Health

From Cholera to Typhoid: 2022, the Year of Epidemics

From Cholera to Typhoid: 2022, the Year of Epidemics

The year 2022 concludes with concerning epidemiological data regarding the resurgence of diseases that vaccines had previously eradicated, such as measles, smallpox, and hepatitis B, according to epidemiological surveillance reports from the Ministry of Health. Additionally, there has been a significant increase in diseases related to food safety, with 9,000 cases of food and water-related illnesses reported this year until mid-month, reflecting a 700% increase compared to 2021, which recorded 1,268 cases. This dramatic deterioration in Lebanon's health situation has developed over the years of crisis since 2019, as numbers have risen annually. The cholera outbreak in the last quarter of this year, alongside the spread of hepatitis A in some regions, has exacerbated the situation, leading to these elevated figures.

**Cholera in a Temporary Retreat**

In terms of cholera, reports indicate that the outbreak is still ongoing, with nearly 5,500 cases reported since the first case in October until mid-month, and the death toll has risen to 23, indicating a 0.5% fatality rate, which could be lower as some infected individuals may either not report their cases or be unaware of their symptoms. Infections have primarily been concentrated among children under 15 years old, accounting for 41% of cases. About 21% of those infected with cholera in Lebanon require hospitalization, with the northern governorates and Tripoli accounting for 80.5% of infections, totaling 4,287 cases according to the Ministry of Health. Lebanese laboratories, in partnership with foreign labs, have identified the cholera bacteria strain circulating in Lebanon as "O1 El-Tor Ogawa," the same strain found in neighboring regions, indicating a shared infection risk between Lebanon, Syria, and Iraq.

To combat the bacteria, the government, international organizations, and NGOs have relied solely on two measures: vaccines and chlorine; there has never been any serious effort to operate water purification stations or maintain sewage systems in infected areas. Approximately 480,000 vaccine doses have been distributed in Lebanon until the fourth of this month, at which point the official counting halted, and no official updates have been received from the Ministry of Health. Vaccination against cholera has been administered through a single dose, which provides only partial immunity lasting up to three months according to specialists, who warn that "vaccines are the last resort in combating cholera, as the primary goal to curb the spread is clean water." They did assure that Lebanon has moved from a red danger zone to an orange phase due to rapid measures taken by the Ministry of Health, with hopes of reaching a safe phase.

Additionally, methods for cleaning water in Lebanon in 2022 have relied solely on chlorine, with tons of the substance distributed. UNICEF reports alone indicate the distribution of hundreds of thousands of chlorine tablets for water disinfection in homes and schools in high-risk areas, along with over 50 tons of chlorine compounds for disinfecting large municipal tanks.

**The Danger of Food Safety**

In addition to the cholera epidemic, local outbreaks primarily related to "food safety" have emerged, according to epidemiological surveillance reports from the Ministry of Health. In northern Lebanon, especially in Tripoli, there have been multiple outbreaks of hepatitis A, consistently linked to sewage water contaminating drinking water supplies. The result has been 2,114 reported cases, with 66.5% occurring in the north and 36% of cases involving individuals under 9 years old. Compared to 2021, cases of hepatitis A alone have surged by 490%.

Alongside the previous epidemics, typhoid fever has also seen significant increases in infections, with a 300% rise compared to 2021. This disease is caused by the salmonella bacteria, which can enter the human body through contaminated food or water, with the most significant number of cases distributed across the northern governorates, Akkar, and Beqaa, where the largest refugee camps lacking basic sanitary conditions are located. The current year has recorded a 700% increase in food and water-related illnesses.

2022 has not stopped there, as it also documented "1,070 cases of food poisoning and dysentery, and 215 cases of brucellosis," the latter resulting from the consumption of unpasteurized milk or improperly cooked meat. Additionally, there have been 259 cases of "meningitis," which can arise from various factors (viruses, bacteria, or parasites); however, according to Dr. Nada Ghosn, head of epidemiological surveillance at the Ministry of Health, "there is no meningitis epidemic in Lebanon as the cases are not caused by bacteria, but by other factors."

**Silent COVID**

The cumulative number of confirmed COVID-19 cases in Lebanon since the first recorded case surpasses 1.2 million, with more than 50% of these occurring in 2021, according to official figures from the Ministry of Health. Reports from the ministry also indicate that "the cumulative death toll has reached 10,743 people, 1,607 of whom died in 2022."

Thus, the COVID virus continues to spread and collect infections, but slowly and without media attention this time due to its loss of global and local prominence, as well as the good turnout for vaccinations in the years preceding 2022, with 50% of the resident Lebanese population having received at least one vaccine dose. However, there was not a great turnout for vaccinations in 2022, with the rate only rising by 10%, as the percentage of vaccinated individuals by the end of 2021 was 40%. The fully vaccinated population, having received three vaccine doses, did not exceed 40%.

**H3N2 Continues**

In addition to these epidemics, the year 2022 witnessed a strong resurgence of the H3N2 influenza virus, which has a significant impact on health and necessitates hospitalization for those with severe underlying conditions or immunocompromised individuals. This wave is clearly evident in schools, "which have been filled with cases since the influenza season began in the cold months," according to various directors from both private and public schools. However, these infections have remained under wraps, not prompting any closures, even for classes, as occurred during the COVID pandemic. A principal of a major school in the south described the break as "the lifeline we've been waiting for to close," adding that "the percentage of sick students in his school reached 25%."

Medically, a specialist in infectious diseases reassures that "this wave will not transform into a pandemic on a global scale since this strain of the virus is well-known and not new," emphasizing the importance of "getting the influenza vaccine as it prevents severe symptoms and provides 50% protection." They warn that "the wave will not subside until the end of the cold months, and it has not yet reached its peak, with expectations for further increases in cases during January and February of the new year."

**NGOs: The Shadow Ministry of Health**

Non-governmental organizations, from various backgrounds and reference countries, have prominently taken control on the ground, participating even in vaccination campaigns through the deployment of teams in targeted villages and districts for cholera vaccination. The situation becomes clearer through dozens of reports issued by these organizations that highlight their achievements in a single area; for example, a report from the "Action Against Hunger" American organization operating on Lebanese soil mentions three other supporting associations in "combating the cholera epidemic."

It is noted that these associations operate without real oversight from the state, leading to a lack of accountability in case of mistakes. For instance, their reports repeatedly mention "disposing of waste or the contents of septic tanks" without specifying where these contaminated materials are discarded, a point previously discussed in the news.

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