Transmissible Dermatological Diseases Affecting Syrian Refugees in Lebanon

The Syrian war led many to seek shelter in Lebanon, creating a major refugee crisis. Displaced populations in crowded unequipped settlements are vulnerable to infectious diseases. The burden and incidence of various transmissible skin conditions affecting Syrian refugees in Lebanon and their impact on the Lebanese public health system were evaluated. Literature regarding these conditions among Syrian refugees in host countries, and epidemiological data from the Lebanese Ministry of Public Health Surveillance Unit and primary health-care network were reviewed. Lebanon has witnessed skin disorder outbreaks associated with the Refugee crisis, mainly leishmaniasis, scabies and lice infestations with little data about bacterial and fungal infections and a minor surge in reports of Leprosy. Additional surveillance is needed to monitor disease prevalence, and the emergence of potential outbreaks. Preventive measures, early detection and treatment, improved living conditions, and coordination between the Lebanese health authorities and non-governmental organizations are essential for early intervention and management

Hepatitis B Screening Prior to Chemotherapy in the Middle East: A Retrospective Cohort Study

Background: Hepatitis B virus (HBV) reactivation can be asymptomatic or manifest as fatal fulminant hepatitis. Most international guidelines recommend screening patients prior to immunosuppressive therapy. Aims: To determine HBV screening rates and modalities in patients receiving chemotherapy at the American University of Beirut Medical Center. Methods: A retrospective cohort review of electronic health records of  adult patients who received chemotherapeutic agents, between June 2015 and June 2016. Patients clinical characteristics were documented. Adequate screening was defined as performing all: HBsAg, HBs Abs, and anti HBc Abs(total). Results: A total of 1547 patients were initially assessed. 45.6% were males with a mean age of 56. 382(30%) had hematologic malignancies, of whom 111 underwent HSCT. Of those included, 303(24%) patients were screened by at least one test for HBV and 42(3.3%) for HBsAg, anti HBc Abs and HBs Abs. Patients who were appropriately screened were significantly younger(p=0.008) and more likely to have hematologic malignancies (n=35, 83.3%, p<0.0001). Among patients with hematologic malignancies, appropriately screened patients (n=35) were younger (p=0.042) and had a history of HSCT(n=19, 54.3%, p=0.001). Conclusion: Rates of screening for HBV prior to chemotherapy at our medical center are low, and not always complete or adequate. There is an urgent need to implement a better screening policy

COVID-19 pandemic: an insult over injury for Lebanon

The outbreak of the novel coronavirus disease in 2019 (COVID-19) caused a plethora of challenges worldwide and tested healthcare systems across the six continents. Lebanon had recently faced harsh political and economic crises. We aim to describe the effect of COVID-19 on an already crisis-stricken country. A descriptive analysis of the burden of COVID-19 pandemic on Lebanon was performed. Relevant data on COVID-19 was retrieved from the Lebanese Ministry of Public Health from February 21 till June 13th, 2020. Results obtained were analyzed and a literature review was performed. 1422 confirmed COVID-19 cases were identified and reported in Lebanon by June 13th, 2020, comprising an incidence rate of 208/million persons. There has been a total of 31 deaths thus far, with a reported death rate of 5/million persons. The age group with the highest number of cases was 20–29 years. Beirut was the district with the highest number of cases (18%). The COVID-19 crisis has impacted the country on a multifactorial level. COVID-19 could not have come at a worse time for Lebanon. The country is on brink of bankruptcy, the healthcare system is struggling for survival and the government is striving to regain the trust of the population

Préface

Saida is an ancient city located on the Mediterranean Sea. The city has a lot of heritage and is considered to be one of the oldest in inhabited cities in the world. The recent British Museum excavations have found evidence of civilization sequence that extends to the 3rd millennium B.C. No one knows exactly the true boarders of the Phoenician Kingdom of Sidon. It is believed to be one of the largest, foremost, and once most prospers. The vast majority of modem time families of Saida lived th..

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

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

COVID-19: Second Wave or Multiple Peaks, Natural Herd Immunity or Vaccine – We Should be Prepared

Between December 31, 2019, and August 30, 2020 (date of this article), the novel coronavirus and its corresponding infection, coronavirus disease (COVID-19), increased to more than 25 million cases, and 843 158 deaths have been registered. Countries around the world have been affected, albeit in different levels and intensities. Despite implementations of preventive public health measures, most countries are seriously preparing for 1 or more waves. The threat of this surge is likely to persist until herd immunity is acquired either by natural infection or through vaccination. However, given the time frame needed for herd immunity to occur and the low probability that a vaccine will be available on a global scale by the coming fall and winter seasons, contingency preparedness plans should be established and put in place for the coming days or months. These plans should help mitigate new peaks of the pandemic while relaxing the social isolation rules, patient, public health, and hospital levels. In this article, we discuss recommendations that practicing physicians and public health agencies should provide to individuals, especially those at risk of infection, to take and implement pre-emptive measures in anticipation of the potential next peak of the pandemic

Available COVID-19 vaccine platforms: A roadmap to eclipsing the SARS-CoV-2 viral saga

The coronavirus disease 2019 (COVID-19) have devastated the globe and continues to be a protracted saga. In the absence of specific efficacious medical remedies, efforts to encounter and contain this emerging virus concentrated on vaccine production. A plethora of novel vaccines has been under development by major companies in different countries. To date, around 60 vaccines are in clinical trials with many other ones continuously added to the evolving pipeline. The variety in their corresponding designed platform and phases, warrants to tackle and understand what is being presented in the literature and launched in the market.  Thus, this study is intended to enlighten and educate the medical community by reviewing the different vaccine platforms, and briefly explaining their mechanism of action with an emphasis on those that reached most advanced stages

Salmonella Typhimurium para-aortic root abscess managed non-surgically

Introduction: Para-aortic root abscess is a destructive vascular condition that can result in significant morbidity and mortality. We describe a rare case of para-aortic root abscess due to Salmonella Typhimurium that was successfully managed medically. Presentation of case: A 72-year-old diabetic man with a prosthetic aortic graft presented with fever and expressive aphasia with left sided weakness. Magnetic resonance imaging (MRI) of the brain showed multiple embolic cerebral vascular accidents. Computed tomography angiography (CTA) of the chest showed a 5.7 × 2.7 cm (cm) para-aortic root abscess. Blood cultures grew Salmonella Typhimurium. The patient was started on ceftriaxone initially, and then ciprofloxacin was added on day 5. Given an unacceptably high risk of mortality expected with surgery, the patient was managed medically.After five months of both ceftriaxone and ciprofloxacin, ceftriaxone was stopped. Twelve months later, the patient is doing well on ciprofloxacin alone with a plan for lifelong suppression. Discussion: Cases of para-aortic root abscess due to Salmonella Typhimurium have not been reported in the literature. There are no guidelines to dictate the antibiotic choice or management of para-aortic root abscess due to Salmonella Typhimurium. Conclusion: This report adds to the body of literature regarding the treatment of this infection including successful non-surgical management

Hepatitis B and C: neglected infectious diseases among Syrian refugees in Lebanon

# Background Hepatitis B and C are life-threatening infections that can result in liver-associated complications. Lebanon is a country experiencing its worst economic and political crises to date and is considered to be of low endemicity for hepatitis B virus (HBV) and hepatitis C virus (HCV). We aimed to assess the prevalence of HBV and HCV infections among Lebanese and Syrian refugees residing in Lebanon, to describe the current situation beyond statistical scrutiny and identify risks and long-term consequences associated with neglecting these infections. # Methods We extracted data on the prevalence of HBV and HCV among the Lebanese population and Syrian refugees residing in Lebanon from 2013 to 2018 and sorted them based on age and gender. We compared the prevalence of HBV and HCV among these groups to the prevalence among the Syrians remaining in Syria, after which we calculated the expected number of HBV and HCV cases in Lebanon based on the total number of registered Syrian refugees in Lebanon. We conducted an extensive literature review using MEDLINE, Google Scholar, and PubMed. # Results The prevalence of HBV and HCV in Lebanon from 2013 to 2018 was 1.74% and 0.21%, respectively. 13% of HBV cases and 6% of HCV cases were associated with Syrian refugees. HBV and HCV were more prevalent among men than women for both the Lebanese population and the Syrian refugees. Among the total population, the 20-39 age group represented 40% of HBV and 30% of HCV cases. For the Syrian refugee subgroup, 57% of HBV cases and 28% of HCV cases were reported among individuals aged 20-39 years. The prevalence of HBV and HCV among the total Syrian population in Syria was 5.6% and 2.8%, which was significantly higher than the prevalence among the Syrian refugees in Lebanon for both HBV (0.003%) and HCV (0.001%). The number of HBV and HCV cases recorded among the Syrian refugees in Lebanon was significantly lower than the expected number of HBV and HCV cases. # Conclusions Hepatitis B and C are neglected diseases among the Syrian refugee population in Lebanon. Continued neglect can increase the risk of chronic viral hepatitis complications and mortality, further increasing the health and economic burden in Lebanon. Urgent action is needed from the host country and the international community to achieve better surveillance, detection, and linkage to medical care in order to manage and prevent unexpected consequences