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Epidemiology and risk factors for extrapulmonary tuberculosis in Lebanon

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SETTING: Lebanon is a relatively low TB-burden country, but has a high proportion of extrapulmonary tuberculosis (EPTB). Concern has been expressed that Syrian-born refugees could add to the TB burden and rates of EPTB: since 2011, >1 000 000 Syrian refugees have entered Lebanon.

OBJECTIVE: The Lebanese National Tuberculosis Programme (NTP) sought to identify factors for the high proportion of EPTB and to assess the potential impact of Syrian refugees.

DESIGN: NTP line-listed data from 2014–2015 were analyzed with logistic regression identified risk factors for EPTB. A trend analysis for 2011–2015 assessed TB burden by nationality and site of TB.

RESULTS: Of 1347 reported TB cases from 2014 to 2015, 507 (38%) were EPTB and 46% were Lebanese. In analysis limited to Lebanese-born, the proportion of EPTB cases was relatively stable, 47% in 2011 and 52% in 2015. Modeling identified risk factors for EPTB as being female (aOR 1.79, 95%CI 1.39–2.32) and 5–15 years old (aOR 3.31, 95%CI 1.47–7.45) compared with children aged <5 years. Between 2011 and 2015, the proportion of TB cases among Syrian-born increased from 3% in 2011 to 21% in 2015 (P < 0.001); however, the proportion of EPTB versus PTB cases among Syrians remained stable (P = 0.264).

CONCLUSION: Syrian TB cases increased almost 10-fold in five years (2011–2015) but their contribution to EPTB did not change. The high proportion of EPTB in Lebanon and those aged 5–15 years merits further investigation.
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Keywords: EPTB; Lebanon; Syria; refugees

Document Type: Research Article

Affiliations: 1: Emory University Rollins School of Public Health, Atlanta, GA 2: Centers for Disease Control and Prevention, Atlanta, GA, USA 3: National Tuberculosis Programme, Beirut, Lebanon

Publication date: April 1, 2020

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

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