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Emerging outbreaks associated with conflict and failing healthcare systems in the Middle East

Published online by Cambridge University Press:  13 August 2018

Issam I. Raad ,
Anne-Marie Chaftari ,
Rita Wilson Dib ,
Edward A. Graviss  and
Ray Hachem
Issam I. Raad*
Affiliation:
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Anne-Marie Chaftari
Affiliation:
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Rita Wilson Dib
Affiliation:
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Edward A. Graviss
Affiliation:
Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas
Ray Hachem
Affiliation:
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
*
Author for correspondence: Dr Issam I. Raad, Department of Infectious Diseases, Infection Control and Employee Health, Unit 1460, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030. E-mail: iraad@mdanderson.org
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Abstract

The escalating conflicts in the Middle East have been associated with the rapid collapse of the existing healthcare systems in affected countries. As millions of refugees flee their countries, they become vulnerable and exposed to communicable diseases that easily grow into epidemic crises. Here, we describe infectious disease epidemics that have been associated with conflicts in the Middle East, including cholera, poliomyelitis, measles, cutaneous leishmaniasis, and diphtheria, that call for appropriate preventive measures. Local ongoing wars and failing healthcare systems have resulted in regional and global health threats that warrant international medical interventions.

Type
Review
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 10 , October 2018 , pp. 1230 - 1236
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

1. Sharara, SL, Kanj, SS. War and infectious diseases: challenges of the Syrian civil war. PLoS Path 2014;10:e1004438.Google Scholar
2. Ben Taleb, Z, Bahelah, R, Fouad, FM, Coutts, A, Wilcox, M, Maziak, W. Syria: health in a country undergoing tragic transition. Int J Pub Health 2015;60(Suppl 1):S63–S72.Google Scholar
3. Mahjour, J. WHO warns of increased risk of disease epidemics in Syria and in neighbouring countries as summer approaches. World Health Organization Regional Office for the Eastern Mediterranean. 2013. http://www.emro.who.int/press-releases/2013/disease-epidemics-syria.html.Google Scholar
4. Corps, IM. Syria: the 21st century’s worst crisis. International Medical Corps website. https://internationalmedicalcorps.org/pages/adwords/ad-words-syria?gclid=CPu9q-ud99MCFZSEaQodIG0OVQ. Accessed May 17, 2017.Google Scholar
5. Stone-Brown, K. Syria: a healthcare system on the brink of collapse. BMJ 2013;347:f7375.Google Scholar
6. Sen, K, Al-Faisal, W, Al-Saleh, Y. Syria: effects of conflict and sanctions on public health. J Pub Health 2013;35:195–199.Google Scholar
7. Harris, JB, LaRocque, RC, Qadri, F, Ryan, ET, Calderwood, SB. Cholera. Lancet 2012;379:2466–2476.Google Scholar
8. Mutreja, A, Kim, DW, Thomson, NR, et al. Evidence for several waves of global transmission in the seventh cholera pandemic. Nature 2011;477:462–465.Google Scholar
9. O’Connor, KA, Cartwright, E, Loharikar, A, et al. Risk factors early in the 2010 cholera epidemic, Haiti. Emerg Infect Dis 2011;17:2136–2138.Google Scholar
10. Hameed, S, Kalin, S. Cases in Iraq cholera outbreak rise to 121, but no new deaths: ministry. Reuters website: https://www.reuters.com/article/us-iraq-cholera/cases-in-iraq-cholera-outbreak-rise-to-121-but-no-new-deaths-ministry-idUSKCN0RN1DL20150923. Published September 23, 2015. Accessed July 11, 2018.Google Scholar
11. World Health Organization. Weekly epidemiological record. Relevé épidémiologique hebdomadaire October 10, 2008;83:365–372.Google Scholar
12. Update on Current Cholera Outbreak in Iraq. SITREP – Situation Report No. 21. World Health Organization website. http://www.emro.who.int/irq/information-resources/updates-on-the-current-cholera-outbreak-in-iraq.html. Published 2015. Accessed July 12, 2018.Google Scholar
13. Lam, E, Al-Tamimi, W, Russell, SP, et al. Oral cholera vaccine coverage during an outbreak and humanitarian crisis, Iraq, 2015. Emerg Infect Dis 2017;23:38–45.Google Scholar
14. WHO ramps up response to cholera outbreak in two regions. World Health Organization website. http://www.who.int/cholera/news/22october2015/en/. Published October 21, 2015. Accessed July 11, 2018.Google Scholar
15. EMRO. Yemen, cholera response. Weekly Epidemiol Bull W4 2018 (Jan 22–Jan 28). World Health Organization website. http://www.emro.who.int/images/stories/yemen/Yemen_Cholera_Response_-_Weekly_Epidemiological_Bulletin_-_W4_2018_Jan_22-_28.pdf?ua=1. Published 2018. Accessed July 11, 2018.Google Scholar
16. Kennedy, J, Harmer, A, McCoy, D. The political determinants of the cholera outbreak in Yemen. Lancet Global Health 2017;10:e970–e971. doi: 10.1016/S2214-109X(17)30332-7.Google Scholar
17. World Health Organization. Electronic Disease Early Warning System (eDEWS)—daily epidemiological update 2017-08-23. Reliefweb website. https://reliefweb.int/report/yemen/yemen-electronic-disease-early-warning-system-edews-cholera-response-daily-8. Published August 24, 2017. Accessed July 11, 2018.Google Scholar
18. Zaidi, A. Make plans to eliminate cholera outbreaks. Nature 2017;550:9–9.Google Scholar
19. World Health Organization. Weekly update—cholera in Yemen, 20 May 2017. World Health Organization website. http://www.emro.who.int/surveillance-forecasting-response/outbreaks/weekly-update-cholera-in-yemen-20-may-2017.html. Published May 20, 2017. Accessed July 11, 2018.Google Scholar
20. UN News. Yemen: UN report urges probe into rights violations amid ‘entirely man-made’ catastrophe. UN News website. https://news.un.org/en/story/2017/09/564302-yemen-un-report-urges-probe-rights-violations-amid-entirely-man-made. Published July 21, 2017. Accessed July 11, 2018.Google Scholar
21. Wadman, M. Cholera vaccination campaign in Yemen is dropped. Science Open Access website. http://www.sciencemag.org/news/2017/07/cholera-vaccination-campaign-yemen-dropped. Published July 12, 2017. Accessed July 11, 2018.Google Scholar
22. Qadri, F, Islam, T, Clemens, JD. Cholera in Yemen—an old foe rearing its ugly head. N Engl J Med 2017;377:2005–2007.Google Scholar
23. Herzog, C. Successful comeback of the single-dose live oral cholera vaccine CVD 103-HgR. Travel Med Infect Dis 2016;14:373–377.Google Scholar
24. WHO scales up disease surveillance reporting in East Mosul and Hamdaniya districts, Iraq. World Health Organization website. http://www.emro.who.int/irq/iraq-news/who-scales-up-disease-surveillance-reporting-in-east-mosul-and-hamdaniya-districts-iraq.html. Accessed July 11, 2018.Google Scholar
25. Cholera risk assessment in Iraq. World Health Organization website. http://applications.emro.who.int/docs/epi/2017/Epi_Monitor_2017_10_17.pdf?ua=1&ua=1 Published April 23, 2017. Accessed July 11, 2018.Google Scholar
26. Arie, S. Polio virus spreads from Syria to Iraq. BMJ 2014;348:g2481. doi: 10.1136/bmj.g2481.Google Scholar
27. Abroug, F, Slim, A, Ouanes-Besbes, L, et al. Family cluster of Middle East respiratory syndrome coronavirus infections, Tunisia, 2013. Emerg Infect Dis 2014;20:1527–1530.Google Scholar
28. Sparrow, A. Syria’s polio epidemic: the suppressed truth. The New York Review of Books website. http://www.nybooks.com/articles/2014/02/20/syrias-polio-epidemic-suppressed-truth/2014. Published February 20, 2014. Accessed July 11, 2018.Google Scholar
29. Mbaeyi, C, Ryan, MJ, Smith, P, et al. Response to a large polio outbreak in a setting of conflict—Middle East, 2013–2015. Morbid Mortal Wkly Rept 2017;66:227–231.Google Scholar
30. Eichner, M, Brockmann, SO. Polio emergence in Syria and Israel endangers Europe. Lancet 2013;382:1777.Google Scholar
31. Foot, T. Foreign jihadists ‘responsible’ for polio outbreak in Syria. The Independent website. https://www.independent.co.uk/news/world/middle-east/foreign-jihadists-responsible-for-polio-outbreak-in-syria-8920102.html. Published November 4, 2013. Accessed July 11, 2018.Google Scholar
32. First mass vaccination campaign starts since polio found in Iraq. UNICEF website. https://www.unicef.org/media/media_73006.html. Published April 6, 2014. Accessed July 11, 2018.Google Scholar
33. Al-Moujahed, A, Alahdab, F, Abolaban, H, Beletsky, L. Polio in Syria: problem still not solved. Avicenna J Med 2017;7:64–66.Google Scholar
34. National polio immunization campaign launched in Yemen. World Health Organization website. http://www.emro.who.int/yem/yemen-news/national-polio-immunization-campaign-launched-in-yemen.html. Published February 20, 2017. Accessed July 11, 2018.Google Scholar
35. Syrian Arab Republic, Annual Report. 2017. World Health Organization. website. http://www.who.int/hac/crises/syr/sitreps/en/. Published 2017. Accessed July 11, 2018.Google Scholar
36. Syria: Measles epidemic signals growing humanitarian needs. Medecins Sans Frontieres (Doctors Without Borders) website. https://www.msf.org/syria-measles-epidemic-signals-growing-humanitarian-needs. Published June 18, 2013. Accessed July 11, 2018.Google Scholar
37. Nimer, NA. Canadian Journal of Infectious Diseases and Medical Microbiology, 2018, Article ID 8679174, 8 pages. doi: 10.1155/2018/8679174.Google Scholar
38. Epidemiologic Surveillance Department. Lebanese Ministry of Public Health website. https://www.moph.gov.lb/en/Pages/2/194/surveillance-data#/en/view/196/general-surveillance-data-past-years. Published 2014. Accessed July 12, 2018.Google Scholar
39. Qirbi, N, Ismail, SA. Ongoing threat of a large-scale measles outbreak in Yemen. Lancet Global Health 2016;4:e451.Google Scholar
40. OCHA. Humanitarian Bulletin—Yemen, Issue 1. Office for the Coordination of Humanitarian Affairs website. https://reliefweb.int/sites/reliefweb.int/files/resources/OCHA%20Yemen%20Humanitarian%20Bulletin%20-%208%20March%202012.pdf. Published March 8, 2012. Accessed July 11, 2018.Google Scholar
41. Immunization, vaccines and biologicals. Measles and rubella surveillance data. Distribution of measles cases by country and by month, 2011–2017. World Health Organization website. http://www.who.int/immunization/monitoring_surveillance/data/en/. Updated June 12, 2018. Accessed July 11, 2018.Google Scholar
42. Syrian Arab Republic: WHO and UNICEF estimates of immunization coverage: 2016 revision. World Health Organization website. http://www.who.int/immunization/monitoring_surveillance/data/syr.pdf. Published July 4, 2017. Accessed July 11, 2018.Google Scholar
43. World Health Organization, UNICEF. Immunization, measles (% of children ages 12–23 months)—Syrian Arab Republic. The World Bank website. https://data.worldbank.org/indicator/SH.IMM.MEAS. Published 2016. Accessed July 11, 2018.Google Scholar
44. Pakenham-Walsh, N, Ana, J. Confusing drug packaging contributes to death of 15 children. Lancet Global Health 2014;2:e634.Google Scholar
45. Regional situation report. World Health Organization webiste. http://www.emro.who.int/images/stories/syria/WHO_SitRep_April2015.pdf?ua=1. Published April 2015. Accessed July 11, 2018.Google Scholar
46. Al-Kamel, MA. Leishmaniasis in Yemen: a clinicoepidemiological study of leishmaniasis in central Yemen. Int J Dermatol 2016;55:849–855.Google Scholar
47. Burki, T. Infectious diseases in Malian and Syrian conflicts. Lancet Infect Dis 2013;13:296–297.Google Scholar
48. Hayani, K, Dandashli, A, Weisshaar, E. Cutaneous leishmaniasis in Syria: clinical features, current status and the effects of war. Acta Dermato-Venereol 2015;95:62–66.Google Scholar
49. Saroufim, M, Charafeddine, K, Issa, G, et al. Ongoing epidemic of cutaneous leishmaniasis among Syrian refugees, Lebanon. Emerg Infect Dis 2014;20:1712–1715.Google Scholar
50. Alawieh, A, Musharrafieh, U, Jaber, A, Berry, A, Ghosn, N, Bizri, AR. Revisiting leishmaniasis in the time of war: the Syrian conflict and the Lebanese outbreak. Int J Infect Dis 2014;29:115–119. doi: 10.1016/j.ijid.2014.04.023.Google Scholar
51. Leishmaniasis cases recorded among Syrian refugees in Iraqi Domise camp. Alsumaria TV website. https://www.alsumaria.tv/news/79442/leishmaniasis-cases-recorded-among-syria/en. Published July 16, 2013. Accessed July 12, 2018.Google Scholar
52. Postigo, JA. Leishmaniasis in the World Health Organization Eastern Mediterranean Region. Int J Antimicrob Agent 2010;36(Suppl 1):S62–65. doi: 10.1016/j.ijantimicag.2010.06.023.Google Scholar
53. World Health Organization. Diphtheria—Yemen: disease outbreak news. Reliefweb website. https://reliefweb.int/report/yemen/diphtheria-yemen-disease-outbreak-news-22-december-2017. Published December 22, 2017. Accessed July 11, 2018.Google Scholar
54. Yemen: diphtheria spreads as war and blockade leave health system in tatters, 2017. Medecins Sans Frontieres (Doctors Without Borders) website. https://www.doctorswithoutborders.org/what-we-do/news-stories/news/yemen-diphtheria-spreads-war-and-blockade-leave-health-system-tatters. Published December 12, 2017. Accessed July 11, 2018.Google Scholar
55. Nebehay, S. Suspected diphtheria cases in Yemen near 500: WHO. Reuters website. https://www.reuters.com/article/us-yemen-diphtheria/suspected-diphtheria-cases-in-yemen-near-500-who-idUSKBN1ET1BQ. Published January 4, 2018. Accessed July 11, 2018.Google Scholar
56. WHO responds effectively to an outbreak of hepatitis A among Syrian refugees in northern Iraq. World Health Organization website. http://www.emro.who.int/irq/iraq-news/hepatitis-outbreak-2013.html. Published November 17, 2013. Accessed July 11, 2018.Google Scholar
57. Ismail, SA, Abbara, A, Collin, SM, et al. Communicable disease surveillance and control in the context of conflict and mass displacement in Syria. Int J Infect Dis 2016;47:15–22.Google Scholar
58. Coleman, RE, Hochberg, LP, Putnam, JL, et al. Use of vector diagnostics during military deployments: recent experience in Iraq and Afghanistan. Mil Med 2009;174:904–920; PMID: 19780365.Google Scholar
59. Mogalli, NM, El Hossary, SS, Khatri, ML, et al. Clinicoepidemiologic pattern of cutaneous leishmaniasis and molecular characterization of its causative agent in Hajjah governorate, northwest of Yemen. Acta Trop 2016;163:130–134. doi: 10.1016/j.actatropica.2016.08.012.Google Scholar