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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
J02AC02 ITRAZOL G Itraconazole - 100mg 100mg Capsule 149,167 L.L
J02AC02 ITRAZOL G Itraconazole - 100mg 100mg Capsule 559,038 L.L
A07DA03 IMODIUM B Loperamide HCl - 2mg 2mg Capsule 138,416 L.L
A07FA51 INFLORAN B Bifidobacterium infantis - 1milliard, Lactobacillus acidophilus - 1milliard Capsule 647,732 L.L
M01AB01 INDOMEL G Indometacin - 25mg 25mg Capsule 170,220 L.L
L01EF01 IBRANCE B Palbociclib - 75mg 75mg Capsule 172,164,216 L.L
L01EF01 IBRANCE B Palbociclib - 100mg 100mg Capsule 172,164,216 L.L
L01EF01 IBRANCE B Palbociclib - 125mg 125mg Capsule 172,164,216 L.L
L04AX06 IMNOVID B Pomalidomide - 2mg 2mg Capsule, hard 290,515,206 L.L
L04AX06 IMNOVID B Pomalidomide - 4mg 4mg Capsule, hard 290,515,206 L.L
D10BA01 ISOSUPRA LIDOSE G Isotretinoin - 16mg 16mg Capsule, hard 1,826,282 L.L
L04AX06 IMNOVID B Pomalidomide - 4mg 4mg Capsule, hard L.L
R03BB04 INHALEX G Tiotropium bromide - 18mcg 18mcg Capsule, inhalation 1,906,913 L.L
D06BA51 IALUGEN PLUS B Silver sulfadiazine - 10mg/g, Sodium hyaluronate - 2mg/g Cream 1,064,323 L.L
S01AE07 IMOX G Moxifloxacin (HCl) - 0.5% 0.5% Drops 464,970 L.L
S01BC01 INDOCOLLYRE B Indometacine - 5mg/5ml 0.1% Drops 408,528 L.L
S01GA01 IRIDINA DUE G Naphazoline HCl - 0.5mg/ml 0.5mg/ml Drops solution 469,001 L.L
D06BA51 IALUGEN PLUS B Silver sulfadiazine - 10mg/g, Sodium hyaluronate - 0.5mg/g Gauze 1,463,444 L.L
M02AA13 IBUSTICK G Ibuprofen - 50mg/g 50mg/g Gel, roll on 857,372 L.L
S01BA15 ILUVIEN B Fluocinolone acetonide - 0.19mg 0.19mg Implant 629,182,630 L.L
S01BA15 ILUVIEN B Fluocinolone acetonide - 0.19mg 0.19mg Implant L.L
G03AC08 IMPLANON NXT B Etonogestrel - 68mg 68mg Implant 12,299,971 L.L
R03AK08 INUVER NEXTHALER B Formoterol fumarate dihydrate - 6mcg/dose, Beclometasone dipropionate - 100mcg/dose Inhalation powder 4,031,528 L.L
R03AK08 INUVER B Formoterol fumarate - 6mcg/dose, Beclometasone dipropionate - 100mcg/dose Inhalation solution 3,225,222 L.L
R03BB01 IPRAVENT G Ipratropium bromide - 20mcg/2ml 20mcg/2ml Inhalation solution 630,262 L.L
R03BB01 IPRATROPIUM ARROW ADULTES G Ipratropium bromide - 0.5mg/2ml 0.5mg/2ml Inhalation solution for nebuliser 303,708 L.L
R03AL02 IPRASAL VEM G Salbutamol (sulfate) - 2.5mg/2.5ml, Ipratropium bromide (monohydrate) - 0.5mg/2.5ml Inhaltion solution with nebuliser 417,935 L.L
L01CE02 IRINOTECAN HYDROCHLORIDE G Irinotecan HCl - 100mg/5ml 100mg/5ml Injectable concentrate for solution 2,085,644 L.L
L04AB02 INFLIXIREL BioTech Infliximab - 100mg 100mg Injectable concentrate for solution L.L
L04AB02 INFLIXIREL BioTech Infliximab - 100mg 100mg Injectable concentrate for solution 18,065,957 L.L
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