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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
C01CA03 ? NORADRENALINE G Norepinephrine tartrate - 8mg/4ml 8mg/4ml Injectable solution 330,201 L.L
A04AA01 ? ONDANSETRON USP G Ondansetron - 8mg/4ml 8mg/4ml Injectable solution 447,948 L.L
N02BE01 ? PARACETAMOL G Paracetamol - 1g/100ml 1g/100ml Injectable solution 191,978 L.L
N03AB02 ? PHENYTOIN SODIUM 5% USP G Phenytoin (sodium) - 250mg/5ml 5ml Injectable solution 276,448 L.L
V03AB35 ? SUGAMMADEX G Sugammadex - 200mg/2ml 100mg/ml Injectable solution 5,214,109 L.L
D10BA01 A-CNOTREN G Isotretinoin - 20mg 20mg Capsule, soft gelatin 1,526,524 L.L
D10AD01 A-RET G Tretinoin - 0.05% 0.05% Cream 335,961 L.L
N02BE51 A.B.C NIGHT G Paracetamol - 500mg, Diphenhydramine HCl - 25mg Tablet, film coated 260,152 L.L
N02BE51 A.B.C.-COLD G Paracetamol - 500mg, Chlorphenamine maleate - 4mg, Phenylephrine HCl - 5mg Tablet, film coated 534,977 L.L
B01AC06 A.S HEART G Acetylsalicylic acid - 81mg 81mg Tablet, enteric coated 148,463 L.L
N05AX12 ABILIFY MAINTENA B Aripiprazole - 400mg 400mg Injectable powder for suspension, prolonged release+solvent 29,491,998 L.L
N05AX12 ABIPREX 10 G Aripiprazole - 10mg 10mg Tablet 1,075,074 L.L
N05AX12 ABIPREX 15 G Aripiprazole - 15mg 15mg Tablet 1,075,074 L.L
L02BX03 ABIRATERONE ACETATE NEAPOLIS G Abiraterone acetate - 250mg 250mg Tablet 75,418,662 L.L
L02BX03 ABIRATERONE ACETATE SPC G Abiraterone acetate - 250mg 250mg Tablet, film coated 73,748,373 L.L
L02BX03 ABLAX 250 G Abiraterone acetate - 250mg 250mg Tablet 45,056,853 L.L
L02BX03 ABLAX 250 G Abiraterone acetate - 250mg 250mg Tablet L.L
L02BX03 ABLAX 500 G Abiraterone acetate - 500mg 500mg Tablet 45,056,853 L.L
L02BX03 ABLAX 500 G Abiraterone acetate - 500mg 500mg Tablet L.L
L01CD01 ABRAXANE BioTech Paclitaxel Albumin- bound - 5mg/ml 5mg/ml Injectable powder for dispersion 17,850,751 L.L
L02BX03 ABREMIA G Abiraterone acetate - 250mg 250mg Tablet 77,478,802 L.L
L02BX03 ABREMIA G Abiraterone acetate - 250mg 250mg Tablet L.L
L04AB04 ABRILADA BioTech Adalimumab - 40mg 40mg Injectable solution 40,259,574 L.L
L04AB04 ABRILADA BioTech Adalimumab - 40mg 40mg Injectable solution 40,259,574 L.L
J07BX05 ABRYSVO B RSV subgroup A stabilized perfusion F antigen 60mcg - 60mcg, RSV subgroup B stabilized perfusion F antigen 60mcg - 60mcg, Glycoprotein F stabilized in the perfusion conformation - Injectable powder + solvent 22,650,721 L.L
D10BA01 ABSORICA LIDOSE G Isotretinoin - 16mg 16mg Capsule, hard 1,827,045 L.L
N02AB03 ABSTRAL B Fentanyl (citrate) - 200mcg 200mcg Tablet 5,261,143 L.L
N02AB03 ABSTRAL B Fentanyl (citrate) - 100mcg 100mcg Tablet 3,419,743 L.L
N07BB03 ACAMPROSATE BIOGARAN G Acamprosate - 333mg 333mg Tablet, gastroresistant 3,641,813 L.L
V01AA ACARIZAX 12 SQ-HDM ORAL LYOPHILISATE B Allergen extracts - 12 SQ-HDM Tablet, lyophilised 9,366,451 L.L
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