Clinical Report: Epidemiological Overview of the 2022–2023 Cholera Outbreak in Lebanon

Overview

Lebanon experienced its first cholera outbreak in over 29 years starting October 2022, with 8,072 suspected cases and 23 deaths reported by June 2023. Coordinated multisectoral interventions, including a cholera vaccine campaign, successfully contained the outbreak amid a complex humanitarian crisis.

Background

Lebanon has faced multiple humanitarian emergencies since 2019, including economic collapse, social unrest, and an influx of refugees, severely impacting healthcare access and sanitation. These factors increased vulnerability to communicable diseases, culminating in a cholera outbreak following a similar event in neighboring Syria. The outbreak marked the first local cholera cases in nearly three decades and posed significant public health challenges in a resource-limited setting.

Data Highlights

Key Findings

• The outbreak affected all 8 governorates and 23 of 26 districts in Lebanon.
• Females represented 53% of suspected cases.
• Laboratory confirmation was performed on 8.3% of suspected cases, confirming Vibrio cholerae O1 or O139.
• A one-dose cholera vaccine campaign was initiated in November 2022, achieving nearly 45% coverage by February 2023.
• Multisectoral prevention and control strategies, supported by national and international stakeholders, were critical in outbreak containment.
• Water sources and environmental samples were tested to identify contamination and guide interventions.

Clinical Implications

Clinicians should maintain high suspicion for cholera in patients presenting with acute watery diarrhea in outbreak settings, especially amid humanitarian crises. Early laboratory confirmation and reporting are essential for outbreak control. Vaccination campaigns and improvements in water, sanitation, and hygiene infrastructure are vital components of cholera prevention and control in vulnerable populations.

Conclusion

The 2022–2023 cholera outbreak in Lebanon underscores the impact of humanitarian crises on infectious disease resurgence. Coordinated surveillance, vaccination, and multisectoral interventions effectively contained the outbreak despite significant systemic challenges.

References

1. Lebanese Ministry of Public Health/WHO/2023 -- Epidemiological Overview of the Cholera Outbreak in Lebanon (2022–2023)