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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
L01FX06 QARZIBA 4.5 mg/ml Injectable lyophilised powder for solution L.L
L01FX13 PADCEV 30mg Injectable powder for concentrate for solution L.L
J07CA09 HEXASIIL VACCINE (DIPHTERIA, TETANUS, PERTUSSIS, HEPATITIS B, POLIO, HAEMOPHILUS INFLUENZA TYPE B) Diphteria Toxoid - ?30IU/0.5ml, Tetanus toxoid - ?40IU/0.5ml, Bordetella pertussis (Whole cell) - ?4IU/0.5ml, Hepatitis B, surface antigen - 15mcg/0.5ml, Polio virus inactivated type 1 (Mahoney strain) - 40D antigen units/0.5ml, Polio virus inactivated type 2 (MEF-I strain) - 8D antigen units/0.5ml, Polio virus inactivated type 3 (Saukett strain) - 32D antigen units/0.5ml, H. Influenza type b polysaccharide1 ,2 - 10mcg/0.5ml, 1 conjugated to tetanus protein - 19-33mcg, 2 adsorbed on aluminium hydroxide hydrated, Al+++ - ?1.25mg Injectable suspension 3,594,779 L.L
D06AX TRIPLE ANTIBIOTIC ORIGINAL OINTMENT Bacitracin - 400U, Neomycin (sulfate) - 3.5mg, Polymyxin B (sulfate) - 5000U 580,540 L.L
C08CA08 LUSOPRESS B Nitrendipine - 20mg 20mg Tablet, scored 757,927 L.L
C09DX03 VOCADO HCT B Olmesartan medoxomil - 20mg, Amlodipine - 5mg, Hydrochlorothiazide - 12.5mg Tablet, film coated 1,482,258 L.L
D06AX01 FUCIDIN CREAM B Fusidic acid - 2% 2% Cream 491,846 L.L
G03DA04 UTROGESTAN B Progesterone micronised natural - 200mg 200mg Capsule 587,259 L.L
H03AA01 EUTHYROX B Levothyroxine sodium - 150mcg 150mcg Tablet, scored 615,480 L.L
R06AX29 LABIXTEN B Bilastine - 2.5mg/ml 2.5mg/ml Solution 463,626 L.L
A01AB09 DAKTARIN ORAL B Miconazole nitrate - 20mg/g 20mg/g Gel 318,491 L.L
A05AA02 URSOFALK B Ursodeoxycholic acid - 250mg 250mg Capsule 2,823,413 L.L
C08CA13 LERCADIP B Lercanidipine HCl - 10mg 10mg Tablet, film-scored 1,021,320 L.L
D06AX01 FUCIDIN CREAM B Fusidic acid - 2% 2% Cream 345,368 L.L
G03DA04 UTROGESTAN B Progesterone micronised natural - 200mg 200mg Capsule 587,259 L.L
H03BB02 TAPAZOLE B Methimazole (Thiamazole) - 5mg 5mg Tablet 565,694 L.L
M01BX DORIXINA B1B6B12 B Lysine clonixinate - 125mg, Vitamin B1 - 50mg, Vitamin B6 - 30mg, Vitamin B12 - 50mcg Tablet, film coated 804,962 L.L
N02BE01 TYLENOL B Paracetamol - 350mg 350mg Suppository 239,204 L.L
R03AK07 SYMBICORT B Formoterol fumarate dihydrate - 9mcg/Inhalation, Budesonide - 320mcg/Inhalation Inhalation powder 3,378,420 L.L
R06AX29 LABIXTEN B Bilastine - 6mg/ml 6mg/ml Drops solution 1,647,551 L.L
L02AE03 ZOLADEX LA B Goserelin (acetate) - 10.8mg 10.8mg Injectable suspension L.L
A05AA04 OCALIVA B Obeticholic acid - 10mg 10mg Tablet, film coated 224,503,943 L.L
C08CA13 LERCADIP B Lercanidipine HCl - 20mg 20mg Tablet, film-scored 1,679,803 L.L
C09DX03 VOCADO HCT B Olmesartan medoxomil - 40mg, Amlodipine - 5mg, Hydrochlorothiazide - 25mg Tablet, film coated 1,523,917 L.L
G03DA04 UTROGESTAN B Progesterone micronised natural - 200mg 200mg Capsule 587,259 L.L
H03BB02 THYROZOL B Methimazole (Thiamazole) - 5mg 5mg Tablet, film coated 233,829 L.L
M02AA AIRTAL DIFUCREM 1.5% B Aceclofenac - 1.5g/100g 1.5% Cream 536,193 L.L
N02BE01 PANADOL B&I B Paracetamol - 120mg/5ml 120mg/5ml Suspension, sugar free, alcohol free 210,983 L.L
H01CB02 SANDOSTATIN LAR B Octreotide (acetate) - 20mg 20mg Injectable powder for suspension+diluent L.L
A05AA04 OCALIVA B Obeticholic acid - 5mg 5mg Tablet, film coated 224,503,943 L.L
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