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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
A01AD11 DILO MOUTHWASH G Diclofenac sodium - 0.74mg/ml 0.74mg/ml 1,062,276 L.L
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
D06AX TRIPLE ANTIBIOTIC ORIGINAL OINTMENT Bacitracin - 400U, Neomycin (sulfate) - 3.5mg, Polymyxin B (sulfate) - 5000U 580,540 L.L
H05AA02 BONTEO BioTech Teriparatide - 20mcg/dose 20mcg/dose 17,383,843 L.L
N02BE51 ADOL EXTRA G Paracetamol - 500mg, Caffeine - 65mg Caplet 122,290 L.L
N02BE51 PANADOL NIGHT B Paracetamol - 500mg, Diphenhydramine HCl - 25mg 500mg Caplet 315,803 L.L
N02BE51 PANADOL SINUS B Paracetamol - 500mg, Pseudoephedrine HCl - 30mg Caplet 228,453 L.L
N02BE51 PANADOL COLD & FLU DAY B Paracetamol - 500mg, Caffeine - 25mg, Phenylephrine HCl - 5mg Caplet 284,895 L.L
N02BE51 PANADOL MIGRAINE B Paracetamol - 250mg, Acetylsalicylic acid - 250mg, Caffeine - 65mg Caplet 604,729 L.L
N06AB04 LECITAL 20 G Citalopram - 20mg 20mg Caplet 1,247,086 L.L
N06AB04 LECITAL 40 G Citalopram - 40mg 40mg Caplet 1,761,778 L.L
A10BB12 JOSWE GLEMAX 2 G Glimepiride - 2mg 2mg Caplet 139,760 L.L
A10BB12 JOSWE GLEMAX 3 G Glimepiride - 3mg 3mg Caplet 235,172 L.L
N02BE01 ADOL G Paracetamol - 500mg 500mg Caplet 81,974 L.L
N06AB10 ZELAX 10 G Escitalopram (oxalate) - 10mg 10mg Caplet 833,182 L.L
A10BB12 JOSWE GLEMAX 4 G Glimepiride - 4mg 4mg Caplet 235,172 L.L
A10BB12 JOSWE GLEMAX 6 G Glimepiride - 6mg 6mg Caplet 663,858 L.L
N06AB10 ZELAX 20 G Escitalopram (oxalate) - 20mg 20mg Caplet 1,544,075 L.L
M01AE51 ADVIL COLD & SINUS B Ibuprofen - 200mg, Pseudoephedrine HCl - 30mg Caplet, coated 288,926 L.L
N05AH03 PREXAL 5 G Olanzapine - 5mg 5mg Caplet, film coated 718,956 L.L
C10AA05 JOSWE ATORVAST 10 G Atorvastatin - 10mg 10mg Caplet, film coated 849,308 L.L
N05AH03 PREXAL 10 G Olanzapine - 10mg 10mg Caplet, film coated 881,561 L.L
C10AA05 JOSWE ATORVAST 20 G Atorvastatin - 20mg 20mg Caplet, film coated 956,816 L.L
N05AX08 RESPAL 1 G Risperidone - 1mg 1mg Caplet, film coated 309,084 L.L
C10AA05 JOSWE ATORVAST 40 G Atorvastatin - 40mg 40mg Caplet, film coated 1,327,716 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
C10BX03 JOSWE DUBARA 5/10 G Amlodipine - 5mg, Atorvastatin - 10mg Caplet, film coated 2,370,538 L.L
C10BX03 JOSWE DUBARA 10/10 G Amlodipine - 10mg, Atorvastatin - 10mg Caplet, film coated 2,655,433 L.L
C09DB01 ARBITEN AM 5/160 G Amlodipine - 5mg, Valsartan - 160mg Caplet, film coated 857,372 L.L
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