**Background:** Cholera, caused by toxigenic strains of *Vibrio cholerae* serogroups O1 and O139, is an acute diarrheal illness transmitted via the feco-oral route, primarily through contaminated water or food. Despite a global roadmap aiming to reduce cholera mortality by 90% by 2030, the disease remains a marker of inequality and inadequate sanitation. Lebanon, already burdened by the COVID-19 pandemic and a severe economic crisis (GDP growth rate of −21.4 in 2020 and −7 in 2021), experienced the re-emergence of cholera in October 2022 after a 30-year absence since the last outbreak in 1993. The Syrian crisis further strained Lebanon's health system by increasing the population by 30% through refugee influx, facilitating cross-border transmission via shared water resources.
**Methods:** This is a narrative minireview that synthesizes epidemiological data from the Lebanese Ministry of Public Health, WHO reports, and published literature to describe the microbiology, pathophysiology, epidemiology, diagnosis, management, and control measures related to the 2022 cholera outbreak in Lebanon. The paper also reviews preparedness efforts and provides recommendations for outbreak containment.
**Key Results:** As of December 29, 2022, the Lebanese Ministry of Public Health reported 669 confirmed cholera cases and 23 deaths. The outbreak began in October 2022, with 376 cases reported that month, declining to 47 cases by December 2022. Cases were distributed across Lebanese regions, including areas with high refugee concentrations and other areas with low socioeconomic status, lack of immunizations, and poor living conditions. The WHO and Lebanese Ministry of Public Health announced the re-emergence on October 10, 2022. In response, Lebanon received 13,440 doses of cholera vaccine donated by France, and an additional 900,000 vaccines were expected by mid-December 2022, supported by WHO and funded by the United Nations Central Emergency Response Fund and the Contingency Fund for Emergencies. A 20-bed field hospital for cholera patients was established in the north, where resources are minimal. The Lebanese Ministry of Public Health committed to covering treatment costs for all Lebanese patients, with international bodies covering treatment for refugees. The paper notes that 40% of Lebanon's population is now below the poverty line, and the country's pharmaceutical industry, though including 12 WHO-certified companies, operates at only 50% capacity, with 95% of medications imported at high costs.
**Clinical Implications:** The re-emergence of cholera in Lebanon highlights the vulnerability of health systems during concurrent crises—economic collapse, refugee influx, and post-pandemic strain. Diagnosis relies on clinical suspicion (acute watery diarrhea with severe dehydration in patients ≥2 years old during an outbreak) and confirmation via culture or PCR for *V. cholerae* O1 or O139. Management centers on fluid resuscitation (oral rehydration solutions; intravenous Ringer's lactate or normal saline for severe dehydration), with antibiotics (tetracycline, doxycycline, azithromycin) reserved for severely dehydrated patients to avoid widespread resistance. Zinc supplementation (20 mg daily for children >6 months) reduces disease duration and severity. Long-term control requires improved water sanitation, economic investment in healthcare, surveillance of water resources, and vaccination of at-risk populations including refugees and healthcare workers. The paper recommends allocating a larger percentage of GDP to healthcare, increasing hospital beds for cholera patients, requiring negative stool examinations for travelers entering Lebanon by land, and subsidizing local pharmaceutical production to ensure availability of low-cost, high-quality medications.