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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
H01BB03 PABAL RTS B Carbetocin - 100mcg/ml 100mcg/ml Injectable solution 12,185,492 L.L
B01AB05 PARINOX 40 BioTech Enoxaparin sodium - 4000IU (40mg)/0.4ml 4000IU (40mg)/0.4ml Injectable solution 358,358 L.L
B01AB05 PARINOX 40 BioTech Enoxaparin sodium - 4000IU (40mg)/0.4ml 4000IU (40mg)/0.4ml Injectable solution 3,225,222 L.L
B01AB05 PARINOX 80 BioTech Enoxaparin sodium - 8000IU (80mg)/0.8ml 8000IU (80mg)/0.8ml Injectable solution 494,022 L.L
B01AB05 PARINOX 60 BioTech Enoxaparin sodium - 6000IU (60mg)/0.6ml 6000IU (60mg)/0.6ml Injectable solution 438,989 L.L
B01AB05 PARINOX 20 BioTech Enoxaparin sodium - 2000IU (20mg)/0.2ml 2000IU (20mg)/0.2ml Injectable solution 188,138 L.L
L01BA04 PEMETREXED NEAPOLIS G Pemetrexed (disodium) - 100mg 100mg Injectable solution 10,554,169 L.L
L03AB11 PEGASYS BioTech Peginterferon alfa-2a - 180mcg/0.5ml 180mcg/0.5ml Injectable solution L.L
A04AA05 PALONAN G Palonosetron HCl - 250mcg/5ml 250mcg/5ml Injectable solution 2,194,495 L.L
G03DA03 PROLUTON DEPOT B Hydroxyprogesterone caproate - 250mg/ml 250mg/ml Injectable solution 270,112 L.L
A10AB04 PROLOG BioTech Insulin lispro - 100U/ml 100U/ml Injectable suspension 1,503,312 L.L
J07AL02 PREVENAR 13 B Polysaccharide for serotypes 1, 3, 4, 5 , 6A, 7F, 9V,14, 18C, 19A, 19F, 23F (2.2mcg)Polysaccharide for serotypes 6B (4.4mcg)Conjugated to CRM197 carrier protein and adsorbed on aluminium phosphate (0.125mg aluminium) - Injectable suspension 6,352,343 L.L
J07AL02 PNEUMOSIL (10-VALENT) G Pneumococcal polysaccharide conjugate vaccine (adsorbed) - Injectable suspension 3,386,483 L.L
J07AL02 PREVENAR 20 B Pneumococcal polysaccharide for serotypes 1, 3, 4, 5 , 6A, 7F,8, 9V,10A, 11A, 12F, 14, 15B, 18C, 19A, 19F,22F, 23F, 33F (2.2mcg) Pneumococcal polysaccharide for serotypes 6B (4.4mcg)Conjugated to CRM197 carrier protein (approximately 51mcg) adsorbed on aluminium phosphate (0.125mg aluminium) - Injectable suspension 7,415,107 L.L
J07BF03 POLIOMYELITIS VACCINE INACTIVATED B Poliomyelitis virus type 1 inactivated - 40D.U, Poliomyelitis virus type 2 inactivated - 8D.U, Poliomyelitis virus type 3 inactivated - 32D.U Injectable suspension 1,206,771 L.L
R05CA12 PROSPAN COUGH LIQUID B Dried Ivy leaf extract - 35mg/5ml 35mg/5ml Liquid 353,431 L.L
A11CC05 PEDIAVIT D G Vitamin D3 - 400IU 400IU Liquid 550,975 L.L
A11CC05 PEDIAVIT D 800 G Vitamin D3 - 800IU 800IU Liquid 580,540 L.L
P03AC04 PERMACARE G Permethrin - 1% 1% Lotion 590,011 L.L
D11AH01 PROTOPIC B Tacrolimus monohydrate - 0.1% 0.1% Ointment 2,127,303 L.L
D02AF POMMADE ACIDE SALICYLIQUE G Salicylic acid - 10% 10% Ointment 284,127 L.L
A06AB58 PICOPREP B Magnesium oxide - 3.5g, Citric acid - 12g, Sodium picosulfate - 10mg Powder 694,767 L.L
J01CR02 POSMOX G Amoxicillin (trihydrate) - 875mg, Clavulanic Acid (potassium) - 125mg 1g Powder 616,824 L.L
N02BE51 PANADOL COLD & FLU VAPOUR RELEASE + DECONGESTANT B Paracetamol - 600mg, Phenylephrine HCl - 10mg Powder for solution 460,938 L.L
B02BA01 PHYTOMENADIONE (VITAMINE K1) PANPHARMA G Phytomenadione - 10mg/ml 10mg/ml Solution 740,457 L.L
N05AX08 PMS-RISPERIDONE G Risperidone - 1mg/ml 1mg/ml Solution 604,729 L.L
R05CA12 PROSPAN COUGH SYRUP B Dried Ivy leaf extract - 35mg/5ml 35mg/5ml Solution 353,431 L.L
A13A POTENCIATOR G Arginine Aspartate - 5g/10ml 5g Solution 1,402,972 L.L
H02AB06 PEDIACORT G Prednisolone sodium phosphate - 15mg/5ml 15mg/5ml Solution 417,231 L.L
H02AB06 PREDOXONE G Prednisolone sodium phosphate - 15mg/5ml 15mg/5ml Solution 417,231 L.L
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