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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
J05AH02 VIRIFLU G Oseltamivir - 75mg 75mg Capsule 1,371,615 L.L
A11AA VITA-GERIN G Ginseng extract - 40mg, Vitamin A, palmitate - 2667IU, Vitamin D3 - 200IU, ?-Tocopheryl acetate - 10mg, Thiamine mononitrate - 1.4mg, Riboflavine - 1.6mg, Pyridoxine HCl - 2mg, Cyanocobalamin - 1mcg, Biotin - 150mcg, Nicotinamide - 18mg, Ascorbic acid - 60mg, Folic acid - 100mcg, Calcium phosphate - 100mg, Lecithin - 100mg, Magnesium sulfate - 10mg, Iron sulphate - 10mg, Copper sulfate - 2mg, Sodium selenite anhydrous - 50mcg, Zinc sulfate - 1mg Capsule 1,342,499 L.L
A11CC05 VITEX D3 G Vitamin D3 - 10,000IU 10,000IU Capsule 447,500 L.L
A11CC05 VIT-X-FORTE G Vitamin D3 - 10,000IU 10,000IU Capsule 895,895 L.L
B03AD VITA-FERIN C G Ferrous fumarate - 300mg, Folic acid - 0.5mg, Vitamin C - 200mg Capsule 716,268 L.L
N07XX08 VYNDAMAX B Tafamidis - 61mg 61mg Capsule 784,020,041 L.L
C05CA05 VENOSMIL G Hidrosmin - 200mg 200mg Capsule 976,973 L.L
C10AX06 VASCEPA B Eicosapentaenoic acid (Ethyl ester) - 1g 1g Capsule 21,464,912 L.L
N03AX12 VOLAR G Gabapentin - 300mg 300mg Capsule 1,100,607 L.L
N06AX16 VENLAX XR 150 G Venlafaxine HCl - 150mg 150mg Capsule, extended release 944,529 L.L
N06AX16 VENLAX XR 150 G Venlafaxine HCl - 150mg 150mg Capsule, extended release 1,416,794 L.L
N06AX16 VENLAX XR 37.5 G Venlafaxine - 37.5mg 37.5mg Capsule, extended release 383,955 L.L
N06AX16 VENLAX XR 37.5 G Venlafaxine - 37.5mg 37.5mg Capsule, extended release 575,933 L.L
N06AX16 VENLAX XR 75 G Venlafaxine HCl - 75mg 75mg Capsule, extended release 895,895 L.L
N06AX16 VENLAX XR 75 G Venlafaxine HCl - 75mg 75mg Capsule, extended release 1,343,843 L.L
N06AX16 VENLAFAXINE ARROW GENERIQUES LP G Venlafaxine - 150mg 150mg Capsule, prolonged release 987,724 L.L
N06AX16 VENLAFAXINE ARROW GENERIQUES LP G Venlafaxine - 37.5mg 37.5mg Capsule, prolonged release 1,075,074 L.L
N06AX16 VENLAFAXINE BIOGARAN LP G Venlafaxine HCl - 37.5mg 37.5mg Capsule, prolonged release 538,881 L.L
N06AX16 VENLAFAXINE ARROW GENERIQUES LP G Venlafaxine - 75mg 75mg Capsule, prolonged release 1,075,074 L.L
N06AX16 VENLAFAXINE BIOGARAN LP G Venlafaxine HCl - 75mg 75mg Capsule, prolonged release 584,571 L.L
B01AB11 VESSEL DUE F TAB. B Sulodexide - 250LRU 250LSU Capsule, soft gelatin 2,792,505 L.L
A11CC05 VIDROP G Vitamin D3 - 100IU/drop 100IU/drop Drops 346,711 L.L
S02CA02 VIOCORTENE B Clioquinol - 10mg/ml, Flumetasone pivalate - 0.2mg/ml Drops 568,253 L.L
S01AE07 VIGAMOX G Moxifloxacin (HCl) - 5mg/ml 5mg/ml Drops solution 670,577 L.L
M02AA15 VOLDIC G Diclofenac sodium (diethylamine) - 10mg/g 1% Emulgel 172,012 L.L
M02AA15 VOLTAREN EMULGEL 12HRS B Diclofenac Diethylamine - 23.2mg/g 23.2mg/g Gel 1,169,143 L.L
S01AD09 VIRGAN B Ganciclovir - 1.5mg/g 1.5mg/g Gel 804,962 L.L
M02AA15 VOLTAREN EMULGEL 12HRS B Diclofenac Diethylamine - 23.2mg/g 23.2mg/g Gel 717,612 L.L
C05CA05 VENOSMIL G Hidrosmin - 2% 2% Gel 588,603 L.L
R03AC02 VENTOLIN EVOHALER B Salbutamol (sulfate) - 100mcg/dose 100mcg/dose Inhalation aerosol metered dose 260,705 L.L
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