How Is Lebanon's Progress Towards Measles Elimination? Review of Surveillance Performance Indicators, 2013-2024.

BACKGROUND

Lebanon adopted the World Health Organization (WHO)'s regional strategic plan (2012-2020) to achieve measles elimination. We aimed to analyze WHO measles surveillance performance indicators to identify areas for improvement.

METHODS

We reviewed suspected measles and rubella cases notified to the national epidemiological surveillance program between January 2013 and December 2024. A suspected case was defined as any patient with a febrile maculopapular rash or considered clinically compatible by physicians. We assessed notification rates of discarded non-measles/rubella suspected cases, timeliness of investigations within 48 h, completeness of case investigations (demographic and vaccination data), and proportion of cases tested for measles/rubella. Mean proportions and standard deviations were calculated across years and provinces.

RESULTS

A total of 6581 suspected cases were reported, predominantly from hospitals (66%). Outbreaks occurred in 2013 (n = 1760), 2018-2019 (n = 1984) and 2023-2024 (n = 346). Outside outbreak years, the notification rate ranged between 0.7 and 1.8 per 100,000 population. Timely investigation was achieved in 72% (±30%) of cases, while adequate investigation reached 52% (±19%). Laboratory testing was performed in 62% (±16%) of cases.

CONCLUSIONS

Surveillance in Lebanon showed suboptimal sensitivity, a high proportion of hospitalized cases, and variability in completeness of epidemiological and laboratory investigations. Strengthening outpatient reporting and continuous training of healthcare professionals are essential to improve surveillance performance.