerable challenges of this field work (such that is has not been attempted before) these unique protocols and SOPs have enabled us to be on course to complete the sampling of over a 1000 individuals, from over 250 families, and over 600 camels from over 200 herds within the planned field work schedule. 
 
Title Research Questionnaire 
Description This study represents the first such study of its kind, seeking to identify the prevalence and epidemiology of sub-clinical MERS-CoV among camel owning (and non-camel owning) livestock keeping populations and the potential links that exist with infected camel populations. In view of this a unique questionnaire has been created that seeks to establish risk factors for sub-clinical MERS-CoV infection in humans, as well as risk factor for infection in camels, in addition to other significant zoonoses in the region, particularly Brucellosis. 
Type Of Material Model of mechanisms or symptoms - human 
Year Produced 2017 
Provided To Others? No  
Impact So far data has been collected from almost 100 families and camel herds, with initial data analysis suggesting significant risk factors for infection with MERS-CoV, both in humans and camels populations. 
 
Title The design of a unique protocol for PBMC analysis, within the confines of a highly challenging fieldwork environment 
Description Due to the relatively short period of antibody presence in human serum post-infection with MERS-CoV it has been essential to also conduct Peripheral Blood Monocular site analysis to enable more sensitive analysis of disease exposure by selected individuals. The challenges of the field environment (up to a 4 hour return journey from the sampling sites and the absence of an existing laboratory suitable for sample processing) however necessitated the creation of a novel sample preparation protocol suitable to meet these demands, as well as the creation of a bespoke field laboratory on Aqaba. 
Type Of Material Biological samples 
Year Produced 2017 
Provided To Others? No  
Impact The addition of PBMC analysis to the existing serology enables greater sensitivity in determining levels of MERS-CoV exposure among at risk populations and greater resolution in risk factor analysis. 
 
Title Young camel cohort study 
Description We have designed and are implementing a cohort study of 20 young camels spread across four herds within the study sampling frame, with weekly nasal swabs and monthly serum samples being collected and stored for laboratory analysis (serology and virus detection / isolation). 
Type Of Material Model of mechanisms or symptoms - mammalian in vivo 
Year Produced 2018 
Provided To Others? No  
Impact To date the timing of MERS-CoV infection, viral shedding and seroconversion among young camels is poorly understood, though vital for vaccine development and piloting in the field - likely to be the next stage of the award project. 
 
Title Data base - Camel owning and non-camel livestock owners 
Description A data set has been created describing the sampling frame used to select camel and non-camel owning livestock owners for the human and camel studies. This sampling frame has been created through the random selection of camel owners and livestock owners from Ministry of Agriculture lists. 
Type Of Material Database/Collection of data 
Year Produced 2019 
Provided To Others? No  
Impact This data set has been used as the sampling frame for the human and livestock study, with camel and livestock owners present on these lists contacted and assessed for compliance. Camel or livestock owners who no longer owned camels / other livestock were removed, as were those who could not be contacted and those who refused to participate, with records updated accordingly. 
 
Title Data base - Camel study 
Description A data base has been created to record all data gathered during the camel study, including location, age, sex, presence of a nasal discharge, racing vs non-racing and serological status regarding MERS-Cov (along with other key zoonosis tested including brucellosis, Hepatitis E and toxoplasmosis). 
Type Of Material Database/Collection of data 
Year Produced 2018 
Provided To Others? No  
Impact This dataset will be used to determine population and herd level seroprevalences for MERS-CoV and risk factors for infection at both an individual and herd level (alongside other relevant zoonoses including brucellosis, Hepatitis E and toxoplasmosis). 
 
Title Data base - Human and camel study, household head 
Description In addition to the data set recording questionnaire responses, biometric parameters and serological results from each individual within a household, an additional data set recording questionnaire responses at a household level has also been created. These questions refer to herd level livestock management practices as well as household level data and practices including household size, level of income indicators, drinking water sources and the presence of rodents among other parameters. This data set also includes household and herd level seroprevalences for MERS-CoV (and other significant zoonoses such as brucellosis, Hepatitis E and toxoplasmosis). All data has been recorded and securely uploaded using ODK and all data management is being conducted according the strict protocols surrounding anonymity outlined within the ethical approval. 
Type Of Material Database/Collection of data 
Year Produced 2018 
Provided To Others? No  
Impact This data set will enable both household and camel herd level risk factors for MERS-CoV to be identified (along with other relevant zoonoses including brucellosis, Hepatitis E and toxoplasmosis) as well as and modelling of transmission of the disease from livestock to humans. 
 
Title Data base - Human study all household members 
Description A data base has been created to describe the full membership of each household, identifying who normally lives in each household, their age, sex, relationship to the household head and whether or not they were present at the time of sampling and if present whether or not they were willing to be sampled, or whether age (>5yrs), disability or pregnancy precluded them from being sampled. 
Type Of Material Database/Collection of data 
Year Produced 2018 
Provided To Others? No  
Impact This database has been created to determine levels of compliance and sampling prevalence within each household and to generate information on average household size and other population demographics. 
 
Title Data base - Human study, household members 
Description This database includes data collected on 1187 individuals sampled during the human study which was carried out in the two southern governorates of Jordan (Aqaba and Ma'an). This database includes demographic information, data regarding direct and indirect contact with camels and other livestock, consumption of raw milk and other dairy products and any existing co-morbidities. A full physical examination was performed at the time of sampling and this biometric data is also stored within the same data base, along with relevant details of family relationships (relationship to 'household head') and residence within the household. All data has been fully anonymised and is being strictly managed according to constraints outlined with ethical approval. This data base includes serological results for a number of key zoonoses within the region in addition to MERS-CoV, with Hepatitis E, toxoplasmosis and brucellosis also tested for and included. 
Type Of Material Database/Collection of data 
Year Produced 2018 
Provided To Others? No  
Impact This data set provides a unique repository of information on diverse aspects of individuals behaviour and activities within entire households with regard to livestock owning (and camels in particular), as well as in depth information of the prevalence of non-communicable diseases, education levels and indicators of wealth, as well as a full range of biometric data gathered through physical examination. This data set will be used to facilitate a large-scale community-based cross-sectional study of the age and gender-specific MERS-CoV sero-prevalence among camel owning and non-camel owning populations in these areas, followed by mathematical analysis to identify risk factors for infection in each setting. In addition seroprevalence and risk factors for infection will be analysed for Hepatitis E, toxoplasmosis and brucellosis along with non-communicable diseases such as diabetes, high blood pressure and smoking related respiratory disease. 
 
Title Qualitative / Ethnographic study 
Description The beginnings of a dataset from the qualitative methods (semi-structured interviews and participatory observation) outlining the role, significance and value of camels among livestock owning populations in southern Jordan and the cultural factors that influence the mitigation of potential risk factors. 
Type Of Material Database/Collection of data 
Year Produced 2018 
Provided To Others? No  
Impact This dataset generated through from the qualitative methods which will be growing and has potential to influence the project and impacts though providing an accurate cultural lens that will enable potential control factors for disease transmission to be effectively implemented in the field. 
 
Title Risk Factor analysis questionnaires (human and camel) 
Description The use of ODK to create and store a unique database of risk factor for MERS-CoV (and other signifiant zoonoses such as Brucellosis) in human and camel populations. 
Type Of Material Database/Collection of data 
Year Produced 2017 
Provided To Others? No  
Impact This database constitutes a unique repository of data comprising both physiological data (from the physical examination), medical history and questionnaire responses for humans and camels (owners). In addition to providing key data towards an improved understanding of MERS-CoV risk factors and epidemiology (along with other significant zoonoses such as Brucellosis) this database also provides vital information towards a wider understanding of public health issues among Bedouin populations, particularly around non-transmissible diseases such as high blood pressure, diabetes and smoking related respiratory disease. 
 
Description RVC / JUST Medical Faculty 
Organisation Jordan University of Science and Technology
Country Jordan 
Sector Academic/University 
PI Contribution The OIE Veterinary Education Twinning Programme between the Royal Veterinary College (RVC) and the Jordan University of Science and Technology (JUST) began in January 2015 with funding for an initial period of 3 years. It is one of the first education twinning programmes endorsed by the World Organisation for Animal Health (OIE). The aim of the program is to establish a knowledge exchange platform to share best educational and research practice in the broad field of Veterinary Public Health and to use this platform to facilitate the long term engagement of RVC and JUST in Veterinary Public Health training and research in the Middle East and the Arab region. However, until this onset of this award engagement had been solely between RVC and the JUST Veterinary Faculty. This award has now created a new engagement between the RVC, LSHTM, and the Faculty of Medicine at JUST.
Collaborator Contribution Professor Wail Hayajneh (JUST) is the Dean of the Medical Faculty at JUST and Associate Professor of Paediatric Infectious Diseases. He is also a board member of the Infectious Diseases and Vaccines Centre, University of Jordan and head of the Infection Control Committee, King Abdullah University Hospital Irbid. In addition he has until recently been coordinating the Infectious Diseases Group of Jordan and Deputy CEO of King Abdullah University Hospital Jordan. Professor Hayajneh brings a wealth of experience working among viral infectious diseases in Jordan, both within a clinical and research settings.
Impact Together with the new collaboration established between the RVC / LSHTM and the anthropology department at Yarmouk University Irbid, Jordan, this award has produced the first integrated multidisciplinary one health approach to the control of MERS-CoV in Jordan. This collaboration has been multidisciplinary and has already resulted in several key outputs including: detailed study design, questionnaire design and administration,providing the laboratory facilities necessary to determine initial seroprevalence results for both camels and humans, with human seroprevalence for MERS-CoV higher than expected and higher than currently identified among at risk populations in the published literature.
Start Year 2017
 
Description RVC / JUST collaboration with Food and Agriculture Organization 
Organisation Food and Agricultural Organisation (FAO)
Department Jordan
Country Jordan 
Sector Public 
PI Contribution Arranging and participating in regular (monthly) MERS-CoV Focal Point Committee meetings in Amman, involving representatives from PREDICT-2, the Ministry of Health, Ministry of Agriculture, Ministry of Environment, World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), World Organisation for Animal Health (OIE), Royal Scientific Society (RSS), Hashemite Fund for Development of Jordan Badia and the RVC / JUST OIE twinning initiative. Such meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings contributing toward a comprehensive, cohesive and synergistic 'One Health' approach to MERS-CoV research, training, surveillance and control in Jordan, avoiding any potentially wasteful duplication of efforts. Such meetings provide a valuable on-going knowledge exchange platform building capacity for improved disease surveillance and control policy and action in Jordan, particularly with regard to MERS-CoV.
Collaborator Contribution As stated above, these meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings, contributing toward a comprehensive, cohesive and synergistic One Health approach to MERS-CoV research, training, surveillance and control in Jordan.
Impact As stated above, these meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings, contributing toward a comprehensive, cohesive, equitable and synergistic One Health approach to MERS-CoV research, training, surveillance and control in Jordan These regular meetings have an enabled the creation of an integrated MERS-CoV surveillance and response strategy by the Ministry of Health and Ministry of Agriculture, in direct collaboration with WHO, FAO and JUST / RVC. This collaboration is multi-disciplinary, including medical sciences (Ministry of Health, JUST / RVC), veterinary medicine (Ministry of Agriculture, FAO, JUST / RVC), biological sciences (PREDICT-2, RSS) and social sciences (Hashemite Fund for Development of Jordan Badia) among others.
Start Year 2018
 
Description RVC / JUST collaboration with World Health Organization 
Organisation World Health Organization (WHO)
Country Global 
Sector Public 
PI Contribution Arranging and participating in regular(monthly) MERS-CoV Focal Point Committee meetings in Amman, involving representatives from PREDICT-2, the Ministry of Health, Ministry of Agriculture, Ministry of Environment, World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), World Organisation for Animal Health (OIE), Royal Scientific Society (RSS), Hashemite Fund for Development of Jordan Badia and the RVC / JUST OIE twinning initiative. Such meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings contributing toward a comprehensive, cohesive and synergistic 'One Health' approach to MERS-CoV research, training, surveillance and control in Jordan, avoiding any potentially wasteful duplication of efforts. Such meetings provide a valuable on-going knowledge exchange platform building capacity for improved disease surveillance and control policy and action in Jordan, particularly with regard to MERS-CoV.
Collaborator Contribution As stated above, these meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings, contributing toward a comprehensive, cohesive and synergistic One Health approach to MERS-CoV research, training, surveillance and control in Jordan.
Impact As stated above, these meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings, contributing toward a comprehensive, cohesive, equitable and synergistic One Health approach to MERS-CoV research, training, surveillance and control in Jordan These regular meetings have an enabled the creation of an integrated MERS-CoV surveillance and response strategy by the Ministry of Health and Ministry of Agriculture, in direct collaboration with WHO, FAO and JUST / RVC. This collaboration is multi-disciplinary, including medical sciences (Ministry of Health, JUST / RVC), veterinary medicine (Ministry of Agriculture, FAO, JUST / RVC), biological sciences (PREDICT-2, RSS) and social sciences (Hashemite Fund for Development of Jordan Badia) among others.
Start Year 2018
 
Description RVC / JUST collaboration with the Ministry of Agriculture, Jordan 
Organisation Government of Jordan
Department Ministry of Agriculture
Country Jordan 
Sector Public 
PI Contribution Arranging and participating in regular (monthly) MERS-CoV Focal Point Committee meetings in Amman, involving representatives from the Ministry of Health, Ministry of Agriculture, Ministry of Environment, World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), World Organization for Animal Health (OIE), PREDICT-2, Royal Scientific Society (RSS), Hashemite Fund for Development of Jordan Badia together with the RVC / JUST OIE twinning initiative. Such meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings contributing toward a comprehensive, cohesive and synergistic 'One Health' approach to MERS-CoV research, training, surveillance and control in Jordan - and avoiding potentially wasteful duplication of efforts. Such meetings provide a valuable on-going knowledge exchange platform building capacity for improved disease surveillance and control policy and action in Jordan, particularly with regard to MERS-CoV.
Collaborator Contribution As stated above, these meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings, contributing toward a comprehensive, cohesive and synergistic One Health approach to MERS-CoV research, training, surveillance and control in Jordan.
Impact This partnership facilitated the conducting of a two day training event on disease surveillance and control in Amman, 16th and 17th October 2018, with 25% of the Jordanian State Veterinarians represented, including senior members from the ministry of Agriculture. This event was a direct outcome of the existing partnership between the RVC / JUST and had a particular focus on MERS-CoV among other highly relevant zoonoses within the region, including Brucellosis. In addition the existing partnership between JUST / RVC and the Ministry of Agriculture Jordan has significantly enabled and facilitated current MRC GCRF funded research activities in the south of Jordan. As stated the Focal Point Committee meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings, contributing toward a comprehensive, cohesive, equitable and synergistic One Health approach to MERS-CoV research, training, surveillance and control in Jordan These regular meetings have an enabled the creation of an integrated MERS-CoV surveillance and response strategy by the Ministry of Health and Ministry of Agriculture, in direct collaboration with WHO, FAO and JUST / RVC. This collaboration is multi-disciplinary, including medical sciences (Ministry of Health, JUST / RVC), veterinary medicine (Ministry of Agriculture, FAO, JUST / RVC), biological sciences (PREDICT-2, RSS) and social sciences (Hashemite Fund for Development of Jordan Badia) among others.
Start Year 2018
 
Description RVC / JUST collaboration with the Ministry of Health, Jordan 
Organisation Ministry of Health Jordan
Country Jordan 
Sector Public 
PI Contribution Arranging and participating in regular (monthly) MERS-CoV Focal Point Committee meetings in Amman, involving representatives from the Ministry of Health, Ministry of Agriculture, Ministry of Environment, World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), World Organization for Animal Health (OIE), PREDICT-2, Royal Scientific Society (RSS), Hashemite Fund for Development of Jordan Badia and the RVC / JUST OIE twinning initiative. Such meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings contributing toward a comprehensive, cohesive and synergistic 'One Health' approach to MERS-CoV research, training, surveillance and control in Jordan, avoiding any potentially wasteful duplication of efforts. Such meetings provide a valuable on-going knowledge exchange platform building capacity for improved disease surveillance and control policy and action in Jordan, particularly with regard to MERS-CoV.
Collaborator Contribution As stated above, these meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings, contributing toward a comprehensive, cohesive and synergistic One Health approach to MERS-CoV research, training, surveillance and control in Jordan.
Impact As stated above, these meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings, contributing toward a comprehensive, cohesive, equitable and synergistic One Health approach to MERS-CoV research, training, surveillance and control in Jordan These regular meetings have an enabled the creation of an integrated MERS-CoV surveillance and response strategy by the Ministry of Health and Ministry of Agriculture, in direct collaboration with WHO, FAO and JUST / RVC. This collaboration is multi-disciplinary, including medical sciences (Ministry of Health, JUST / RVC), veterinary medicine (Ministry of Agriculture, FAO, JUST / RVC), biological sciences (PREDICT-2, RSS) and social sciences (Hashemite Fund for Development of Jordan Badia) among others.
Start Year 2018
 
Description RVC / LSHTM and PREDICT 2 Jordan (USAID) / EcoHealth Alliance 
Organisation United States Agency for International Development
Department PREDICT
Country United States 
Sector Public 
PI Contribution In Jordan, PREDICT-2 is implemented by EcoHealth Alliance and the Faculty of Veterinary Medicine, Jordan University of Science and Technology. The RVC was the first research institute to begin examining the epidemiology and control of camel zoonoses, and MERS-CoV in particular, in Jordan (beginning in 2013). As such the RVC has built up a long standing network of local relationships among Bedouin communities in southern of Jordan, along its long porous border with Saudi Arabia. In view of this the RVC is uniquely placed to offer a detailed and well established research platform to other complimentary projects such as PREDICT 2. Prof Ehab Abu Basha is the country director for PREDICT 2, as well as being the lead co-investigator from JUST for this award in Jordan, and is thus ideally placed to enable maximum synergy between these two complimentary state-of-the-art research projects. In addition the collaboration with Yarmouk University Anthropology department and LSHTM offer PREDICT 2 access to valuable added capacity in medical anthropology, human epidemiology and medical statistics.
Collaborator Contribution The PREDICT-2 project, part of USAID's Emerging Pandemic Threats program, is developing a global early warning system to detect, track, and predict the emergence of new zoonotic pathogens from wildlife that could pose a threat to human health. As such PREDICT 2 harnesses the expertise of some of the world's most outstanding virologists and epidemiologists. The link between bats and MERS-CoV has been clearly established though the exact nature of this link and it's on-going relevance remain unclear. With this in mind PREDICT 2 Jordan offers the opportunity for effective synergy with the multidisciplinary research into MERS-CoV generated by this award.
Impact The natural synergy between PREDICT 2 and this award has already enabled significant sharing of resources, capacity building and data sharing, significantly enhancing the existing outputs from this award. This collaboration is indeed multidisciplinary with expertise in Anthropology, Pubic Health / Veterinary Public Health, Virology, Epidemiology, Medical / Veterinary Stastitcs as well as existing local relationships and research platforms being offered through this award.
Start Year 2017
 
Description RVC / LSHTM and Yarmouk University, Iribid 
Organisation Yarmouk University
Country Jordan 
Sector Academic/University 
PI Contribution Yarmouk University represents the only Anthropology Department in Jordan, and has until now, been largely unengaged in the field of Medical Anthropology, with no on-going relationships currently existing in this field between JUST and Yarmouk University (despite both being located in Irbid). Prof. Tony Barnett (LSHTM) Dr. Lauren Blake (RVC) and Dr. Jackie Cardwell have begun an ongoing dialogue by Skype and email, with the first field visit to Yamouk planned for the beginning of April providing the opportunity for formal training and capacity building in fully integrated qualitative / quantitive approaches to veterinary and human public health, with a particular focus on MERS-CoV
Collaborator Contribution As stated above Yamouk University represents the only Anthropology Department in Jordan and as such is uniquely placed to offer opportunity for regional capacity building in the field of Medical Anthropology and a One Health approach to the control of important regionally vital emerging infectious diseases such as MERS-CoV. In addition local experts in Bedouin culture, such as Prof. Husban and Prof. Abu Daluo, provide this award with invaluable local insight and knowledge into to the approach, design and analysis of it's qualitative component.
Impact This is a multi-disciplinary collaboration involving the RVC, LSHTM, JUST Medical Faculty, JUST Veterinary Faculty and Yarmouk University Anthropology department. The outcome of this collaboration so far is the first multi-disciplinary mixed method approach to the control of emerging infectious diseases in Jordan, with a new relationship established between Yamouk and JUST in the field of Medical Anthropology and emerging infectious diseases. This relationship has already contributed significantly to the qualitative study design process.
Start Year 2017
 
Description RVC / LSHTM collaboration with Jenner Institute, Oxford University 
Organisation University of Oxford
Department Jenner Institute
Country United Kingdom 
Sector Academic/University 
PI Contribution Professor Sarah Gilbert's laboratory is at the global forefront of MERS-CoV vaccine development (in both humans and camels) and as such is keen to develop partnerships that will facilitate potential vaccine field studies in the future. Our current research work in Jordan provides a potentially highly suitable context for future vaccine deployment in both humans and / or camels.
Collaborator Contribution Professor Gilbert's expertise in MERS-CoV vaccine development offers key input into current and future study design and implementation in Jordan, enabling research activities to be appropriately tailored for potential future vaccine deployment activities.
Impact This collaboration has to led to on-going dialogue with CEPI (Coalition for Epidemic Preparedness Innovations) with the aim of closely aligning our current research activities with exisiting global MERS-CoV vaccine development objectives.
Start Year 2019
 
Description RVC / LSHTM partnership with NIH / NIAID, Virus Ecology Unit, Laboratory of Virology, Rocky Mountains Laboratories, Montana, USA 
Organisation National Institutes of Health (NIH)
Country United States 
Sector Public 
PI Contribution The RVC was the first research institute to begin field work epidemiological studies in Jordan looking at camel zoonoses, and MERS-CoV in particular. As a result of this the RVC was able to offer the NIH / NIAID, Virus Ecology Unit, Rocky Mountains Laboratories, unique access to camel and human biological samples from Southern Jordan, generated by this award. The RVC, working closely in partnership with LSHTM, has an existing, well-established link with JUST - a major state-supported university with faculties of medicine and veterinary medicine and one of the region's leading science universities. This twinning programme between RVC and JUST, which began in January 2015, was one of the very first educational twinning programmes to be endorsed by the World Organisation for Animal Health (OIE). Through this strategic partnership between the RVC and LSHTM, alongside the OIE approved RVC / JUST twinning initiative, this project seeks to harness the UK's world leading expertise in public health and medical research to strengthen resilience and response to MERS-CoV, an important emerging viral threat in Jordan, a globally strategic LMIC. The RVC VEEPH is an FAO reference centre for veterinary epidemiology and this group has established itself at the forefront of MERS-CoV research in the region.
Collaborator Contribution The mission of the Virus Ecology Unit is to elucidate the ecology of emerging viruses and drivers of zoonotic and cross-species transmission. The Virus Ecology Unit uses a combined field and experimental research approach and conducts research at the Rocky Mountain Laboratories (RML) state-of-the-art high- and maximum-containment facilities, as well as at field study sites in Africa (the Republic of the Congo, Mali), the Caribbean (Trinidad and Tobago) and the Middle East (Jordan). Dr. Vincent Munster and Dr. Neeltje Van Doremalen represent two of the world's leading experts in MERS-CoV, with Virus Ecology Unit operating at the forefront of current research.
Impact Initial data has been generated on human and camel prevalence of MERS-CoV, as well as the presence of MERS-CoV in fomite samples, with all technical expertise and personnel required for this provided by NIH (RML). This combined data represents the first large-scale combined serological survey of human populations and camel herds in Jordan, with higher than expected human prevalences detected.
Start Year 2017
 
Description RVC /JUST collaboration with Royal Scientific Society of Jordan 
Organisation Royal Scientific Society
Country Jordan 
Sector Charity/Non Profit 
PI Contribution Arranging and participating in regular (monthly) MERS-CoV Focal Point Committee meetings in Amman involving representatives from PREDICT-2, the Ministry of Health, Ministry of Agriculture, Ministry of Environment, World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), World Organization for Animal Health (OIE), Royal Scientific Society (RSS), Hashemite Fund for Development of Jordan Badia and the RVC / JUST OIE twinning initiative. Such meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings contributing toward a comprehensive, cohesive and synergistic 'One Health' approach to MERS-CoV research, training, surveillance and control in Jordan, avoiding any potentially wasteful duplication of efforts. Such meetings provide a valuable on-going knowledge exchange platform building capacity for improved disease surveillance and control policy and action in Jordan, particularly with regard to MERS-CoV.
Collaborator Contribution As stated above, these meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings, contributing toward a comprehensive, cohesive, equitable and synergistic One Health approach to MERS-CoV research, training, surveillance and control in Jordan.
Impact As stated above, these meetings provide the opportunity for regular dissemination of knowledge, activities and relevant findings, contributing toward a comprehensive, cohesive, equitable and synergistic One Health approach to MERS-CoV research, training, surveillance and control in Jordan These regular meetings have an enabled the creation of an integrated MERS-CoV surveillance and response strategy by the Ministry of Health and Ministry of Agriculture, in direct collaboration with WHO, FAO and JUST / RVC. This collaboration is multi-disciplinary, including medical sciences (Ministry of Health, JUST / RVC), veterinary medicine (Ministry of Agriculture, FAO, JUST / RVC), biological sciences (PREDICT-2, RSS) and social sciences (Hashemite Fund for Development of Jordan Badia) among others.
Start Year 2018
 
Description RVC and LSHTM partnership 
Organisation London School of Hygiene and Tropical Medicine (LSHTM)
Department Department of Infectious Disease Epidemiology
Country United Kingdom 
Sector Academic/University 
PI Contribution The Royal Veterinary College has an existing, well-established link with Jordan University of Science and Technology (JUST) - a major state-supported university with faculties of medicine and veterinary medicine and one of the region's leading science universities. This twinning programme between RVC and JUST, which began in January 2015, was one of the very first educational twinning programmes to be endorsed by the World Organisation for Animal Health (OIE). Through this strategic partnership between the RVC and LSHTM, alongside the OIE approved RVC / JUST twinning initiative, this project seeks to harness the UK's world leading expertise in public health and medical research to strengthen resilience and response to MERS-CoV, an important emerging viral threat in Jordan, a globally strategic LMIC. The RVC VEEPH is an FAO reference centre for veterinary epidemiology and this group has established itself at the forefront of MERS-CoV research in the region, collaborating with leading virologists from the US NIAID/NIH to conduct the first large-scale serological survey of camel herds in Jordan and the first recorded viral isolation among camels in Jordan. In addition, research into camel zoonoses, particular MERS-CoV, among camel owning (mostly Bedouin) communities has been on-going in the south of Jordan since 2013 with a network and community relationships and goodwill already established. Professor Javier Guitian (RVC) is a veterinary epidemiologist with more than 15 years' experience conducting research on zoonotic diseases and building capacity in veterinary epidemiology in Europe, Asia, Africa and South America. He has led research projects involving large-scale field studies of zoonotic diseases such as brucellosis, avian influenza, toxoplasmosis, trypanosomiasis and cysticercosis. He has relevant previous experience in Jordan, where he has led nation-wide surveys of ruminant brucellosis and livestock keepers' assessments of knowledge, attitudes and practices towards zoonotic diseases. He is PhD supervisor of Peter Holloway, who is studying camel zoonoses, including MERS, in Southern Jordan. In partnership with Dr. Mangtani, Prof. Guitian is currently leading projects on human and animal brucellosis in West Africa and India. Prof. Guitian is co-PI of the ongoing Royal Veterinary College (RVC) - Jordan University of Science and Technology (JUST) educational twining program. This is one of the first educational twinning programmes to be endorsed by the World Organisation for Animal Health (OIE). Among other objectives, the program aims at building capacity in Jordan and the region to carry out research on livestock diseases of public health importance. Jackie Cardwell (RVC) is a lecturer in epidemiology at the RVC and has a particular interest in the use of mixed (qualitative and quantitative) approaches to understanding health and welfare issues in animal and human populations. Peter Holloway is post-graduate student at the RVC currently completing his PhD on the epidemiology and control of camel zoonoses in southern Jordan, following an MSc in in international animal health (Tropical Animal Health and Production). Over the past 4 years Peter has been largely based in the Middle East, including a year of Arabic studies before commencing his PhD studies with the RVC. Peter has good local knowledge and an established network of relationships among Bedouin communities southern of Jordan. Dr. Lauren Blake is providing technical expertise in the oversight of the qualitative aspects of this study, with the field work being conducted by Suk Woo Lee and MSc anthropologist with long term experience in the Middle East, particularly among Bedouin populations, and high competency in Arabic.
Collaborator Contribution London School of Hygiene and Tropical Medicine is a leading school for population research with expertise in epidemiology, statistical and mathematical modelling for human health and health policy, ranked as the top university in Europe for research impact in the CWTS Leiden Ranking, published in July 2015. LSHTM has world-leading expertise and experience in quantification of the impact of exposures to adverse microbiological threats, environmental and chemical threats as well as the implications of public health policy and prioritisation - ranging from examples as diverse as early neonatal causes of death to global zoonoses such as avian influenza and BSE. Dr Punam Mangtani is a senior clinical epidemiologist whose research includes assessing safety of vaccines, levels and trends in the burden of infectious diseases, assessing surveillance systems, effectiveness of interventions, inequalities in health and economic evaluations of interventions. She has had a long standing collaboration on research into zoonotic and food borne diseases with RVC. The project is benefiting from her clinical and epidemiological expertise in assessing burden, the use of secondary data, assessment of probability of risk, measures of impact and awareness of the critical information requirements needed to inform risk modelling. Professor Tony Barnett is an interdisciplinary social scientist who works on the social sciences of infectious diseases who retired from the project in September 2017 after building effective collaborative relationships with the anthropology department at Yarmouk University, Irbid and an initial study plan for the social science component of the project. (The project qualitative research is now being led by Dr. Lauren Blake, from the RVC.) Our LSHTM collaborators, including statistician Stephen Nash, were also key in the epidemiological study design and the design of questionnaires to assess the risk of transmission from camels to humans in households. Statistical support for the sampling, database design and final analyses is also being obtained from our LSHTM collaborators
Impact This collaboration has been multidisciplinary with both qualitative and quantitative input from LSHTM. This collaboration has already resulted in several key outputs including: detailed study design (both quantitative and qualitative), sample size calculations, questionnaire design and administration, data management tools including ODK, initial seroprevalence results for both camels and humans, with human seroprevalence for MERS-CoV higher than expected and higher than currently identified among at risk populations in the published literature.
Start Year 2017
 
Description RVC/LSHTM and Coalition for Epidemic Preparedness Innovations (CEPI) 
Organisation Coalition for Epidemic Preparedness Innovations
Country Norway 
Sector Learned Society 
PI Contribution It is important that the scientific community continue to expand research and development for MERS-CoV medical countermeasures aligned with priorities identified by the WHO R&D blueprint Roadmap for MERS-CoV, in parallel with CEPI's funding of vaccine development. This R & D includes studies that generate estimates of MERS-CoV incidence among at risk populations in affected regions, contribute to improving risk prediction for MERS-CoV disease, and facilitate the design and location of future MERS-CoV vaccine trials. The recently completed GCRF Foundation award project, 'A one health approach to the investigation and control of MERS-CoV among camel and human populations in Jordan, as potential model for the region', and proposed GCRF Health and Context award study, 'Responding to the challenge of MERS-CoV: Development and testing of interventions to reduce risk among Bedouin populations in Southern Jordan' are both closely aligned with these criteria. Epidemiological data generated by the Foundation award serves toward meeting existing critical knowledges, with significant opportunity for the Health and Context award, if successful, to contribute still further.
Collaborator Contribution CEPI's mission is to accelerate the development of vaccines against emerging infectious diseaes (EIDs) and enable equitable access to these vaccines for affected populations during outbreaks. CEPI invests in promising vaccine candidates targeting emerging infectious diseases to drive the development of vaccines for human populations at risk and currently has 4 MERS-CoV vaccine candidates in their portfolio. As such, CEPI are in a unique position to advise and offer valuable technical input into the on-going analysis of data generated from the recent Foundation award project 'A one health approach to the investigation and control of MERS-CoV among camel and human populations in Jordan, as potential model for the region', and proposed GCRF Health and Context award study, 'Responding to the challenge of MERS-CoV: Development and testing of interventions to reduce risk among Bedouin populations in Southern Jordan', in order that research outputs accurately tailored to the needs of current vaccine research, development and deployment strategies.
Impact CEPI is supportive of high quality multi-disciplinary epidemiological studies, performed in compliance with international and national guidelines on scientific integrity and research ethics, that can generate critical data to inform vaccine evaluation, disease burden estimates and future vaccine use. If successful the forthcoming GCRF H & C award will be conducted buy the RVC (veterinary medicine / animal health / veterinary public health) in collaboration with LSHTM (human medicine / public health) and strategic partnership with Jordan University of Science and Technology (faculty of Veterinary Science and faculty of Medicine) and Yarmouk University (Faculty of Anthropology).
Start Year 2019
 
Title Field Epidemiology Training smart phone application 
Description A large-scale workshop was run in Amman last year, organised and hosted by the RVC / JUST with the Ministry of Agriculture, involving one quarter of the state veterinarians working within Jordan, with the aim of building capacity for disease surveillance and control. During this training event a series of small-group workshops were held, with participants asked to discuss and give feed-back on perceived existing limitations for disease control and surveillance activities in Jordan - and to suggest potential solutions that might address these limitations. During these feed-back sessions one of the recurring themes was a perceived lack of knowledge and training in basic epidemiology among state veterinarians, together with a lack of the necessary skills to perform basic field epidemiological surveys. One of the potential solutions mentioned several times during these feedback sessions was the provision of basic field epidemiology training materials, possibly in the form of an eBook or smartphone application. In response to this a smart phone application has been developed to train field veterinarians (state and private practitioners) in Jordan to perform both basic and more advanced levels of disease surveillance and control. This has been produced to build capacity within Jordan for rapid disease response, particular in the field of emerging infectious diseases, such as MERS-CoV, but also to address other pressing public health and animal health issues in Jordan, such as brucellosis, leishmaniasis, rabies and infectious bronchitis among others. The application provides a series of short training modules (chapters) that introduce and develop key principles and strategies required for disease surveillance. In addition, a series of worked examples give practical information on how such surveillance might be conducted in the local Jordanian context, together with embedded tools to perform epidemiological calculations, such as sample size, true prevalence and risk analysis. All components are available in both Arabic and English and operates on both iOS and Android platforms. 
Type Of Technology Webtool/Application 
Year Produced 2019 
Impact A pilot version of the product is currently being field tested within a pre-selected group of state veterinarians in Jordan, with review and development of the content still on-going. Initial feedback has been very positive. The application will be freely available in Jordan to veterinarians working in both the state and public sector. It is expected that the finalised version of this app will be available for nationwide dissemination within the next 2-3 months. 
 
Description A formal working group, expert panel or dialogue - Capacity building workshop conducted with senior policy makers at the Ministry of Health, including the Head of Disease Surveillance and senior staff from Jordan University of Science and Technology 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact GCRF Foundation award research findings were presented and discussed with senior representatives from the Ministry of Health (MoH) and Jordan University of Science and Technology (JUST) at MoH in Amman, including Dr Sultan Abdullah and Prof. Ehab Abu Basha, recent Dean of Faculty Veterinary Science, JUST and Prof. Javier Guitian, RVC. Relevant policy implications regarding potential interventions to existing zoonotic disease surveillance activities were highlighted, with particular reference the on-going threat from MERS-CoV, alongside other potential emerging infectious diseases, together with other relevant zoonotic burdens in Jordan, including brucellosis, toxoplasmosis and Hepatitis E. A commitment to on-going strategic partnership between RVC/JUST and MoA was reached, with significant potential for this to be realised through the pending GCRF Health and Context application, 'Responding to the challenge of MERS-CoV: Development and testing of interventions to reduce risk among Bedouin populations in Southern Jordan'.
Year(s) Of Engagement Activity 2019
 
Description An inaugural one health research methods capacity building event involving senior faculty members from Yarmouk (Department of Anthropology) and Jordan University of Science and Technology (Faculty of Medicine and Faculty of Veterinary Science). 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact A multi-disciplinary 'one health' capacity building event was convened in Irbid, Jordan, bringing together for the first time senior academic (deans and recent deans of faculty) representatives from Yarmouk and Jordan University of Science and Technology (JUST). This inaugural event involved senior faculty members from the Department of Anthropology, Yarmouk and Faculties of Medicine and Faculty of Veterinary Science, JUST along with representatives from the RVC, London including Prof. Javier Guitian. Both of these Jordanian universities are situated within close proximity within the city of Irbid, though had until this event, never previously experienced collaboration between the of faculty of anthropology (Yarmouk) and the faculties human medicine / veterinary medicine (JUST), with many delegates meeting for the first time. While the concept of 'one health' is not entirely new in Jordan, practical outworking of this, particularly mixed methods research practices involving synergy between qualitative and quantitative methods, has yet to be undertaken in a significant manner at a national level. This event therefore represented a breakthrough opportunity for future collaboration with these leading Jordanian universities, with the pending GCRF Health and Context application, 'Responding to the challenge of MERS-CoV: Development and testing of interventions to reduce risk among Bedouin populations in Southern Jordan' offering a unique pathway to realising this potential.
Year(s) Of Engagement Activity 2019
 
Description Capacity building workshop conducted with senior policy makers at the Ministry of Agriculture, including the Chief Veterinary Officer and senior staff from the Faculty of Veterinary Science, Jordan University of Science and Technology 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact GCRF Foundation award research findings were presented and discussed with senior representatives from the Ministry of Agriculture (MoA) and Jordan University of Science and Technology (JUST) at the MoA in Amman, including the Chief Veterinary Officer, Dr Mahmoud Al Hanatleh and Prof. Ehab Abu Basha, recent Dean of Faculty Veterinary Science, JUST and Prof Javier Guitian, RVC. Relevant policy implications regarding potential interventions to existing zoonotic disease surveillance activities were highlighted, with particular reference the on-going threat from MERS-CoV, alongside other potential emerging infectious diseases, together with other relevant zoonotic burdens in Jordan, including brucellosis, toxoplasmosis and Hepatitis E. A commitment to on-going strategic partnership between RVC/JUST and MoA was reached, with significant potential for this to be realised through the pending GCRF Health and Context application, 'Responding to the challenge of MERS-CoV: Development and testing of interventions to reduce risk among Bedouin populations in Southern Jordan'.
Year(s) Of Engagement Activity 2019
 
Description Children's Museum of Jordan, "Outbreak: Epidemics in a Connected World" exhibition, April -December 2019 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact The Children's Museum in Jordan presented a temporary exhibition titled, "Outbreak: Epidemics in a Connected World" from April to December 2019, the opening of which coincided with World Health Day (April 7th, 2019). This exhibition offered visitors an opportunity to share in the experience of epidemiologists trying to identify and contain infectious disease outbreaks. The museum partnered with Jordan University of Science and Technology (coordinated by Co-I Prof. Ehab Abu-Basha) to describe the interdisciplinary efforts of Jordanian researchers in the fight against emerging infectious diseases, including MERS-CoV.
Year(s) Of Engagement Activity 2019
 
Description Engagement with Ecohealth Alliance 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact A visit by the national USAID Predict (Echohealth Alliance) / FAO MERS-CoV project co-ordinators and staff to Aqaba where the RVC / LSHTM project is based. Agreements made to share in project research resources, particular the use of -80 storage facilities belonging to USAID Predict in Irbid.
Year(s) Of Engagement Activity 2017
 
Description Formal meetings with local tribal and community leaders among livestock owning populations in southern Jordan 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact A series of regional meetings were conducted with local tribal and council leaders to establish dialogue, listen to concerns and inform and educate regarding the project aims, design and protocols. The response was very positive with a clear message of welcome and gratitude from the community leaders involved. Participants expressed the common sentiment that Bedouin health (the majority of livestock owners in southern Jordan would identify themselves as Bedouin) has been largely neglected by the government health services, with particular key problems such as high levels of Brucellosis, diabetes and dental disease, in need of urgent intervention.
Year(s) Of Engagement Activity 2017,2018
 
Description Formal meetings with the regional Ministry of Health and Ministry of Agriculture leadership in Aqaba governorate 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact A series of formal meetings were conducted with the Ministry of Health and Agriculture in Aqaba governorate, with the opportunity for group discussion and participatory feedback regarding current perceptions of MERS-CoV prevalence and surveillance among relevant stake holders. A brief outline of intended project aims was then presented and discussed along with study protocol with appropriate opportunity for feedback and discussion.
Year(s) Of Engagement Activity 2017,2018
 
Description Grass roots stakeholder workshops (study participants), Southern Jordan 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Study participants or study members
Results and Impact A series of 12 workshops were run in rural locations across the south of Jordan to provide feedback on study findings and training in zoonotic disease prevention, with particular reference to MERS-CoV and over 160 delegates (male and female) in attendance. The workshops also addressed wider study findings including prevalences and risk factors for brucellosis, toxoplasmosis and Hepatitis E, along with potentially significant co-morbidities for MERS-CoV infection in humans such as diabetes, high blood pressure and chronic respiratory diseases associated with smoking. Culturally appropriate training on hygiene and health practices to mitigate risk of disease was provided on each occasion, in an open forum with the opportunity for group discussion and feedback.
Year(s) Of Engagement Activity 2019,2020
 
Description Meeting with Jordanian Ministry of Agriculture national working group on MERS-CoV, Amman. 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact A formal meeting was conducted with the policy makers and field surveillance directors for zoonotic and emerging infectious diseases, including MERS-CoV, at the headquarters of the Animal Health department, Ministry of Agriculture, Amman, to liaise regarding future opportunities for training, collaboration, capacity building and the effective national and regional dissemination of project outcomes.
Year(s) Of Engagement Activity 2017
 
Description OIE twining event, Grand Hyatt Hotel, Amman 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Over 50 delegates attended an all-day event with the purpose of highlighting the achievements of the three-year OIE twinning initiative between the Royal Veterinary College (RVC) London and Jordan University of Science and Technology (JUST), including the GCRF funded research into the epidemiology and control of MERS-CoV in Jordan. Delegates included the His Excellency the British Ambassador to Jordan, Principals of both the RVC and JUST along with senior representatives from the OIE Middle East, UK government Department for International Development, Newton Fund director Jordan and senior representatives from the Jordanian Ministry of Agriculture and the Food and Agriculture Organisation. Outputs from this event included dissemination of the project outcomes to a national and international audience providing impact through the facilitating of future research activities and partnerships between the UK and Jordan, and providing a platform for the promotion of some of the many benfits achieved through UK aid spending in Jordan.
Year(s) Of Engagement Activity 2018
 
Description Prof Ehab Abu-Basha (Co-I, Faculty of Veterinary Medicine, JUST) spoke on the subject 'One Health in action' at the Medical Student Association Conference in Jordan, March 22, 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Undergraduate students
Results and Impact On March 22, 2019, Prof Ehab Abu-Basha (Co-I, Faculty of Veterinary Medicine, JUST) attended the Medical Student Association Conference in Jordan as a speaker and gave a presentation entitled 'One Health in action', which directly drew upon his experiences working with MERS-CoV in Jordan as part of the GCRF Foundation award project multidisciplinary research team. The conference was attended by over 300 Medical students from 5 Universities in Jordan, together with Faculty of Medicine staff and promoted the importance of inter-disciplinary research methods in the surveillance, prevention and control of zoonoses and emerging infectious diseases in Jordan and the wider region.
Year(s) Of Engagement Activity 2019
 
Description Training event for State Veterinarians, Jordan 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Over 40 Jordanian state veterinarians, representing a third of the total workforce in Jordan, gathered for a 2 day training event in Amman to develop capacity in disease surveillance and control. This event included digitally interactive seminars, group discussions and training built upon current RVC / JUST research activities in Jordan, including MRC GCRF funded One Health investigation into MERS-CoV livestock-to-human transmission pathways. Outcomes from this event included requests from State Veterinarians for training resources in field epidemiology to build capacity for disease surveillance and control and a commitment to provide such resources.
Year(s) Of Engagement Activity 2018
 
Description WHO technical meeting on MERS-CoV "Global Technical Meeting for MERS-CoV, held at WHO Headquarters in Geneva Switzerland from 25-27 September 2017 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact One of the collaborators at LSHTM was invited to a meeting of an international group of experts on MercoV together with public health practitioners in both animal and human health in areas of the world at risk or where there has been outbreaks (South Korea). The purpose was to provide an update of the science so far to increase an understanding of the disease, and discuss next steps. Such information is informing gaps in research (eg the modes of transmission in the community) that this project may help fill. It was also possible to communicate with other experts (including those directly involved in this project) including virologists, immunologists and vaccinologists this intended project and gain an understanding of the scope for new research eg on vaccine programmes that could be subsequently considered as possible to carry out our field site. The project also benefited from the opportunity to meet with Jordanian vet and human public health as well and NGO staff who provide or will in the future provide support for this study. The policy environment context was also better understood. Dr. Vincent Munster (NIH) and Prof. Ehab Abu Basha (JUST) also attended, both whom represent important project partners / co-investigators. In additional, important contacts were made with EMPHNET (Eastern Mediterranean Public Health Network) with the plans made for additional funding (scholarships) through EMPHNET for local staff professional development.
Year(s) Of Engagement Activity 2017