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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
C09DB01 ARBITEN AM 10/160 G Amlodipine - 10mg, Valsartan - 160mg Caplet, film coated 857,372 L.L
M01AE51 PROFINAL XP G Ibuprofen - 400mg, Caffeine - 65mg Caplet, film coated 286,238 L.L
A04AD12 APREPITANT BIOGARAN 125MG APREPITANT BIOGARAN 80MG G Aprepitant - 125mg, Aprepitant - 80mg 125mg Capsule 2,980,643 L.L
G03DA04 UTROGESTAN B Progesterone micronised natural - 200mg 200mg Capsule 587,259 L.L
J01DD15 MINOCET G Cefdinir - 300mg 300mg Capsule 1,407,003 L.L
J02AC02 ITRAZOL G Itraconazole - 100mg 100mg Capsule 149,167 L.L
M01AX21 ART G Diacerein - 50mg 50mg Capsule 1,146,298 L.L
A05AA02 URSOFALK B Ursodeoxycholic acid - 250mg 250mg Capsule 2,823,413 L.L
G03DA04 UTROGESTAN B Progesterone micronised natural - 200mg 200mg Capsule 587,259 L.L
J01DD15 SEFARIN G Cefdinir - 300mg 300mg Capsule 1,490,321 L.L
J02AC02 ITRAZOL G Itraconazole - 100mg 100mg Capsule 559,038 L.L
G03DA04 UTROGESTAN B Progesterone micronised natural - 200mg 200mg Capsule 587,259 L.L
J01DD15 XEVANEER G Cefdinir - 300mg 300mg Capsule 1,350,562 L.L
J02AC02 TRACON G Itraconazole - 100mg 100mg Capsule 559,038 L.L
J01AA02 DOXYKEY G Doxycycline (hyclate) - 100mg 100mg Capsule 174,700 L.L
J01AA02 DOXYLAG G Doxycycline (hyclate) - 100mg 100mg Capsule 174,700 L.L
L04AD02 PROGRAF 1MG B Tacrolimus - 1mg 1mg Capsule 25,241,922 L.L
J01AA02 MONODOKS G Doxycycline (hyclate) - 100mg 100mg Capsule 248,611 L.L
L04AD02 PROGRAF 1MG B Tacrolimus - 1mg 1mg Capsule 25,241,922 L.L
A02BC01 AXIPRON G Omeprazole - 20mg 20mg Capsule 373,358 L.L
J01AA02 RETADOX G Doxycycline (hyclate) - 100mg 100mg Capsule 209,895 L.L
L04AD02 TACROGRAF 1 G Tacrolimus - 1mg 1mg Capsule 12,679,940 L.L
A02BC01 DIGCAP G Omeprazole - 20mg 20mg Capsule 593,850 L.L
L04AD02 PROGRAF 5MG B Tacrolimus - 5mg 5mg Capsule 94,286,686 L.L
A02BC01 EPIRAZOLE G Omeprazole - 20mg 20mg Capsule 208,296 L.L
J01AA04 TETRALYSAL B Lymecycline - 300mg 300mg Capsule 796,899 L.L
L04AD02 PROGRAF 5MG B Tacrolimus - 5mg 5mg Capsule 94,286,686 L.L
A02BC01 GASTRAZOLE G Omeprazole - 20mg 20mg Capsule 134,384 L.L
J01AA07 TETRACYCLINE G Tetracycline HCl - 250mg 250mg Capsule 3,906,998 L.L
L04AD02 TACROGRAF 5 G Tacrolimus - 5mg 5mg Capsule 67,507,154 L.L
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