American University of Beirut

Outbreak alert

​​​October 18, 2022​​

​What is cholera?​

Cholera is a diarrheal disease caused by a bacterial agent. It is primarily transmitted via contaminated water, food, and unclean hands. Most cases of cholera are either mild or asymptomatic (i.e., the patient does not develop symptoms). However, one in 10 people could suffer from severe disease requiring hospitalization, with extreme cases causing death due to dehydration. The people at high risk of having severe disease include children, older adults, and immunosuppressed individuals. Those infected with cholera must monitor their stool and stay hydrated.

In Lebanon, who is being affected most by the cholera outbreak?

This disease affects anyone who does not have access to clean water or lives in an area with suboptimal sanitation measures. In Lebanon, cholera cases have been reported among Syrian refugees and Lebanese people without access to adequately treated water. Inadequate waste management infrastructure in refugee camps and parts of Lebanon increases the likelihood of water contamination. The majority of reported cases thus far are in Northern Lebanon and the Beqaa, but it can spread outside those regions, causing a national health problem.

Cholera hasn't been seen for decades in Lebanon. Why this sudden spike in cases?

Cholera outbreaks have been occurring in Iraq for the last few years, and there is currently a cholera outbreak in Syria. There was also a massive rise of cholera in Yemen recently, and after years of relatively minimal outbreaks in Haiti, we have seen a recent surge. The lack of proper water treatments in these countries leads to water contamination with sewage waste. This is especially true in countries experiencing conflict or deteriorating infrastructure due to economic crises.

Unfortunately, the economic situation (poverty and suboptimal living conditions), lack of electricity, and use of transported water have created an environment within Lebanon that increases the likelihood of infectious diseases, such as cholera, entering the water system. In Lebanon, transporting water for most of our residential use creates opportunities for contamination. We don't know whether the water at the source is properly treated or if contamination has occurred during transportation.

Are there concerns that it will break out further within Lebanon?

So long as preventative measures are taken to protect communities, the outbreak can be contained. Initiatives are taking place now in rural areas and cities to ensure that water sources are appropriately treated, regularly tested for quality, and wastewater infrastructure monitored to prevent cross-contamination. Additionally, several activities are taking place to contain cholera:  awareness campaigns and training healthcare workers nationwide on methods of cholera identification, treatment, and case management. 

What can be done to help contain and prevent the cholera outbreak?​

If we have learned anything through the COVID-19 pandemic, it is "cross-talk" and cooperation between all stakeholders. It's not only the Ministry of Public Health that is needed to tackle disease outbreaks. Local municipalities, epidemiologic surveillance units, hospitals, labs, and academic institutions are critical for an effective response. In the case of cholera, it's also important for the Ministry of Agriculture to be involved because the runoff water from agriculture is part of the problem. These are the type of holistic strategies the pandemic taught us for an effective response. 

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