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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
N06AX27 SPRAVATO B Esketamine (HCl) - 28mg 28mg/device Solution 44,561,381 L.L
N06AX27 SPRAVATO B Esketamine (HCl) - 28mg 28mg/device Solution 25,122,440 L.L
N06AX27 SPRAVATO B Esketamine (HCl) - 28mg 28mg/device Solution 66,978,978 L.L
L04AD01 SANDIMMUN NEORAL SOFT GELATIN B Ciclosporin - 25mg 25mg Capsule, soft gelatin 2,385,320 L.L
N05AH04 SEROPINE 25 G Quetiapine fumarate - 25mg 25mg Tablet, film coated 1,233,647 L.L
L04AX04 SOTIRA G Lenalidomide - 25mg 25mg Capsule 76,719,234 L.L
N03AX09 SEIZET 25 G Lamotrigine - 25mg 25mg Tablet, dispersible/ chewable 573,821 L.L
L01EX01 SUTENT B Sunitinib maleate - 25mg 25mg Capsule 98,852,769 L.L
L01EX01 SOVIDEX G Sunitinib maleate - 25mg 25mg Capsule 64,804,314 L.L
N06AB05 SEROXAT CR B Paroxetine (HCl) - 25mg 25mg Tablet, controlled release 2,845,587 L.L
N06AB06 SERTRALINE BIOGARAN G Sertraline HCl - 25mg 25mg Capsule 130,353 L.L
L04AD01 SANDIMMUN B Ciclosporin - 50mg/ml 250mg/5ml Injectable concentrated solution 6,992,013 L.L
H02AB09 SOLU CORTEF ACT-O-VIAL B Hydrocortisone (sodium succinate) - 250mg 250mg Injectable lyophilised powder for solution+diluent 421,967 L.L
N02BE01 SULDEX 250 G Paracetamol - 250mg 250mg Suppository 127,985 L.L
N01AH03 SUFENTANIL RENAUDIN G Sufentanil (citrate) - 250mcg/5ml 250mcg/5ml Injectable solution 3,524,899 L.L
A03BB01 SCOBUREN G Butylscopolamine bromide - 20mg/ml 20mg/ml Injectable solution 370,901 L.L
A03BB01 SCOPINAL G Butylscopolamine bromide - 20mg/ml 20mg/ml Injectable solution 178,731 L.L
M01AC02 SORAL G Tenoxicam - 20mg/2ml 20mg/2ml Injectable lyophilised powder for solution+solvent 588,603 L.L
M03AC11 SISACURE G Cisatracurium (besylate) - 20mg/10ml 20mg/10ml Injectable solution 1,408,347 L.L
H01CB02 SANDOSTATIN LAR B Octreotide (acetate) - 20mg 20mg Injectable powder for suspension+diluent L.L
C10AA01 SIMVAKEY G Simvastatin - 20mg 20mg Tablet, film coated 249,955 L.L
C10AA01 SIMVASTATIN NORMON G Simvastatin - 20mg 20mg Tablet, film coated 264,737 L.L
C10AA01 SIMVASTATIN-REMEDICA G Simvastatin - 20mg 20mg Tablet, film coated 542,912 L.L
C10AA01 STAVINE G Simvastatin - 20mg 20mg Tablet 207,336 L.L
C10AA03 STAVACOR G Pravastatin sodium - 20mg 20mg Tablet, scored 725,419 L.L
A02BC01 SANAMIDOL G Omeprazole - 20mg 20mg Capsule 456,906 L.L
A02BC01 STOMAZOLE G Omeprazole - 20mg 20mg Capsule 593,850 L.L
A02BC01 STOMAZOLE G Omeprazole - 20mg 20mg Capsule 15,757,784 L.L
C10AA05 STORVAS G Atorvastatin (calcium) - 20mg 20mg Tablet, film coated 362,837 L.L
G04BE03 SILDENAFIL STRAGEN G Sildenafil - 20mg 20mg Tablet, coated 38,048,630 L.L
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