Challenges facing measles elimination: the Lebanese experience

Abstract Background Despite achieving a high vaccine coverage of measles, Lebanon, like many other countries, is still far away from achieving measles eradication. In this article, the trend of measles outbreaks in Lebanon was studied in an attempt to outline the factors that explain why the eradication plan has failed and provided potential solutions to overcome them. The relationship between the incidence of measles and mumps outbreaks in Lebanon was explored and delineated Methods In this observational study, cases of measles and mumps in Lebanon recorded between 2002 and 2018 were collected from the Lebanese Ministry of Public Health Epidemiological Surveillance Unit public database. The data was plotted on graphs taking into consideration the dates of the cases, age groups affected, and vaccination status. Results The average number of measles cases in the 1-4 years age group was the highest and was equal to 189.9 cases/year. This value declined in individuals aging less than 14 years but was followed by an increase to 82.7 cases/year in individuals older than 14 years. Following every spike in measles cases during the period between 2002 and 2018, a parallel increase in mumps cases was seen on multiple occasions. Strikingly, an average of 27.1% of the recorded measles cases belonged to vaccinated individuals, while 32.1% were unvaccinated and 40.74% had an unspecified vaccination status. Conclusions Although measles is a disease that mainly targets children, it seems essential that booster immunization programs must be held to protect young adults. The close relationship between measles and mumps incidence in Lebanon might aid in anticipating future outbreaks in order to take action before their occurrence. Finally, vaccine handling and storage in Lebanon must be re-assessed in lights of the occurrence of measles outbreaks to ensure implementing best appropriate vaccine handling till administration. Eradication plans must be tailored to hone and fit the Lebanese context.