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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
A06AB07 COLON-X G Frangula Purshiana - 62.5mg, Plantago Afra - 100mg, Foeniculum Vulgare - 50mg, Zingiber Officinale - 50mg, Aniseed powder - 20mg, Glycyrrhiza Glabra - 12.5mg, Senna Alexandrina - 25mg Tablet, film coated 833,182 L.L
A06AB58 CITRAFLEET G Sodium picosulfate - 10mg/sachet, Magnesium oxide (light) - 3.5g/sachet, Citric acid (anhydrous) - 10.97g/sachet, Potassium - 195mg/sachet Powder for solution 1,191,988 L.L
R03AL02 COMBIVENT B Salbutamol (sulfate) - 2.5mg/2.5ml, Ipratropium bromide - 500mcg/2.5ml Inhaltion solution with nebuliser 745,833 L.L
J01DH51 CELLABAXIN G Imipenem (monohydrate) - 500mg, Cilastatin (sodium) - 500mg Injectable solution 10,699,559 L.L
A07BA51 CARBOSYLANE B Simethicone (blue-red) - 45mg (blue-red), Activated charcoal (blue-red) - 140mg (blue-red) Capsule 585,915 L.L
J01DH51 CILANEM G Imipenem anhydrous - 500mg, Cilastatin (sodium) - 500mg Injectable solution 850,652 L.L
A07BA51 CARBOSYMAG B Simethicone (green-orange) - 45mg (green-orange), Magnesium oxide (green) - 180mg (green), Activated charcoal (green-orange) - 140mg (green-orange) Capsule 384,339 L.L
S01CA01 CO-AVAZIR G Tobramycin - 0.3%, Dexamethasone - 0.1% Drops suspension 193,513 L.L
C09BA01 CAPTACE PLUS G Hydrochlorothiazide - 25mg, Captopril - 50mg Tablet, scored 1,028,487 L.L
C01EX CARDIOVITEX G Coenzyme Q10 - 300mg, Magnesium oxide - 100mg Tablet 2,822,069 L.L
J01EE01 CO-TRIMOXAZOLE G Trimethoprim - 160mg, Sulfamethoxazole - 800mg Tablet 7,529,090 L.L
J01EE01 CO-TRIMOXAZOLE G Trimethoprim - 160mg, Sulfamethoxazole - 800mg Tablet 183,019 L.L
C09BB04 COVERAM B Perindopril arginine - 5mg, Amlodipine - 5mg Tablet 821,088 L.L
C09BB04 COVERAM B Perindopril arginine - 10mg, Amlodipine - 5mg Tablet 1,116,733 L.L
R03DA55 CAMPHO-PNEUMINE AMINOPHYLLINE ENFANTS G Eucalyptol - 0.03g, Camphre - 0.04g, Gaiacol ethyl glycolate - 0.12g, Aminophylline - 0.06g Suppository 284,127 L.L
R03DA55 CAMPHO-PNEUMINE AMINOPHYLLINE ENFANTS G Eucalyptol - 0.03g, Camphre - 0.04g, Gaiacol ethyl glycolate - 0.12g, Aminophylline - 0.06g Suppository 426,190 L.L
C09BB04 COVERAM B Perindopril arginine - 10mg, Amlodipine - 10mg Tablet 1,116,733 L.L
R03DA55 CAMPHO-PNEUMINE AMINOPHYLLINE ADULTES G Amyleine HCl - 0.01g, Eucalyptol - 0.05g, Camphre - 0.1g, Gaiacol ethyl glycolate - 0.26g, Aminophylline - 0.15g Suppository 326,362 L.L
R03DA55 CAMPHO-PNEUMINE AMINOPHYLLINE ADULTES G Amyleine HCl - 0.01g, Eucalyptol - 0.05g, Camphre - 0.1g, Gaiacol ethyl glycolate - 0.26g, Aminophylline - 0.15g Suppository 490,183 L.L
C09BX02 COSYREL B Perindopril arginine - 5mg, Bisoprolol fumarate - 5mg Tablet, film coated, scored 749,864 L.L
C09BX02 COSYREL B Perindopril arginine - 10mg, Bisoprolol fumarate - 5mg Tablet, film coated, scored 749,864 L.L
J05AR01 CONDINE G Lamivudine - 150mg, Zidovudine - 300mg Tablet, film coated 5,818,474 L.L
S01ED51 COMBIGAN 2mg/ml 5mg/ml B Timolol - 5mg/ml, Brimonidine tartrate - 2mg/ml Drops solution 1,181,238 L.L
S01ED51 COMBIGAN 2mg/ml 5mg/ml B Timolol - 5mg/ml, Brimonidine tartrate - 2mg/ml Drops solution 1,181,238 L.L
S01ED51 COMBISOPT G Timolol maleate - 5mg/ml, Dorzolamide HCl - 20mg/ml Drops solution 935,570 L.L
A11AA CAL-VIT G Riboflavine - 9mg/100ml, Cyanocobalamine - 570mcg/100ml, Pyridoxine HCl - 35mg/100ml, Thiamine HCl - 190mg/100ml, Inositol - 150mg/100ml, Nicotinamide - 120mg/100ml, Calcium Pantothenate - 27mg/100ml, Sodium hypophosphite - 70mg/100ml Syrup 163,821 L.L
A08AA62 CONTRAVE B Naltrexone Hydrochloride - 8mg, Bupropion Hydrochloride - 90mg Tablet, prolonged release 11,653,550 L.L
A11AA COMPLEVIT G Ascorbic acid - 1.32g, Riboflavine - 0.018g, Nicotinamide - 0.264g, Cyanocobalamine - 0.9g, Pyridoxine HCl - 0.132g, Thiamine mononitrate - 0.288g, Iron Ammonium Citrate - 3.6g Syrup 218,854 L.L
A11AB CYPRO-VITA B Vitamin C - 20mg, Vitamin B3 - 5mg, Vitamin B12 - 2.5mg, Vitamin B6 - 0.6mg, Vitamin B2 - 0.75mg, Vitamin B1 - 0.6mg, Vitamin D3 - 167IU, Vitamin A - 1670IU, Cyproheptadine HCl - 4mg Tablet, film coated 409,552 L.L
D08AC52 CYTEAL Solution Antiseptique G Chlorhexidine digluconate - 0.5ml/100ml, Hexamidine - 0.1g/100ml, Chlorocresol - 0.3g/100ml Solution 376,772 L.L
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