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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
N02AB03 PECFENT B Fentanyl (citrate) - 400mcg/spray 400mcg/spray Spray 5,718,050 L.L
N02AB03 PECFENT B Fentanyl (citrate) - 100mcg/spray 100mcg/spray Spray 4,343,299 L.L
D04AB01 PROCOMIL G Lidocaine - 10% 10% Spray 139,760 L.L
A07EC02 PENTASA B Mesalazine - 1g 1g Suppository 4,153,817 L.L
C05AX05 PROCTO GLYVENOL B Lidocaine - 40mg, Tribenoside - 400mg Suppository 399,121 L.L
N02AJ06 PARACO-DENK 1000/60 G Paracetamol - 1000mg, Codeine phosphate hemihydrate - 60mg Suppository 636,981 L.L
M01AE03 PROFENID B Ketoprofen - 100mg 100mg Suppository 321,178 L.L
N02BE01 PARA-DENK 250 SUPPOS. G Paracetamol - 250mg 250mg Suppository 190,826 L.L
N02BE01 PARA-DENK 250 SUPPOS. G Paracetamol - 250mg 250mg Suppository 190,826 L.L
N02BE01 PARA-DENK 125 SUPPOS. G Paracetamol - 125mg 125mg Suppository 190,826 L.L
N02BE01 PARA-DENK 125 SUPPOS. G Paracetamol - 125mg 125mg Suppository 190,826 L.L
J01EE01 PAEDIATRIC CO-TRIMOXAZOLE MIXTURE G Trimethoprim - 40mg/5ml, Sulfamethoxazole - 200mg/5ml Suspension 190,698 L.L
P01AB01 PHOSVIT G Metronidazole benzoate - 125mg/5ml 125mg/5ml Suspension 207,336 L.L
P01AB01 PHOZOLE G Metronidazole benzoate - 125mg/5ml 125mg/5ml Suspension 207,336 L.L
R05DB21 PRIVITUSS G L-Cloperastine - 708mg/100ml 708mg/100ml Suspension 785,828 L.L
M01AE01 PEDIAFEN G Ibuprofen - 100mg/5ml 100mg/5ml Suspension 200,936 L.L
M01AE01 PROFINAL G Ibuprofen - 100mg/5ml 100mg/5ml Suspension 208,296 L.L
N02BE01 PANADOL B&I B Paracetamol - 120mg/5ml 120mg/5ml Suspension, sugar free, alcohol free 210,983 L.L
N02BE01 PAROL INFANTS G Paracetamol - 120mg/5ml 120mg/5ml Syrup 281,567 L.L
A11AA PHARMATON KIDDI B Vitamin E - 15mg/15ml, Phosphorous - 200mg/15ml, Calcium - 130mg/15ml, Vitamin D3 - 600IU/15ml, D Panthenol - 10mg/15ml, Nicotinamide - 20mg/15ml Syrup 417,935 L.L
R05C PULMONAL SIROP G Belladona tincture - 0.5g/5ml, Drosera tincture - 2g/5ml, Ammonium bromide - 2g/5ml, Sodium benzoate - 2g/5ml Syrup 148,463 L.L
R06AA52 PULMONAL EXPECTORANT G Diphenhydramine HCl - 0.015g/5ml, Ammonium HCl - 0.1g/5ml Syrup 177,899 L.L
R06AD02 PROMETHAZINE HYDROCHLORIDE G Promethazine HCl - 5mg/5ml 5mg/5ml Syrup 204,776 L.L
H02AB06 PREDALONE G Prednisolone - 15mg/5ml 15mg/5ml Syrup 890,776 L.L
H02AB06 PREDO G Prednisolone sodium phosphate - 15mg/5ml 15mg/5ml Syrup 1,018,633 L.L
H02B PREDALONE PLUS G Prednisolone sodium phosphate - 10mg/5ml, Dexchlorpheniramine maleate - 2mg/5ml Syrup 890,776 L.L
N02BE01 PARAMOL G Paracetamol - 120mg/5ml 120mg/5ml Syrup, alcohol free 85,750 L.L
G03DC02 PRIMOLUT NOR B Norethisterone acetate - 5mg 5mg Tablet 296,989 L.L
G03FB01 PROGYLUTON B Norgestrel - 0.5mg (tablet 2), Estradiol valerate - 2mg (tablet 1, tablet 2) Tablet 193,513 L.L
A10BG03 PIODIAB 30 G Pioglitazone HCl - 30mg 30mg Tablet 2,111,753 L.L
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