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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
J07AP03 TYPHIBEV TYPHOID CONJUGATED VACCINE (MONOVALENT) B Salmonella typhi polysaccharides Vi purified - 25mcg of Vi-PS2/0.5ml Injectable suspension 4,020,777 L.L
J07CA02 TETRAXIM (Vaccin Diphterique, tetanique, coquelucheux acellulaire et Poliomyelitique inactivé adsorbé) B Diphteria toxoid purified - ?30IU, Tetanus toxoid purified - ?40IU, Poliomyelitis virus type 1 inactivated - 40D.U., Poliomyelitis virus type 2 inactivated - 8D.U., Poliomyelitis virus type 3 inactivated - 32D.U., Bordetella Pertussis Antigens: toxoid - 25mcg, Bordetella Pertussis Antigens: filamentous haemagglutinin - 25mcg Injectable suspension 1,628,737 L.L
H02AB08 TRIACORT G Triamcinolone acetonide - 40mg/ml 40mg/ml Injectable suspension 745,833 L.L
N05AX13 TREVICTA B Paliperidone - 175mg 175mg Injectable suspension, prolonged release 35,006,803 L.L
N05AX13 TREVICTA B Paliperidone - 263mg 263mg Injectable suspension, prolonged release 40,713,289 L.L
N05AX13 TREVICTA B Paliperidone - 350mg 350mg Injectable suspension, prolonged release 50,113,451 L.L
N05AX13 TREVICTA B Paliperidone - 525mg 525mg Injectable suspension, prolonged release 75,169,610 L.L
N05AX13 TREVICTA B Paliperidone - 350mg 350mg Injectable suspension, prolonged release L.L
N05AX13 TREVICTA B Paliperidone - 525mg 525mg Injectable suspension, prolonged release L.L
R02A TRACHISAN G Lidocaine HCl - 1mg, Tyrothricin - 0.5mg, Chlorhexidine gluconate - 1mg Lozenge 228,453 L.L
S01AA12 TOBRACIN G Tobramycin - 0.3% 0.3% Ointment 280,863 L.L
D11AH01 TACRUS G Tacrolimus monohydrate - 0.1% 0.1% Ointment 1,857,190 L.L
D11AH01 TRACZIMUS G Tacrolimus monohydrate - 0.1% 0.1% Ointment 1,276,650 L.L
D11AH01 TRECZIMUS G Tacrolimus monohydrate - 0.1% 0.1% Ointment 1,276,650 L.L
D11AX TRIO-2000 G Hydroquinone - 4%, Tretinoin - 0.05%, Hydrocortisone acetate - 1% Ointment 2,495,068 L.L
D06AA04 TETRACYCLINE OINTMENT G Tetracycline HCl - 3% 3% Ointment 107,507 L.L
R03BB04 TIOVA-T G Tiotropium bromide monohydrate - 18mcg 18mcg Rotacaps 384,339 L.L
S01EE05 TAFLUPRO G Tafluprost - 0.0015% 0.0015% Solution 1,912,288 L.L
D10AD01 TRETINOIN G Tretinoin - 0.05% 0.05% Solution 623,287 L.L
D10AD01 TRETINOIN G Tretinoin - 0.025% 0.025% Solution 564,414 L.L
D10AD01 TRETINOIN G Tretinoin - 0.1% 0.1% Solution 682,160 L.L
B03AE10 TOT'HEMA B Copper (gluconate) - 0.70mg/10ml, Manganese (gluconate) - 1.33mg/10ml, Iron (gluconate) - 50mg/10ml Solution 604,729 L.L
D01AE15 TERAFAN G Terbinafine HCl - 1% 1% Solution 355,798 L.L
R01AD09 TABUNEX G Mometasone furoate - 0.05% 0.05% Spray 419,279 L.L
R01AB06 TRIOFAN B Xylometazoline HCl - 0.5mg/ml, Carbocysteine - 5mg/ml Spray, solution 608,761 L.L
R01AB06 TRIOFAN B Xylometazoline HCl - 1mg/ml, Carbocysteine - 10mg/ml Spray, solution 646,388 L.L
R01AD08 TICANASE G Fluticasone propionate - 50mcg/actuation 12g/Bottle Spray, suspension 405,840 L.L
N02BE01 TYLENOL B Paracetamol - 350mg 350mg Suppository 239,204 L.L
R05FA02 TUSCALMAN A B Noscapine HCl - 5mg, Guaifenesin - 25mg Suppository 624,963 L.L
R05FA02 TUSCALMAN B B Noscapine HCl - 10mg, Guaifenesin - 50mg Suppository 615,992 L.L
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