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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
R03BA02 AERONIDE G Budesonide - 400mcg 400mcg Capsule, inhalation 2,116,552 L.L
R03AC13 AEROFOR G Formoterol fumarate - 12mcg 12mcg Capsule, inhalation 897,687 L.L
R03AC13 AEROFOR G Formoterol fumarate - 12mcg 12mcg Capsule, inhalation 1,709,368 L.L
L04AD02 ADVAGRAF B Tacrolimus monohydrate - 1mg 1mg Capsule, prolonged release L.L
L04AD02 ADVAGRAF B Tacrolimus monohydrate - 3mg 3mg Capsule, prolonged release L.L
L04AD02 ADVAGRAF B Tacrolimus monohydrate - 3mg 3mg Capsule, prolonged release 68,645,618 L.L
L04AD02 ADVAGRAF B Tacrolimus monohydrate - 1mg 1mg Capsule, prolonged release 25,729,044 L.L
L04AD02 ADVAGRAF B Tacrolimus monohydrate - 5mg 5mg Capsule, prolonged release 85,485,667 L.L
L04AD02 ADVAGRAF B Tacrolimus monohydrate - 0.5mg 0.5mg Capsule, prolonged release 13,297,758 L.L
B01AB11 ANGIOFLUX G Sulodexide - 250LRU 250LRU Capsule, soft 1,999,638 L.L
D10BA01 A-CNOTREN G Isotretinoin - 20mg 20mg Capsule, soft gelatin 1,526,524 L.L
D06AX01 ACIDE FUSIDIQUE BGR G Fusidic acid - 2% 2% Cream 202,920 L.L
M02AA AIRTAL DIFUCREM 1.5% B Aceclofenac - 1.5g/100g 1.5% Cream 536,193 L.L
M02AX10 ALGESAL SURACTIVE B Salycilic acid - 6.54g/100g, Diethylamine - 3.46g/100g, Myrtecaine - 1g/100g Cream 1,006,538 L.L
D06BB10 ALDARA B Imiquimod - 5% 5% Cream 6,301,277 L.L
D06BB53 ACTI-VIR H G Aciclovir - 5%, Hydrocortisone acetate - 1% Cream 833,182 L.L
D07AC14 ADVANTAN B Methylprednisolone aceponate - 1mg/g 1mg/g Cream 385,683 L.L
D07XC04 AZONIT - D G Diflucortolone valerate - 1mg/g, Isoconazole nitrate - 10mg/g Cream 225,766 L.L
D10AD01 A-RET G Tretinoin - 0.05% 0.05% Cream 335,961 L.L
D10AD01 AVOTIN-A G Tretinoin - 0.05% 0.05% Cream 440,780 L.L
D10AD06 AKLIEF B Trifarotene - 50mcg/g 50mcg/g Cream 4,359,425 L.L
C05A ANTROLIN B Nifedipine - 0.3%, Lidocaine - 1.5% Cream 1,333,092 L.L
C05A ANTROLIN B Nifedipine - 0.3%, Lidocaine - 1.5% Cream 1,333,092 L.L
D11AX11 AVOQUIN G Hydroquinone - 4% 4% Cream 916,501 L.L
S01AE07 AROX G Moxifloxacin (HCl) - 0.5% 0.5% Drops 423,310 L.L
S01EE01 API-LOPROST G Latanoprost - 0.005% 0.005% Drops 447,500 L.L
S03AA07 API-CIPROCIN G Ciprofloxacine (HCl) - 3mg/ml 3mg/ml Drops 530,818 L.L
S01AA26 AZYTER G Azithromycin (dihydrate) - 15mg/g 15mg/g Drops solution 412,560 L.L
S01EA05 ALPHAGAN P B Brimonidine tartrate - 1.5mg/ml 0.15% Drops solution 999,819 L.L
S01EA05 ALPHAGAN P B Brimonidine tartrate - 1.5mg/ml 0.15% Drops solution 999,819 L.L
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