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Epidemiological Surveillance
Surveillance can be defined as the ongoing, systematic, collection of data related to health events; their verification, analysis, interpretation, and the dissemination of information to those who need to know, in order to reduce morbidity and mortality and to improve health (WHO).

Acute Flaccid Paralysis

Generalities on Poliovirus
Agent Virus: poliovirus (genus enterovirus), with 3 serotypes: 1, 2 and 3
Incubation period 7-14 days (3-35 days)
Period of transmissibility 7-10 days before onset, up to 3-6 weeks after onset
Reservoir Humans
Modes of transmission -Person-to-person: faecal-oral route, and rarely pharyngeal
-Rarely through water and food
Clinical presentation -90-95% asymptomatic infection
-4-8% mild illness (influenza-like illness or gastro-intestinal illness)
-1-2% aseptic meningitis
-<1% paralytic poliomyeltis
Resources
Case definition MOPH circular no 34 (2012)
MOPH circular no 76 (2006)
Forms - General reporting form
- Specific reporting form
- Investigation form: data collection
- Investigation form: additional data
- Investigation form: specimen collection
- Investigation form: Rapid OPV3/IPV3 coverage survey
- Investigation form: Follow up at day 60
- Investigation form: Final classification
Guidelines Acute Flaccid Paralysis surveillance guideline: Ar, En, Fr
Data - AFP surveillance tables
- AFP surveillance bulletin

Anthrax

Generalities
Agent - Bacteria: Bacillus anthracis, Gram positive, aerobic, rod-shaped, encapsulated, spore-forming, and non-motile
- Can be used in biological warfare
Incubation period 1-7 days (up to 60 days for inhalation form)
Period of transmissibility - Person-to-person transmission rare: direct contact with skin lesions (cutaneous form)
- Contaminated articles and soils remain infective for several years
Reservoir - Animals (herbivores both livestock and wildlife) who shed the bacilli in terminal hemorrhages or blood at death
- Soil and environment where spores may remain viable for years
- Dried or processed skins and hides of infected animals, that may harbor spores for years
Modes of transmission - Cutaneous form: contact with tissues, hair, wool, hides, products of infected animals; contact with soil containing spores or contaminated with bone meal; possible flies bite that fed on infected animals
- Inhalation form: inhalation of spore-laden dust in industries (tanning hides, processing wool or bone products…); accidental inhalation in laboratory; intentional release of spores using aerosol devices including mail-items
- Digestive form: ingestion of contaminated undercooked meat
- Injection form: injection of contaminated heroin
Clinical presentation - Cutaneous form (95% of cases)on exposed skin: evolutive lesions from itchiness, to papular, vesicular, then eschar with or without surrounding redness with extensive oedema. Untreated lesions may progress to regional lymph nodes and/or to septicemia. Case fatality is 5-20%.
- Inhalation form (rare): mild respiratory infection that evolves in 3-6 days to acute respiratory distress. At Chest XR, a mediastinal widening (with or without pleural effusion) is observed. Meningitis may occur. Case fatality is almost 100% with delayed or no treatment.
- Intestinal form (rare): fever with intestinal symptoms (abdominal pain and diarrhea). Case fatality is 25-75%.
- Oropharyngeal form: a painless mucosal lesion in the oral cavity or oropharynx, with cervical adenopathy, edema, pharyngitis, fever, and possibly septicemia
- Injection form: similar to cutaneous form, but there may be infection deep under the skin or in the muscle. Complications: septicemia, meningitis, death
Resources
Case definition MOPH circular no. 98 (2015)
Forms - General reporting form
- Anthrax investigation form
Data No reported cases in Lebanon from 2000 to 2015

Bilharziasis

Generalities
Agent Fluke worms: schistosoma haemotobium, S. mansoni, S. japonicum, S. intercalatum, S. mekongi
Incubation period 2-6 weeks
Period of transmissibility - No person to person transmission
- Infected human can excrete eggs for years
Reservoir - Humans, rodents
- Intermediate snail hosts: Bulinus (S. Haematobium), Biomphalania (S. Mansoni)
Modes of transmission - Skin penetration of larvae (cercaviae) in contaminated water
- Eggs of schistosoma leave the human body via urine and fees
- Eggs hatch in water and liberate larva (miracidia) that penetrate into freshwater snail host (genus Bulinus or genus Biomphalania). Several weeks after, larva (cercariae) emerge from snails and penetrate human skin while swimming, wading, or washing…
Clinical presentation - Parasite living in mesenteric / vesical veins
- Urinary form: Hematuria (S. Haemotobium) - Intestinal/hepatic form: gastro-intestinal symptoms with or without hepato(spleno)megaly
- Complications: chronic infection, malignancy
Resources
Case definition MOPH circular no. 130 (2006)
Forms - General reporting form
- Bilharziasis investigation form
Data Refer to "Surveillance data" webpage

Brucellosis

 
Generalities
Agent Bacteria: Brucella abortus (biovars 1-6,9) Brucella melitensis (biovars 1-3), Brucella suis (biovars 1-5), Brucella canis, B. ceti, and B. pinnepedalis
Incubation period 5-60 days (commonly 1-2 months)
Period of transmissibility Rare person-to-person transmission: exposure to contaminated fomites, tissues or massive bleeding
Reservoir - Cattle, goat, sheep, swine
- Also: camel, bison, elk, equid, deer, dog, marine mammal...
Modes of transmission - Consumption of unpasteurized dairy products
- Contact through skin breaks with infected animal tissues (placenta, blood, abortion)
- Airborne in pens, stables, laboratories, abattoirs
- Accidental self-inoculation of animal vaccine
Clinical presentation Systematic bacterial infection, with irregular fever
Resources
Case definition MOPH circular no 55 (2007)
Forms General reporting form
Brucellosis investigation form
Data Refer to "Surveillance data"

Cholera

Generalities
Agent - Bacteria: Vibrio cholera, serogroup O1 (biotype classical or El Tor, subtype Ogawa or Inaba), or serogroup O139
- Enterotoxin producer
Incubation period 2-5 days (can be few hours to 5 days)
Period of transmissibility As long as the bacteria is excreted in feces, up to few days after recovery
Reservoir Humans, brackish waters and estuaries
Modes of transmission - Consumption of contaminated water
- Consumption of contaminated food: by water, by human feces, by soiled hands, raw or undercooked seafood
- Person-to-person transmission: fecal-oral route
Clinical presentation - Acute abundant watery diarrhea (rice-water stool)
- Asymptomatic infection is common
- Complications: dehydration and death. Case fatality can reach 50% if untreated, and is <1% if treated
Resources
Case definition MOPH circular no. 99 (2015)
Forms - General reporting form
- Cholera investigation form
Data Refer to "Surveillance data" webpage

Coronavirus: invasive/novel

Generalities
Agent Coronaviruses belong to a large family of viruses that can cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS).
1) Classical coronavirus: viruses that can infect humans and animals.
- Human coronavirus (HCoV): causing mild illness (229E, OC43, NL63, and HKU1...)
- Animal coronavirus: may infect pigs, domestic and wild birds, bats, rodents, dogs, cats and cattle. They cause acute and chronic diseases in animals such as respiratory and gastro-enteric diseases, neurologic diseases, and liver disease.
2) Novel coronavirus:
- Severe Acute Respiratory Syndrome (SARS-CoV) who caused a large outbreak in 2002-2003.
- Middle East respiratory syndrome–Novel Coronavirus (MERS-CoV): first identified in 2012
Incubation period - HCoV: 2-4 days
- SARS-CoV: 2-10 days (mean; 5 days)
- MERS-CoV: 2-14 days
Period of transmissibility - HCoV: during the active disease
- SARS-CoV: from onset to 21 days
- MERS-CoV: during illness. The duration of infectivity after resolution of symptoms is unknown.
Reservoir - HCoV: Humans
- SARS-CoV: cave-dwelling bats (genus Rhinolophus), Himalayan masked palm civet (Paguma larvata), other wildlife animals
- MERS-CoV: may be camels and bats
Modes of transmission - HCoV: person-to-person transmission via repiratory droplets, aerosls, fecal oral route, fomites
- SARS-CoV: 1) Animal-to-person; 2) Person-to-person: while caring for, or living with a patient; via respiratory secretions, via body fluids; or airborne (aerosolized sewage, mechanical ventilation...)
- MERS-CoV: 1) Limited person-to-person transmission: close contact, when providing unprotected care to a patient; 2) Suspected animal-to-person transmission via droplet contact, fomite transmission, food-borne, airbone
Clinical presentation - HCoV: usually self-limited illness as upper respiratory infection, otitis media, gastroenteritis. Complications: pneumonia, encephalitis, peritonitis...
- SARS-CoV: pneumonia, acute respiratory distress syndrome (ARDS). Global case fatality in 2003: 10%.
- MERS-CoV: usually, acute lower respiratory infection with or without gastrointestinal symptoms. It may be asymptomatic. The illness may be severe in people with chronic medical conditions. It may evolve to respiratory failure, organ failure (as renal failure), septic shock... Global case fatality: 27%.
Resources
Case definition - MOPH circular no. 35 (2012): SARS-CoV
- MOPH circular no. 37 (2014): MERS-CoV
Forms - General reporting form
- Specific MERS-CoV reporting form
- SARS-CoV investigation form
- MERS-CoV investigation form
Data - SARS-CoV: No SARS-CoV was detected in Lebanon in 2003
- MERS-CoV: one case detected and confirmed in 2014

Creutzfeldt Jakob Disease or Human Spongiform Encephalopathy

Generalities
Agent - Abnormal form of self-replicating host-encoded protein or prion protein
- 4 forms: sporadic (sCJD), iatrogenic (iCJD), genetic (gCJD) and and new variant (vCJD)
Incubation period - For iCJD: 15 months – 30 years
- For vCJD: may be 6-9 years
Period of transmissibility As long as prions are present, found in lymphoid tissues from early incubation, and lately in the Central Nervous System CNS
Reservoir - For sCJD, iCJD: Humans
- For vCJD: cattle affected with Bovine Spongiform Encephalopathy (BSE)
Modes of transmission - sCJD: unknown
- iCJD: transmission from sCJD via human pituitary hormone therapy, human dura mater grafts, corneal grafts, neurosurgical instruments
- gCJD: hereditary mutation on chromosome 20
- vCJD: blood transfusion, hypothesis of consumption of food from animal infected by BSE agent
Clinical presentation - sCJD and iCJD: subacute spongiform encephalopathy (confusion, progressive dementia, ataxia, myoclonic jerking...), with typical Electro-encephalogramm (EEG), fatal within 3-12 months
- vCJD: subacute spongiform encephalopathy in younger age group, without typical EEG, with longer clinical course and behavioral disturbance
- gCJD: Fatal Familial Insomnia (FFI), Gerstmann-Staussler-Schneiker Syndrome (GSSS)
- Case fatality: 100%
Resources
Case definition MOPH circular no. 42 (2007)
MOPH circular no. 44 (2007): new variant
Forms - General reporting form
- CJD investigation form
Data Refer to "Surveillance data" webpage

Diphtheria

Generalities
Agent - Bacteria: Corynebacterium diphtheria (4 biotypes: gravis, mitis, intermedius, and belfani), and Corynebacterium ulcerans
- Toxin producer (DTX)
Incubation period 2-4 days (1-10 days)
Period of transmissibility Usually 2 weeks
Reservoir Humans
Modes of transmission - Person-to person via droplets (respiratory secretions), skin lesions, or fomites; and rarely through indirect contact
- Raw milk can serve as vehicle
Clinical presentation - Anterior nasal, pharyngeal and tonsillar (pseudo-membranes), laryngeal (stridor) forms
- Cutaneous diphtheria (vesicles and later ulcers)
- May be asymptomatic
- Main complications: myocarditis, neuropathy from mild weakness to total paralysis
Resources
Case definition MOPH circular no 107 (2006)
Forms - General reporting form
- Diphtheria case investigation form
- Diphtheria contacts investigation form
Data Refer to "Surveillance data" webpage

Food Poisoning

Generalities
Agent Several agents:
1) Bacteria: Bacillus cereus, Brucella, Campylobacter jejuni, Campylobacter coli, Clostridium botulinum, Clostridium perfringes, Escherichia coli, Listeria monocytogenes, Salmonella, Shigella, Staphylococcus aureus, Vibrio cholera, Vibrio parahaemolyticus, Vibrio vulnificus, Yersinia Enterocolitica...
2) Virus: Enteric Adenovirus, Coronavirus, Rotavirus, Parvovirus, Calicivirus, Astrovirus, POliovirus, Enterovirus, Hepatitis A virus, Hepatitis E virus...
3) Parasites: Entamoeba histolytica, Giardia intestinalis, Toxoplasma gondii, Trichinella spiralis...
4) Natural toxins: Scomboid fish poisoning (histamine poisoning), Paralytic shellfish poisoning, Tetrodotoxin poisoning (puffer fish poisoning), Mushrooms toxins, Plant toxins...
5) Chemicals: Pesticides, Toxic metals, Polychlorinated biphenyls, Fluoride, Zinc, Nitrites, Sodium hydroxide, Monosodium glutamate...
Incubation period Varies with the agent
Period of transmissibility Varies with the agent
Reservoir Varies with the agent
Modes of transmission - Mainly, Consumption of contaminated food
- Other: person-to-person (fecal orat route), vertical transmission...
Clinical presentation Varies with the agent. It includes:
- Gastroenteritis
- Systematic infection
- Neurological manifestations
- Cholinergic syndrome ...
Resources
Case definition - MOPH circular no. 81 (2001)
- MOPH circular no. 36 (2007): Trichinellosis
Forms - Investigation form
- Inspection form
- Trichinella investigation form
- Botulism investigation form
Data Refer to "Surveillance Data"

Gonococcal infection

Generalities
Agent Bacteria: Neisseria gonorrheae (gonococcus)
Incubation period - 1-14 days
- For gonococcal neonatorum: 1-5 days
Period of transmissibility - For months if untreated
- Effective treatment ends communicability within hours.
- For gonococcal neonatorum: as long as discharge persists, if untreated. Transmissibility stops 24 hours after antibiotic treatment.
Reservoir - Humans
- For gonococcal neonatorum: infection of maternal cervix
Modes of transmission - Contact with exudates from mucus membranes of infected people, secondary of sexual intercourse
- For gonococcal neonatorum: contact with infected birth canal during childbirth
Clinical presentation - For males: acute purulent urethritis
- For females: cervicitis, that may be asymptomatic. Complications: endometritis, salpingitis, peritonitis, infertility, ectopic pregnancy, congenital conjunctivitis
- Other form: pharyngeal, anorectal infection
- General complications: septicemia, arthritis, skin lesions, endocarditis, meningitis, death
- For gonococcal neonatorum: acute conjunctivitis with pus. Complications: corneal ulcer, blindness
Resources
Case definition - MOPH circular no. 61 (2007)
- MOPH circular no. 60 (2007): Gonococcal conjunctivitis neonatorum
Forms - General reporting form
- Gonococcal infection investigation form
Data Refer to "Surveillance Data" section

Hemorrhagic fever

Generalities
Agent Several agents are responsible of the occurrence of febrile hemorrhagic manifestations.
1) Bacteria: Mainly Neisseria meningitis…
2) Virus:
- Dengue virus: genus Flavivirus, family Flaviviridae. It includes 4 serotypes 1-4.
- Yellow fever virus: genus Flavivirus, family Flaviviridae
- Chikungunya: genus Alphavirus, family Togaviridae
- Rift Valley fever virus: genus Phlebovirus, family Bunyaviridae
- Lassa virus: arenavirus
- Crimean-Congo hemorrhagic fever virus: genus Nairovirus, family Bunyaviridae
- Ebola Disease virus: genus Ebolavirus, family Filoviridae. It includes several subtypes.
- Marburg virus: genus Marburgvirus, family Filoviridae …
Incubation period varies with the agent
Period of transmissibility varies with the agent
Reservoir varies with the agent
Modes of transmission varies with the agent
Clinical presentation varies with the agent
Resources
Case definition - MOPH circular no. 49 (2007)
- MOPH circular no. 70 (2014): Ebola virus disease
- MOPH circular no. 50 (2007): Marburg
- MOPH circular no. 132 (2006): Yellow fever
Forms - General reporting form
- Specific hemorrhagic fever reporting form
- Hemorrhagic fever investigation form
- Ebola contact follow up investigation form
Data Refer to "Surveillance Data" section

Hepatitis A

Generalities
Agent Hepatitis A virus HAV, family Picornaviridae
Incubation period 28-30 days (range 15-50 days)
Period of transmissibility During the second half of the incubation period, and up to one week after jaundice onset
Reservoir Humans, rarely chimpanzees and other primates
Modes of transmission - Person-to-person transmission: fecal oral route
- Ingestion of contaminated food: prepared by food handler or undercooked mollusks harvested from contaminated water, contaminated produce
- Ingestion of contaminated water or drinks
- Transfusion of blood and clotting factor concentrates obtained from viremic donors
- Injectable drug-use
Clinical presentation - Febrile jaundice
- Asymptomatic in childhood
- Case fatality: 0.1-0.3 % (1.8% for >50 years) secondary to fulminant acute hepatitis
Resources
Case definition MOPH circular no 47 (2007)
Forms - General reporting form
- Hepatitis A investigation form
Data Refer to "Surveillance Data"

Hepatitis B

Generalities
Agent - Hepatitis B virus HBV, hepadnovirus
- 4 subtypes: adw, ayw, adr, ayr
- 8 genotypes: A-H
Incubation period 45-180 days (60-90 days)
Period of transmissibility If HBs Ag(+) or HBe Ag(+)
Reservoir Humans
Modes of transmission - Person-to-person transmission: body fluids (blood, blood products, saliva, CSF, pleura, peritonial, percardial, synovial fluid, amniotic liquid, semen, vaginal secretions)
- Modes: percutaneous and mucosal exposure to infective body fluids (sexual, perinatal, injectable drugs, nosocomial...)
Clinical presentation - Clinical jaundice. May be asymptomatic
- Complications: chronic hepatitis, cirhhosis, hepatocarcinoma cancer. Chronic infection varies with age: 90% if infected <1 year, 20-50% if infected at 1-5 years old, 1-10% if infected at older ages
Resources
Case definition MOPH circular no. 111 (2006)
Forms - General reporting form
- Hepatitis B/C/D investigation form
Data Refer to "Surveillance Data"

Hepatitis C

Generalities
Agent Hepatitis C virus, genus Hepacavirus, family Falviviridae
Incubation period 2 weeks to 6 months
Period of transmissibility From 1 or more weeks before onset, and may persists indefinitely
Reservoir Humans
Modes of transmission Person-to-person transmission:
- Parenterally: transfusion of blood/blood products, parental exposure to contaminated instruments, nosocomial...
- Rarely: sexual, mother to child
Clinical presentation - Febrile jaundice
- Asymptomatic in 90%
- Complications: chronic infection (50-80%), cirrhosis, liver cancer
Resources
Case definition MOPH circular no. 131 (2006)
Forms - General reporting form
- Hepatitis B/C/D investigation form
Data Refer to "Surveillance Data"

Hepatitis D

Generalities
Agent Hepatitis D virus, virus-like particle
Incubation period 2-8 weeks
Period of transmissibility Blood infectious during all the phase of active delta hepatitis
Reservoir Humans
Modes of transmission Person-to-person transmission: - Exposure to infected blood and serous body fluids
- Contaminated needles, syringes
- Contaminated plasma derivatives
- Sexual intercourse
Clinical presentation - Febrile jaundice
- Always associated with Hepatitis B infection
- Complications: fulminant hepatitis
Resources
Case definition MOPH circular no. 123 (2006)
Forms - General reporting form
- Hepatitis B/C/D investigation form
Data No case reported from 1995 to 2015

Hepatitis E

Generalities
Agent Hepatitis E virus, Hepevirus, family Hepeviridae
Incubation period 15-64 days (median 26-42 days)
Period of transmissibility Virus is present in stool up to 2 weeks after jaundice onset
Reservoir Humans
Modes of transmission - Consumption of contaminated water
- Person-to-person transmission: fecal-oral route
Clinical presentation - Febrile jaundice, similar to hepatitis A
- No chronic infection
- Case fatality: 20 % among pregnant women infected during the 3rd trimester
Resources
Case definition MOPH circular no. 35 (2007)
Forms - General reporting form
- Hepatitis E investigation form
Data No case reported from 1995 to 2015

Human T Lymphotropic Virus 1

Generalities
Agent Human T-cell lymphotrophic virus-1 (HTLV-1), family Retrovirus
Incubation period - Adult T-cell leukemia/lymphoma: few decades
- HTLV-1 associated myelopathy/tropical spastic paraparesis: 3.3 years (median)
Period of transmissibility As long as the infection persists
Reservoir Humans
Modes of transmission Person-to-person transmission:
- Vertical transmission: placenta-fetal, or via breastfeeding
- Sexual intercourse
- Blood: blood and blood products transfusion, intra-venous drug users, blood accidents…
Clinical presentation - Asymptomatic carrier
- Adult T-cell leukemia/lymphoma (2-4%) - HTLV1- associated myelopathy/tropical spastic paraparesis (<1%)
- Other: HTLV-associated uveitis, infective dermatitis, polymyositis, chronic arthropathy, panbronchiolitis...
Resources
Case definition MOPH circular no. 176 (2015)
Forms - General reporting form
- HTLV-1 investigation form
Data Two cases reported in 2007

Hydatid Disease (Cystic) or Cystic Echinococcosis

Generalities
Agent Tapeworm: Echinococcus granulosus
Incubation period 12 months to years
Period of transmissibility No person-to-person transmission
Reservoir - Definitive hosts: Dogs and other canides
- Intermediate hosts: herbivores (sheep, cattle...)
- Canines are infected by eating viscera from infected herbivores while gazing in areas contaminated by infected dog feces
Modes of transmission - Direct hand-to-mouth transfer of worm eggs after contact with infected dogs
- Consumption of contaminated food, water, soil, or fomites
- Flies may disperse eggs after feeding on infected feces
Clinical presentation Symptoms depending on cysts topography, size and number. They are compatible with a slowly growing tumour.
Resources
Case definition MOPH circular no. 76 (2007)
Forms - General reporting form
- Hydatid disease investigation form
Data Refer to "Surveillance data" section

Influenza: novel virus

Generalities
Agent - Emergence of novel subtypes of Influenza A virus due to antigenic shift. Types B and C do not have subtypes.
- Infection with novel influenza virus is a mandatory notifiable disease. Seasonal (common flu) influenza virus is not mandatory notifiable disease.
Incubation period 2-7 days
Period of transmissibility - Usually, 3-5 days before onset and until 7 days after onset
- Patient may remain infctious for 3 weeks.
Reservoir Aquatic birds, domestic poultry, mammalian (pigs, horses, whales, seals, ferrets, cats…)
Modes of transmission 1) Animal-to-person:
- Airbone, while slaughtering, defeathering, handling carcasses of infected poultry
- Consumption of raw contaminated poultry
- Direct contact with infected animals
2) Person-to-person:
- Direct and/or indirect contact with droplets of infected person
- Airborne (in case of aerosol-generated procedures) from an infected person
Clinical presentation - Upper respiratory infection
- Complication: lower respiratory infection
Resources
Case definitions - MOPH circular no. 38 (2012): Novel Influenza
- MOPH circular no. 66 (2007): Novel Influenza A(H5N1)
- MOPH circular no. 60 (2013): Novel Influenza A(H7N9)
Forms - General reporting form
- Novel Influenza investigation form
- Novel Influenza PCR request form
Data - Human cases: non case confirmed of A(H5N1) and A(H7N9) in Lebanon up to 2015
- Animal cases: Influenza A(H5N1) detected in poultry farms in Baalbeck caza in 2016. The containment plan was activated in 21 April 2016.

Intestinal Infections

Generalities
Agent Several agents are responsible of the occurrence of intestinal infections. Some are listed below.
1) Bacteria:
- Campylobacter: spiral-shaped bacteria with 17 species including C. jejuni and C. coli
- Enterohaemorrhagic Escherichia coli EHEC, known as Verocytotoxin producing E. coli VTEC, or Shiga-toxin producing E.coli STEC. It includes the serogroups O26, O45, O111, O103, O121
- Enteroinvasive Escherichia coli EIEC: includes the serogroups O28ac, O29, O112, O124, O136, O143, O144, O152, O164, O167
- Enterotoxigenic Escherichia coli ETEC, elaborates enterotoxines and includes the serogroups O6, O8, O15, O20, O25, O27, O63, O78, O80, O114, O115, O128ac, O148, O153, O157, O159, O167, O169
- Enteropathogenic Escherichia coli EPEC: includes the serogroups O55, O86, O111, O119, O125, O126, O127, O128ab, O142
- Salmonella: Bacteria: non-typhoid salmonella serotypes
- Shigella: Shigella dysenteriae, S. flexneri, S. boydii, S. sonnei
- Other bacteria
2) Virus:
- Rotavirus: family Reoviridae. It includes several groups A-F. Group A , the most common, includes several serotypes.
- Other viruses
3) Parasites:
- Entamoeba histolytica: protozoa
- Giardiasis: Giardia intestinalis (formely lamblia or duodenalis)
Incubation period varies with the agent
Period of transmissibility varies with the agent
Reservoir varies with the agent
Modes of transmission varies with the agent
Clinical presentation varies with the agent
Resources
Case definition - MOPH circular no. 51 (2007): Amibiasis
- MOPH circular no. 51 (2007): Shigellosis
Forms - General reporting form
- Dysentery investigation form
Data Refer to "Surveillance Data" section

Legionellosis

Generalities
Agent - Legionella, Gram negative bacilli. There are 20 different species. 80% of human infections are due to L. Pneumophila serogroup 1.
- Other species: L. micdadei, L. bozemanii, L. longbeachae, L. dumoffii…
Incubation period - For Legionaires'disease: 5-6 days (2-10 days)
- For Pontiac fever: 24-48 hours (5-66 hours)
Period of transmissibility No person-to-person transmission
Reservoir - Water: Legionnella is waterborne, found in water system, air conditionning cooling tower, whirpool spas... Legionella growth increases with warm water temperature (25-42C), sale and sediment, and low biocide levels
- Potting soil may be reservoir for certain spp (L. longbeachar)
Modes of transmission - Inhalation of contaminated aerosols
- Microaspiration of contaminated water
- Contaminated soil
Clinical presentation Two forms:
- Legionaires' disease: pneumonia with non productive cough. Case fatality: 15%
- Pontiac fever: self-limited flu-like illness without pneumonia
Resources
Case definition MOPH circular no. 175 (2015)
Forms - General reporting form
- Legionellosis investigation form
Data Notifiable disease since 2014

Leishmaniasis

Generalities
Agent - Protozoa: Leishmamia
- Cutaneous/mucosal form: Leishamania tropica, L, major, L. aethiopica, L. braziliensis, L. mexicana, L. infantum/chagazi, L. donovani
- Visceral form: Leishamania donovani, L. infantum and L. infantum/chagazi
Incubation period 1 week to several months
Period of transmissibility - Rare person-to-person transmission: via transfusion
- Human is infectious to sandfly as long as parasites remain in lesion (cutaneous) or in blood (visceral)
Reservoir Humans, wild rodents, hyraxes, edentates, marsupials, domestic/wild dogs and canidae
Modes of transmission - Bite of infective female phelbotomines (sandflies). Female sandflies become infected by feeding from reservoir hosts: animals (zoonotic cycle), or humans (anthroponotic cycle).
- The sandflies are from genus phlebotomus in the Old World, and genus Lutzoma in the New World.
Clinical presentation - Intracellular parasite
- Cutaneous/mucosal form: single or multiple macule skin lesion(s) that evolve to papule(s) that enlarge and become indolent ulcer(s). Involvement of the mucosa of the nasopharynx is characterized by progressive tissue destruction.
- Visceral form: chronic systematic disease characterized by fever, hepato-splenomegaly, lympho-anedopathy, anemia, leukopenia, thrombocytopenia. Fatal if untreated.
Resources
Case definition - MOPH circular no. 34 (2013): Cutaneous/mucocal form
- MOPH circular no. 122 (2006): Visceral form
Forms - General reporting form
- Leishmaniasis investigation form
Data Refer to "Surveillance Data" section

Leprosy

Generalities
Agent Bacteria: Mycobacterium leprae
Incubation period From 9 months to 20 years
Period of transmissibility - During active disease
- Effective antibiotherapy stops transmission within one day of treatment
Reservoir Humans, but also observed in monkeys
Modes of transmission Person-to-person: close contact with nasal mucosa of a patient to the skin or respiratory tract of another person
Clinical presentation - Chronic bacterial disease of the skin, peripheral nerves and upper airway, characterized by skin lesions (hypo-pigmentation with definite loss of sensation) and thicknesses of peripheral nerves and signs of peripheral nerves involvment
- Two forms:
1) Lepromatous multibacillary form (>5 skin lesions): symmetrical and bilateral nodules, papules, and diffuse infiltrations, involvement of nasal mucosa, ocular involvement…
2) Tuberculoid paucibacillary form (1-5 skin lesions): single or few skin lesions, sharply demarcated, anaesthesic or hypoaesthesic, bilateral asymmetrical involvement of peripheral nerves
Resources
Case definition MOPH circular no. 38 (2007)
Forms - General reporting form
- Leprosy investigation form
Data Refer to "Surveillance data" webpage

Measles

Generalities
Agent Measles virus, genus morbillivirus, family paramyxoviridae
Incubation period 10 days (7-18 days, may be to 21 days)
Period of transmissibility 4 days before rash and 4 days after rash onset
Reservoir Humans
Modes of transmission - Person-to-person: direct contact with droplets, rarely indirect contact
- Airborne (if confined place)
Clinical presentation - Febrile maculo-papular rash
- Complications: otitis media (7-9%), pneumonia (1-6%), gastro-enteritis (8%) and dehydration, blindness, convulsions (1/200), encephalitis (1/1000)
- Encephalitis: post-infectious encephalitis 1 week from onset; or acute encephalitis of delayed type weeks and months after onset)
- Long term complication: sub-acute sclerosing pan-encephalitis SSPE, 7 years or more after onset (1/25000 case, and 1/8000 if onset under 2 years old)
- Case fatality: 3-6% in developing countries, 1-3/1000 in developed countries
Resources
Case definition MOPH circular no 11 (2013)
Forms - Rash reporting form
- Rash investigation form
Guideline Measles surveillance guideline: Ar, En, Fr
Data - Measles 2017
- Measles 2016
- Measles 2015
- Measles 2014
- Measles 2013
- Measles 2012

Meningitis

Generalities
Agent There are several agents causing meningitis.
1) Main Bacteria:
- Neisseria meningitidis (meningococcus): Gram negative diplococci. Main invasive serotypes are A, B, C, W135, X, and Y.
- Haemophilus influenza: Gram negative cocco-bacilli. There are 6 serotypes from (a) to (f). The serotype (b) is responsible of invasive infection.
- Streptococcus pneumonia (pneumococcus): Gram positive diplococci. There are more than 90 serotypes.
- Leptospira: spirochetes, Leptospira interrogans (26 serogroups)
- Listeria monocytogenes: Gram positive, rod-shapped
- Other bacterial agents: Staphylococcus, enteric bacteria, group B streptococci, Mycobacterium tuberculosis…
2) Virus:
- Mumps
- Measles
- West Nile virus: a Flavivirus
- Enterovirus: including Coxsackieviruses A (2-4, 7, 9-10), Coxsackieviruses B (1-6), Echoviruses (2, 5-7, 9-11, 14, 18, 30), Enterovirus 71, Poliovirus (1-3)
- Herpes Simplex virus (types 1 and 2): family Herpesviridae
- Varicella-Zoster virus: Human (alpha) Herpesvirus 3 (varicella-zoster) from the group Herpesvirus
- Adenovirus: Adenovirus, several types (1, 2, 3, 4, 5 and 7), genus Mastadenovirus, family Adenoviridae, - Lymphocytic choriomeningitis virus: an Arenavirus
- Sandfly fever viruses: genus Phlebovirus, family Bunyaviridae. They include more than 60 antigenically distinct virus serotypes. Two main groups are identified: a) Sandfly fever group including the Naples serocomplex (Karimabad virus, Arabia virus, Massilia virus, Punique virus, Tehran virus, Toscana virus …) and Sicilian serocomplex; and b) Uukuniemi group
-Other virus: arboviruses…
3) Parasites: - Candida albicans, cryptococcus…
Incubation period varies with the agent
Period of transmissibility varies with the agent
Reservoir varies with the agent
Modes of transmission varies with the agent
Clinical presentation varies with the agent
Resources
Case definition MOPH circular no. 52 (2007): Meningitis
MOPH circular no. 63 (2007): Neisseria meningitidis
MOPH circular no. 54 (2007): Haemophilus influenzae b
MOPH circular no. 36 (2012): West Nile Virus
Forms - Meningitis reporting form
- Meningitis investigation form
Data - Meningitis 2017
- Meningitis 2016
- Meningitis 2015
- Meningitis 2014
- Meningitis 2013
- Meningitis 2012
- Meningitis 2011

Meningococcal Infection

Generalities
Agent Bacteria: Neisseria meningitidis (meningococcus), Gram negative diplococci
- 12 serogroups have been identified
- Six serogrouprs are responsible of invasive infection: A, B, C, W135, X, and Y.
Incubation period 2-10 days, commonly 3-4 days
Period of transmissibility Cases should be considered infectious from exposure until 24 hours after starting treatment of prophylaxis with appropriate antibiotics with substantial concentrations in oro/nasopharyngeal secretions
Reservoir - Humans
- Asymptomatic carriage in nasopharynx is common.
Modes of transmission - Person-to-person transmission by direct contact with respiratory droplets of infected people
- Most cases acquired through exposure to asymptomatic carriers
Clinical presentation - Bacterial meningitis
- Septicaemia: rare ans severe with purpura
- Complications: cerebral lesions, hearing loss, learning disorders among 10-20% of survivors
- Case fatality: 8-15% despite treatment
Resources
Case definition MOPH circular no. 63 (2007)
MOPH circular no. 72 (2003): contacts
Forms - Meningitis reporting form
- Meningitis investigation form
Data - Meningitis 2017
- Meningitis 2016
- Meningitis 2015
- Meningitis 2014
- Meningitis 2013
- Meningitis 2012
- Meningitis 2011

Mumps

Generalities
Agent Mumps virus, genus Rubulavirus, family Paramyxoviridae
Incubation period 16-18 days (range 12-25 days)
Period of transmissibility - Virus present in saliva 7 days prior and 9 days after parotiditis onset
- Virus present in urine 6 days prior and 15 days after onset
- Max 2 days prior and 4 days after onset
Reservoir Humans
Modes of transmission Person to person transmission: droplet and can be airborne
Clinical presentation - Parotiditis most common manifestation (30-40%)
- Asymptomatic in 20%
- Complications: orchitis, oophoritis, sensoneuronal loss, hearing loss, pancreatitis (4%), aseptic meningitis/encephalitis. Rarely nephritis, arthropathy, cardiac abnormalities, death
Resources
Case definition MOPH circular no 110 (2006)
Forms - General reporting form
- Mumps investigation form
Data Refer to "Surveillance data" webpage

Pertussis or Whooping cough

Generalities
Agent Bacteria: Bordetella pertussis (the bacillus of pertussis) or Bordetella parapertussis (causes parapertussis)
Incubation period 9-10 days (6-20 days)
Period of transmissibility - During the early catarrahal phase (up to 3 weeks)
- No longer after 5 days of antibiotic treatement
Reservoir - Humans for B. pertussis
- Ovins for B. parapertussis
Modes of transmission Person-to-person: direct contact with droplets and respiratory discharges, rarely by indirect contact though contaminated objects or air
Clinical presentation - Upper respiratory infection
- Complications: apnea (<1 y), encephalopathy, hernias, death
- Mis-diasgnosed among adults
Resources
Case definition MOPH circular no. 109 (2006)
Forms - General reporting form
- Pertussis investigation form
Data Refer to "Surveillance data" webpage

Plague

Generalities
Agent Bacteria: Yersinia pestis
Incubation period 1-7 days
Period of transmissibility - Pneumonic plague: during the active phase
- Bubonic phase (rare): if contact with pus from suppurative buboes
Reservoir Wild rodents, lagomorphs (rabbits, hares), wild carnivores and domestic cats
Modes of transmission - Most common via bite of infected rodent fleas (Xenopsylla cheopis): 1) Wild rodent fleas linked to zoonotic/sylvatic cycle; 2) Commensal rodent fleas infected by peri-domestic mammals and linked to poor hygiene
- Handling infected animals
- Contact with infected cats via bites or droplets
- Laboratory exposure
- Person-to-person: 1) Airborne droplets from patients with pneumonia or pharyngitis plague; 2) Pulex irritans fleas (human flea)
- Aerosol: deliberate use
Clinical presentation - Bubonic plague (90%: febrile lymph nodes that become swollen, inflamed, tender and may suppurate. Inguinal area is more concernet than axillary and cervical areas. Complications: septicemic plague, meningitis, disseminated intravascular coagulation, pneumonia, mediastinitis, pleural effusion, endotoxin shock. Case fatality is 50-60% if untreated.
- Secondary pneumonic plague: source of primary pneumonic or pharyngitis plague, causing localized outbreaks. Fatal if untreated.
Resources
Case definition MOPH circular no. 113 (2006)
Forms - General reporting form
- Plague investigation form
Data Refer to "Surveillance Data"

Rabies

Generalities
Agent Rabies virus, genus Lyssavirus, family Rhabdoviridae
Incubation period 3-8 weeks (few days to several years)
Period of transmissibility - Rabid dogs/cats are infectious 3-7 days before onset and up to death.
- Rabid bats are infectious 12 days before onset and up to death.
- Person-to-person transmission is possible but have never been confirmed.
Reservoir - Wild and domestic cannidae (dogs, foxes, wolves) and other carnivores (cats...)
- In some countries: bats
Modes of transmission - Usually: virus-laden saliva of rabid animal introduced through wound (scratch, bite, existing wound)
- Possible: mucous membranes (eyes, nose, mouth) contaminated with saliva
- Airborne in cave with rabid bats
Clinical presentation Encephalomyelitis, with hydrophobia, fatal within 1-2 weeks from onset
Resources
Case definitions MOPH circular no. 109 (2006): Human rabies
MOPH circular no. 50 (2005): Rabies exposure
Forms - General reporting form
- Rabies investigation form
- Exposure investigation form
Data on Human rabies Refer to "Surveillance Data"  
Data on Rabies Exposure The data reflects the exposed persons managed by anti-rabies centers:
- Year 2015
- Year 2014
- Year 2013

Rubella and Congenital Rubella Syndrome

Generalities
Agent Rubella virus, genus Rubullovirus, family Togaviridae
Incubation period 14-17 days (range 14-21 days)
Period of transmissibility - 7 days before rash and 4 days after rash onset
- From congenital rubella: infants shed the virus for several months after birth
Reservoir Humans
Modes of transmission - Person-to-person: direct contact with droplets
- Infants with Congenital Rubella Syndrome shed large quantities of virus in their pharyngeal secretions and urine.
- Materno-foetal transmission: 90% of infants born to women infected with rubella during the 1st trimester. The risk of transmission is 10-20% by the 16th week, and rare after the 20th week.
Clinical presentation - Febril maculo-papular rash
- Complications: thrombocytopenia (1/3000), post-infectious encephalitis (1/6000), rarely chronic arthritis
- Congenital Rubella Syndrome: Congenital malformation as deafness, cataracts, microphtalmia, congenital glaucoma, pigmentary retinopathy, nystagmus, microcephaly, meningo-encephalitis, mental retardation, patent ductus arteious, atrial or ventricular septal defects, other congenital heart disease, purpura, hepatosplenomegaly, jaundice, radiolucent bone disease
Resources
Case definitions - MOPH circular no 12 (2013): Acquired Rubella
- MOPH circular no 45 (2007): Congenital Rubella Syndrome
Forms - Rash reporting form
- CRS reporting form
- Rash investigation form
- CRS investigation form
Data - Rubella 2017
- Rubella 2016
- Rubella 2015
- Rubella 2014
- Rubella 2013
- Rubella 2012  

Smallpox

Generalities
Agent Variola virus of Orthopoxvirus species
Incubation period 7-19 days (10-14 days for illness, 2-4 days more for rash)
Period of transmissibility 3 weeks from onset of skin lesions
Reservoir Humans
Modes of transmission - Person-to-person: direct contact with droplets or skin lesions
- Conjunctiva or placenta may be points of entry
Clinical presentation - Prodomic phase with fever and flu-like illness
- Classical form: fever with characteristic centrifugal deep-seated skin eruption: succession of macules, papules, vesicles, and pustules then crusted scabs. The lesions appear first at on the face, extremities, including the palms and soles, sand subsequently on the trunk. Skin lesions are at same stage in same area.
- Two forms: minor with a case fatality < 1% and major with case fatality 20-50%. In less than 3%, the major form shows bleeding into the skin and mucous membranes (hemorrhagic smallpox).
Resources
Case definition MOPH circular no. 37 (2012)
Forms - General reporting form
- Smallpox investigation form
Data - Smallpox was declared eradicated in 1979
- Last minor case: 1977 in Somalia
- Last major case: 1976 in Bangladesh

Syphilis

Generalities
Agent Spirochete: Treponema pallidum, subsp. palidum
Incubation period 10 days to 3 months (usually 3 weeks)
Period of transmissibility During the primary and secondary syphilis
Reservoir Humans
Modes of transmission Person-to person transmission:
- Sexual transmission with direct contact with infectious exsudats from skin lesions or mucous membranes
- Tranplacental transmission
- Blood transfusion
- Direct contact following unprotected clinical examination of infectious lesions
Clinical presentation - Primary lesion: chancre appears as indurated painless ulcer with serous exsudates
- Secondary skin eruption: maculopapular of the palms and soles with lymphadenopathy
- Tertiary: meningitis, meningovascular syphilis, cardiovascular syphilis, gummas on skin , viscera, bones or mucosa
- Fetal infection: congenital syphilis with generalized systemic disease and Central Nervous System (CNS) involvment. Congenital syphilis may be asymptomatic in the first weeks of life. Late manifestations include: involvement of the CNS, Hutchinson teeth (small, wide-spaced grayish incissors), saddlenose, sabre shins (periostitis), interstitial keratitis, and deafness
Resources
Case definition - MOPH circular no. 62 (2007)
- MOPH circular no. 64 (2007): Congenital syphilis
Forms - General reporting form
- Syphilis investigation form
Data Refer to "Surveillance Data" section

Tetanus and Tetanus Neonatorum

Generalities
Agent - Bacteria: clostridium tetani or tetanus bacillus
- Toxin producer
Incubation period - 3-21 days (1 day to several months), and commonly 10 days
- Tetanus Neonatorum: 6 days (3-28 days)
Period of transmissibility No person-to-person transmission
Reservoir - Intestines of horses and animals, and humans
- Tetanus spores are ubiquitous in environment and soil
Modes of transmission - Skin entry: Introduction of spores through puncture wound contaminated with soil, street dust or animal or human feces
- Rarely by injectable contaminated drugs
- Tetanus Neonatorum: 1) During delivery: introduction via the umbilical cord of tetanus spores through the use of an unclean instrument to cut the cord; 2) After delivery: by dressing the umbilical stumps with substance heavily contaminated with tetanus spores
Clinical presentation - Muscle contraction, trismus (masseter contraction), neck/ trunk spasms, opisthotonos
- Case fatality from 10% to 90% depending on availability of intensive care
- Tetanus Neonatorum: Few days after birth the infant develops progressively trismus, generalized stiffness, spasms, convulsions and opisthotonos. Typically, an infant who sucks and cries well for the first few days after birth, and then shows progressive difficulty and inability to feed. Complications: 80% as case fatality, 5-20% of mental retardation among survivors
Resources
Case definition MOPH circular no. 53 (2007)
MOPH circular no. 108 (2006): Tetanus Neonatorum
Forms - General reporting form
- Tetanus investigation form
- Tetanus Neonatorum investigation form: Ar, Fr
Data Refer to "Surveillance data" webpage

Typhoid fever

Generalities
Agent Bacteria: salmonella enterica subsp. enteric serovar typhi or paratyphi A, B or C
Incubation period - Typhi: 3 to 60 days (8-14 days)
- Paratyphi: 1-10 days
Period of transmissibility - As long as the bacteria is in feces, usually after the 1st week of illness through convalescence .
- Approximately 10% of untreated cases will excrete S. typhi for 3 months and between 2-5% of all cases become chronic carriers.
Reservoir Humans
Modes of transmission - Consumption of contaminated food: shellfish, fruits /vegetables, milk and milk products by food handlers
- Food can be contaminated by flies
- Consumption of contaminated water
- Sexual transmission
Clinical presentation a) Systemic bacteria infection:
-Mild illness: low grade fever, malaise and dry cough,disturbances of bowel function(constipation in adults, diarrhea in children), headache, malaise and anorexia. Bronchitic cough is common in the early stage of the illness. During the period of fever, up to 25% of patients show a rash or rose spots, on the chest, abdomen and back.
-Severe illness: abdominal discomfort, altered mental status and multiple complications(intestinal hemorrhage or peritonitis due to intestinal perforation)
b) Carrier state: 1-5% of patients, depending on age, become chronic carriers harboring S.typhi in the gallbladder
Resources
Case definition MOPH circular no 46 (2007)
Forms - General reporting form
- Typhoid Fever investigation form
Data Refer to "Surveillance Data" section
"Surveillance data" page provides you with the reported cases related to mandatory notifiable diseases.
You will find a first section where data is displayed at national, mohafaza and caza level for the current year.
The second section displays data at national and mohafaza levels for at least the past 10 years.
 

General surveillance data: current year

 
National Beirut Bekaa (Great) Mount-Lebanon
    Hermel Aley
    Baalbeck Baabda
    Rashaya Chouf
    West-Bekaa Jbeil
    Zahleh Kesrwan
      Metn
       
Nabatieh mohafaza North (Great) South Other
Bint Jbeil Akkar Jezzine Syrian population
Hasbaya Batroun Saida  
Nabatieh caza Becharreh Sour  
Marjeoun Koura    
  Minieh Dannieh    
  Tripoli    
  Zghorta    
       

General surveillance data: past years

 
2016 2015 2014 2013
Lebanon Lebanon Lebanon Lebanon
By week By week By week By week
Beirut Beirut Beirut Beirut
Bekaa (Great) Bekaa (Great) Bekaa (Great) Bekaa (Great)
Mount-Lebanon Mount-Lebanon Mount-Lebanon Mount-Lebanon
Nabatieh mohafaza Nabatieh mohafaza Nabatieh mohafaza Nabatieh mohafaza
North (Great) North (Great) North (Great) North (Great)
South South South South
Syrian Syrian Syrian Syrian  
       
2012 2011 2010 2009
Lebanon Lebanon Lebanon Lebanon
By week By week By week By week
Beirut Beirut Beirut Beirut
Bekaa (Great) Bekaa (Great) Bekaa (Great) Bekaa (Great)
Mount-Lebanon Mount-Lebanon Mount-Lebanon Mount-Lebanon
Nabatieh mohafaza Nabatieh mohafaza Nabatieh mohafaza Nabatieh mohafaza
North (Great) North (Great) North (Great) North (Great)
South South South South
       
2008 2007 2006 2005
Lebanon Lebanon Lebanon Lebanon
By week By week By week By week
Beirut Beirut Beirut Beirut
Bekaa (Great) Bekaa (Great) Bekaa (Great) Bekaa (Great)
Mount-Lebanon Mount-Lebanon Mount-Lebanon Mount-Lebanon
Nabatieh mohafaza Nabatieh mohafaza Nabatieh mohafaza Nabatieh mohafaza
North (Great) North (Great) North (Great) North (Great)
South South South South
       
 
 

Classical reporting system

Contexte Official surveillance system relies on official laws. The Lebanese Law related to communicable diseases issued on the 31st December 1957 requests from physicians and healthcare facilities to report to the MOPH selected communicable diseases.
On the other hand, the MOPH issues continuously decisions, circulars, and memos that specifies technical aspects of the national surveillance system (case definitions, forms…).
Objectives - Measure disease burden and describe the characteristics. This includes: a) Measure incidence, prevalence, and mortality rates; b) Describe event/disease by time, place and person; c) Monitor trends; d) Identify high risk populations or areas; e) Identify risk factors; f) Evaluate specific diseases control programs.
- Detect alerts and outbreaks. The detection of an outbreak gives an opportunity to investigate, find etiologies and implement corrective measures, thus aiming to reduce cases and prevent later outbreaks. Early warning and response system refers to the outbreak detection at early stages; when timely corrective measures can prevent additional new cases and stop the natural evolution of the outbreak.
Target diseases and syndromes 40 diseases and syndromes are targetted by the classical surveillance system. The diseases are displayed in 2 groups: immediate notification and weekly notification:
- The immediate notifiable diseases and syndromes are: Acute Flaccid Paralysis, Anthrax, Cholera, Diphtheria, Food Poisoning, Hemorrhagic Fever, Influenza novel viruses, Invasive Coranaviruses, Measles, Meningitis, Meningococcal infection, Mumps, Pertussis, Plague, Rabies, Rubella and Congenital Rubella Syndrome, Smallpox, Tetanus including Tetanus Neonatorum, and Unusual Event
- The weekly notifiable diseases and syndromes are: Bilharziasis, Brucellosis, Creutzfeldt-Jakob Disease (Transmissible Spongiform Encephalopathy), Gonococcal Infection,Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, Hepatitis E, Human Immunodeficiency Virus, Human T-cell Lymphotropic Virus 1, Hydatid Disease, Intestinal Infections, Legionellosis, Leishmaniasis, Leprosy, Malaria, Syphilis, Tuberculosis, Typhoid Fever and Typhus.  
Data Sources All Physicians and Healthcare facilities
Case definitions Refer to webpages "Notifiable Diseases"
Form Reporting form
Results Refer to webpage "Surveillance data"

Influenza Surveillance

Severe Acute Respiratory Infection Surveillance (SARI)
Rationale Severe acute respiratory infections (SARI) can be the result of several agents: viral, bacterial, and parasites, even though bacterial and parasitic agents can be less common. Among the viruses, influenza viruses are among the major causes of SARI.
Any preventive or control measure related to Influenza requires the availability of surveillance, including the seasonality pattern and the causative agents.
SARI surveillance in Lebanon was established in collaboration of the World Health Organization.
Objectives The objectives of Severe Acute Respiratory Infection (SARI) in Lebanon are:
- To estimate morbidity (incidence) of SARI in Lebanon
- To identify baseline figures and alert/outbreak thresholds
- To describe SARI cases by time, place, person, susceptibility, severity
- To identify circulating influenza strains and detect novel viruses
- To contribute to the global influenza surveillance
Sources of data Data sources are hospital sentinel sites. Sentinel surveillance focuses on collection of data from specific pre-selected health sites to carefully monitor a specific disease. The collection of the data is systemic. The sites are selected based on key criteria: willingness, activity and representativeness of the population.
The current sentinel sites are:
- In the mohafazas of Beirut and Mount Lebanon: Rafik Hariri University Governmental Hospital (RHUH), Dahr Bacheq Governmental Hospital, Ain Wa Zen Hospital, Notre Dame de Secours Hospital
- In the mohafazas of Bekaa and Baalbeck/Hermel: Zahleh Governmental Hospital and Khoury Hospital
- In the mohafazas of North and Akkar: Tripoli Governmental Hospital and Mounla Hospital
- In the mohafazas of South and Nabatieh: Saida Governmental Hospital, Hammoud Hospital and Nabih Berry / Nabatieh Governmental Hospital
Case Definition An acute respiratory infection with:
- History of fever or measured fever of >=38°C and cough
- Onset within the last 10 days
- Requiring hospitalization
Case Investigation For each SARI case, data is collected including demographical and clinical data. Also, clinical specimens are collected for laboratory testing. The needed specimens are: nasopharyngeal swab (preferable one), oropharyngeal swab, bronchoalveolar lavage (if done), or tracheal aspirate (if patient intubated).
Laboratory Testing Laboratory testing for SARI patients are performed at the National Influenza Center at RHUH. The laboratory testing includes RT-PCR for Influenza viruses A and B.
SARI forms - Lab request form
Results - Latest weekly surveillance data
- Latest semestrial bulletin
- Link to WHO Flunet database

Medical center and dispensaries based reporting

Objectives - To enhance reporting from the ambulatory health system
- To monitor communicable diseases by time, place and person
- To detect alerts and outbreaks at local level
Sources of data - Medical centers and dispensaries of the Ministry of Public Healht MOPH
- Medical centers and dispensaries of the Ministry of Social Affairs MOSA
- Other governemental medical centers and dispensaries
- Medical centers and dispensaries of various Non-Governemetal Organizations NGO
- Field medical units
Target diseases and syndromes - Vaccine preventable diseases: acute flaccid paralysis, measles, rubella, pertussis (whooping cough) and mumps
- For other communicable diseases: acute diarrhea, bloody/dysenteric diarrhea, cholera, acute jaundice, acute respiratory infection (including flu-like illness), unexplained fever, scabies and leishmania
- Others: asthma, accidents/injuries
Guidelines Medical center and dispensaries based surveillance guideline: Ar, En
Reporting form Weekly reporting form
Results - Latest weekly national bulletin
- Latest weekly bulletin for field medical units in Bekaa and Baalbeck/Hermel

Hospital mortality surveillance

Objectives - Measure and monitor on weekly basis mortality indicators in hospital settings in Lebanon
- Detect alerts and identify outbreaks at an early stage
- Detect deaths from emerging and re-emerging diseases
- Assist decision makers on proper control measures
Sources of data - Data sources are both public and private hospitals across Lebanon.
- The MOPH decision requested each hospital to designate a focal person from the medical staff to monitor deaths occurring in the hospital, register them into the nominative hospital death logbook, and report them to the MOPH using an anonymous form
Target deaths - Deaths occurring in the hospital settings
- Deaths received by the hospital settings
Guidelines Hospital mortality surveillance guideline: Ar, En, Fr
Reporting form Weekly reporting form
Results Latest weekly national bulletin

National Cancer Registry

Definition A cancer registry is defined as a location, be it an office or institution, where collection, storage, analysis and interpretation of data on cancer patients take place (Jenson et al, 1991).
Objectives - To measure cancer incidence
- To describe cancer by time, place, persons and disease
- To provide a national database for further epidemiological research
Case definition Target cases are:
- Incident cases by year of diagnosis
- Malignant tumors confirmed by histopathology and/or hematology findings
- Cancers of all sites
Sources of data Data are collected through two main channels: the capture system (passive reporting) and the recapture system (active reporting).
1) The capture system: 
The capture system is based on physician’s routine reporting of cancer cases. Physician’s complete and send forms:
- Directly from their clinic; or
- Indirectly through the MOPH Drug Dispensing Center (DDC), where anti-cancer drugs are distributed to eligible patients
2) The recapture system: 
The recapture system is based on gathering information directly from histopathological and hematological laboratories. Data are collected in various ways, using hard or soft copies, or using database file or individual laboratory results depending on laboratories resources. This process is active since the NCR personnel actually contact the sites to obtain the necessary data. The recapture system validates and complements the capture approach.
Medical coding The coding of cancer primary sites and cancer morphology is done using International Classification of Diseases for Oncology, third edition (ICD-O-3).
The code includes information on the topography (primary site), the histology, the behavior and the grade of the tumor.
The structure is C##.# M####/##, where:
- C##.# specifies the primary site
- M#### specifies the histology
- /## specifies the behavior and the grade of the tumor
Reporting form NCR reporting form
Results Year 2015:
Final 2015 figures will be posted soon once compared with 2014 figures (end May 2017).
Year 2010:
- Counts by site, both gender
- Counts by site, males
- Counts by site, females
- Proportions by site, males
- Proportions by site, females
- Incidence rates by site, males
- Incidence rates by site, females
- Pediatric: main groups (counts)
- Pediatric: main groups (%)
- Pediatric: groups
Year 2009:
- Counts by site, both gender
- Counts by site, males
- Counts by site, females
- Proportions by site, males
- Proportions by site, females
- Incidence rates by site, males
- Incidence rates by site, females
- Pediatric: main groups (counts)
- Pediatric: main groups (%)
- Pediatric: groups
Year 2008:
- Counts by site, both gender
- Counts by site, males
- Counts by site, females
- Proportions by site, males
- Proportions by site, females
- Incidence rates by site, males
- Incidence rates by site, females
- Pediatric: main groups (counts)
- Pediatric: main groups (%)
- Pediatric: groups
Year 2007:
- Counts by site, both gender
- Counts by site, males
- Counts by site, females
- Proportions by site, males
- Proportions by site, females
- Incidence rates by site, males
- Incidence rates by site, females
- Pediatric: main groups (counts)
- Pediatric: main groups (%)
- Pediatric: groups
Year 2006:
- Counts by site, both gender
- Counts by site, males
- Counts by site, females
- Proportions by site, males
- Proportions by site, females
- Incidence rates by site, males
- Incidence rates by site, females
- Pediatric: main groups (counts)
- Pediatric: main groups (%)
- Pediatric: groups
Year 2005:
- Counts by site, both gender
- Counts by site, males
- Counts by site, females
- Proportions by site, males
- Proportions by site, females
- Incidence rates by site, males
- Incidence rates by site, females
- Pediatric: main groups (counts)
- Pediatric: main groups (%)
- Pediatric: groups
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