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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
J01DD15 MINOCET G Cefdinir - 300mg 300mg Capsule 1,407,003 L.L
J01AA02 MONODOKS G Doxycycline (hyclate) - 100mg 100mg Capsule 248,611 L.L
A07AA02 MEDISTAN G Nystatin - 500,000IU 500,000IU Capsule 417,231 L.L
J01CA04 MOXILEN G Amoxicillin (trihydrate) - 500mg 500mg Capsule 3,717,068 L.L
N06DA52 MEXAZIL XR 28/10 G Memantine HCl - 28mg, Donepezil HCl - 10mg Capsule 4,333,444 L.L
N06DA52 MEXAZIL XR 14/10 G Memantine HCl - 14mg, Donepezil HCl - 10mg Capsule 3,432,174 L.L
A11CC05 MAXI-D 10.000 G Vitamin D3 - 10,000IU 10,000IU Capsule 895,895 L.L
A11CC05 MEGAVIT-D 50 G Vitamin D3 - 50000IU 50000IU Capsule 1,940,253 L.L
A11CC05 MEGAVIT-D 50 G Vitamin D3 - 50000IU 50000IU Capsule 3,687,248 L.L
A11CC05 MEGAVIT-D 25 G Vitamin D3 - 25000IU 25000IU Capsule 1,130,108 L.L
A11CC05 MEGAVIT-D 25 G Vitamin D3 - 25000IU 25000IU Capsule 2,147,588 L.L
R05CB06 MUCOSOLVAN LA B Ambroxol HCl - 75mg 75mg Capsule 345,368 L.L
R05CB06 MUCOCURE SR G Ambroxol - 75mg 75mg Capsule 276,448 L.L
R05CB06 MUCOXELLIN LA G Ambroxol - 75mg 75mg Capsule 276,448 L.L
G04CA02 MINGO G Tamsulosin - 0.4mg 0.4mg Capsule 673,201 L.L
A03AX58 METEOSPASMYL B Alverine citrate - 60mg, Simethicone - 300mg Capsule 474,376 L.L
A03E MEPHIGASTRYL G Belladone powder - 0.005g, Magnesium hydroxide - 0.1g, Meprobamate - 0.1g, Prochlorperazine maleate - 0.01g Capsule 296,925 L.L
J01DD08 MUREX 200 G Cefixime - 200mg 200mg Capsule 430,030 L.L
J01DD08 MAGNACEF 400 G Cefixime - 400mg 400mg Capsule 1,232,304 L.L
J01DD08 MUREX G Cefixime - 400mg 400mg Capsule 679,984 L.L
A02BC01 MEDIZOLE GP G Omeprazole - 20mg 20mg Capsule, hard, gastro-resistant 503,941 L.L
L04AX07 MAROVAREX G Dimethyl Fumarate - 120mg 120mg Capsule, hard, gastro-resistant 9,838,676 L.L
L04AX07 MAROVAREX G Dimethyl Fumarate - 240mg Capsule, hard, gastro-resistant 60,848,734 L.L
G04BD06 MICTONORM XL B Propiverine HCl - 30mg 30mg Capsule, modified release 1,648,895 L.L
G04BD06 MICTONORM XL B Propiverine HCl - 45mg 45mg Capsule, modified release 1,877,348 L.L
D07AC13 METASONE G Mometasone furoate - 0.1% 0.1% Cream 335,321 L.L
D01AE14 MYCOSTER B Ciclopirox - 1% 1% Cream 325,210 L.L
G01AF04 MYCODERM-V G Miconazole nitrate - 2% 2% Cream 361,494 L.L
G03CA03 MONTADIOL G Estradiol - 0.01% 0.01% Cream 1,105,982 L.L
S01AE07 MOXITEC G Moxifloxacin (HCl) - 5mg/ml 5mg/ml Drops solution 464,970 L.L
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