Descriptive Epidemiology of the 2022–2023 Cholera Outbreak in Lebanon and Lessons Learned in the Context of a Humanitarian Emergency Situation

Category	Detail
Condition	Cholera outbreak caused by Vibrio cholerae O1 or O139
Key Mechanisms	Transmission via contaminated water and poor sanitation in a humanitarian crisis context
Target Population	General population in Lebanon, including refugees and vulnerable groups during a humanitarian emergency
Care Setting	Hospitals, medical centers, community health settings, and field investigations

First cholera outbreak in Lebanon in over 29 years, with 8072 suspected cases and 23 deaths reported from October 2022 to June 2023.
Outbreak spread across all 8 governorates and 23 of 26 districts, with a case fatality ratio of 0.28%.
Coordinated multisectoral prevention and control strategies, including a 1-dose cholera vaccine campaign, led to successful containment.

Suspected case defined as acute watery diarrhea in cholera areas or with dehydration/death in noncholera areas per WHO guidelines.
Confirmed case requires positive culture or PCR for Vibrio cholerae O1 or O139.
Testing strategy includes culture, PCR, and rapid diagnostic tests depending on outbreak phase and area.

Implement coordinated multisectoral prevention and control strategies supported by national and international stakeholders.
Conduct cholera vaccination campaigns with at least a 1-dose strategy targeting affected populations.
Ensure access to clean drinking water, sanitation, and hygiene services especially in humanitarian crisis settings.

Use national online platforms (e.g., DHIS2) for case notification and data management.
Perform field investigations including active case search and environmental sampling.
Generate daily epidemiological reports for decision makers and public dissemination.

Humanitarian emergencies, economic crisis, social unrest, and refugee influx increase vulnerability to cholera outbreaks.
Limited access to healthcare, clean water, and sanitation exacerbates transmission risk.
Delayed diagnosis and inadequate surveillance can hinder outbreak control.

Suspected and confirmed cholera cases in Lebanon during the 2022–2023 outbreak, including vulnerable refugee populations.

Laboratory confirmation prioritized in early outbreak phases; antibiotic susceptibility testing performed to guide therapy.

Adopt WHO case definitions for suspected and confirmed cholera to standardize diagnosis.
Implement rapid and coordinated multisectoral outbreak response including vaccination, water sanitation, and hygiene interventions.
Strengthen laboratory capacity for culture, PCR, and rapid diagnostic testing to confirm cases and monitor antibiotic resistance.
Engage community reporting mechanisms (e.g., hotlines) to enhance surveillance and early detection.
Regularly update and share epidemiological data with stakeholders to guide public health actions.

Clinical Scorecard: Epidemiological Overview of the Cholera Outbreak in Lebanon (2022–2023) and Insights Gained from the Humanitarian Crisis Response