Measles and mumps outbreaks in Lebanon: trends and links

Abstract

Background: Lebanon has experienced several measles and mumps outbreaks in the past 20 years. In this article, a case-based surveillance of both measles and mumps outbreaks in Lebanon was carried out in an attempt to outline factors contributing to the failure of elimination plans and to provide potential solutions. The relationship between the outbreaks of both diseases was described and explored. Methods: A retrospective descriptive study of confirmed cases of measles and mumps in Lebanon between 2003 and 2018 collected from the Lebanese Ministry of Public Health Epidemiological Surveillance Unit public database was carried out. The information collected was graphically represented taking into consideration dates of reported cases, age groups affected, and vaccination status. Results: The mean number of measles cases was 150.25 cases/year in the 1-4 years age group, 87 cases/year in individuals aging between 5 and 14, and 63.68 cases/year in those > 14 years old. In the latter group, only 18.05% were unvaccinated. The mean number of mumps cases was 30.4 cases/year in the < 4 year age group and 53.8 cases/year in the 10-19 years age group. During the study period, every spike in measles cases was followed by a similar spike in mumps. 9.66% of measles cases occurred in individuals who received at least 2 doses of the vaccine, 52.26% in the unvaccinated, and 38% in those whose vaccination status was undetermined. Conclusions: Measles in Lebanon is a disease of the pediatric population, but adults remain at risk. Outbreaks of mumps followed those of measles and were mainly among adolescents. Presence of a large number of Syrian refugees in the country may further complicate the situation. Vaccination activities need to be intensified.

Lebanon is losing its front line

“…During the pandemic, the health of refugees deteriorated, as the crowded conditions in tents provided little protection from the virus. In addition, immunization campaigns have been arrested, including delays in vaccinations of preventable illnesses that are already more prevalent in the refugee population, such as the highly contagious measles virus [ 4 ].…”

Acute flaccid paralysis incidence rate and epidemiology in children in Lebanon: a rise in numbers in the post-vaccination and refugee crisis era

“…Studies have shown that Syrian refugees in Lebanon live in poor conditions and suffer mostly from communicable diseases and diseases affecting women 16 . Despite efforts to provide healthcare to these vulnerable populations, outbreaks of many infectious diseases took place 17 , and cases of AFP kept increasing throughout the years. The incidence rate stabilized from 2017 till 2019 ranging from 4.14 and 4.96 per 100,000, respectively.…”

Assessing knowledge, attitude and practice on breastfeeding, immunization, and oral care among mothers in Lebanese primary health care centers. (c2020)

“…Mothers brought in their children's vaccination cards along with a document from the public school to ascertain the child's recent immunization status. This was a law passed by the Lebanese government in 2013 that insisted on obligatory vaccination in public schools or else the children won't continue the academic year (El Zarif et al, 2020). This means that with this practice, more caretakers are fulfilling immunization requirements compared to developed countries that are still showing vaccination hesitancy when it comes to school entry vaccines (McNeil et al, 2019).…”

“…As for vaccinations, the Lebanese MOPH and PHC centers are doing a great job in providing vaccines and knowledge attitude and practice interventions in the literature are showing positive results, but more focus should be done in remote areas where measles and mumps are suspected to reemerge (El Zarif et al, 2020). Therefore, more in depth assessment of vaccination coverage is needed in Lebanon to reach the target above 95 % as suggested by the WHO -EPI.…”

“…this cross sectional study because the main aim was to look at over all general vaccination practice indicators. The latest evidence by ElZarif et al, (2020) as well asMansour et al, (2019) still claim that total vaccination rates are still less than 95 % in children of ages 12 -59 months. The World Health Organizations' global summary on vaccine monitoring showed a rise in mumps and measles outbreak in 2013 and 2015 respectively (WHO, 2016).…”