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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
A07AX03 FUROXYL G Nifuroxazide - 200mg 200mg Capsule 366,037 L.L
J05AH02 FLUMIVIR G Oseltamivir - 75mg 75mg Capsule 1,384,158 L.L
B03AB02 FERRICURE B Iron (polysaccharide complex) - 150mg 150mg Capsule 1,001,163 L.L
J01CR50 FLUMOX G Flucloxacillin (monohydrate) - 250mg, Amoxicillin (trihydrate) - 250mg Capsule 348,055 L.L
C10AB05 FENOSUP LIDOSE G Fenofibrate - 160mg 160mg Capsule 774,053 L.L
C10AB05 FINACOR G Fenofibrate micronised - 160mg 160mg Capsule 774,309 L.L
A03CA02 FLUDINIUM G Clidinium bromide - 2.5mg, Trifluoperazine HCl - 1mg Capsule 386,515 L.L
N06AB03 FLUOXETINA-Key G Fluoxetine (HCl) - 20mg 20mg Capsule 448,843 L.L
N06AB03 FLUOXETINE BIOGARAN G Fluoxetine (HCl) - 20mg 20mg Capsule 239,204 L.L
N06AB03 FULSAC G Fluoxetine (HCl) - 20mg 20mg Capsule 435,405 L.L
N06AB03 FLUTIN G Fluoxetine (HCl) - 20mg 20mg Capsule 362,837 L.L
J01DD08 FIXIM G Cefixime (trihydrate) - 200mg 200mg Capsule 890,968 L.L
J02AC01 FLUNAZOL G Fluconazole - 50mg 50mg Capsule 534,465 L.L
J02AC01 FUNZOL 50 G Fluconazole - 50mg 50mg Capsule 373,588 L.L
J01DD08 FIXIM G Cefixime (trihydrate) - 400mg 400mg Capsule 1,435,224 L.L
J02AC01 FAZOL 150 G Fluconazole - 150mg 150mg Capsule 623,468 L.L
J02AC01 FLOCAZOLE G Fluconazole - 150mg 150mg Capsule 172,012 L.L
J02AC01 FLUCOKEY G Fluconazole - 150mg 150mg Capsule 103,476 L.L
J02AC01 FLUKAS G Fluconazole - 150mg 150mg Capsule 147,823 L.L
J02AC01 FLUNAZOL G Fluconazole - 150mg 150mg Capsule 149,742 L.L
J02AC01 FUNGIMID 150 G Fluconazole - 150mg 150mg Capsule 172,012 L.L
J02AC01 FUNZOL 150 G Fluconazole - 150mg 150mg Capsule 170,668 L.L
J02AC02 FONGINOX G Itraconazole - 100mg 100mg Capsule 778,149 L.L
J02AC02 FONGINOX G Itraconazole - 100mg 100mg Capsule 174,060 L.L
C01BC04 FLECAINIDE BIOGARAN L.P. G Flecainide acetate - 100mg 100mg Capsule, extended release 1,154,361 L.L
C01BC04 FLECAINIDE BIOGARAN L.P. G Flecainide acetate - 50mg 50mg Capsule, extended release 1,154,361 L.L
L04AA27 FINGOLIMOD ZENTIVA G Fingolimod Hydrochloride - 0.5mg 0.5mg Capsule, hard 32,406,715 L.L
J02AC01 FLUORES G Fluconazole - 150mg 150mg Capsule, hard 428,686 L.L
R03AK06 FLUDALT DUO G Salmeterol (xinafoate) - 50mcg, Fluticasone propionate - 100mcg Capsule, inhalation 1,777,706 L.L
R03AK06 FLUDALT DUO G Salmeterol (xinafoate) - 50mcg, Fluticasone propionate - 250mcg Capsule, inhalation 2,487,891 L.L
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