Will we see malaria back in Lebanon ?
Introduction
Malaria is caused by the parasite Plasmodium, which is transmitted to humans by the bite of Anopheles mosquitoes.
With 216 million people currently infected in 99 countries and 655 000 deaths per year in 2011, malaria is the most common parasitic disease. Around half of the world’s population is exposed and 80% of cases occur in sub-Saharan Africa.
Malaria causes symptoms that typically include fever, fatigue, vomiting, and headaches. In severe cases, it can cause yellow skin, seizures, coma, or death.
Historical background
- The first serious study reporting the presence of Malaria in Lebanon dates back to 1895. That year, professors Brown, Axe, Negre, Rouvier and Boyer from the French Medical Faculty conducted an epidemiological investigation which showed that malaria was the most common disorder, followed by syphilis, urinary calculi, typhoid and tuberculosis.
- In 1914, in his manuscript « Health and social hygiene at mount Lebanon » to be addressed to the Governor in order to improve and take necessary measures in these fields, doctor Georges Baz, stated:”Forget malaria? It is rampant in the Lebanon, specialy in the population centers of Bourj Hammoud, Jdeidet El Matn, Bauchrieh, Wadi el Sitt.”
Dr Georges Baz was born in Amchit on 31 December 1861. After studying English, he began his medical studies (at the American university) that lasted 4 years. Graduated in 1882, he brilliantly passed examination of the colloquium in Constantinople and returned to the Lebanon to practice medicine in Gbeil during winter and in Deir el Kamar during summer. Author of various articles in magazines Al-Mashriq Al-Mouktataf, he also wrote in the newspaper Al-Bashir a series of popular medical articles which were published subsequently by the Catholic press. In 1916, he was exiled with his family by the ottomans to Kirchehir in Anatolia. Returning to the Lebanon in 1919, general Gouraud appointed him doctor of the official schools of Beirut. In addition to its medical activities, Dr. Georges Baz occupied for several years Chairman of the municipal Council of Gbeil. He retired in 1929 and died in Beirut on March 3, 1956 in his 95 th year.
As for Quinine, a medicine for preventing or treating malaria fever, it’s use was well known. The young doctor Darwiche Baz (great uncle of Dr G. Baz, cited before), who can be considered as the first graduate Lebanese doctor, was the one who popularized the use of white quinine or kina baida (quinine sulfate). It was imported then from Egypt. Despite its beneficial effects, white quinine had significant side effects (ringing in the ear, dizziness and vomiting). A popular prejudice had spread the idea that this product was so toxic that it deserved the appellation of ‘cure of healing or death’.
During French mandat and until 1953, Gramiccia assesed the endemic prevelance of the disease. The affected population was 6% in the northern coastal region. In the hills, it was only 1-3% although, in the Oronte it reached11% while the disease was frankly endemic in the Bekaa valley.
All this information is now only of historical value
Postcard written from Zahle by Dr Farid Graieb in 1928 to a pharmaceutical labarotary in Paris requesting antimalarial medicine because the disease is rampant in quantity in the Bekaa.
Another postcard written from Sur, a coastal city in Lebanon, in 1931 by Dr Farhat, to request antimalarial medicine.
- In 1956 a local eradication program was launched and it resulted in complete curtailment of the transmission.
- It is at the European conference on the eradication of malaria in Palermo on March 31, 1960, that W.H.O. declared 1962 as the year for the eradication of malaria.
- Lebanon joined the campaign by emitting two stamps:
Design size: 25 x 36 mm
Designer: P. Korolef
Producer: J. Saikali, Beirut
Stamp margins: designer’s name lower left; printer’s name lower right
Process: lithography
Format: panes of 50 (10 x 5)
Quantity:
Paper: white
Watermark: none
Perforation: 13½ x 13
Purpose: publicized the malaria eradication campaign
Sub-topics: mosquito; modified design #1
Various FDC from Lebanon were reported:
To symbolize this malaria campaign, an emblem was adopted by the majority of countries: a mosquito bearing a world globe with the Caduceus.
The risk of disease can be reduced by preventing mosquito bites, by using mosquito nets and insect repellents, or with mosquito-control measures such as spraying insecticides and draining standing water.
International struggle against Malaria -FDC
The arab states united to fight Malaria-FDC
- In 1963, World Health Organization declared Lebanon a country free of malaria.
- Since then we had few breakouts of limited local transmission in 1996 and 1998-99, but the majority of cases was imported from areas with ongoing malaria transmission (around 130 case/year).
In the majority of reported cases Lebanese travelers acquired malaria abroad and had not adhered to a chemoprophylaxis regimen that was appropriate for the country in which they acquired the infection.
- Lebanon continues to be free of indigenous cases of malaria.
But with the globalization and ease of travel, importation of malaria cases from endemic areas will be in continuous rising, thus the importance of strengthening the capacity of the primary health sectors in travel medicine to reduce the morbidity and to prevent the mortality of imported cases.
These infected cases reveal the existence of vector borne disease transmission during airplane travel, and emphasize the importance of obtaining a travel history during the evaluation of an ill patient. In addition, the cases reinforce the need for vigilance in the control of vectors of disease around seaports, airports and hospitals.
Will we see malaria back in Lebanon ?
In January 2016, Lebanon recorded one malaria death (a lebanese plane hostess returning from Abidjan), the first to occur in several years, raising fear over the possibility that it could become a widespread concern in the country with the garbage crisis. And of course the media gave the situation an image more dramatic than it really is.
Nevertheless, the detritus is supplying both an abode and a food resource for mosquito larvae. Thus has the number of mosquitoes in the country risen and specially bringing them into closer contact with people. It is stupid to deny the existence of garbage -related infections. Rats, flies and mosquitos are reservoires and vectors for disease.
It is also known that changes in temperature result in changes of mosquito behavior with the potential to become a serious health threat as a bridge vector of zoonotic pathogens to humans
The risk for the reappearance of malaria in Lebanon where it was previously eradicated exists but is relatively small ; Fortunately malaria is mainly a travel medicine issue.
How unhealthy a country Lebanon has become !
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Fadi
