October 21, 2022
Announcing the outbreak:
- Reporting began on October 6, 2022, when Ministry of Public Health in Lebanon notified World Health Organization of two laboratory-confirmed cases from the northern part of the country.
- The first case was a 51-year-old Syrian man living in a random area in the North Governorate, it was reported on October 5, 2022. The patient was admitted to hospital on October 10, then infection was transmitted to a 47-year-old health worker. Immediately after first two cases were confirmed, an additional 10 cases were confirmed.
- As of October 21, a total of 220 cases and 5 deaths have been confirmed, the age group most affected being children under five and females. Cases were reported from several regions, the most important of which are: Miniyeh-Dinnieh district, Baalbek district and Akkar district.
- Wastewater tests also confirmed presence of Vibrio cholerae in 3 water sources.
- The last cholera outbreak in Lebanon was in 1993 and no local transmission has been documented since then.
Cholera Disease:
- Cholera is an intestinal disease that causes severe diarrhea caused by infection with the bacterium Vibrio Cholera. It is transmitted by ingesting food or water contaminated with cholera bacteria. The infection is often mild or asymptomatic, but it can sometimes be severe and life-threatening.
- There are many serogroups for cholerae, but only two strains of serogroups O1 and O139 have caused major epidemics.
History of the Disease:
During the 19th century, cholera spread worldwide from its original source in the Ganges delta in India. Six subsequent epidemics killed millions of people on all continents. The seventh epidemic began in South Asia in 1961 and reached Africa in 1971 and the Americas in 1991. The cholera epidemic is now spreading in many countries to a limited extent, and death rate has greatly decreased due to development of sanitation systems, methods of water purification and sterilization, and the provision of appropriate health care.
Disease Transmission:
Cholera bacteria are usually transmitted through water or food contaminated with feces of a person infected with cholera bacteria. Cholera spreads rapidly in places with inadequate sanitation, water treatment and poor hygiene.
Cholera bacteria can also live in brackish rivers and coastal waters. Shellfish eaten raw are also a potential source of infection.
It is unlikely that infection is transmitted directly from one person to another; Therefore, casual contact with an infected person is not a risk factor for contracting the disease.
Symptoms and Diagnosis:
About 1 in 10 people infected with cholera have severe symptoms such as: profuse watery diarrhea, vomiting, thirst, leg cramps, restlessness or irritability, and dehydration. Rapid loss of body fluids, as well leads to kidney failure if left untreated, severe dehydration can lead to shock, coma, and death within hours.
To confirm cholera, a stool sample or rectal swab must be taken and tested in a laboratory for cholera bacteria.
Treatment:
- Treatment of dehydration and immediate restoration of lost fluids and salts, which is the primary treatment for cholera patients.
- Antibiotic therapy, which reduces fluid loss and duration of illness, is used in severe cholera cases.
- Zinc therapy helps reduce cholera symptoms in children.
Vaccinations:
- Vaxchora is a single-dose oral vaccine approved by FDA in the USA for use in people between 2 and 64 years of age who are traveling to an area of active cholera transmission and taken 10 days prior to travel. Production of this vaccine has been temporarily stopped and is not currently available, according to the producing company announcement in 2020.
- Dukoral, ShanChol and Euvichol-Plus are two- or three-dose oral vaccines for those over two years of age and are only available for major vaccination campaigns.
Public Health Response:
- Active surveillance and case detection in high-risk camps, informal settlements and hotspot areas intensified, including water quality monitoring, and health-care providers were trained to respond.
- Updating surveillance protocols, developing a preparedness and response plan in cooperation with World Health Organization and UNICEF.
- Distributing 1,000 Biolin rapid diagnostic tests and coordinating with International Coordinating Group (ICG) on provision of oral cholera vaccine to cover 400,000 refugees and host communities, including potential prison vaccination.
Protection:
- Improving access to safe drinking water and sanitation infrastructure and strengthening preventive hygiene and food safety practices in affected communities to control cholera.
- Strengthening and monitoring of cholera for early detection of suspected cases, provision of appropriate treatment, and prevention of its spread. Early and adequate treatment reduces hospital mortality to less than 1%.
- Use of oral cholera vaccine to control and prevent cholera outbreaks in target areas known to be at risk of cholera infection. The population must also be made aware of risks and ways to prevent cholera.
HealthCare Providers:
- All staff must be trained in cholera prevention and infection control measures, such as hand washing and safe disposal of human waste
- Hands should be washed with soap and clean water before and after each contact with patient. If soap and water are not available, a hand sanitizer containing at least 60% alcohol can be used, or if neither is available, a 0.05% chlorine solution should be used.
- Disinfect surfaces using chlorine-containing solutions.
Risk Assessment:
The health system was severely affected by a three-year financial crisis and an explosion in the port of Beirut that destroyed the capital’s basic medical infrastructure, and Lebanon hosts the largest number of refugees in the world relative to its area and population, so the response to the cholera outbreak may be affected. negatively because of the country's fragile health system. Because of the porous borders that allow free movement between Lebanon and neighboring countries, it is highly likely that cholera cases will spill over to neighboring areas.
World Health Organization does not recommend any restrictions on travel or trade to and from Lebanon based on the information currently available.
Sources:
- WHO
- Center for Disease Control and Prevention CDC