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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
D06AX01 FUCIDIN CREAM B Fusidic acid - 2% 2% Cream 491,846 L.L
D06AX01 FUCIDIN CREAM B Fusidic acid - 2% 2% Cream 345,368 L.L
M02AA10 FASTUM B Ketoprofen - 2.5g/100g 2.5% Gel 177,387 L.L
M02AA10 FASTUM B Ketoprofen - 2.5g/100g 2.5% Gel 337,304 L.L
L02BA03 FASLODEX B Fulvestrant - 250mg/5ml 250mg/5ml Injectable solution L.L
D06AX01 FUCIDIN B Fusidic acid (sodium salt) - 20mg/g 2% Ointment 259,362 L.L
D06AX01 FUCIDIN OINTMENT B Fusidic acid (sodium salt) - 2% 2% Ointment 491,846 L.L
D06AX01 FUCIDIN OINTMENT B Fusidic acid (sodium salt) - 2% 2% Ointment 345,368 L.L
S01AA13 FUCITHALMIC VISCOUS B Fusidic acid - 10mg/g 1% Drops 443,468 L.L
M02AA15 FLECTOR E.P TISSUGEL B Diclofenac (epolamine) - 1% 1% Patch 1,204,083 L.L
A06AD15 FORLAX POUDRE POUR SOLUTION BUVABLE B Macrogol 4000 - 10g 10g Powder for solution 450,187 L.L
A06AD65 FORTRANS POUDRE POUR SOLUTION BUVABLE B Potassium chloride - 0.750g, Sodium chloride - 1460g, Sodium bicarbonate - 1680g, Sodium sulfate anhydrous - 5700g, Macrogol 4000 - 64.000g Powder for solution 1,136,891 L.L
R03BA05 FLIXOTIDE EVOHALER B Fluticasone propionate - 250mcg/actutaion 250mcg/actutaion Inhalation suspension 1,484,946 L.L
R03BA05 FLIXOTIDE EVOHALER B Fluticasone propionate - 125mcg/actuation 125mcg/actuation Inhalation suspension 802,274 L.L
R03BA05 FLIXOTIDE EVOHALER B Fluticasone propionate - 50mcg/actuation 50mcg/actuation Inhalation suspension 671,921 L.L
S01CA01 FRAKIDEX B Dexamethasone disodium phosphate - 0.1g/100g, Framycetin sulfate - 0.5g/100g Ointment 141,103 L.L
G04B FONCITRIL 4000 B Citric acid - 1.189g, Potassium Citrate - 1.73g, Sodium citrate - 1.845g Granules 1,613,955 L.L
A10BK01 FORXIGA B Dapagliflozin - 10mg 10mg Tablet, film coated 2,927,964 L.L
R03DX10 FASENRA B Benralizumab - 30mg 30mg Injectable solution L.L
C03BA11 FLUDEX B Indapamide - 1.5mg 1.5mg Tablet, sustained release 517,379 L.L
D07CC01 FUCICORT B Fusidic acid - 20mg/g, Betamethasone (valerate) - 1mg/g Cream 376,276 L.L
D07CC01 FUCICORT B Fusidic acid - 20mg/g, Betamethasone (valerate) - 1mg/g Cream 501,253 L.L
R03DX10 FASENRA B Benralizumab - 30mg 30mg Injectable solution 214,213,273 L.L
L02BA03 FASLODEX B Fulvestrant - 250mg/5ml 250mg/5ml Injectable solution 46,628,557 L.L
M05BB03 FOSAVANCE B Alendronic acid (sodium alendronate) - 70mg, Colecalciferol - 5600IU Tablet 1,988,887 L.L
B03AB02 FERRICURE B Iron (polysaccharide complex) - 150mg 150mg Capsule 1,001,163 L.L
B03AB09 FERPLEX B Iron trivalent (ferric proteinsuccinylate) - 800mg 800mg Solution 1,202,739 L.L
R05CB01 FLUIMUCIL B N-acetylcysteine - 600mg 600mg Tablet, effervescent 567,102 L.L
R05CB01 FLUIMUCIL MUCOLYTIC B N-acetylcysteine - 2% 2% Syrup 595,322 L.L
B03AC FERINJECT B Iron trivalent (ferric carboxymaltose) - 500mg/10ml 500mg/10ml Injectable solution 10,212,033 L.L
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