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Human rabies control in Lebanon: a call for action

  • M. F. Kassir (a1), T. El Zarif (a2), G. Kassir (a1), A. Berry (a3), U. Musharrafieh (a4) (a5) and A. R. Bizri (a5)...


The status of rabies as a neglected disease has made its eradication rather challenging in different parts of the world despite the availability of a successful vaccine. Lebanon, in particular, is a country endemic to the disease with several cases of rabies deaths reported over the past 30 years. The risk of rabies, however, has taken a new turn over the past few years in Lebanon with two emerging situations that have made the control of the disease rather challenging: the neighbouring Syrian war and the local garbage crisis. Both of these milestone events might have contributed to an increase in the number of disease vectors as well as individuals at risk, thus nourishing the cycle of disease transmission. In this observational study, the effect of these two events are investigated, with an update on the status of this preventable, yet often neglected, disease in the country. Both events were found to be concomitant with a notable increase in the number of dog bites and thus possible rabies exposure. Current regulations are explored through interviews with veterinarians, and custom recommendations, ranging from policies to control dog populations to awareness campaigns in high-risk individuals, are then proposed to help control the disease.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: T. Zarif, E-mail:


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1.Koury, R and Warrington, SJ (2017) Rabies. In StatPearls[Internet]. Treasure Island, FLStatPearls, Publishing LLC.
2.Hemachudha, T, Laothamatas, J and Rupprecht, CE (2002) Human rabies: a disease of complex neuropathogenetic mechanisms and diagnostic challenges. Lancet Neurology 1, 101109.
3.Durrheim, DN and Blumberg, L (2017) Rabies-what is necessary to achieve ‘zero by 30’? Transactions of the Royal Society of Tropical Medicine and Hygiene 111, 12.
4.Fooks, AR et al. (2014) Current status of rabies and prospects for elimination. Lancet 384, 13891399.
5.Taylor, LH and Knopf, L, Partners for Rabies P (2015) Surveillance of human rabies by national authorities – a global survey. Zoonoses and Public Health 62, 543552.
6.Hampson, K, Cleaveland, S and Briggs, D (2011) Evaluation of cost-effective strategies for rabies post-exposure vaccination in low-income countries. PLoS Neglected Tropical Diseases 5, e982.
7.Hampson, K et al. (2015) Estimating the global burden of endemic canine rabies. PLoS Neglected Tropical Diseases 9, e0003709.
8.World Health Organization (2013) WHO expert consultation on rabies. Second report. World Health Organization technical report series 982, 1139, back cover.
9.Smith, TG et al. (2017) Evaluation of immune responses in dogs to oral rabies vaccine under field conditions. Vaccine (in press).
10.Taylor, LH et al. (2017) The role of dog population management in rabies elimination – a review of current approaches and future opportunities. Frontiers in Veterinary Science 4, 109.
11.Seimenis, A (2008) The rabies situation in the Middle East. Developments in Biologicals 131, 4353.
12.Anon (2017) Human rabies: 2016 updates and call for data. The Weekly Epidemiological Record 92, 7786.
13.Bizri, AR et al. (2000) Human rabies in Lebanon: lessons for control. Epidemiology and Infection 125, 175179.
14.Bizri, A et al. (2014) Challenges facing human rabies control: the Lebanese experience. Epidemiology and Infection 142, 14861494.
15.Ismail, SA et al. (2016) Communicable disease surveillance and control in the context of conflict and mass displacement in Syria. International Journal of Infectious Diseases 47, 1522.
16.Morsi, RZ et al. (2017) The protracted waste crisis and physical health of workers in Beirut: a comparative cross-sectional study. Environmental Health 16, 39.
17.Alawieh, A et al. (2014) Revisiting leishmaniasis in the time of war: the Syrian conflict and the Lebanese outbreak. International Journal of Infectious Diseases 29, 115119.
18.Ammar, W et al. (2016) Health system resilience: Lebanon and the Syrian refugee crisis. Journal of Global Health 6, 020704.
19.Hatch, C, Sneddon, J and Jalloh, G (2004) A descriptive study of urban rabies during the civil war in Sierra Leone: 1995–2001. Tropical Animal Health and Production 36, 321334.
20.Raymond, TN et al. (2015) Do open garbage dumps play a role in canine rabies transmission in Biyem-Assi health district in Cameroon? Infection Ecology & Epidemiology 5, 26055.
21.Hilal, N et al. Approaching the Waste Crisis in Lebanon: Consequences and Insights into Solutions. K2P Evidence Summary: American University of Beirut; 2015 December 2015; K2P Evidence Summary.
22.Ben Taleb, Z et al. (2015) Syria: health in a country undergoing tragic transition. International Journal of Public Health 60(Suppl 1), S63S72.
23.Hossain, SM et al. (2016) Nutritional situation among Syrian refugees hosted in Iraq, Jordan, and Lebanon: cross sectional surveys. Conflict and Health 10, 26.
24.Sharara, SL and Kanj, SS (2014) War and infectious diseases: challenges of the Syrian civil war. PLoS Pathogens 10, e1004438.
25.Khawaja, M, Assaf, S and Yamout, R (2011) Predictors of displacement behaviour during the 2006 Lebanon war. Global Public Health 6, 488504.
26.Horton, DL et al. (2015) Complex epidemiology of a zoonotic disease in a culturally diverse region: phylogeography of rabies virus in the Middle East. PLoS Neglected Tropical Diseases 9, e0003569.
27.The World Bank Group. Climate Change Knowledge Portal database ( Accessed 07 February 2018.
28.Ghodieh, A (2017) Geospatial implications assessment of Zahrat Al Finjan solid waste landfill, North of West Bank, Palestine. IUG Journal of Natural Studies 25, 0109.
29.Centers for Disease Control and Prevention. Rabies Vaccine. ( Accessed 15 January 2018.
30.Alameddine, M et al. (2016) Upscaling the recruitment and retention of human resources for health at primary healthcare centres in Lebanon: a qualitative study. Health & Social Care in the Community 24, 353362.
31.Manning, SE et al. (2008) Human rabies prevention – United States, 2008: recommendations of the advisory committee on immunization practices. MMWR. Recommendations and Reports 57(RR-3), 128.
32.American Veterinary Medical Association. Rabies Pre-exposure Vaccination and Titers for Veterinarians. ( Accessed 07 February 2018.
33.Trevejo, RT (2000) Rabies preexposure vaccination among veterinarians and at-risk staff. Journal of the American Veterinary Medical Association 217, 16471650.
34.Flanagan-Klygis, EA, Sharp, L, Frader, JE (2005) Dismissing the family who refuses vaccines: a study of pediatrician attitudes. Archives of Pediatrics and Adolescent Medicine 159, 929934.
35.Lionel Harischandra, PA et al. (2016) Sri Lanka takes action towards a target of zero rabies death by 2020. WHO South-East Asia Journal of Public Health 5, 113116.
36.American Veterinary Medical Association. Microchipping of Animals. ( Accessed 15 February 2018.
37.Anon. Global Elimination of Dog-Mediated Human Rabies: WHO, Oie, FAO, GARC; 2015 10-11/12/2015.
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
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