Date: Wed 22 Apr 2015
Source: Daily Star [edited]
Health officials say that Lebanon has seen a sharp rise in the number of hepatitis A cases over the past 2 years. The contagious viral infection is spread through oral ingestion of contaminated water and food. "We are living now in a current epidemic of hepatitis A. It has been going on for more than 2 years," infectious disease specialist Abdul-Rahman Bizri said. Bizri is part of a team of infectious disease advisers helping the Health Ministry trace and monitor the epidemic.
Those who have monitored the spread of hepatitis A in Lebanon point to a range of factors that facilitated its spread and severity: namely, Lebanon's weak public health infrastructure in the face of a rapid influx of Syrian refugees, a substandard water management system, and a shift in the age of hepatitis A onset among the Lebanese population.
In 2014, there were 2500 recorded cases of hepatitis A, up from 1000 cases in the year prior, Bizri said. "Our regular average used to be around 300 cases per year. Now we are witnessing 5 times the average."
Randa Hamadeh, the Immunization and Essential Drugs Program manager for the Lebanese Health Ministry, described the prevalence of hepatitis A as a "huge problem". Hamadeh pointed to culprits similar to those mentioned by Bizri, namely an overburdened health care system, contaminated water and unhygienic living conditions. "We are trying to work with NGOs and municipalities to enhance hygiene and prevent disease," she said.
The outbreak of war in Iraq, and more recently Syria, has lead to a crisis of mass displacement and the breakdown of regional-level disease prevention measures, Bizri said. "The untold effect of this crisis is not only direct casualties from war, but also the spread of disease, due to the fact that many public health systems in the region have failed."
Nadim Farajalla, faculty research director of the Climate Change and Environment in the Arab World Program at the American University of Beirut, said that both groundwater and surface water in Lebanon are at risk of carrying hepatitis A due to sewage that largely goes untreated "in most areas of Lebanon."
"It is estimated that 80 per cent of the surface water in Lebanon is contaminated with sewage effluent," Farajalla said. In residential buildings across the country, "some people build a well to augment water supply, but it might be contaminated," Farajalla said. Consequently, household water reserves could become a point of cross-contamination, where well water is mixed with the government water supply.
Speaking on water safety deficiencies, Bizri said the recent drought between 2013 and 2014 exacerbated the risk of disease outbreak. "Drought means less water, less water means less hygiene, less hygiene means more disease."
Bizri said the ministry recommends hepatitis A vaccination as part of its official schedule, but implementation is not universal. Private health care providers dominate the health system in Lebanon, and offer the vaccine at a cost. Public health facilities are at a relative disadvantage in their ability to offer the vaccine. "If you go to a private physician you will get the vaccine," Bizri said.
Hamadeh, of the Health Ministry's Immunization and Essential Drugs Program, said the ministry was prioritizing hygiene awareness campaigns over vaccinations in the fight against hepatitis A. But financial limitations prevent the ministry from providing the vaccine to all in Lebanon, she said. "We don't have the capacity, knowing that vaccine was very expensive and no one was able to secure the necessarily funds," Hamadeh said.
Hamadeh said that the Health Ministry has focused on community-based preventive hygiene measures in communities to prevent hepatitis A, specifically in "securing clean water, and [hygiene] at the level of schools." She mentioned that Arsal, an area heavily populated with Syrian refugees in the eastern Bekaa Valley, had previously seen a hepatitis A outbreak, which has since been contained. [byline: Sarah Weatherbee]
[The following is extracted from
"Hepatitis A is usually spread when the hepatitis A virus is taken in by mouth from contact with objects, food, or drinks contaminated by the faeces (or stool) of an infected person. A person can get hepatitis A through:
- when an infected person does not wash his or her hands properly after going to the bathroom and touches other objects or food
- when a parent or caregiver does not properly wash his or her hands after changing diapers or cleaning up the stool of an infected person
- when someone has sex or sexual contact with an infected person (not limited to anal-oral contact)
Contaminated food or water
- Hepatitis A can be spread by eating or drinking food or water contaminated with the virus. (This can include frozen or undercooked food.) This is more likely to occur in countries where hepatitis A is common and in areas where there are poor sanitary conditions or poor personal hygiene. The food and drinks most likely to be contaminated are fruits, vegetables, shellfish, ice, and water. In the USA, chlorination of water kills hepatitis A virus that enters the water supply.
Who is at risk for hepatitis A?
Although anyone can get hepatitis A, in the USA, certain groups of people are at higher risk, such as those who:
- travel to or live in countries where hepatitis A is common
- are men who have sexual contact with other men
- use illegal drugs, whether injected or not
- have clotting-factor disorders, such as hemophilia
- live with someone who has hepatitis A
- Have oral-anal sexual contact with someone who has hepatitis A."
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