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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
A12AX CALPEROS D3 A SUCER B Vitamin D3 - 400IU, Calcium - 500mg Tablet, chewable 667,890 L.L
C10BA06 ZYMPASS B Rosuvastatin (calcium) - 20mg, Ezetimibe - 10mg Tablet, film coated 2,482,077 L.L
H01CC02 CETROTIDE B Cetrorelix (acetate) - 0.25mg 0.25mg Injectable lyophilised powder for solution+diluent 21,354,452 L.L
J01DD08 SUPRAX 100 B Cefixime (trihydrate) - 100mg/5ml 100mg/5ml Powder for suspension 581,884 L.L
L04AD01 SANDIMMUN NEORAL SOFT GELATIN B Ciclosporin - 25mg 25mg Capsule, soft gelatin 2,385,320 L.L
S01ED51 GANFORT B Timolol maleate - 5mg/ml, Bimatoprost - 300mcg/ml Drops solution 950,097 L.L
A03AX13 OVOL FOR GAZ B Simethicone - 180mg 180mg Capsule, liquid gel 241,892 L.L
A12AX CI-CAL+D B Calcium citrate - 250mg, Vitamin D3 - 125IU Tablet 796,899 L.L
C10BA06 ZYMPASS B Rosuvastatin (calcium) - 40mg, Ezetimibe - 10mg Tablet, film coated 2,482,077 L.L
H01CC02 CETROTIDE B Cetrorelix (acetate) - 0.25mg 0.25mg Injectable lyophilised powder for solution+diluent 3,420,079 L.L
L04AD01 SANDIMMUN NEORAL SOFT GELATIN B Ciclosporin - 100mg 100mg Capsule, soft gelatin 8,264,592 L.L
N02BE51 123 COMPLETE B Acetaminophen (day tablet, night tablet) - 500mg, Dextromethorphan HBr (day tablet, night tablet) - 5mg, Phenylephrine HCl (day tablet, night tablet) - 5mg, Carbinoxamine maleate (night tablet) - 3mg Tablet 537,537 L.L
R03DC03 SINGULAIR B Montelukast (sodium) - 10mg 10mg Tablet, film coated 1,248,430 L.L
S01ED51 GANFORT B Timolol maleate - 5mg/ml, Bimatoprost - 300mcg/ml Drops solution 950,097 L.L
A03AX58 METEOSPASMYL B Alverine citrate - 60mg, Simethicone - 300mg Capsule 481,096 L.L
A12AX CI-CAL+D B Calcium citrate - 250mg, Vitamin D3 - 1,000IU Tablet 1,118,077 L.L
C09DA06 ATACAND PLUS B Candesartan cilexetil - 16mg, Hydrochlorothiazide - 12.5mg Tablet 705,517 L.L
H02AB01 DIPROFOS B Betamethasone (dipropionate) - 5mg/ml, Betamethasone (sodium phosphate) - 2mg/ml Injectable suspension 446,156 L.L
J02AC01 DIFLUCAN B Fluconazole - 150mg 150mg Capsule 286,238 L.L
L04AD01 SANDIMMUN NEORAL B Ciclosporin - 100mg/ml 100mg/ml Solution 8,264,592 L.L
S01ED51 DUOTRAV B Timolol (maleate) - 5mg, Travoprost - 40mcg Drops solution 1,933,789 L.L
A10BA02 GLUCOPHAGE XR B Metformin HCl - 750mg 750mg Tablet, prolonged release 665,875 L.L
A12AX CI-CAL+D B Calcium citrate - 250mg, Vitamin D3 - 800IU Tablet, chewable 804,962 L.L
C09DA06 BLOPRESS PLUS 16MG B Candesartan cilexetil - 16mg, Hydrochlorothiazide - 12.5mg Tablet 1,257,837 L.L
H02AB02 DECADRON B Dexamethasone - 0.5mg/5ml 0.5mg/5ml Elixir 449,227 L.L
L01BC06 XELODA B Capecitabine - 500mg 500mg Tablet, film coated 17,946,398 L.L
L04AD02 PROGRAF 1MG B Tacrolimus - 1mg 1mg Capsule 25,241,922 L.L
M03BA03 LUMIRELAX B Methocarbamol - 500mg 500mg Tablet 667,890 L.L
C10BX06 TRINOMIA B Acetylsalicylic acid - 100mg, Atorvastatin - 20mg, Ramipril - 2.5mg Capsule, hard 1,029,383 L.L
J01DD08 SUPRAX 100 B Cefixime (trihydrate) - 100mg/5ml 100mg/5ml Powder for suspension 1,166,455 L.L
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