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Influenza Surveillance

Severe Acute Respiratory Infection Surveillance (SARI)
Rationale Severe acute respiratory infections (SARI) can be the result of several agents: viral, bacterial, and parasites, even though bacterial and parasitic agents can be less common. Among the viruses, influenza viruses are among the major causes of SARI.
Any preventive or control measure related to Influenza requires the availability of surveillance, including the seasonality pattern and the causative agents.
SARI surveillance in Lebanon was established in collaboration of the World Health Organization.
Objectives The objectives of Severe Acute Respiratory Infection (SARI) in Lebanon are:
- To estimate morbidity (incidence) of SARI in Lebanon
- To identify baseline figures and alert/outbreak thresholds
- To describe SARI cases by time, place, person, susceptibility, severity
- To identify circulating influenza strains and detect novel viruses
- To contribute to the global influenza surveillance
Sources of data Data sources are hospital sentinel sites. Sentinel surveillance focuses on collection of data from specific pre-selected health sites to carefully monitor a specific disease. The collection of the data is systemic. The sites are selected based on key criteria: willingness, activity and representativeness of the population.
The current sentinel sites are:
- In the mohafazas of Beirut and Mount Lebanon: Rafik Hariri University Governmental Hospital (RHUH), American University of Beirut Medical Center, Quarantina Governmental Hospital
- In the mohafazas of Bekaa and Baalbeck/Hermel: Baalbeck Governmental Hospital
- In the mohafazas of North and Akkar: Kheir Hospital
Case Definition An acute respiratory infection with:
- History of fever or measured fever of >=38°C and cough
- Onset within the last 10 days
- Requiring hospitalization
Case Investigation For each SARI case, data is collected including demographical and clinical data. Also, clinical specimens are collected for laboratory testing. The needed specimens are: nasopharyngeal swab (preferable one), oropharyngeal swab, bronchoalveolar lavage (if done), or tracheal aspirate (if patient intubated).
Laboratory Testing Laboratory testing for SARI patients are performed at the National Influenza Center at RHUH. The laboratory testing includes RT-PCR for Influenza viruses A and B.
SARI forms - Laboratory request form
Results - Latest weekly bulletin
- Latest weekly severity indicators
- Link to WHO database
 
Intensive Care Unit Based Surveillance (ICU)
Objectives The main objectives of ICU-based surveillance are to:
 - Measure and monitor on weekly basis morbidity indicators related to severe acute respiratory infections in Lebanon
 - Detect abnormal pattern and novel agents at an early stage, and investigate them
 - Assist decision makers on proper control measures
Data sources Data sources are both ICUs in public and private hospitals across Lebanon. The MOPH decision requested each hospital to designate a focal person from the ICU medical staff in charge of reporting to the MOPH.
Case definition - Severe Acute Respiratory Infection with fever and dyspnea
- Whatever was the etiological agent
- Admitted to ICU
Data collection Data is collected using a specific form. The form is sent every week by the hospital event if no cases were reported. The reporting form is a nominative line-listing.
Guidelines ICU-based surveillance for acute respiratory infection: Ar, En, Fr
Weekly form - ICU weekly reporting form
Results - Latest weekly summary
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ATC Name B/G Ingredients Dosage Form Price
C09CA06 ANDESART 16 G Candesartan cilexetil - 16mg 16mg Tablet 665,202 L.L
C09CA06 ANDESART 8 G Candesartan cilexetil - 8mg 8mg Tablet 498,566 L.L
S01HA02 ANESTOCIL B Oxybuprocaine HCl (Benoxinate HCl) - 0.4% 0.4% Drops solution 442,124 L.L
C09CA03 ANGINET G Valsartan - 80mg 80mg Tablet, film coated 387,027 L.L
C09CA03 ANGINET G Valsartan - 160mg 160mg Tablet, film coated 544,256 L.L
R02A ANGINOVAG G Lidocaine HCl - 100mg/100ml, Hydrocortisone acetate - 60mg/100ml, Tyrothricin - 400mg/100ml, Dequalinium chloride - 100mg/100ml, ?-Glycerrhetinic acid - 60mg/100ml Spray 643,701 L.L
B01AB11 ANGIOFLUX G Sulodexide - 250LRU 250LRU Capsule, soft 1,999,638 L.L
C09DB01 ANGIOSAR G Amlodipine besylate - 10mg, Valsartan - 160mg Tablet, film coated 857,372 L.L
C09DX01 ANGIOSAR PLUS G Valsartan - 320mg, Amlodipine - 10mg, Hydrochlorothiazide - 25mg Tablet, film coated 1,689,210 L.L
M01AE02 ANODYNE 500 G Naproxen - 500mg 500mg Suppository 342,680 L.L
R03AL03 ANORO ELLIPTA B Vilanterol - 25mcg, Umeclidinium bromide - 62.5mcg Inhalation powder 5,367,774 L.L
R03DA11 ANSIMAR G Doxofylline - 20mg/ml 20mg/ml Syrup 550,975 L.L
R03DA11 ANSIMAR G Doxofylline - 400mg 400mg Tablet 544,256 L.L
J01CA01 ANTALPEN G Ampicillin (trihydrate) - 125mg/5ml 125mg/5ml Powder for suspension 174,060 L.L
J01CA01 ANTALPEN G Ampicillin (trihydrate) - 250mg 250mg Capsule 218,854 L.L
J01CA01 ANTALPEN G Ampicillin (trihydrate) - 500mg 500mg Capsule 285,407 L.L
J01CA01 ANTALPEN FORTE G Ampicillin (trihydrate) - 250mg/5ml 250mg/5ml Powder for suspension 206,056 L.L
N02AJ08 ANTARENE CODEINE G Ibuprofen - 200mg, Codeine - 30mg Tablet, coated 255,330 L.L
A03BB01 ANTIPAN G Hyoscine N butylbromide - 20mg/ml Injectable solution 355,798 L.L
A03BB01 ANTIPAN G Hyoscine N butylbromide - 20mg/ml Injectable solution 2,557,140 L.L
B01AC04 ANTIPLEX G Clopidogrel (Bisulfate) - 75mg 75mg Tablet, film coated 1,295,464 L.L
C05A ANTROLIN B Nifedipine - 0.3%, Lidocaine - 1.5% Cream 1,333,092 L.L
C05A ANTROLIN B Nifedipine - 0.3%, Lidocaine - 1.5% Cream 1,333,092 L.L
N05BA08 ANXYL G Bromazepam - 3mg 3mg Tablet, scored 167,660 L.L
S03AA07 API-CIPROCIN G Ciprofloxacine (HCl) - 3mg/ml 3mg/ml Drops 530,818 L.L
S01EE01 API-LOPROST G Latanoprost - 0.005% 0.005% Drops 447,500 L.L
R05CB06 API-MUCOL G Ambroxol HCl - 15mg/5ml 15mg/5ml Syrup 326,554 L.L
S01CA01 API-TOBRASON G Dexamethasone - 1mg/ml, Tobramycin - 3mg/ml Drops suspension 294,302 L.L
S01CA01 API-TOBRASON G Dexamethasone - 1mg/g, Tobramycin - 3mg/g Ointment 243,235 L.L
A10AB06 APIDRA BioTech Insulin glulisine - 100IU/ml 100IU/ml Injectable solution 2,221,372 L.L
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