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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
B05BB01 R-SOL G Calcium chloride, 2H2O - 0.033%, Potassium chloride - 0.03%, Sodium chloride - 0.86% Injectable solution 205,933 L.L
A02BC04 RABEC G Rabeprazole (sodium) - 10mg 10mg Tablet, film coated 212,327 L.L
A02BC04 RABEC G Rabeprazole (sodium) - 20mg 20mg Tablet, film coated 212,327 L.L
A02BC04 RABEZOL 20 G Rabeprazole sodium - 20mg 20mg Tablet, enteric coated 282,847 L.L
A02BC04 RABEZOL 20 G Rabeprazole sodium - 20mg 20mg Tablet, enteric coated 639,925 L.L
J06BB05 RABISHIELD-100 (RABIES HUMAN MONOCLONAL ANTIBODY rDNA) BioHuman Rabies, Human IgG1 Monoclonal Antibody - 100IU/2.5ml 100IU/2.5ml 8,455,824 L.L
J07BG01 RABIVAX-S (RABIES VACCINE INACTIVATED) BioTech Freeze dried inactivated purified rabies antigen (Pitman Moore PM3218 as virus strain) - Injectable freeze dried material 1,552,138 L.L
A07XA04 RACECADOTRIL ARROW G Racecadotril - 100mg 100mg Capsule 583,228 L.L
A07XA04 RACECADOTRIL BGR G Racecadotril - 100mg 100mg Capsule 575,165 L.L
A07XA04 RACECADOTRIL BIOGARAN CONSEIL G Racecadotril - 100mg 100mg Capsule 287,582 L.L
H02AB02 RADOLINE G Dexamethasone sodium phosphate - 8mg/2ml 8mg/2ml Injectable solution 3,711,565 L.L
G03XC01 RALOXIFENE ARROW G Raloxifene HCl - 60mg 60mg Tablet, coated 1,425,817 L.L
P01AB01 RAMAZOL G Metronidazole - 500mg 500mg Tablet 216,359 L.L
A02BC04 RAMEP G Rabeprazole (sodium) - 20mg 20mg Tablet, gastroresistant 518,809 L.L
C09AA05 RAMIPRIL-REMEDICA G Ramipril - 5mg 5mg Tablet 623,543 L.L
C09AA05 RAMIPRIL-REMEDICA G Ramipril - 10mg 10mg Tablet 896,343 L.L
C09BB07 RAMIPRIL/AMLODIPINE GENERICON G Ramipril - 2.5mg, Amlodipine - 5mg Capsule, hard 1,358,625 L.L
C09BB07 RAMIPRIL/AMLODIPINE GENERICON G Ramipril - 5mg, Amlodipine - 5mg Capsule, hard 1,358,625 L.L
C09BB07 RAMIPRIL/AMLODIPINE GENERICON G Ramipril - 10mg, Amlodipine - 5mg Capsule, hard 1,358,625 L.L
C09BB07 RAMIPRIL/AMLODIPINE GENERICON G Ramipril - 10mg, Amlodipine - 10mg Capsule, hard 1,358,625 L.L
C01EB18 RANEXA B Ranolazine - 375mg 375mg Tablet, prolonged release 3,985,837 L.L
C01EB18 RANEXA B Ranolazine - 500mg 500mg Tablet, prolonged release 3,985,837 L.L
C01EB18 RANEXA B Ranolazine - 750mg 750mg Tablet, prolonged release 3,985,837 L.L
L04AA10 RAPAMUNE B Sirolimus - 1mg 1mg Tablet 12,907,489 L.L
L04AA10 RAPAMUNE B Sirolimus - 1mg 1mg Tablet L.L
R05DB13 RAPICOD G Butamirate citrate - 0.15% 0.15% Syrup 296,989 L.L
M01AB05 RAPIDUS G Diclofenac potassium - 50mg 50mg Tablet, coated 287,582 L.L
N04BD02 RASAGILINE BIOGARAN G Rasagiline - 1mg 1mg Tablet 5,214,109 L.L
G04BE08 RAVANA G Tadalafil - 20mg 20mg Tablet 500,421 L.L
G04BE08 RAVANA G Tadalafil - 5mg 5mg Tablet 1,501,264 L.L
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