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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
R06AB54 ALERGICAL EXPECTORANT B Chlorpheniramine maleate - 50mg/100ml, Guaifenesin - 2000mg/100ml, Dihydroxypropyltheophylline - 500mg/100ml, Paracetamol - 2000mg/100ml Syrup 485,127 L.L
S01GA04 ALERJON G Oxymetazoline HCl - Drops solution 528,130 L.L
L01BC01 ALEXAN G Cytarabine - 100mg/5ml 100mg/5ml Injectable solution 388,370 L.L
L01BC01 ALEXAN G Cytarabine - 1,000mg/20ml 1,000mg/20ml Injectable solution 2,848,946 L.L
L01BC01 ALEXAN G Cytarabine - 1,000mg/20ml 1,000mg/20ml Injectable solution L.L
R02A ALFA-AMYLASE BGR CONSEIL G Alpha-Amylase - 3,000U.CEIP 3,000U.CEIP Tablet, coated 290,270 L.L
R02A ALFA-AMYLASE BGR CONSEIL G Alpha-Amylase - 200U.CEIP/ml 200U.CEIP/ml Syrup 384,339 L.L
G04CA01 ALFOCIN G Alfuzosin HCl - 10mg 10mg Tablet, extended release 858,779 L.L
G04CA01 ALFUZOSINE ARROW LP G Alfuzosin HCl - 10mg 10mg Tablet, film coated, sustained release 743,145 L.L
G04CA01 ALFUZOSINE BIOGARAN LP G Alfuzosin HCl - 10mg 10mg Tablet, coated, prolonged release 1,115,389 L.L
M02AX10 ALGESAL SURACTIVE B Salycilic acid - 6.54g/100g, Diethylamine - 3.46g/100g, Myrtecaine - 1g/100g Cream 1,006,538 L.L
M01AE01 ALGIFAST 400 B Ibuprofen Lysine - 400mg 400mg Powder for suspension 473,033 L.L
M01AE01 ALGIFAST PEDIATRIC B Ibuprofen Lysine - 20mg/ml 20mg/ml Suspension 393,746 L.L
M01AB15 ALGIKEY G Ketorolac trometamine - 30mg/ml 30mg/ml Injectable solution 873,498 L.L
N02BE01 ALGIVIC G Paracetamol - 250mg 250mg Suppository 215,015 L.L
N02BE01 ALGIVIC G Paracetamol - 500mg 500mg Suppository 147,183 L.L
N02BE01 ALGIVIC INFANT G Paracetamol - 125mg 125mg Suppository 199,657 L.L
N02AJ06 ALGOCOD G Paracetamol - 500mg, Codeine phosphate - 30mg Tablet, effervescent 299,677 L.L
N02AJ13 ALGODOL G Paracetamol - 325mg, Tramadol HCl - 37.5mg Capsule 317,403 L.L
R05DA20 ALGOMIEL COUGH SYRUP G Dextromethorphan HBr - 5mg, Carbinoxamine maleate - 2mg Syrup 639,925 L.L
L01BA04 ALIMTA B Pemetrexed (disodium) - 500mg 500mg Injectable concentrated powder for solution 78,132,798 L.L
L01BA04 ALIMTA B Pemetrexed (disodium) - 100mg 100mg Injectable concentrated powder for solution 16,854,009 L.L
S01GX07 ALLERGODIL B Azelastine HCl - 0.5mg/ml 0.5mg/ml Drops solution 709,549 L.L
R01AC03 ALLERGODIL NASAL B Azelastine HCl - 0.14mg/dose 0.14mg/dose Spray, solution 657,139 L.L
M04AA01 ALLOPURINOL BIOGARAN G Allopurinol - 100mg 100mg Tablet 107,507 L.L
M04AA01 ALLOPURINOL BIOGARAN G Allopurinol - 300mg 300mg Tablet 212,327 L.L
M04AA01 ALLOPURINOL BIOGARAN G Allopurinol - 200mg 200mg Tablet 169,324 L.L
D11AX18 ALMIRAL G Diclofenac sodium - 1% w/w 1% w/w Gel 396,434 L.L
M01AB05 ALMIRAL G Diclofenac sodium - 75mg/3ml 75mg/3ml Injectable solution 415,247 L.L
N02CC05 ALMOVITAE G Almotriptan - 12.5mg 12.5mg Tablet, film coated 1,148,985 L.L
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