In October 2022, an outbreak of cholera began in Lebanon. It is likely the result of a serious outbreak in neighboring Syria, which is itself traced back to contaminated water in the Euphrates.
As of October 13, 26 cases have been reported and one person has died. This outbreak is the first incidence of cholera in Lebanon since 1993. In June 2023, the Lebanon Ministry of Health announced that the cholera outbreak that began in October 2022 was over. [1]
Cholera is an infection of the small intestine by some strains of a species of bacterium known as Vibrio cholerae . [2] Symptoms may range from none to mild to severe. [3] They include large amounts of watery diarrhea as well as vomiting and muscle cramps. Diarrhea can be so severe that it leads within hours to severe dehydration and kidney failure. [4]
If people with cholera are treated quickly and properly, the mortality rate is less than 1%; with untreated cholera, the mortality rate rises to 50–60%. [5]
A cholera outbreak is currently ongoing in Syria which was declared officially on September 10, 2022. Between September 10 and 30, 10,000 suspected cases have been detected. [6] On 22 October 2022, the Syria Ministry of Health reported a cholera outbreak in 13 of 14 governorates, with a total of 44 deaths and 942 confirmed cases. [7]
The UN Humanitarian Coordinator stated that according to a rapid assessment, the outbreak is linked to people drinking unsafe water from the Euphrates and using contaminated water to irrigate crops, resulting in food contamination. He said that the outbreak was compounded by the ongoing civil war, as much of the already vulnerable population of Syria is reliant on unsafe water sources. [8]
On October 6, 2022, Firas al-Abiad, the head of the Health Ministry of Lebanon, announced that the country has detected its first case of cholera since 1993. The case, recorded on the previous day, was from the northern province of Akkar, and the infected person was a Syrian national receiving treatment. [9]
On October 7, another case was confirmed, and it was announced that there are several other suspected cases. An official in the ministry said that it was highly probable that the outbreak originated in Syria, although there were no confirmed links yet. [10]
By October 12, the number of confirmed cased had risen to 26, as declared by the ministry. On the same day, the first death from the disease was announced. [11] [12]
By October 21, there was a total of 227 cases and 7 deaths. [13] By October 27, according to the Ministry of Public Health, there were a total of 803 suspected and confirmed cases, with at least 11 deaths reported. [14] By December 9, there stands a total of 5,105 cholera suspected and confirmed cases have been reported along with a total of 23 associated deaths. [15] Children are said to make up approximately 50% of all cases, and children aged between zero and four years make up around a third of all cases in Lebanon. [16]
According to L'orient-Le Jour, the response of the Lebanese government is based on three main pillars - raising awareness of sanitary measures, providing clean water to all households on a permanent basis, and ensuring safe wastewater treatment and disposal. [17]
The Lebanese Health Minister said that for the government, "the primary issue is prevention that contributes to limiting the spread of the pandemic. Prevention is more important than cure." He met with representatives of vaccine factories in Lebanon, who confirmed the availability of large quantities of vaccines sufficient for the next eight months, in addition to the availability of raw materials needed to manufacture the vaccine. [18]
Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and muscle cramps may also occur. Diarrhea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance. This may result in sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet. Dehydration can cause the skin to turn bluish. Symptoms start two hours to five days after exposure.
Vibrio cholerae is a species of Gram-negative, facultative anaerobe and comma-shaped bacteria. The bacteria naturally live in brackish or saltwater where they attach themselves easily to the chitin-containing shells of crabs, shrimp, and other shellfish. Some strains of V. cholerae are pathogenic to humans and cause a deadly disease called cholera, which can be derived from the consumption of undercooked or raw marine life species.
El Tor is a particular strain of the bacterium Vibrio cholerae, the causative agent of cholera. Also known as V. cholerae biotype eltor, it has been the dominant strain in the seventh global cholera pandemic. It is distinguished from the classic strain at a genetic level, although both are in the serogroup O1 and both contain Inaba, Ogawa and Hikojima serotypes. It is also distinguished from classic biotypes by the production of hemolysins.
Vibrio is a genus of Gram-negative bacteria, possessing a curved-rod (comma) shape, several species of which can cause foodborne infection, usually associated with eating undercooked seafood. Being highly salt tolerant and unable to survive in fresh water, Vibrio spp. are commonly found in various salt water environments. Vibrio spp. are facultative anaerobes that test positive for oxidase and do not form spores. All members of the genus are motile. They are able to have polar or lateral flagellum with or without sheaths. Vibrio species typically possess two chromosomes, which is unusual for bacteria. Each chromosome has a distinct and independent origin of replication, and are conserved together over time in the genus. Recent phylogenies have been constructed based on a suite of genes.
The third cholera pandemic (1846–1860) was the third major outbreak of cholera originating in India in the 19th century that reached far beyond its borders, which researchers at University of California, Los Angeles (UCLA) believe may have started as early as 1837 and lasted until 1863. In the Russian Empire, more than one million people died of cholera. In 1853–1854, the epidemic in London claimed over 10,000 lives, and there were 23,000 deaths for all of Great Britain. This pandemic was considered to have the highest fatalities of the 19th-century epidemics.
The fourth cholera pandemic of the 19th century began in the Ganges Delta of the Bengal region and traveled with Muslim pilgrims to Mecca. In its first year, the epidemic claimed 30,000 of 90,000 pilgrims. Cholera spread throughout the Middle East and was carried to the Russian Empire, Europe, Africa, and North America, in each case spreading via travelers from port cities and along inland waterways.
The seventh cholera pandemic is the seventh major outbreak of cholera and occurred principally from the years 1961 to 1975, but the strain involved persists to the present. WHO and some other authorities believe this should be considered as an ongoing pandemic. As stated in its cholera factsheet dated 30 March 2022, the World Health Organization (WHO) continues to define this outbreak as a current pandemic, and with cholera having become endemic in many countries. In 2017, WHO announced a global strategy aiming to end this pandemic by 2030.
A cholera vaccine is a vaccine that is effective at preventing cholera. For the first six months after vaccination it provides about 85 percent protection, which decreases to 50 percent or 62 percent during the first year. After two years the level of protection decreases to less than 50 percent. When enough of the population is immunized, it may protect those who have not been immunized.
The 2010s Haiti cholera outbreak was the first modern large-scale outbreak of cholera—a disease once considered beaten back largely due to the invention of modern sanitation. The disease was reintroduced to Haiti in October 2010, not long after the disastrous earthquake earlier that year, and since then cholera has spread across the country and become endemic, causing high levels of both morbidity and mortality. Nearly 800,000 Haitians have been infected by cholera, and more than 9,000 have died, according to the United Nations (UN). Cholera transmission in Haiti today is largely a function of eradication efforts including WASH, education, oral vaccination, and climate variability. Early efforts were made to cover up the source of the epidemic, but thanks largely to the investigations of journalist Jonathan M. Katz and epidemiologist Renaud Piarroux, it is widely believed to be the result of contamination by infected United Nations peacekeepers deployed from Nepal. In terms of total infections, the outbreak has since been surpassed by the war-fueled 2016–2021 Yemen cholera outbreak, although the Haiti outbreak is still one of the most deadly modern outbreaks. After a three-year hiatus, new cholera cases reappeared in October 2022.
Seven cholera pandemics have occurred in the past 200 years, with the first pandemic originating in India in 1817. The seventh cholera pandemic is officially a current pandemic and has been ongoing since 1961, according to a World Health Organization factsheet in March 2022. Additionally, there have been many documented major local cholera outbreaks, such as a 1991–1994 outbreak in South America and, more recently, the 2016–2021 Yemen cholera outbreak.
As of 24 September 2012, a cholera outbreak in Sierra Leone had caused the deaths of 392 people. It was the country's largest outbreak of cholera since first reported in 1970 and the deadliest since the 1994–1995 cholera outbreak. The outbreak has also affected Guinea, which shares a reservoir near the coast. This was the largest cholera outbreak in Africa in 2012.
Diseases and epidemics of the 19th century included long-standing epidemic threats such as smallpox, typhus, yellow fever, and scarlet fever. In addition, cholera emerged as an epidemic threat and spread worldwide in six pandemics in the nineteenth century. The third plague pandemic emerged in China in the mid-nineteenth century and spread worldwide in the 1890s.
An outbreak of cholera began in Yemen in October 2016. The outbreak peaked in 2017 with over 2,000 reported deaths in that year alone. In 2017 and 2019, war-torn Yemen accounted for 84% and 93% of all cholera cases in the world, with children constituting the majority of reported cases. As of November 2021, there have been more than 2.5 million cases reported, and more than 4,000 people have died in the Yemen cholera outbreak, which the United Nations deemed the worst humanitarian crisis in the world at that time. However, the outbreak has substantially decreased by 2021, with a successful vaccination program implemented and only 5,676 suspected cases with two deaths reported between January 1 and March 6 of 2021.
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The COVID-19 pandemic in Lebanon was a part of the ongoing worldwide Coronavirus pandemic, which is caused by severe acute respiratory syndrome coronavirus 2. The virus was confirmed to have reached Lebanon in February 2020.
The COVID-19 pandemic in Egypt was a part of the worldwide pandemic of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2. The virus was confirmed to have reached Egypt on 14 February 2020.
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The 2022 mpox outbreak in Asia is a part of the ongoing outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak was reported in Asia on 20 May 2022 when Israel reported a suspected case of mpox, which was confirmed on 21 May. As of 10 August 2022, seven West Asian, three Southeast Asian, three East Asian and one South Asian country, along with Russia, have reported confirmed cases.
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