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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
A10AB05 NOVORAPID FLEXPEN BioTech Insulin aspart - 100IU/ml 100IU/ml Injectable solution 3,123,090 L.L
A10AB05 NOVORAPID FLEXPEN BioTech Insulin aspart - 100IU/ml 100IU/ml Injectable solution 3,123,090 L.L
L03AA02 NEUTROMAX BioTech Filgrastim - 300mcg/ml 300mcg/ml Injectable solution L.L
A11DB NEUROBION B Vitamin B12 - 1000mcg, Vitamin B6 - 100mg, Vitamin B1 - 100mg Injectable solution 545,600 L.L
A11DB NEUROBION B Vitamin B12 - 1000mcg, Vitamin B6 - 100mg, Vitamin B1 - 100mg Injectable solution 287,582 L.L
A11DB NEURORUBINE G Vitamin B12 - 1mg, Vitamin B6 - 100mg, Vitamin B1 - 100mg Injectable solution 302,365 L.L
L03AA02 NEOGRASTIM 30 BioTech Filgrastim - 300mcg/ml 300mcg/ml Injectable solution 1,970,969 L.L
L03AA02 NEUTROMAX BioTech Filgrastim - 300mcg/ml 300mcg/ml Injectable solution 2,553,301 L.L
L03AA02 NEUPOGEN BioTech Filgrastim - 300mcg/0.5ml 300mcg/0.5ml Injectable solution 5,250,393 L.L
L03AA02 NIVESTIM BioTech Filgrastim - 30MIU/0.5ml 30MIU/0.5ml Injectable solution 17,110,745 L.L
L03AA13 NEULASTIM BioTech Pegfilgrastim - 6mg/0.6ml 6mg/0.6ml Injectable solution 56,925,965 L.L
H01AC01 NORDITROPIN NORDIFLEX BioTech Somatropin recombinant - 5mg/1.5ml 5mg/1.5ml Injectable solution 7,582,922 L.L
H01AC01 NORDITROPIN FLEXPRO BioTech Somatropin recombinant - 10mg/1.5ml 10mg/1.5ml Injectable solution 18,877,698 L.L
H01AC08 NGENLA B Somatrogon - 60mg/1.2ml 60mg/1.2ml Injectable solution 46,927,262 L.L
H01AC08 NGENLA B Somatrogon - 24mg/1.2ml 24mg/1.2ml Injectable solution 21,959,797 L.L
N02AF02 NALBUPHINE RENAUDIN 1% G Nalbuphine HCl - 20mg/2ml 20mg/2ml Injectable solution 1,181,238 L.L
M01AE17 NORMODEX G Dexketoprofen (trometamol) - 50mg/2ml 50mg/2ml Injectable solution 329,241 L.L
A04AA02 NEOSET G Granisetron (HCl) - 3mg/3ml 3mg/3ml Injectable solution 405,840 L.L
C08CA04 NICARDIPINE AGUETTANT G Nicardipine chlorhydrate - 10mg/10ml 10mg/10ml Injectable solution 2,801,912 L.L
C08CA04 NICARDIPINE ARROW G Nicardipine chlorhydrate - 10mg/10ml 10mg/10ml Injectable solution 2,590,928 L.L
C08CA04 NICARDIPINE MEDIS G Nicardipine chlorhydrate - 10mg/10ml 10mg/10ml Injectable solution 1,295,464 L.L
C01CA03 NORADRENALINE NOREPINEPHRINE (tartrate) Aguettant G Norepinephrine tartrate - 2mg/ml 2mg/ml Injectable solution 1,896,162 L.L
C01CA03 NORADRENALINE NOREPINEPHRINE (tartrate) Aguettant G Norepinephrine tartrate - 2mg/ml 2mg/ml Injectable solution 1,896,162 L.L
C01CA03 NORADRENALINE RENAUDIN G Norepinephrine tartrate - 8mg/4ml 0.2% Injectable solution 2,000,981 L.L
A10AD05 NOVOMIX 30 BioTech Insulin aspart - 30%, Insulin aspart protamine - 70% 100IU/ml Injectable suspension 4,264,012 L.L
A10AD05 NOVOMIX 30 BioTech Insulin aspart - 30%, Insulin aspart protamine - 70% 100IU/ml Injectable suspension 4,264,012 L.L
A10AD05 NOVOMIX 30 BioTech Insulin aspart - 30%, Insulin aspart protamine - 70% 100IU/ml Injectable suspension 4,264,012 L.L
S01AA23 NETTACIN B Netilmicin - 0.3% 0.3% Ointment 593,978 L.L
C01DA02 NITRODERM TTS 5 B Glyceryl trinitrate - 5mg/24h 5mg/24h Patch 705,284 L.L
N04BC09 NEUPRO B Rotigotine - 2mg/24h 2mg/24h Patch 4,427,961 L.L
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