Bizri Abdul Rahman, Fares Jawad, Musharrafieh Umayya
Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon.
Conflict Medicine Program, Office of Strategic Health Initiatives, American University of Beirut, Beirut, Lebanon.
Avicenna J Med. 2018 Oct-Dec;8(4):147-152. doi: 10.4103/ajm.AJM_130_18.
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.
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.
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.
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.
叙利亚危机改变了接纳大量难民国家的传染病流行病学状况。黎巴嫩出现了几起与大量叙利亚难民存在相关的疫情，即甲型肝炎病毒（HAV）疫情。我们探讨了2014年疫情期间黎巴嫩甲型肝炎病毒的流行病学情况以及叙利亚战争的影响，并提出在当前社会经济条件下预防和尽量减少甲型肝炎病毒传播的解决方案。
我们回顾了2001年1月至2017年12月期间向公共卫生部流行病学监测股报告的所有甲型肝炎病毒病例。黎巴嫩叙利亚难民的人口统计数据和分布情况与新的甲型肝炎病毒病例报告相关联。
2013年黎巴嫩报告的甲型肝炎病毒病例数急剧上升，这与叙利亚危机和难民涌入同时发生。2013年和2014年报告的大多数病例涉及叙利亚难民及其在贝卡省和北部省份的相关定居地区。
难民的涌入使黎巴嫩本就不堪重负的卫生基础设施更加紧张，现有公共卫生服务不堪重负，导致报告的甲型肝炎病毒病例发病率上升。黎巴嫩卫生当局和国际社会需要加大传染病监测和预防力度。为受影响社区提供适当的卫生设施和免费疫苗接种是控制甲型肝炎病毒疫情的有效解决方案。然而，财政限制以及卫生预算需要进行优先排序，使得甲型肝炎病毒免疫接种的优先级较低。黎巴嫩的情况可能反映了其他接纳大量难民的国家的情况。
