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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
J01CR02 MEGAMOX-JPI G Amoxicillin (trihydrate) - 500mg, Clavulanic Acid (potassium) - 125mg 625mg Tablet 245,923 L.L
J01CR02 AUGMENTIN ES B Amoxicillin (trihydrate) - 600mg/5ml, Clavulanic Acid (potassium) - 42.9mg/5ml 642.9mg/5ml Powder for suspension 846,621 L.L
J01CR02 AMOCLAN BID G Amoxicillin (trihydrate) - 600mg/5ml, Clavulanic Acid (potassium) - 42.9mg/5ml 642.9mg/5ml Powder for suspension 507,972 L.L
J01CR02 JULMENTIN ES G Amoxicillin (trihydrate) - 600mg/5ml, Clavulanic Acid (potassium) - 42.9mg/5ml 642.9mg/5ml Powder for suspension 507,972 L.L
N07BC01 BUVIDAL B Buprenorphine - 64mg 64mg Injectable solution prolonged release 34,835,645 L.L
N02BE01 PARANOR G Paracetamol - 650mg 650mg Tablet 162,605 L.L
V03AE07 PHOSPHOLOW G Calcium acetate - 660mg 660mg Tablet 846,621 L.L
N02BE01 PANADOL JOINT B Paracetamol - 665mg 665mg Tablet, film coated, prolonged release 291,614 L.L
N02BE01 FEBRADOL JOINT G Paracetamol - 665mg 665mg Tablet 289,246 L.L
G03GA05 GONAL-f BioHuman Follitropin alfa - 900IU/1.5ml 66mcg/1.5ml Injectable solution 29,625,401 L.L
G03AC08 IMPLANON NXT B Etonogestrel - 68mg 68mg Implant 12,299,971 L.L
N05AX13 INVEGA B Paliperidone - 6mg 6mg Tablet, extended release 5,825,557 L.L
N05AX15 REAGILA G Cariprazine - 6mg 6mg Capsule, hard 6,394,003 L.L
H02AB13 DEFAL B Deflazacort - 6mg 6mg Tablet 415,247 L.L
N05BA08 BROMAZEPAM BIOGARAN G Bromazepam - 6mg 6mg Tablet, scored 180,075 L.L
P02CF01 IVER G Ivermectin - 6mg 6mg Tablet 431,373 L.L
P02CF01 IVERMECTIN BENTA G Ivermectin - 6mg 6mg Tablet 784,548 L.L
P02CF01 IVERMECTIN BENTA G Ivermectin - 6mg 6mg Tablet 470,985 L.L
A10BB12 JOSWE GLEMAX 6 G Glimepiride - 6mg 6mg Caplet 663,858 L.L
L03AA13 ZIEXTENZO BioTech Pegfilgrastim - 6mg 6mg Injectable solution 41,050,549 L.L
N03AX22 FYCOMPA B Perampanel - 6mg 6mg Tablet, film coated 8,751,127 L.L
J07AX URO-VAXOM B Lyophilized bacterial lysates of E-Coli - 6mg 6mg Capsule 2,689,029 L.L
S01LA09 VABYSMO B Faricimab - 6mg/0.05ml 6mg/0.05ml Injectable solution 54,991,170 L.L
L03AA13 NEULASTIM BioTech Pegfilgrastim - 6mg/0.6ml 6mg/0.6ml Injectable solution 56,925,965 L.L
N04BC09 NEUPRO B Rotigotine - 6mg/24h 6mg/24h Patch 9,427,593 L.L
C01EB10 CARDESINE G Adenosine - 6mg/2ml 6mg/2ml Injectable solution 563,070 L.L
M05BA06 BONDRONAT B Ibandronic acid (monosodium monohydrate) - 6mg/6ml 6mg/6ml Injectable concentrated powder for solution 24,963,868 L.L
A10BJ02 SAXENDA BioTech Liraglutide - 6mg/ml 6mg/ml Injectable solution 16,747,035 L.L
B01AB12 HIBOR G Bemiparin Sodium - 7,500IU 7,500IU Injectable solution 2,198,526 L.L
B05XA01 CHLORURE DE POTASSIUM RENAUDIN G Potassium chloride - 7.46g/100ml 7.46% Injectable solution 385,683 L.L
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