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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
C08DA51 TARKA B Verapamil - 180mg, Trandolapril - 2mg Capsule, modified release 2,422,948 L.L
C08DA51 TARKA B Verapamil - 240mg, Trandolapril - 4mg Tablet, modified release 3,797,532 L.L
A02AC10 TUMS EXTRA STRENGTH 750 ASSORTED FRUIT B Calcium carbonate - 750mg Tablet, chewable 421,967 L.L
M03BB52 TRANCODEX G Paracetamol - 450mg, Chlormezanone - 100mg Tablet 99,828 L.L
C09BA03 TENSIKEY COMPLEX G Lisinopril - 20mg, Hydrochlorothiazide - 12.5mg Tablet 536,193 L.L
C09BA05 TRILTEC PLUS G Ramipril - 10mg, Hydrochlorothiazide - 12.5mg Tablet 2,243,577 L.L
C09BA05 TRILTEC PLUS G Ramipril - 5mg, Hydrochlorothiazide - 12.5mg Tablet 2,189,823 L.L
B02BC30-V03AK TISSEEL LYO B Fibrinogen, human (clottable protein) (I) - 91mg/ml, Aprotinin, synthetic (I) - 3000KIU/ml, Thrombin, Human (II) - 500IU/ml, Calcium chloride (II) - 40?mol/ml Injectable powder for solution + solution 53,437,592 L.L
B02BC30-V03AK TISSEEL LYO B Fibrinogen, human (clottable protein) (I) - 91mg/ml, Aprotinin, synthetic (I) - 3000KIU/ml, Thrombin, Human (II) - 500IU/ml, Calcium chloride (II) - 40?mol/ml Injectable powder for solution + solution 24,369,850 L.L
B02BC30-V03AK TISSEEL LYO B Fibrinogen, human (clottable protein) (I) - 91mg/ml, Aprotinin, synthetic (I) - 3000KIU/ml, Thrombin, Human (II) - 500IU/ml, Calcium chloride (II) - 40?mol/ml Injectable powder for solution + solution 13,394,024 L.L
C09BX01 TRIPLIXAM B Perindopril arginine - 5mg, Indapamide - 1.25mg, Amlodipine - 5mg Tablet, film coated 968,910 L.L
C09BX01 TRIPLIXAM B Perindopril arginine - 10mg, Indapamide - 2.5mg, Amlodipine - 5mg Tablet, film coated 1,237,679 L.L
C09BX01 TRIPLIXAM B Perindopril arginine - 10mg, Indapamide - 2.5mg, Amlodipine - 10mg Tablet, film coated 1,315,622 L.L
S01ED51 TWINZOL G Dorzolamide HCl - 2%, Timolol - 0.5% Drops solution 632,950 L.L
D07CC01 TOPIZONE G Fusidic acid - 20mg/g, Betamethasone (valerate) - 1mg/g Cream 216,359 L.L
J05AR03 TRUVADA B Emtricitabine - 200mg, Tenofovir disoproxil - 245mg Tablet, film coated 21,319,383 L.L
J05AR12 TELADINE G Lamivudine - 300mg, Tenofovir disoproxil fumarate - 300mg Tablet 17,454,739 L.L
J05AR13 TRIUMEQ B Dolutegravir - 50mg, Abacavir sulfate - 600mg, Lamivudine - 300mg Tablet, film coated 74,756,237 L.L
S01ED51 TRAVOPROST/TIMOLOL BIOGARAN G Travoprost - 40mcg/ml, Timolol - 5mg/ml Drops solution 501,253 L.L
D07XC04 TRAVOCORT B Diflucortolone valerate - 0.1%, Isoconazole nitrate - 1% Cream 435,405 L.L
S01GA52 TRILLERG G Antazoline HCl - 0.5mg, Tetryzoline HCl - 0.4mg Drops solution 310,428 L.L
B03AA07 TIMOFEROL G Iron bivalent (as dried ferrous sulfate) - 50mg (172.73mg), Ascorbic acid - 30mg Capsule 678,787 L.L
J01CR05 TAZOCIN B Piperacillin (sodium) - 4g, Tazobactam (sodium) - 0.5g Injectable lyophilised powder for solution 1,306,215 L.L
J01CR05 TAZOBACT G Piperacillin sodium - 4g, Tazobactam (sodium) - 500mg Injectable powder for solution 783,460 L.L
S02AA30 TYOTOCIN B Hexylresorcinol - 0.1%, Antipyrine - 5%, Benzocaine - 1.25%, Tyrothricin - 0.05% Drops solution 409,552 L.L
B03AE10 TOT'HEMA B Copper (gluconate) - 0.70mg/10ml, Manganese (gluconate) - 1.33mg/10ml, Iron (gluconate) - 50mg/10ml Solution 604,729 L.L
J07AP03 TYPHIBEV TYPHOID CONJUGATED VACCINE (MONOVALENT) B Salmonella typhi polysaccharides Vi purified - 25mcg of Vi-PS2/0.5ml Injectable suspension 4,020,777 L.L
A11DB TRILAGAVIT G Vitamin B12 - 1mg, Vitamin B6 - 100mg, Vitamin B1 - 200mg Tablet, film coated 399,121 L.L
A11DB TRILAGAVIT G Vitamin B12 - 1mg/3ml, Vitamin B6 - 100mg/3ml, Vitamin B1 - 100mg/3ml Injectable solution 579,196 L.L
R05FA02 TUSCALMAN A B Noscapine HCl - 5mg, Guaifenesin - 25mg Suppository 624,963 L.L
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