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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
N02BE51 ADOL EXTRA G Paracetamol - 500mg, Caffeine - 65mg Caplet 122,290 L.L
N02BE01 ADOL G Paracetamol - 500mg 500mg Caplet 81,974 L.L
M01AE51 ADVIL COLD & SINUS B Ibuprofen - 200mg, Pseudoephedrine HCl - 30mg Caplet, coated 288,926 L.L
C09DB01 ARBITEN AM 5/160 G Amlodipine - 5mg, Valsartan - 160mg Caplet, film coated 857,372 L.L
C09DB01 ARBITEN AM 10/160 G Amlodipine - 10mg, Valsartan - 160mg Caplet, film coated 857,372 L.L
A04AD12 APREPITANT BIOGARAN 125MG APREPITANT BIOGARAN 80MG G Aprepitant - 125mg, Aprepitant - 80mg 125mg Capsule 2,980,643 L.L
M01AX21 ART G Diacerein - 50mg 50mg Capsule 1,146,298 L.L
A02BC01 AXIPRON G Omeprazole - 20mg 20mg Capsule 373,358 L.L
C09AA05 APO-RAMIPRIL G Ramipril - 2.5mg 2.5mg Capsule 463,626 L.L
N06BA09 APO-ATOMOXETINE G Atomoxetine (HCl) - 60mg 60mg Capsule 4,731,669 L.L
N06BA09 APO-ATOMOXETINE G Atomoxetine (HCl) - 40mg 40mg Capsule 4,114,846 L.L
C09AA05 APO-RAMIPRIL G Ramipril - 5mg 5mg Capsule 794,211 L.L
N06BA09 APO-ATOMOXETINE G Atomoxetine (HCl) - 25mg 25mg Capsule 3,703,630 L.L
J01CA01 ANTALPEN G Ampicillin (trihydrate) - 250mg 250mg Capsule 218,854 L.L
J01CA01 ANTALPEN G Ampicillin (trihydrate) - 500mg 500mg Capsule 285,407 L.L
N06BA09 APO-ATOMOXETINE G Atomoxetine (HCl) - 10mg 10mg Capsule 2,981,987 L.L
C09AA05 APO-RAMIPRIL G Ramipril - 10mg 10mg Capsule 1,178,550 L.L
J01CA04 AMOXICILLIN G Amoxicillin (trihydrate) - 500mg 500mg Capsule 6,199,145 L.L
J01CA04 AMOXICILLINE ARROW LAB G Amoxicillin (trihydrate) - 500mg 500mg Capsule 564,414 L.L
J01CA04 AMOXIDREX G Amoxicillin (trihydrate) - 500mg 500mg Capsule 254,690 L.L
J01CA04 AMOXIDREX G Amoxicillin (trihydrate) - 500mg 500mg Capsule 7,332,097 L.L
J01CA04 AMOXYCILLIN G Amoxicillin (trihydrate) - 500mg 500mg Capsule 4,073,187 L.L
L04AX04 APO-LENALIDOMIDE G Lenalidomide - 5mg 5mg Capsule 49,795,454 L.L
L04AX04 APO-LENALIDOMIDE G Lenalidomide - 10mg 10mg Capsule 53,945,075 L.L
L04AX04 APO-LENALIDOMIDE G Lenalidomide - 15mg 15mg Capsule 56,434,848 L.L
J01FA10 AZOMYCIN G Azithromycin (dihydrate) - 250mg 250mg Capsule 361,494 L.L
L04AX04 APO-LENALIDOMIDE G Lenalidomide - 25mg 25mg Capsule 58,924,620 L.L
J01FA10 AZOMYNE G Azithromycin (dihydrate) - 250mg 250mg Capsule 385,683 L.L
J01FA10 AZOX 250 G Azithromycin (dihydrate) - 250mg 250mg Capsule 346,711 L.L
L01XX35 ANAGRELIDE BIOGARAN G Anagrelide - 0.5mg 0.5mg Capsule 15,754,068 L.L
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