{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T02:57:47Z","timestamp":1780369067111,"version":"3.54.1"},"reference-count":13,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiologia"],"abstract":"<jats:p>Background: Lebanon adopted the World Health Organization (WHO)\u2019s regional strategic plan (2012\u20132020) 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\u20132019 (n = 1984) and 2023\u20132024 (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% (\u00b130%) of cases, while adequate investigation reached 52% (\u00b119%). Laboratory testing was performed in 62% (\u00b116%) 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.<\/jats:p>","DOI":"10.3390\/epidemiologia7030069","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T16:46:18Z","timestamp":1779381978000},"page":"69","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["How Is Lebanon\u2019s Progress Towards Measles Elimination? Review of Surveillance Performance Indicators, 2013\u20132024"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1444-1416","authenticated-orcid":false,"given":"Lina","family":"Chaito","sequence":"first","affiliation":[{"name":"Epidemiological Surveillance Program, Ministry of Public Health, Beirut 0127, Lebanon"},{"name":"Mediterranean and Black Sea Programme in Intervention Epidemiology Training (MediPIET), European Centre for Disease Prevention and Control (ECDC), 171 83 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0087-0906","authenticated-orcid":false,"given":"Pawel","family":"Stefanoff","sequence":"additional","affiliation":[{"name":"Mediterranean and Black Sea Programme in Intervention Epidemiology Training (MediPIET), European Centre for Disease Prevention and Control (ECDC), 171 83 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2148-7711","authenticated-orcid":false,"given":"Hawraa","family":"Sweidan","sequence":"additional","affiliation":[{"name":"Epidemiological Surveillance Program, Ministry of Public Health, Beirut 0127, Lebanon"},{"name":"Mediterranean and Black Sea Programme in Intervention Epidemiology Training (MediPIET), European Centre for Disease Prevention and Control (ECDC), 171 83 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"May","family":"Younes","sequence":"additional","affiliation":[{"name":"Epidemiological Surveillance Program, Ministry of Public Health, Beirut 0127, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0891-2499","authenticated-orcid":false,"given":"Mona","family":"Albuaini","sequence":"additional","affiliation":[{"name":"National Measles Laboratory (NML), Rafic Hariri University Hospital (RHUH), Beirut 0127, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada","family":"Ghosn","sequence":"additional","affiliation":[{"name":"Epidemiological Surveillance Program, Ministry of Public Health, Beirut 0127, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2025, July 20). A New Era in the Fight Against Measles and Rubella. WHO. Available online: https:\/\/www.who.int\/news\/item\/22-02-2023-a-new-era-in-the-fight-against-measles-and-rubella."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Strebel, P., Grabowsky, M., Hoekstra, E., Gay, A., and Cochi, S. (2024). Evolution and contribution of a global partnership against measles and rubella, 2001\u20132023. Vaccines, 12.","DOI":"10.3390\/vaccines12060693"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"139","DOI":"10.15585\/mmwr.mm7307a1","article-title":"Progress toward measles elimination, World Health Organization Eastern Mediterranean Region, 2019\u20132022","volume":"73","author":"Musa","year":"2024","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_4","unstructured":"World Health Organization Regional Office for the Eastern Mediterranean (2025, September 26). Lebanon: Measles in Lebanon. WHO EMRO. 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BMC Public Health, 19.","DOI":"10.1186\/s12889-019-6418-9"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e837","DOI":"10.1016\/j.ijid.2011.11.002","article-title":"Epidemiological analysis of measles and evaluation of measles surveillance system performance in Iraq, 2005\u20132010","volume":"16","author":"Jasem","year":"2012","journal-title":"Int. J. Infect. Dis."},{"key":"ref_9","first-page":"511","article-title":"Progress toward measles elimination\u2014Eastern Mediterranean Region, 2008\u20132012","volume":"63","author":"Teleb","year":"2014","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_10","unstructured":"Ministry of Public Health Lebanon (2025, August 05). Cholera Surveillance in Lebanon. Ministry of Public Health Lebanon, Available online: https:\/\/www.moph.gov.lb\/en\/Pages\/127\/64744\/cholera-surveillance-in-lebanon."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Nassar, A.A.H., Al Amad, M.A., Qasim, M., and Dureab, F. (2021). Risk factors for measles outbreak in Ataq and Habban districts, Shabwah governorate, Yemen, February to May 2018. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06207-3"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"255","DOI":"10.3390\/epidemiologia4030026","article-title":"Communicable disease surveillance in Lebanon during the Syrian humanitarian crisis, 2013\u20132019","volume":"4","author":"Farah","year":"2023","journal-title":"Epidemiologia"},{"key":"ref_13","unstructured":"World Health Organization (2025, September 14). Framework for Verifying Elimination of Measles and Rubella. WHO. Available online: https:\/\/www.who.int\/publications\/i\/item\/framework-for-verifying-elimination-of-measles-and-rubella."}],"container-title":["Epidemiologia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2673-3986\/7\/3\/69\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T17:35:52Z","timestamp":1779384952000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2673-3986\/7\/3\/69"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":13,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["epidemiologia7030069"],"URL":"https:\/\/doi.org\/10.3390\/epidemiologia7030069","relation":{},"ISSN":["2673-3986"],"issn-type":[{"value":"2673-3986","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]}}}