Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct-Dec;8(4):147-152.
doi: 10.4103/ajm.AJM_130_18.

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

Abdul Rahman Bizri  1   2 , Jawad Fares  3 , Umayya Musharrafieh  1   4
Affiliations

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

Abdul Rahman Bizri et al. Avicenna J Med. 2018 Oct-Dec.

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.

Keywords: Hepatitis A; Middle East; Syrian crisis; Syrian refugees; vaccination.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Reported HAV cases in Lebanon between January 2001 and December 2017 (inclusive) and the effect of the Syrian Crisis (2013–2017) on HAV incidence in the country. HAV: hepatitis A virus
Figure 2
Figure 2
A map of Lebanon showing the distribution of the Syrian refugee population in the different governorates as per the United Nations High Commissioner for Refugees records in 2017, and the number of hepatitis A virus cases reported in every governorate (2005–2017, inclusive): Areas along the Syrian–Lebanese border (Beqaa and North) have the highest number of Syrian refugees and hepatitis A virus cases reported
See this image and copyright information in PMC

References

    1. Alawieh A, Musharrafieh U, Jaber A, Berry A, Ghosn N, Bizri AR, et al. Revisiting leishmaniasis in the time of war: The Syrian conflict and the Lebanese outbreak. Int J Infect Dis. 2014;29:115–9. - PubMed
    1. Bell BP, Wasley A, Shapiro CN, Margolis HS. Prevention of hepatitis A through active or passive immunization: Recommendations of the advisory committee on immunization practices [ACIP] MMWR. 1999;48:i–37. - PubMed
    1. World Health Organization. Hepatitis A Factsheet. 2017. Jul 5, [Last accessed on 2018 Jul 25]. Available from: http://www.who.int/news-room/fact-sheets/detail/hepatitis-a .
    1. Yayli G, Kiliç S, Ormeci AR. Hepatitis agents with enteric transmission – an epidemiological analysis. Infection. 2002;30:334–7. - PubMed
    1. Ghorbani GA, Mahboobi N, Lankarani KB, Alavian SM. Hepatitis a prevention strategies, Haiti case: Should rescuers be immunized. Iran Red Crescent Med J. 2010;12:221.