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:
Phenotypic and Genotypic Drug Susceptibility Testing for first and second line drugs
Gene Xpert for extra-pulmonary specimens
ترصد البرنامج الوطني لمكافحة التدرن الرئوي
TB Epidemiology in Lebanon
Lebanon is a low TB burden country with an estimated incidence rate of 11/ 100000 population, an estimated mortality rate of 0.89/ 100000 population and a treatment coverage of 87% in 2018 (WHO Global Tuberculosis Report 2019).
However, TB burden is rising among non-nationals due to the massive influx of Syrian refugees since 2012 and to the migrant workforce present in Lebanon. In fact, the number of TB cases in the non-Lebanese community has gradually increased since 2006, reaching a proportion of 62% of the total TB cases in 2018 and 2019 (Figure 1.a).
Figure1.b represents the trends in notified TB cases by resident status between 2007 and 2019. Actually, in 2019, the NTP succeeded to find, diagnose and treat 760 TB cases which is the highest number of notified cases since 2007. We also notice the rise in total notified cases by 14%, and in Lebanese and migrant TB cases by 13.8% and 12.3% respectively in 2019 compared to 2018.
Figure 1.a): Trends in notified TB cases-Nationals/ Non-nationals, 2006-2019
Figure 1.b): Trends in notified TB cases by nationality, 2007-2019
Moreover, the overall treatment success rate was 81% in all reported TB cases in 2018, and 95% in TB cases among Lebanese and refugees. The low treatment success rate among patients from the migrant workforce (63%) could be attributed to the fact that a large number leave the country before completion of treatment. To overcome this challenge and ensure treatment continuation for migrants who leave Lebanon while still under treatment, the NTP has developed a transfer-out form, which includes information about diagnosis, tests’ results and treatment status, to be sent with patients who leave Lebanon. However further international collaboration is needed to be able to retrieve their treatment outcome from NTP in home-country.
TB Surveillance Data-Year 2019
Distribution of TB Cases by a) Type and b) Site of disease (2019)
Distribution of TB Cases by Gender and Age Category (2019)
Distribution of TB Cases by Nationality (2019)
Distribution of TB Cases by Nationality and Age Category (2019)
Distribution of TB Cases by Nationality at District Level (2019) Beirut
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
Loss of appetite
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.
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
National Strategic Plan
The National Strategic Plan (NSP) toward TB Elimination in Lebanon 2017-2021 was launched at a press conference held by the Ministry of Health during the World TB day on 24 March 2017. The NSP is designed for five years and describes five objectives which are in alignment with the WHO End TB Strategy.
Objective 1: By 2021 further decrease the burden of TB to less than 10 cases/100 000 population by increasing the efforts for case detection and improve treatment outcomes through the existing health service network.
Objective 2: By 2021 decrease by half the burden of TB among migrants and increase case finding activities to all refugee populations newly arrived in Lebanon
Objective 3: Achieve and sustain accurate surveillance, monitoring and evaluation, adherence to SOPs and obtain better estimates of TB situation for a reliable measurement of progress.
Objective 4: Increase coordination among all stakeholders involved in TB prevention care and control, public and private, including social support actors by organizing formal meetings with stakeholders.
Objective 5: Raise TB awareness, decrease stigma through a plan for communication and social mobilization and promote research.