title: Revisiting leishmaniasis in the time of war: the Syrian conflict and the Lebanese outbreak.
abstract: BACKGROUND
  Leishmaniasis is a neglected tropical disease, endemic in many worldwide foci including the Middle East. Several outbreaks have occurred in the Middle East over the past decades, mostly related to war-associated population migration. With the start of the Syrian war, the frequency and magnitude of these outbreaks increased alarmingly. We describe the epidemiology of Leishmania infection in Lebanon and the most recent outbreak relevant to the Syrian war.
  
  
  METHODS
  We reviewed all leishmaniasis cases reported to the Epidemiologic Surveillance Department at the Lebanese Ministry of Public Health between 2001 and the first quarter of 2014. The demographics and distribution of Syrian refugees in Lebanon were linked to reports of new Leishmania cases.
  
  
  RESULTS
  In total, 1033 new cases of leishmaniasis were reported in 2013 compared to a previous annual number in the range of 0-6 cases. The majority of cases reported in 2013 involved Syrian refugees and their relevant areas of concentration.
  
  
  CONCLUSIONS
  This new outbreak of leishmaniasis in Lebanon is the first of its kind for more than a decade. The sudden increase in Leishmania cases in Lebanon in 2013 is attributed to the increasing numbers and wide distribution of Syrian refugees in Lebanon. This serves as an example of the risks associated with military conflicts and the ability of communicable diseases to cross borders.
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA; Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Ali
authors.initials: A
authors.lastname: Alawieh
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Umayya
authors.initials: U
authors.lastname: Musharrafieh
authors.affiliation: Faculty of Medicine, Lebanese American University, Jbeil, Lebanon.
authors.forename: Amani
authors.initials: A
authors.lastname: Jaber
authors.affiliation: Communicable Diseases Department, Ministry of Public Health, Beirut, Lebanon.
authors.forename: Atika
authors.initials: A
authors.lastname: Berry
authors.affiliation: Epidemiological Surveillance Department, Ministry of Public Health, Beirut, Lebanon.
authors.forename: Nada
authors.initials: N
authors.lastname: Ghosn
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: ab00@aub.edu.lb.
authors.forename: Abdul Rahman
authors.initials: AR
authors.lastname: Bizri
mesh_terms: D000293:Adolescent; D000328:Adult; D000068337:Armed Conflicts; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007861:Lebanon / Q000453:epidemiology; D007896:Leishmaniasis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012036:Refugees; D014857:Warfare; D055815:Young Adult
keywords: Cutaneous leishmaniasis; Lebanon; Leishmania; Middle East; Visceral leishmaniasis