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National Tuberculosis Program

 
About the National Tuberculosis Program-Lebanon
NTP Centers and Services
 

The National Tuberculosis Program (NTP), under the Ministry of Public Health of Lebanon, operates through the Tuberculosis (TB) central unit at Karantina and 9 TB control centers across the country:


1 center located in Beirut (Karantina), 1 in Mount Lebanon (Barouk), 2 in Bekaa (Zahleh and Hermel), 2 in the North (Tripoli and Halba), and 3 in the South (Nabatieh, Saida and Tyre).

NTP is committed to providing equitable, quality services for the diagnosis and treatment of TB to all notified cases residing in Lebanon, regardless of the geographical region, economic status and country of origin.

The following services are provided FREE of charge at the TB centers falling under the NTP:
  • TB diagnostics and laboratory services (Chest Radiography, Direct Smear Microscopy, Gene Xpert testing, Culture and Drug Sensibility testing for first and second line drugs)
  • TB cases management and treatment (first and second line treatment regimens provided for drug-susceptible and drug-resistant TB cases)
  • Treatment follow-up and Support through Directly Observed Treatment (DOT) and Video Observed Treatment (VOT)
  • TB Contacts investigations and Screening
  • TB Prevention through the provision of preventive treatment for Latent TB cases in high risk groups when recommended (TB-HIV patients, TB Contacts, Immunocompromised patients, Migrants from high TB burden countries)
Furthermore, MOPH contracted the Sanatorium at Azounieh-Mount Lebanon for TB cases that require hospitalization and isolation.

MOPH also nominated and contracted Laboratoire Rdolphe Merieux (LRM) as the National Reference Laboratory (NRL) for TB in Lebanon as of June 2018. The following diagnostic tests are performed by the NRL as per the national TB guidelines:
  • Culture
  • Phenotypic and Genotypic Drug Susceptibility Testing for first and second line drugs
  • Gene Xpert for extra-pulmonary specimens 
 
NTP-Lebanon Organigram
 
 
 
TB Surveillance
TB Epidemiology in Lebanon

Lebanon is a low TB burden country with an estimated total TB incidence of 13 per 100000 populations, an estimated HIV-negative TB mortality of 1.4 per 100000 populations and a treatment coverage of 76% (WHO Global Tuberculosis Report 2021).
The trend of TB notification which increased from 2012 onwards due to the influx of Syrian refugees and to the migrant workforce present in the country drastically dropped over the past 2 years and this is mainly attributed to the decline in notification among migrants (Figure 1). Figure 2 shows that the percentage of foreign born TB cases which gradually increased between 2006 and 2020 dropped to 50% in 2021. 

Figure 1): Trends in notified TB cases by Population Subgroups, 2007-2021


Figure 2): Trends in notified TB cases-Nationals vs. Non-nationals, 2006-2021

 
In 2021, 474 TB cases, including 470 DS-TB and 4 DR-TB were notified, diagnosed and enrolled under TB treatment. The total notification dropped by 38% and 28% compared to 2019 and 2020 respectively. Furthermore, the distribution by population subgroup shows a decline in notification among the different groups, particularly in migrants with a huge drop of 62% compared to 2019 and 51% compared to 2020.

A. Drug-Susceptible TB Cases

Figure 3: Distribution of TB Cases by Type of Disease

 
Figure 4: Distribution of EPTB Cases by Site of Disease


Figure 5: Distribution of TB Cases by Gender and Age Category


Figure 6: Distribution of TB Cases by Nationality


Figure 7: Distribution of TB Cases by Governorate


Figure 8.a: Distribution of TB cases by Nationality-Beirut


Figure 8.b: Distribution of TB cases by Nationality at District Level-Mount Lebanon


Figure 8.c: Distribution of TB cases by Nationality at District Level-North Lebanon


Figure 8.d: Distribution of TB cases by Nationality at District Level-South Lebanon


Figure 8.e: Distribution of TB cases by Nationality at District Level-Bekaa


B. Drug Resistant-TB Cases-2020

In total 4 cases were reported in 2021 including 2 RR-TB, 1 pre-XDR-TB and 1 XDR-TB case. 3 had PTB and 1 had EPTB; all were non-nationals.
Overall, there were 0.6% DR-TB among new notified TB cases and 17% among previously treated TB cases
 

 
For the Public
What is Tuberculosis?

Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affects the lungs and is called Pulmonary TB. It can also affect other organs in the body (such as the bones, lymph nodes, brain…) and is known as Extra-pulmonary TB.

How does it spread?

TB is spread from person to person through the air; a patient with active pulmonary TB releases the germs into the air through coughing, sneezing or spitting; a person needs to inhale only a few of these ­germs to become infected (Latent TB infection).

A patient with Latent TB means he has been infected by TB bacteria but has not (yet) developed active TB disease and cannot transmit it.

People infected with TB bacteria have a 5 to 15% lifetime risk of falling ill with active TB. However, persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a higher risk of falling ill.

Rarely, a person could get infected with TB after the consumption of unpasteurized milk from infected cows.
 
What are the common signs and symptoms of TB

TB bacteria most commonly affects the lungs, and can cause the following symptoms:
  • Cough that lasts 2 weeks or longer
  • Chest pain
  • Fatigue
  • Loss of appetite
  • Weight loss
  • Fever
  • Night Sweats 

How is it treated?

Active, drug-susceptible TB disease is treated with a standard 6 months course of 4 antimicrobial drugs that are provided with information and support to the patient. TB disease can be cured when medicines are taken properly. You should inform your doctor of any adverse event that might occur throughout the treatment course.

Drug resistance emerges when anti-TB medicines are used inappropriately (such as when a patient stops treatment prematurely) and can lead to the development of a dangerous, life threatening form of TB disease.
 
DOT-VOT
Directly Observed Therapy (DOT) and Video Observed Treatment (VOT) improve treatment adherence by requiring a health worker or volunteer to observe patients taking each dose of the medicine on a daily basis.

TB is preventable and curable. Keep in mind that compliance to treatment is critical for cure and always follow the instructions of your healthcare provider.
 
How to prevent the spread of TB?

If you have tuberculosis, you should follow a number of preventive measures that help in reducing the transmission and spread of the disease especially to household members and close people.
  • Do not spit on the ground
  • Do not cough or sneeze in front of others without covering your mouth or nose
  • Maintain good ventilation of the house
  • Allow natural sunlight into the house
 
For Professionals
Lebanon National Strategic Plan to End Tuberculosis, 2023-2030

National TB Guidelines (Links)
TB Algorithms (Links)
Annual TB Reports (Links)

TB Notification Form - إستمارة إبلاغ عن حالة سل
 
IEC Materials
Sputum collection
Coughing Etiquette
TB Symptoms-1
TB Symptoms-2
TB Symptoms-3
General  facts about TB-Ar

كيفية جمع عينة البلغم
آداب السعال
عوارض السل-1
عوارض السل-2
عوارض السل-3


















 
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ATC Name B/G Ingredients Dosage Form Price
N05AX08 PMS-RISPERIDONE G Risperidone - 1mg 1mg Tablet 823,775 L.L
N07AA01 METHYL SULFATE DE NEOSTIGMINE RENAUDIN G Neostigmine methyl sulfate - 0.5mg/ml 0.5mg/ml Injectable solution 467,657 L.L
A02BC01 GASTRAZOLE G Omeprazole - 20mg 20mg Capsule 245,923 L.L
A10BX02 REPAGLINIDE ARROW LAB G Repaglinide - 1mg 1mg Tablet 831,839 L.L
B05CX01 DEXTROSE G Dextrose, H2O - 50g/100ml 50g/100ml Injectable solution 329,815 L.L
C09CA07 TOLURA G Telmisartan - 80mg 80mg Tablet 698,798 L.L
C10AA07 UBSATOR-CA G Rosuvastatin (calcium) - 20mg 20mg Tablet, film coated 499,142 L.L
D10BA01 CURACNE G Isotretinoin - 40mg 40mg Capsule, soft gelatin 3,553,120 L.L
G04CB02 DUTASTERIDE ARROW LAB G Dutasteride - 0.5mg 0.5mg Capsule 1,166,455 L.L
J01DD04 MEDAXONUM G Ceftriaxone (disodium) - 1g 1g Injectable powder for solution 15,482,229 L.L
J01XX01 FOSFOLAG G Fosfomycine (trométamol) - 3g 3g Granules for solution 399,121 L.L
L01BC01 ALEXAN G Cytarabine - 100mg/5ml 100mg/5ml Injectable solution 388,370 L.L
M03BC51 MUSCEROL 3 G Paracetamol - 450mg, Orphenadrine citrate - 35mg, Ibuprofen - 200mg Tablet, film coated 593,850 L.L
N05AX08 RESPAL 1 G Risperidone - 1mg 1mg Caplet, film coated 309,084 L.L
N07AA01 NEOSTIGMINE RENAUDIN G Neostigmine - 5mg/5ml 5mg/5ml Injectable solution 2,460,576 L.L
S01XA20 LUBRI-TEARS G Carmellose sodium - 2mg Drops solution 792,867 L.L
A02BC01 GASTRISEC G Omeprazole - 20mg 20mg Capsule 413,903 L.L
B05CX01 DEXTROSE G Dextrose, H2O - 20g/100ml 20g/100ml Injectable solution 807,874 L.L
C09CA07 TELMICARD 80 G Telmisartan - 80mg 80mg Tablet 865,179 L.L
J01DD04 MESPORIN-1000 IV G Ceftriaxone (sodium) - 1g 1,000mg Injectable powder for solution+diluent 417,935 L.L
J01XX01 FOSFOKEY G Fosfomycine (trométamol) - 3g 3g Granules for solution 399,121 L.L
L01BC01 ALEXAN G Cytarabine - 1,000mg/20ml 1,000mg/20ml Injectable solution 2,848,946 L.L
L04AD02 TACROGRAF 5 G Tacrolimus - 5mg 5mg Capsule 67,507,154 L.L
N02CC03 ZOLMITRIPTAN ARROW GENERIGUES G Zolmitriptan - 2.5mg 2.5mg Tablet, film coated 1,726,838 L.L
N05AX08 RISPERIDONE BIOGARAN G Risperidone - 1mg 1mg Tablet, coated, scored 643,701 L.L
R05CA12 IVY-CALM G Dried Ivy leaf extract - 35mg/5ml 35mg/5ml Syrup 251,299 L.L
S02AA15 CETRAXAL OTICO G Ciprofloxacine (HCl) - 3mg/ml 3mg/ml Drops 821,088 L.L
A02BC01 OMEDAR G Omeprazole - 20mg 20mg Tablet, enteric coated 18,087,352 L.L
A07EC02 SALCROZINE G Mesalazine - 1g 1g Tablet, gastroresistant 4,073,187 L.L
B05D PERITONEAL DIALYSIS SOLUTION WITH 4 1/4% DEXTROSE G Sodium lactate - 0.392g%, Calcium chloride, 2H2O - 0.0257g%, Magnesium chloride, 6H2O - 0.0153g%, Sodium chloride - 0.567g%, Dextrose, H2O - 4.25g% Injectable solution 498,744 L.L
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