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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
S01EE01 MONOPROST G Latanoprost - 50mcg/ml 50mcg/ml Drops solution 1,187,957 L.L
S01FA06 MYDRIACYL B Tropicamide - 1% 1% Drops solution 430,030 L.L
B03AD04 MALTOFER B Iron trivalent (hydroxide polymaltose) - 50mg/ml 50mg/ml Drops solution 649,076 L.L
B03AD04 MALTOFER B Iron trivalent (hydroxide polymaltose) - 50mg/ml 50mg/ml Drops solution 649,076 L.L
S03CA04 MYCICORT G Hydrocortisone acetate - 5mg, Neomycin sulfate - 5mg Drops suspension 166,381 L.L
D01AE14 MYCOSTER B Ciclopirox - 8g/100g 8% Film forming solution 756,583 L.L
D01AE14 MYCOSTER B Ciclopirox - 8g/100g 8% Film forming solution 756,583 L.L
A01AB09 MICONAZ G Miconazole nitrate - 20mg/g 20mg/g Gel 229,093 L.L
A01AB09 MICOZOLE G Miconazole - 20mg/g 20mg/g Gel 104,820 L.L
A01AB09 MYCOHEAL G Miconazole nitrate - 20mg/g 20mg/g Gel 210,983 L.L
D10AD51 MEDCLINIDERM-T G Tretinoin - 0.025%, Clindamycin (phosphate) - 1% Gel 801,186 L.L
D10AD51 MEDCLINIDERM-T G Tretinoin - 0.05%, Clindamycin (phosphate) - 1% Gel 890,776 L.L
D01AC02 MICONAZ G Miconazole nitrate - 20mg/g 20mg/g Gel 427,470 L.L
J01XX01 MONUROL B Fosfomycine (trométamol) - 3g 3g Granules for solution 571,133 L.L
J02AC01 MYXEN G Fluconazole - 50mg/5ml 50mg/5ml Granules for suspension 793,507 L.L
G02BA03 MIRENA 20mcg/24h Levonorgestrel B Levonorgestrel - 20mcg/24h 20mcg/24h Implant 10,530,753 L.L
L01FG01 MVASI BioTech Bevacizumab - 400mg/16ml 400mg/16ml Injectable concentrate for solution 58,035,926 L.L
C01CE02 MILRINONE G Milrinone - 1mg/ml 1mg/ml Injectable concentrate for solution 28,486,446 L.L
L01FG01 MVASI BioTech Bevacizumab - 100mg/4ml 100mg/4ml Injectable concentrate for solution 17,173,671 L.L
L01FA01 MABIXEN 100 BioTech Rituximab - 100mg/10ml 100mg/10ml Injectable concentrate for solution 22,183,393 L.L
L01FA01 MABIXEN 100 BioTech Rituximab - 100mg/10ml 100mg/10ml Injectable concentrate for solution 11,091,696 L.L
L01FA01 MABIXEN 500 BioTech Rituximab - 500mg/50ml 500mg/50ml Injectable concentrate for solution 136,761,210 L.L
L01FA01 MABIXEN 500 BioTech Rituximab - 500mg/50ml 500mg/50ml Injectable concentrate for solution 74,718,320 L.L
G03GA02 MENOPUR BioHuman Menotropin - 75IU 75IU Injectable concentrated powder for solution+diluent 16,864,077 L.L
L01DB07 MITOXANTRON EBEWE G Mitoxantrone - 20mg/10ml 20mg/10ml Injectable concentrated solution 11,064,120 L.L
L01FA01 MABTHERA BioTech Rituximab - 100mg/10ml 100mg/10ml Injectable concentrated solution 35,722,424 L.L
L01FA01 MABTHERA BioTech Rituximab - 500mg/50ml 500mg/50ml Injectable concentrated solution 80,211,932 L.L
J01DC02 MAXIL 750 G Cefuroxime - 750mg 750mg Injectable dry powder 159,917 L.L
J01CA04 MOXILEN G Amoxicillin (sodium) - 1g 1g Injectable dry powder for solution 998,475 L.L
H02AB04 METHYL PREDNISOLONE VIATRIS 40MG G Methylprednisolone (hemisuccinate) - 40mg 40mg Injectable dry powder for solution 258,657 L.L
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