Skip to main content
Top
Published in: BMC Infectious Diseases 1/2020

01-12-2020 | Mumps | Research article

Measles and mumps outbreaks in Lebanon: trends and links

Authors: Talal El Zarif, Mohamed Faisal Kassir, Nazih Bizri, Ghida Kassir, Umayya Musharrafieh, Abdul Rahman Bizri

Published in: BMC Infectious Diseases | Issue 1/2020

Login to get access

Abstract

Background

Lebanon has experienced several measles and mumps outbreaks in the past 20 years. In this article, a case-based surveillance of both measles and mumps outbreaks in Lebanon was carried out in an attempt to outline factors contributing to the failure of elimination plans and to provide potential solutions. The relationship between the outbreaks of both diseases was described and explored.

Methods

A retrospective descriptive study of confirmed cases of measles and mumps in Lebanon between 2003 and 2018 collected from the Lebanese Ministry of Public Health Epidemiological Surveillance Unit public database was carried out. The information collected was graphically represented taking into consideration dates of reported cases, age groups affected, and vaccination status.

Results

The mean number of measles cases was 150.25 cases/year in the 1–4 years age group, 87 cases/year in individuals aging between 5 and 14, and 63.68 cases/year in those > 14 years old. In the latter group, only 18.05% were unvaccinated. The mean number of mumps cases was 30.4 cases/year in the < 4 year age group and 53.8 cases/year in the 10–19 years age group. During the study period, every spike in measles cases was followed by a similar spike in mumps. 9.66% of measles cases occurred in individuals who received at least 2 doses of the vaccine, 52.26% in the unvaccinated, and 38% in those whose vaccination status was undetermined.

Conclusions

Measles in Lebanon is a disease of the pediatric population, but adults remain at risk. Outbreaks of mumps followed those of measles and were mainly among adolescents. Presence of a large number of Syrian refugees in the country may further complicate the situation. Vaccination activities need to be intensified.
Literature
1.
go back to reference Goodson JL, Seward JF. Measles 50 years after use of measles vaccine. Infect Dis Clin N Am. 2015;29(4):725–43.CrossRef Goodson JL, Seward JF. Measles 50 years after use of measles vaccine. Infect Dis Clin N Am. 2015;29(4):725–43.CrossRef
2.
go back to reference Orenstein WA, Cairns L, Hinman A, Nkowane B, Olive JM, Reingold AL. Measles and rubella global strategic plan 2012-2020 midterm review report: background and summary. Vaccine. 2018;36(Suppl 1):A35–42.CrossRef Orenstein WA, Cairns L, Hinman A, Nkowane B, Olive JM, Reingold AL. Measles and rubella global strategic plan 2012-2020 midterm review report: background and summary. Vaccine. 2018;36(Suppl 1):A35–42.CrossRef
3.
go back to reference Thompson KM. Evolution and use of dynamic transmission models for measles and rubella risk and policy analysis. Risk Anal. 2016;36(7):1383–403.CrossRef Thompson KM. Evolution and use of dynamic transmission models for measles and rubella risk and policy analysis. Risk Anal. 2016;36(7):1383–403.CrossRef
4.
go back to reference World Health Organization. Measles vaccines: WHO position paper, April 2017 - recommendations. Vaccine. 2019;37(2):219–22.CrossRef World Health Organization. Measles vaccines: WHO position paper, April 2017 - recommendations. Vaccine. 2019;37(2):219–22.CrossRef
5.
go back to reference Dbaibo G, Tatochenko V, Wutzler P. Issues in pediatric vaccine-preventable diseases in low- to middle-income countries. Hum Vaccin Immunother. 2016;12(9):2365–77.CrossRef Dbaibo G, Tatochenko V, Wutzler P. Issues in pediatric vaccine-preventable diseases in low- to middle-income countries. Hum Vaccin Immunother. 2016;12(9):2365–77.CrossRef
9.
go back to reference Patel MK, Gacic-Dobo M, Strebel PM, Dabbagh A, Mulders MN, Okwo-Bele JM, Dumolard L, Rota PA, Kretsinger K, Goodson JL. Progress toward regional measles elimination - worldwide, 2000-2015. MMWR Morb Mortal Wkly Rep. 2016;65(44):1228–33.CrossRef Patel MK, Gacic-Dobo M, Strebel PM, Dabbagh A, Mulders MN, Okwo-Bele JM, Dumolard L, Rota PA, Kretsinger K, Goodson JL. Progress toward regional measles elimination - worldwide, 2000-2015. MMWR Morb Mortal Wkly Rep. 2016;65(44):1228–33.CrossRef
11.
go back to reference Ozaras R, Leblebicioglu H, Sunbul M, Tabak F, Balkan II, Yemisen M, Sencan I, Ozturk R. The Syrian conflict and infectious diseases. Expert Rev Anti-Infect Ther. 2016;14(6):547–55.CrossRef Ozaras R, Leblebicioglu H, Sunbul M, Tabak F, Balkan II, Yemisen M, Sencan I, Ozturk R. The Syrian conflict and infectious diseases. Expert Rev Anti-Infect Ther. 2016;14(6):547–55.CrossRef
12.
go back to reference Raslan R, El Sayegh S, Chams S, Chams N, Leone A, Hajj Hussein I. Re-emerging vaccine-preventable diseases in war-affected peoples of the eastern Mediterranean region-an update. Front Public Health. 2017;5:283.CrossRef Raslan R, El Sayegh S, Chams S, Chams N, Leone A, Hajj Hussein I. Re-emerging vaccine-preventable diseases in war-affected peoples of the eastern Mediterranean region-an update. Front Public Health. 2017;5:283.CrossRef
13.
go back to reference Mansour Z, Hamadeh R, Rady A, Danovaro-Holliday MC, Fahmy K, Said R, Brandt L, Warrak R, Ammar W. Vaccination coverage in Lebanon following the Syrian crisis: results from the district-based immunization coverage evaluation survey 2016. BMC Public Health. 2019;19(1):58.CrossRef Mansour Z, Hamadeh R, Rady A, Danovaro-Holliday MC, Fahmy K, Said R, Brandt L, Warrak R, Ammar W. Vaccination coverage in Lebanon following the Syrian crisis: results from the district-based immunization coverage evaluation survey 2016. BMC Public Health. 2019;19(1):58.CrossRef
14.
go back to reference Cardemil CV, Dahl RM, James L, Wannemuehler K, Gary HE, Shah M, Marin M, Riley J, Feikin DR, Patel M, et al. Effectiveness of a third dose of MMR vaccine for mumps outbreak control. N Engl J Med. 2017;377(10):947–56.CrossRef Cardemil CV, Dahl RM, James L, Wannemuehler K, Gary HE, Shah M, Marin M, Riley J, Feikin DR, Patel M, et al. Effectiveness of a third dose of MMR vaccine for mumps outbreak control. N Engl J Med. 2017;377(10):947–56.CrossRef
15.
go back to reference Patel MK, Orenstein WA. Classification of global measles cases in 2013&#x2013;17 as due to policy or vaccination failure: a retrospective review of global surveillance data. Lancet Glob Health. 2019;7(3):e313–20.CrossRef Patel MK, Orenstein WA. Classification of global measles cases in 2013&#x2013;17 as due to policy or vaccination failure: a retrospective review of global surveillance data. Lancet Glob Health. 2019;7(3):e313–20.CrossRef
16.
go back to reference Chamat S, Salameh P, Haddad N, Berry A, Chedid P, Bouharoun-Tayoun H. Protection of medical and paramedical university students in Lebanon against measles, mumps, rubella and varicella: active measures are needed. J Infect Public Health. 2011;4(3):125–34.CrossRef Chamat S, Salameh P, Haddad N, Berry A, Chedid P, Bouharoun-Tayoun H. Protection of medical and paramedical university students in Lebanon against measles, mumps, rubella and varicella: active measures are needed. J Infect Public Health. 2011;4(3):125–34.CrossRef
17.
go back to reference Kmeid M, Azouri H, Aaraj R, Bechara E, Antonios D. Vaccine coverage for Lebanese citizens and Syrian refugees in Lebanon. Int Health. 2019;11(6):568–79.CrossRef Kmeid M, Azouri H, Aaraj R, Bechara E, Antonios D. Vaccine coverage for Lebanese citizens and Syrian refugees in Lebanon. Int Health. 2019;11(6):568–79.CrossRef
18.
go back to reference Damm O, Witte J, Wetzka S, Prosser C, Braun S, Welte R, Greiner W. Epidemiology and economic burden of measles, mumps, pertussis, and varicella in Germany: a systematic review. Int J Public Health. 2016;61(7):847–60.CrossRef Damm O, Witte J, Wetzka S, Prosser C, Braun S, Welte R, Greiner W. Epidemiology and economic burden of measles, mumps, pertussis, and varicella in Germany: a systematic review. Int J Public Health. 2016;61(7):847–60.CrossRef
19.
go back to reference Melenotte C, Zandotti C, Gautret P, Parola P, Raoult D. Measles: is a new vaccine approach needed? Lancet Infect Dis. 2018;18(10):1060–1.CrossRef Melenotte C, Zandotti C, Gautret P, Parola P, Raoult D. Measles: is a new vaccine approach needed? Lancet Infect Dis. 2018;18(10):1060–1.CrossRef
20.
go back to reference Manikkavasagan G, Ramsay M. Protecting infants against measles in England and Wales: a review. Arch Dis Child. 2009;94(9):681–5.CrossRef Manikkavasagan G, Ramsay M. Protecting infants against measles in England and Wales: a review. Arch Dis Child. 2009;94(9):681–5.CrossRef
21.
go back to reference Özbek S, Vural M, Tastan Y, Kahraman I, Perk Y, Ilter Ö. Passive immunity of premature infants against measles during early infancy. Acta Paediatr. 1999;88(11):1254–7.CrossRef Özbek S, Vural M, Tastan Y, Kahraman I, Perk Y, Ilter Ö. Passive immunity of premature infants against measles during early infancy. Acta Paediatr. 1999;88(11):1254–7.CrossRef
26.
go back to reference He H, Chen E-F, Li Q, Wang Z, Yan R, Fu J, Pan J. Waning immunity to measles in young adults and booster effects of revaccination in secondary school students. Vaccine. 2013;31(3):533–7.CrossRef He H, Chen E-F, Li Q, Wang Z, Yan R, Fu J, Pan J. Waning immunity to measles in young adults and booster effects of revaccination in secondary school students. Vaccine. 2013;31(3):533–7.CrossRef
27.
go back to reference Kennedy RB, Ovsyannikova IG, Thomas A, Larrabee BR, Rubin S, Poland GA. Differential durability of immune responses to measles and mumps following MMR vaccination. Vaccine. 2019;37(13):1775–84.CrossRef Kennedy RB, Ovsyannikova IG, Thomas A, Larrabee BR, Rubin S, Poland GA. Differential durability of immune responses to measles and mumps following MMR vaccination. Vaccine. 2019;37(13):1775–84.CrossRef
28.
go back to reference Indenbaum V, Hübschen JM, Stein-Zamir C, Mendelson E, Sofer D, Hindiyeh M, Anis E, Abramson N, Haas EJ, Yosef Y, et al. Ongoing mumps outbreak in Israel, January to August 2017. Euro Surveill. 2017;22(35):30605.CrossRef Indenbaum V, Hübschen JM, Stein-Zamir C, Mendelson E, Sofer D, Hindiyeh M, Anis E, Abramson N, Haas EJ, Yosef Y, et al. Ongoing mumps outbreak in Israel, January to August 2017. Euro Surveill. 2017;22(35):30605.CrossRef
29.
go back to reference Avramovich E, Indenbaum V, Haber M, Amitai Z, Tsifanski E, Farjun S, Sarig A, Bracha A, Castillo K, Markovich MP, et al. Measles outbreak in a highly vaccinated population - Israel, July-august 2017. MMWR Morb Mortal Wkly Rep. 2018;67(42):1186–8.CrossRef Avramovich E, Indenbaum V, Haber M, Amitai Z, Tsifanski E, Farjun S, Sarig A, Bracha A, Castillo K, Markovich MP, et al. Measles outbreak in a highly vaccinated population - Israel, July-august 2017. MMWR Morb Mortal Wkly Rep. 2018;67(42):1186–8.CrossRef
30.
go back to reference Mina MJ, Metcalf CJE, de Swart RL, Osterhaus ADME, Grenfell BT. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science. 2015;348(6235):694–9.CrossRef Mina MJ, Metcalf CJE, de Swart RL, Osterhaus ADME, Grenfell BT. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science. 2015;348(6235):694–9.CrossRef
31.
go back to reference de Vries RD, McQuaid S, van Amerongen G, Yüksel S, Verburgh RJ, Osterhaus ADME, Duprex WP, de Swart RL. Measles immune suppression: lessons from the macaque model. PLoS Pathog. 2012;8(8):e1002885.CrossRef de Vries RD, McQuaid S, van Amerongen G, Yüksel S, Verburgh RJ, Osterhaus ADME, Duprex WP, de Swart RL. Measles immune suppression: lessons from the macaque model. PLoS Pathog. 2012;8(8):e1002885.CrossRef
32.
go back to reference Condack C, Grivel J-C, Devaux P, Margolis L, Cattaneo R. Measles virus vaccine attenuation: suboptimal infection of lymphatic tissue and tropism alteration. J Infect Dis. 2007;196(4):541–9.CrossRef Condack C, Grivel J-C, Devaux P, Margolis L, Cattaneo R. Measles virus vaccine attenuation: suboptimal infection of lymphatic tissue and tropism alteration. J Infect Dis. 2007;196(4):541–9.CrossRef
33.
go back to reference Laksono BM, Grosserichter-Wagener C, de Vries RD, Langeveld SAG, Brem MD, van Dongen JJM, Katsikis PD, Koopmans MPG, van Zelm MC, de Swart RL. In vitro measles virus infection of human lymphocyte subsets demonstrates high susceptibility and permissiveness of both naive and memory B cells. J Virol. 2018;92(8):e00131–18.CrossRef Laksono BM, Grosserichter-Wagener C, de Vries RD, Langeveld SAG, Brem MD, van Dongen JJM, Katsikis PD, Koopmans MPG, van Zelm MC, de Swart RL. In vitro measles virus infection of human lymphocyte subsets demonstrates high susceptibility and permissiveness of both naive and memory B cells. J Virol. 2018;92(8):e00131–18.CrossRef
35.
go back to reference Althaus CL, Salathé M. Measles vaccination coverage and cases among vaccinated persons. Emerg Infect Dis. 2015;21(8):1480–1.CrossRef Althaus CL, Salathé M. Measles vaccination coverage and cases among vaccinated persons. Emerg Infect Dis. 2015;21(8):1480–1.CrossRef
36.
go back to reference Mansour Z, Said R, Brandt L, Khachan J, Rady A, Fahmy K, Danovaro-Holliday MC. Factors affecting age-appropriate timeliness of vaccination coverage among children in Lebanon. Gates Open Res. 2018;2:71.CrossRef Mansour Z, Said R, Brandt L, Khachan J, Rady A, Fahmy K, Danovaro-Holliday MC. Factors affecting age-appropriate timeliness of vaccination coverage among children in Lebanon. Gates Open Res. 2018;2:71.CrossRef
37.
go back to reference Sinno DD, Shoaib HA, Musharrafieh UM, Hamadeh GN. Prevalence and predictors of immunization in a health insurance plan in a developing country. Pediatr Int. 2009;51(4):520–5.CrossRef Sinno DD, Shoaib HA, Musharrafieh UM, Hamadeh GN. Prevalence and predictors of immunization in a health insurance plan in a developing country. Pediatr Int. 2009;51(4):520–5.CrossRef
38.
go back to reference Yeung LF, Lurie P, Dayan G, Eduardo E, Britz PH, Redd SB, Papania MJ, Seward JF. A limited measles outbreak in a highly vaccinated US boarding school. Pediatrics. 2005;116(6):1287–91.CrossRef Yeung LF, Lurie P, Dayan G, Eduardo E, Britz PH, Redd SB, Papania MJ, Seward JF. A limited measles outbreak in a highly vaccinated US boarding school. Pediatrics. 2005;116(6):1287–91.CrossRef
39.
go back to reference Kassir MF, El Zarif T, Kassir G, Berry A, Musharrafieh U, Bizri AR. Human rabies control in Lebanon: a call for action. Epidemiol Infect. 2018;147:e46.CrossRef Kassir MF, El Zarif T, Kassir G, Berry A, Musharrafieh U, Bizri AR. Human rabies control in Lebanon: a call for action. Epidemiol Infect. 2018;147:e46.CrossRef
40.
go back to reference Ceccarelli G, Vita S, Riva E, Cella E, Lopalco M, Antonelli F, De Cesaris M, Fogolari M, Dicuonzo G, Ciccozzi M, et al. Susceptibility to measles in migrant population: implication for policy makers. J Travel Med. 2018;25(1):tax080. Ceccarelli G, Vita S, Riva E, Cella E, Lopalco M, Antonelli F, De Cesaris M, Fogolari M, Dicuonzo G, Ciccozzi M, et al. Susceptibility to measles in migrant population: implication for policy makers. J Travel Med. 2018;25(1):tax080.
41.
go back to reference Hussain A, Ali S, Ahmed M, Hussain S. The anti-vaccination movement: a regression in modern medicine. Cureus. 2018;10(7):e2919.PubMedPubMedCentral Hussain A, Ali S, Ahmed M, Hussain S. The anti-vaccination movement: a regression in modern medicine. Cureus. 2018;10(7):e2919.PubMedPubMedCentral
42.
go back to reference Brown KF, Long SJ, Ramsay M, Hudson MJ, Green J, Vincent CA, Kroll JS, Fraser G, Sevdalis N. UK parents’ decision-making about measles–mumps–rubella (MMR) vaccine 10 years after the MMR-autism controversy: a qualitative analysis. Vaccine. 2012;30(10):1855–64.CrossRef Brown KF, Long SJ, Ramsay M, Hudson MJ, Green J, Vincent CA, Kroll JS, Fraser G, Sevdalis N. UK parents’ decision-making about measles–mumps–rubella (MMR) vaccine 10 years after the MMR-autism controversy: a qualitative analysis. Vaccine. 2012;30(10):1855–64.CrossRef
43.
go back to reference Hoffman BL, Felter EM, Chu KH, Shensa A, Hermann C, Wolynn T, Williams D, Primack BA. It's not all about autism: the emerging landscape of anti-vaccination sentiment on Facebook. Vaccine. 2019;37(16):2216-23. Hoffman BL, Felter EM, Chu KH, Shensa A, Hermann C, Wolynn T, Williams D, Primack BA. It's not all about autism: the emerging landscape of anti-vaccination sentiment on Facebook. Vaccine. 2019;37(16):2216-23.
44.
go back to reference Li Y, Liu X, Wang L. Modelling the transmission dynamics and control of mumps in mainland China. Int J Environ Res Public Health. 2017;15(1):33.CrossRef Li Y, Liu X, Wang L. Modelling the transmission dynamics and control of mumps in mainland China. Int J Environ Res Public Health. 2017;15(1):33.CrossRef
45.
go back to reference Plotkin SA. Third dose of MMR vaccine for mumps control. N Engl J Med. 2017;377(24):2403.CrossRef Plotkin SA. Third dose of MMR vaccine for mumps control. N Engl J Med. 2017;377(24):2403.CrossRef
46.
go back to reference Lewnard JA, Grad YH. Vaccine waning and mumps re-emergence in the United States. Sci Transl Med. 2018;10(433):eaao5945.CrossRef Lewnard JA, Grad YH. Vaccine waning and mumps re-emergence in the United States. Sci Transl Med. 2018;10(433):eaao5945.CrossRef
47.
go back to reference Principi N, Esposito S. Mumps outbreaks: a problem in need of solutions. J Inf Secur. 2018;76(6):503–6. Principi N, Esposito S. Mumps outbreaks: a problem in need of solutions. J Inf Secur. 2018;76(6):503–6.
Metadata
Title
Measles and mumps outbreaks in Lebanon: trends and links
Authors
Talal El Zarif
Mohamed Faisal Kassir
Nazih Bizri
Ghida Kassir
Umayya Musharrafieh
Abdul Rahman Bizri
Publication date
01-12-2020
Publisher
BioMed Central
Keywords
Mumps
Vaccination
Published in
BMC Infectious Diseases / Issue 1/2020
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-020-04956-1

Other articles of this Issue 1/2020

BMC Infectious Diseases 1/2020 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.