American University of Beirut (Lebanon) Faculty of Medicine – WHO Collaboration Center: A reference laboratory on Cholera outbreak in Lebanon
Responding to the emergency of the Cholera outbreak in Lebanon at the American University of Beirut Faculty of Medicine is the World Health Organization Collaborating Center for Reference and Research on Bacterial Pathogens (WHO-CC) at the Department of Experimental Pathology, Immunology, and Microbiology (EPIM) and the Center for Infectious Diseases Research (CIDR). Upon the request of the World Health Organization (WHO) and the Lebanese Ministry of Public Health (MoPH), the WHO-CC is exclusively engaged in laboratory testing of Vibrio cholerae, at the phenotypic as well as the genotypic levels, for the purpose of a nationwide genomic surveillance of the etiology of Cholera outbreak in Lebanon.
“The nationwide surveillance of Cholera is essential for a timely public health response and the implementation of control measures by the official authorities to halt the spread of the etiological agent of Cholera,” said Dr. Ghassan Matar. “It will be done through the deciphering of the identity and source of the circulating strain using state of the art technology such as Next Generation Sequencing (NGS).”
Professor Ghassan Matar, who is leading this effort, is chairperson of the Department of EPIM, associate director and laboratory director of the university’s CIDR, and director of the WHO Collaborating Center. Technical lead in this endeavor is Dr. Antoine Abou Fayad, assistant professor in the Department of EPIM. The American University of Beirut Faculty of Medicine WHO-CC is leading regionally and globally in the surveillance on Cholera and other communicable diseases as Dr. Matar serves as a member of the Global Task Force of Cholera Control.
“Through highlighting the specific genotypic characteristics of the circulating strain of V. cholerae, we can track the source of this strain and the MoPH can link this information to epidemiological data and implement proper measures to control the spread of the organism,” said Dr. Matar.
By testing clinical specimens (stool samples) and environmental samples (water and sewage) and vegetables, the American University of Beirut team was able to identify a single strain of Vibrio cholerae circulating in Lebanon. The strain was found to belong to Serotype O1 EL TOR OGAWA, Sequence Type (ST) ST 69, which is resistant to a number of antibiotics. Phylogenetically, the Vibrio cholerae strain in Lebanon is similar to strains causing outbreaks in other countries. The emergency response is still ongoing.
“Our findings have shown that we have a single strain of V. cholerae originating from the North of Lebanon which has spread nationwide,” said Dr. Matar.
Cholera is an acute diarrheal infection caused by the bacterium Vibrio cholerae. The infection is often mild, moderate or without symptoms, yet can sometimes be severe causing profuse watery diarrhea, vomiting with other symptoms and can be life-threatening. It is transmitted and spread in settings due to inadequate hygiene, poor sanitation, unsafe drinking water and insufficient sewage water treatment. People under these conditions are at the highest risk for cholera. Dr. Matar recommends that people adopt preventive measures related to hygiene, safe drinking water from sealed bottles of trusted sources, and using disinfectants to wash fruits and vegetables.
The outbreak of Cholera emerged in Lebanon beginning of October 2022. It started in rural areas in the North of Lebanon, and spread to most regions nationwide reaching a total number of 368 confirmed laboratory cases in October 27, 2022, as reported by the Epidemiological Surveillance Unit of the Lebanese Ministry of Health. The destitute and those living in poor infrastructure particularly with Lebanon’s economic crisis, once again are at the biggest disadvantage, with inadequate hygiene and sanitation, poor water treatment, and unsafe drinking water.