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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
D10AF05 NADIXA G Nadifloxacin - 1% 1% Cream 850,652 L.L
S01AE02 NAFLOX G Norfloxacin - 3mg/ml 3mg/ml Drops 370,901 L.L
C04AX21 NAFTILUX B Naftidrofuryl oxalate acid - 200mg 200mg Capsule 533,505 L.L
C04AX21 NAFTIPRAX B Naftidrofuryl hydrogen oxalate - 200mg 200mg Tablet, film coated 614,328 L.L
G03AA12 NAJAT G Drospirenone - 3mg, Ethinylestradiol - 0.03mg Tablet, coated 417,935 L.L
N02AF02 NALBUPHINE RENAUDIN 1% G Nalbuphine HCl - 20mg/2ml 20mg/2ml Injectable solution 1,181,238 L.L
C10AB05 NANOFIB G Fenofibrate - 145mg 145mg Tablet, film coated 1,371,615 L.L
S01GA51 NAPHCON A B Naphazoline HCl - 0.025%, Pheniramine maleate - 0.3% Drops solution 369,557 L.L
M01AE02 NAPROXENE SODIQUE ARROW G Naproxen (sodium) - 550mg 550mg Tablet, film coated, scored 255,330 L.L
R01AB06 NARIX G Xylometazoline HCl - 90mcg/actuation, Carbocisteine - 900mcg/actuation Spray 518,339 L.L
R01AD11 NASACORT AQ B Triamcinolone acetonide - 55mcg/dose 55mcg/dose Spray, suspension 1,003,850 L.L
R01AD11 NASACORT AQ B Triamcinolone acetonide - 55mcg/dose 55mcg/dose Spray, suspension 1,003,850 L.L
R01AD09 NASONEX B Mometasone furoate (monohydrate) - 50mcg/dose 0.05% Spray, suspension 529,474 L.L
R01AD09 NASONEX B Mometasone furoate (monohydrate) - 50mcg/dose 0.05% Spray, suspension 529,474 L.L
A04AA01 NAUSETRON G Ondansetron (HCl dihydrate) - 8mg 8mg Tablet, scored 1,023,880 L.L
A04AA01 NAUSETRON G Ondansetron - 4mg/5ml 4mg/5ml Solution 958,608 L.L
A04AA01 NAUSETRON G Ondansetron - 4mg/5ml 4mg/5ml Solution 802,466 L.L
A03FA03 NAUZEX G Domperidone - 10mg 10mg Tablet 258,530 L.L
L01CA04 NAVELBINE B Vinorelbine (ditartrate) - 30mg 30mg Capsule, soft gelatin 6,072,824 L.L
L01CA04 NAVELBINE B Vinorelbine (ditartrate) - 20mg 20mg Capsule, soft gelatin 4,048,997 L.L
D10AF05 NAXIDERM G Nadifloxacin - 1% 1% Gel 826,783 L.L
N06AB03 NEANXETIN G Fluoxetine (HCl) - 20mg 20mg Capsule 422,351 L.L
C07AB12 NEBILET B Nebivolol HCl - 5mg 5mg Tablet, scored 694,767 L.L
C07BB12 NEBILET PLUS B Nebivolol HCl - 5mg, Hydrochlorothiazide - 12.5mg Tablet, film coated 716,268 L.L
C07BB12 NEBILET PLUS B Nebivolol HCl - 5mg, Hydrochlorothiazide - 25mg Tablet, film coated 716,268 L.L
C07AB12 NEBIVOLOL ARROW LAB G Nebivolol HCl - 5mg 5mg Tablet, quadrisected 1,370,719 L.L
C07AB12 NEBIVOLOL BIOGARAN G Nebivolol HCl - 5mg 5mg Tablet, scored 529,474 L.L
J01DD02 NEGACEF G Ceftazidime (pentahydrate) - 1g 1g Injectable dry powder for solution 4,421,242 L.L
D06BA05 NEO SULFA G Sulfanilamide - 12g 12g Powder 151,022 L.L
R05FA01 NEO-CODION B Codeine Camphosulfonate - 25mg, Sulfogaiacol - 100mg, Grindelia soft extract - 20mg Tablet, coated 258,018 L.L
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