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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
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
B01AC04 NORMIGORE G Clopidogrel (Bisulfate) - 75mg 75mg Tablet, film coated 1,184,117 L.L
L01EX02 NEXAVAR B Sorafenib - 200mg 200mg Tablet, film coated L.L
C08CA06 NIMOTOP B Nimodipine - 30mg 30mg Tablet, film coated 573,821 L.L
M01AE02 NAPROXENE SODIQUE ARROW G Naproxen (sodium) - 550mg 550mg Tablet, film coated, scored 255,330 L.L
A03AA05 NEWBUTIN SR G Trimebutine maleate - 300mg 300mg Tablet, film coated, sustained release 1,654,270 L.L
J01MA06 NOROXIN B Norfloxacin - 400mg 400mg Tablet, film-scored 574,653 L.L
J02AC04 NOXAFIL B Posaconazole - 100mg 100mg Tablet, gastroresistant 62,027,714 L.L
A02BC05 NEXIUM B Esomeprazole (magnesium trihydrate) - 20mg 20mg Tablet, gastroresistant 1,005,194 L.L
A02BC05 NEXIUM B Esomeprazole (magnesium trihydrate) - 20mg 20mg Tablet, gastroresistant 1,005,194 L.L
N03AF01 NEUROTOP RETARD G Carbamazepine - 600mg 600mg Tablet, prolonged release 1,569,608 L.L
N03AF01 NEUROTOP RETARD G Carbamazepine - 300mg 300mg Tablet, prolonged release 931,283 L.L
C08CA05 NIFELAT 30 LA G Nifedipine - 30mg 30mg Tablet, prolonged release 1,007,882 L.L
C08CA05 NIFELAT 60 LA G Nifedipine - 60mg 60mg Tablet, prolonged release 1,290,089 L.L
C07AB12 NEBIVOLOL ARROW LAB G Nebivolol HCl - 5mg 5mg Tablet, quadrisected 1,370,719 L.L
C01DX16 NICORANDIL BIOGARAN G Nicorandil - 10mg 10mg Tablet, scored 431,373 L.L
C01DX16 NICORANDIL BIOGARAN G Nicorandil - 10mg 10mg Tablet, scored 431,373 L.L
C07AB12 NEBILET B Nebivolol HCl - 5mg 5mg Tablet, scored 694,767 L.L
C07AB12 NEBIVOLOL BIOGARAN G Nebivolol HCl - 5mg 5mg Tablet, scored 529,474 L.L
A04AA01 NAUSETRON G Ondansetron (HCl dihydrate) - 8mg 8mg Tablet, scored 1,023,880 L.L
C08CA05 NIFELAT R G Nifedipine - 20mg 20mg Tablet, sustained release 388,370 L.L
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