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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
B01AC27 UPTRAVI B Selexipag - 1600mcg 1600mcg Tablet, film coated 242,569,645 L.L
J01DH02 MERONEM B Meropenem (trihydrate) - 500mg 500mg Injectable powder for solution 10,398,061 L.L
J02AC05 CRESEMBA B Isavuconazonium sulfate - 200mg 200mg Injectable powder for concentrate for solution 38,436,952 L.L
A10BD19 GLYXAMBI B Linagliptin - 5mg, Empagliflozin - 25mg Tablet, film coated 4,482,387 L.L
S01AA23 NETTACIN B Netilmicin - 0.3% 0.3% Drops solution 681,328 L.L
L04AD02 ADVAGRAF B Tacrolimus monohydrate - 1mg 1mg Capsule, prolonged release L.L
A06AD11 DUPHALAC B Lactulose - 6.7g/10ml 6.7g/10ml Solution 510,660 L.L
R03AL01 ATROVENT COMP. HFA B Fenoterol Hydrobromide - 20mcg/actuation, Ipratropium bromide - 50mcg/actuation Inhalation aerosol metered dose 544,256 L.L
S01AA23 NETTACIN B Netilmicin - 0.3% 0.3% Ointment 593,978 L.L
L04AD02 ADVAGRAF B Tacrolimus monohydrate - 3mg 3mg Capsule, prolonged release L.L
L01BC08 DACOGEN B Decitabine - 50mg 50mg Injectable lyophilised powder for solution 90,496,389 L.L
L04AD01 SANDIMMUN B Ciclosporin - 50mg/ml 250mg/5ml Injectable concentrated solution 6,992,013 L.L
M02AA15 FLECTOR E.P TISSUGEL B Diclofenac (epolamine) - 1% 1% Patch 1,204,083 L.L
R03AL02 COMBIVENT B Salbutamol (sulfate) - 2.5mg/2.5ml, Ipratropium bromide - 500mcg/2.5ml Inhaltion solution with nebuliser 745,833 L.L
A10BD20 SYNJARDY B Empagliflozin - 12.5mg, Metformin HCl - 1000mg 12.5mg/1000mg Tablet, film coated 3,399,653 L.L
C01DA02 NITRODERM TTS 5 B Glyceryl trinitrate - 5mg/24h 5mg/24h Patch 705,284 L.L
L01BC08 DACOGEN B Decitabine - 50mg 50mg Injectable lyophilised powder for solution 90,495,926 L.L
L04AD01 SANDIMMUN NEORAL SOFT GELATIN B Ciclosporin - 50mg 50mg Capsule, soft gelatin 4,309,703 L.L
M02AA15 VOLTAREN EMULGEL 12HRS B Diclofenac Diethylamine - 23.2mg/g 23.2mg/g Gel 1,169,143 L.L
N06AX26 BRINTELLIX B Vortioxetine - 5mg 5mg Tablet, film coated 2,592,272 L.L
S01AD09 VIRGAN B Ganciclovir - 1.5mg/g 1.5mg/g Gel 804,962 L.L
A02BB01 CYTOTEC B Misoprostol - 200mcg 200mcg Tablet 737,770 L.L
A06AD15 FORLAX POUDRE POUR SOLUTION BUVABLE B Macrogol 4000 - 10g 10g Powder for solution 450,187 L.L
A10BD20 SYNJARDY B Empagliflozin - 12.5mg, Metformin HCl - 1000mg 12.5mg/1000mg Tablet, film coated 3,500,441 L.L
G03DA04 PROLUTEX B Progesterone - 25mg 25mg Injectable solution 5,570,227 L.L
J02AX05 MYCAMINE B Micafungin (sodium) - 50mg 50mg Injectable lyophilised powder for solution 13,170,341 L.L
L01BC59 LONSURF B Trifluridine - 20mg, Tipiracil - 8.19mg Tablet, film coated 75,019,126 L.L
L04AD01 SANDIMMUN NEORAL SOFT GELATIN B Ciclosporin - 25mg 25mg Capsule, soft gelatin 2,385,320 L.L
M02AA15 VOLTAREN EMULGEL 12HRS B Diclofenac Diethylamine - 23.2mg/g 23.2mg/g Gel 717,612 L.L
N05AF05 CLOPIXOL DEPOT B Zuclopenthixol decanoate - 200mg/ml 200mg/ml Injectable solution 512,004 L.L
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