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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
P01AB01 FLAGYL B Metronidazole - 500mg 500mg Tablet, film coated 310,428 L.L
J01MA12 FLOBIOX G Levofloxacin - 500mg 500mg Tablet, film coated 629,686 L.L
J01MA12 FLOBIOX G Levofloxacin - 500mg 500mg Tablet, film coated 794,787 L.L
J01MA12 FLOXILEVO G Levofloxacin - 500mg 500mg Tablet, film coated 690,735 L.L
J01MA12 FLOXIN-L 500 G Levofloxacin (hemihydrate) - 500mg 500mg Tablet, film coated 831,903 L.L
V03AE03 FOSRENOL B Lanthanum Carbonate - 500mg 500mg Tablet, chewable 18,751,847 L.L
G01AF01 FLAGYL B Metronidazole - 500mg 500mg Ovule 249,955 L.L
N02BE01 FEBRADOL G Paracetamol - 500mg 500mg Tablet 327,642 L.L
B03AC FERINJECT B Iron trivalent (ferric carboxymaltose) - 500mg/10ml 500mg/10ml Injectable solution 10,212,033 L.L
B03AC FERAPPLIC G Iron trivalent (ferric carboxymaltose) - 500mg/10ml 500mg/10ml Injectable dispersion 34,231,559 L.L
B02BD03 FEIBA BioHuman Factor VIII Inhibitor bypassing fraction - 500IU 500U (50U/ml) Injectable powder for solution+solvent 40,480,699 L.L
R03BA05 FLIXOTIDE EVOHALER B Fluticasone propionate - 50mcg/actuation 50mcg/actuation Inhalation suspension 671,921 L.L
J05AB16 FLEXIVIR G Remdesivir - 50mg 50mg Injectable lyophilised powder for solution 4,837,833 L.L
M01AB05 FLECTOR E.P B Diclofenac (epolamine) - 50mg 50mg Granules 503,941 L.L
J02AC01 FLUNAZOL G Fluconazole - 50mg 50mg Capsule 534,465 L.L
J02AC01 FLUZAN 50 G Fluconazole - 50mg 50mg Tablet 719,276 L.L
J02AC01 FUNZOL 50 G Fluconazole - 50mg 50mg Capsule 373,588 L.L
C01BC04 FLECAINIDE BIOGARAN L.P. G Flecainide acetate - 50mg 50mg Capsule, extended release 1,154,361 L.L
L01BB05 FLUDARABINE PHOSPHATE NEAPOLIS G Fludarabine Dihydrogenophosphate - 50mg/2ml 50mg/2ml Injectable solution L.L
L01BB05 FLUDARABIN EBEWE G Fludarabine Dihydrogenophosphate - 50mg/2ml 50mg/2ml Injectable solution 3,567,902 L.L
L01BB05 FLUDARABINE PHOSPHATE NEAPOLIS G Fludarabine Dihydrogenophosphate - 50mg/2ml 50mg/2ml Injectable solution 4,031,528 L.L
J02AC01 FLUNAZOL G Fluconazole - 50mg/5ml 50mg/5ml Powder for suspension 756,391 L.L
N05AB02 FLUPHENAZINE HCl G Fluphenazine (HCl) - 5mg 5mg Tablet, scored 624,567 L.L
B03BB01 FOLICIL G Folic acid - 5mg 5mg Tablet 584,571 L.L
G04CB01 FINASTEKERN G Finasteride - 5mg 5mg Tablet, film coated 560,382 L.L
G04CB01 FINASTERIDE G Finasteride - 5mg 5mg Tablet, film coated 356,118 L.L
G04CB01 FINASTERIDE ARROW LAB G Finasteride - 5mg 5mg Tablet, film coated 516,036 L.L
R06AE07 FINALLERG G Cetirizine (dihydrochloride) - 5mg/5ml 5mg/5ml Solution 170,668 L.L
A03FA03 FARCOTILIUM G Domperidone - 5mg/5ml 5mg/5ml Suspension 115,570 L.L
R05CB01 FLUIMUCIL B N-acetylcysteine - 600mg 600mg Tablet, effervescent 567,102 L.L
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