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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
R06AX29 LABIXTEN B Bilastine - 6mg/ml 6mg/ml Drops solution 1,647,551 L.L
S01CA01 LEVIOSA G Levofloxacin - 5mg/ml, Dexamethasone - 1mg/ml Drops solution 1,427,161 L.L
S01EA05 LUMIFY B Brimonidine tartrate - 0.025% Drops solution 1,888,099 L.L
S01EE03 LUMIGAN B Bimatoprost - 0.1mg/ml 0.1mg/ml Drops solution 740,457 L.L
S01EE03 LUMIGAN B Bimatoprost - 0.1mg/ml 0.1mg/ml Drops solution 740,457 L.L
S01XA20 LUBRI-TEARS G Carmellose sodium - 2mg Drops solution 792,867 L.L
S01BA14 LOTEMAX B Loteprednol etabonate - 0.5% 0.5% Drops suspension 1,038,790 L.L
S01CA02 LOXTRA G Prednisolone acetate - 2mg/ml, Tetrahydrozoline HCl - 0.4mg/ml, Ofloxacin - 3mg/ml Drops suspension 423,310 L.L
J07CA LANTIGEN B B Streptococcus pneumoniae type 3 (antigenic extracts) - 63.2A.U./ml, Streptococcus pyogenes group A (antigenic extracts) - 126.2A.U./ml, Branhamella catarrhalis (antigenic extracts) - 39.9A.U./ml, Staphylococcus aureus (antigenic extracts) - 79.6A.U./ml, Haemophilus influenzae type b (antigenic extracts) - 50.2A.U./ml, Klebsiella pneumoniae (antigenic extracts) - 39.8A.U./ml Drops suspension 916,501 L.L
C01AA05 LANOXIN PG B Digoxin - 0.05mg/ml 0.05mg/ml Elixir 307,740 L.L
D07AB02 LOCOID CRELO 0.1% B Hydrocortisone butyrate - 1mg/g 0.1% Emulsion 177,387 L.L
D07AB02 LOCOID CRELO 0.1% B Hydrocortisone butyrate - 1mg/g 0.1% Emulsion 177,387 L.L
M02AA15 LOCAGEL G Diclofenac sodium (diethylamine) - 10mg/g 10mg/g Gel 223,078 L.L
D11AX18 LABDIC RELIEF G Diclofenac sodium - 1%w/w, Methyl salicylate - 8%w/w, Menthol - 2%w/w Gel 263,393 L.L
J01GB06 LIKACIN G Amikacin (sulfate) - 500mg/2ml 500mg/2ml Injectable concentrated solution 13,751,774 L.L
B05BA02 LIPIDEM G Triglycerides, Medium Chain - 100g/500ml, Soya bean oil - 80g/500ml, Omega-3 acid triglicerides - 20g/500ml Injectable emulsion 2,486,109 L.L
J05AB01 LOVRAK-JULPHAR G Aciclovir - 250mg 250mg Injectable lyophilised powder 278,175 L.L
A02BC02 LUGANOR G Pantoprazole - 40mg 40mg Injectable lyophilised powder for solution 463,050 L.L
A02BC02 LUGANOR G Pantoprazole - 40mg 40mg Injectable lyophilised powder for solution 4,146,714 L.L
A02BC01 LOZICARE G Omeprazole - 40mg 40mg Injectable powder for solution 12,446,972 L.L
J01DD04 LEBACEF G Ceftriaxone (sodium) - 0.5g 0.5g Injectable powder for solution 3,455,595 L.L
J01DD04 LEBACEF G Ceftriaxone (sodium) - 0.5g 0.5g Injectable powder for solution 3,455,595 L.L
J01DD04 LEBACEF G Ceftriaxone (sodium) - 1g 1g Injectable powder for solution 5,793,881 L.L
J01DD04 LEBACEF G Ceftriaxone (sodium) - 1g 1g Injectable powder for solution 5,793,881 L.L
J01DD04 LEBACEF G Ceftriaxone (sodium) - 1g 1g Injectable powder for solution 5,793,881 L.L
J01DD04 LEBACEF G Ceftriaxone (sodium) - 0.5g, Lidocaine (ampoule) - 0.5g Injectable powder for solution+diluent 511,940 L.L
J01DD04 LEBACEF G Ceftriaxone (sodium) - 0.5g 0.5g Injectable powder for solution+diluent 511,940 L.L
J01DD04 LEBACEF G Ceftriaxone (sodium) - 0.5g 0.5g Injectable powder for solution+diluent 433,869 L.L
J01DD04 LEBACEF G Ceftriaxone (sodium) - 0.5g, Lidocaine (ampoule) - 0.5g Injectable powder for solution+diluent 403,153 L.L
J01DD04 LEBACEF G Ceftriaxone (sodium) - 0.5g, Lidocaine (ampoule) - 0.5g Injectable powder for solution+diluent 403,153 L.L
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