Infectious diseases in the era of refugees: Hepatitis A outbreak in Lebanon

Abstract

Background:The Syrian crisis has altered the epidemiology of infectious diseases in countries hosting large numbers of refugees. Lebanon witnessed several outbreaks linked to the presence of significant numbers of Syrian refugees, namely, Hepatitis A virus (HAV). We explore the epidemiology of HAV in Lebanon and the impact of the Syrian war during the 2014 outbreak and suggest solutions to prevent and minimize the HAV spread amid the current socioeconomic conditions.Methods:We reviewed all HAV cases reported to the Epidemiologic Surveillance Unit at the Ministry of Public Health between January 2001 and December 2017. Demographics and distribution of Syrian refugees in Lebanon were linked to reports of new HAV cases.Results:A sharp rise in the number of reported HAV cases was observed in Lebanon in 2013, concurrent with the Syrian crisis and influx of refugees. Most cases reported in 2013 and 2014 involved Syrian refugees and their relevant areas of settlement in the Beqaa and North governorates.Conclusion:The influx of refugees strained overburdened sanitary infrastructure and overstretched existing public health services in Lebanon, which led to an increase in the incidence of reported HAV cases. The Lebanese health authorities and the international community need to intensify their efforts in surveillance and prevention of communicable diseases. Providing proper sanitation and free vaccination for affected communities are effective solutions to contain the HAV outbreak. Yet, financial constraints and the need to prioritize in the health budget put HAV-immunization at a lower priority. The Lebanese scenario could be reflective to other countries hosting sizeable numbers of refugees.

Epidemiology and Incidence of Retinoblastoma in the Middle East: A Nationwide Study in Lebanon

“…When compared to other countries, Lebanon is a mosaic country in terms of disease distribution, with increasing chronic systemic diseases such as hypertension, diabetes mellitus, and cardiac diseases which are common in high-income countries [ 12 ], and high, yet declining, infectious diseases common to third world countries, with some communicable diseases such as hepatitis A spreading in the population as outbreaks in the era of refugees [ 13 ]. Lebanon is also notable for the high percentage of consanguineous marriage, accounting for 35.5% of total marriages in this country [ 14 ] and further contributing to the spread of autosomal recessive diseases.…”

First Nation-Wide Analysis of Food Safety and Acceptability Data in Lebanon

“…This is important, because norovirus is the leading cause of foodborne gastroenteritis worldwide [ 41 ]. Additionally, 10,400 cases of hepatitis A were reported in Lebanon between 2005 and 2017 [ 42 ]. Similarly, there are recent reports of Cryptosporidium and other parasitic infections in the Lebanese population [ 43 , 44 , 45 ].…”

Emerging and Re-emerging Infectious Diseases in the WHO Eastern Mediterranean Region, 2001-2018

“…39 There were major HAV outbreaks in Syria and Lebanon in 2013 and 2014, concurrent with the Syrian crisis and influx of refugees. 40,41 In Iran, the frequency of HEV varied from 2.3% to over 40%, 42 and have reported 20% in United Arab Emirates (UAE) in mothers, 43 19.4% in Iraq in blood donors, 34 13% in Egypt in workers, 44 10% in Yemen, 33 3% in Pakistan, 45 and 0.3% in Saudi Arabia. 46 According to reports from Pakistan, HAV and HEV are responsible for more than 19% and 12% of all newly diagnosed cases of viral hepatitis, respectively.…”