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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
J06BB05 RABISHIELD-100 (RABIES HUMAN MONOCLONAL ANTIBODY rDNA) BioHuman Rabies, Human IgG1 Monoclonal Antibody - 100IU/2.5ml 100IU/2.5ml 8,455,824 L.L
N05AX08 RESPAL 1 G Risperidone - 1mg 1mg Caplet, film coated 309,084 L.L
N05AX08 RESPAL 2 G Risperidone - 2mg 2mg Caplet, film coated 342,680 L.L
N05AX08 RESPAL 4 G Risperidone - 4mg 4mg Caplet, film coated 557,695 L.L
J01AA02 RETADOX G Doxycycline (hyclate) - 100mg 100mg Capsule 209,895 L.L
M03BB53 RELAXON G Paracetamol - 300mg, Chlorzoxazone - 250mg Capsule 296,989 L.L
L04AX04 REVLIMID B Lenalidomide - 10mg 10mg Capsule L.L
L04AX04 REVLIMID B Lenalidomide - 5mg 5mg Capsule 105,106,076 L.L
L04AX04 REVLIMID B Lenalidomide - 10mg 10mg Capsule 110,200,672 L.L
N06DA03 RIVASTIGMINE ARROW G Rivastigmine - 3mg 3mg Capsule 842,589 L.L
N06DA03 RIVASTIGMINE ARROW G Rivastigmine - 3mg 3mg Capsule 842,589 L.L
L04AX04 REVLIMID B Lenalidomide - 15mg 15mg Capsule 116,241,703 L.L
N06DA03 RIVASTIGMINE ARROW G Rivastigmine - 1.5mg 1.5mg Capsule 684,016 L.L
N06DA03 RIVASTIGMINE ARROW G Rivastigmine - 1.5mg 1.5mg Capsule 684,016 L.L
N06DA03 RIVASTIGMINE ARROW G Rivastigmine - 4.5mg 4.5mg Capsule 842,589 L.L
N06DA03 RIVASTIGMINE ARROW G Rivastigmine - 4.5mg 4.5mg Capsule 842,589 L.L
L04AX04 REVLIMID B Lenalidomide - 25mg 25mg Capsule 127,865,045 L.L
A07XA04 RACECADOTRIL ARROW G Racecadotril - 100mg 100mg Capsule 583,228 L.L
A07XA04 RACECADOTRIL BGR G Racecadotril - 100mg 100mg Capsule 575,165 L.L
A07XA04 RACECADOTRIL BIOGARAN CONSEIL G Racecadotril - 100mg 100mg Capsule 287,582 L.L
G04BX ROWATINEX B Olive oil - 33mg, Cineol - 3mg, Fenchone - 4mg, Anethol - 4mg, Borneol - 10mg, Camphene - 15mg, ?-Pinene - 6.2mg, ?-Pinene - 24.8mg Capsule 255,330 L.L
D10BA01 ROACCUTANE B Isotretinoin - 10mg 10mg Capsule 1,353,249 L.L
J01DB05 ROXIL G Cefadroxil (monohydrate) - 500mg 500mg Capsule 869,466 L.L
D10BA01 ROACCUTANE B Isotretinoin - 20mg 20mg Capsule 2,354,412 L.L
M01AH01 REVCOX G Celecoxib - 200mg 200mg Capsule 506,629 L.L
M01AH01 REVCOX G Celecoxib - 200mg 200mg Capsule 506,629 L.L
A02BC01 RISEK G Omeprazole - 20mg 20mg Capsule, enteric coated 302,365 L.L
A02BC01 RISEK G Omeprazole - 40mg 40mg Capsule, enteric coated 522,755 L.L
C09BB07 RAMIPRIL/AMLODIPINE GENERICON G Ramipril - 2.5mg, Amlodipine - 5mg Capsule, hard 1,358,625 L.L
C09BB07 RAMIPRIL/AMLODIPINE GENERICON G Ramipril - 5mg, Amlodipine - 5mg Capsule, hard 1,358,625 L.L
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