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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
J01DD08 SUPRAX 100 B Cefixime (trihydrate) - 100mg/5ml 100mg/5ml Powder for suspension 1,166,455 L.L
J01DD08 SUPRAX 100 B Cefixime (trihydrate) - 100mg/5ml 100mg/5ml Powder for suspension 1,166,455 L.L
L04AD01 SANDIMMUN NEORAL B Ciclosporin - 100mg/ml 100mg/ml Solution 8,264,592 L.L
J06BD01 SYNAGIS BioTech Palivizumab - 100mg/ml 100mg/ml Injectable solution 57,429,464 L.L
N01AH03 SUFENTANIL RENAUDIN G Sufentanil (citrate) - 5mcg/ml 10mcg/2ml Injectable solution 755,239 L.L
A06AB02 SUPPOLAX G Bisacodyl - 10mg 10mg Suppository 598,051 L.L
C10AA01 SIMVASTATIN NORMON G Simvastatin - 10mg 10mg Tablet, film coated 264,737 L.L
C10AA01 STAVINE G Simvastatin - 10mg 10mg Tablet 207,336 L.L
C10AA03 STAVACOR G Pravastatin sodium - 10mg 10mg Tablet, scored 1,695,801 L.L
C10AA05 STORVAS G Atorvastatin (calcium) - 10mg 10mg Tablet, film coated 362,837 L.L
L04AX04 SOTIRA G Lenalidomide - 10mg 10mg Capsule 72,248,183 L.L
G04BD08 SOLIFAS G Solifenacin succinate - 10mg 10mg Tablet, film coated 971,598 L.L
R03DC03 SINGULAIR B Montelukast (sodium) - 10mg 10mg Tablet, film coated 1,248,430 L.L
G04BD08 SOLIFENACINE ARROW G Solifenacin succinate - 10mg 10mg Tablet, coated 952,784 L.L
C10AA07 SINLIP G Rosuvastatin (calcium) - 10mg 10mg Tablet, film coated 563,070 L.L
C10AA07 SUPERSTAT G Rosuvastatin (calcium) - 10mg 10mg Tablet, coated 517,379 L.L
N02AA01 SKENAN LP G Morphine sulfate - 10mg 10mg Capsule, prolonged release microgranules 419,279 L.L
N05CF02 STILNOX B Zolpidem (tartrate) - 10mg 10mg Tablet, film coated, scored 96,757 L.L
A03BB01 SCOPINAL G Butylscopolamine bromide - 10mg 10mg Tablet, film coated 162,605 L.L
D06BA01 SILVEDERMA G Silver sulfadiazine - 1% 10mg/g Cream 1,220,209 L.L
D06BA01 SILVEDERMA G Silver sulfadiazine - 1% 10mg/g Cream 494,534 L.L
D11AX22 SOOLANTRA B Ivermectin - 10mg/g 10mg/g Cream 2,154,180 L.L
D11AX22 SOOLANTRA B Ivermectin - 10mg/g 10mg/g Cream 1,053,573 L.L
N02BE01 SUPOFEN G Paracetamol - 10mg/ml 10mg/ml Injectable solution 7,675,286 L.L
L01EX01 SUTENT B Sunitinib maleate - 12.5mg 12.5mg Capsule 54,006,801 L.L
L01EX01 SOVIDEX G Sunitinib maleate - 12.5mg 12.5mg Capsule 36,042,560 L.L
L01EX01 SUNITINIB AQVIDA G Sunitinib maleate - 12.5mg 12.5mg Capsule, hard 41,692,397 L.L
N06AB05 SEROXAT CR B Paroxetine (HCl) - 12.5mg 12.5mg Tablet, controlled release 2,330,541 L.L
L01EX01 SUTENT B Sunitinib maleate - 12.5mg 12.5mg Capsule L.L
A10BD20 SYNJARDY B Empagliflozin - 12.5mg, Metformin HCl - 1000mg 12.5mg/1000mg Tablet, film coated 3,399,653 L.L
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