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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
C07AB12 NIVOL G Nebivolol HCl - 5mg 5mg Tablet 590,011 L.L
J01XE01 NITROFURANTOIN G Nitrofurantoin - 100mg 100mg Tablet 925,907 L.L
C07BB12 NIVOL PLUS G Nebivolol HCl - 5mg, Hydrochlorothiazide - 12.5mg 5mg Tablet 609,209 L.L
G02CB03 NOSTIFIX G Cabergoline - 0.5mg 0.5mg Tablet 976,973 L.L
G02CB03 NOSTIFIX G Cabergoline - 0.5mg 0.5mg Tablet 248,611 L.L
N02BE01 NOMAL G Paracetamol - 500mg 500mg Tablet 305,884 L.L
C08CA01 NIPIDOL G Amlodipine - 5mg 5mg Tablet 255,330 L.L
C08CA01 NIPIDOL G Amlodipine - 10mg 10mg Tablet 377,620 L.L
A11DB NEUROBION B Vitamin B12 - 200mcg, Vitamin B6 - 200mg, Vitamin B1 - 100mg Tablet, coated 364,181 L.L
A11DB NEUROBION B Vitamin B12 - 200mcg, Vitamin B6 - 200mg, Vitamin B1 - 100mg Tablet, coated 550,975 L.L
A11DB NEUROMED G Vitamin B12 - 200mcg, Vitamin B6 - 200mg, Vitamin B1 - 100mg Tablet, coated 257,250 L.L
R05FA01 NEO-CODION B Codeine Camphosulfonate - 25mg, Sulfogaiacol - 100mg, Grindelia soft extract - 20mg Tablet, coated 258,018 L.L
G03AA12 NAJAT G Drospirenone - 3mg, Ethinylestradiol - 0.03mg Tablet, coated 417,935 L.L
A02BC05 NEXPRAZOL 20 G Esomeprazole - 20mg 20mg Tablet, enteric coated 275,168 L.L
A02BC05 NEXIUM B Esomeprazole (magnesium trihydrate) - 40mg 40mg Tablet, enteric coated 1,138,235 L.L
A02BC05 NEXIUM B Esomeprazole (magnesium trihydrate) - 40mg 40mg Tablet, enteric coated 1,138,235 L.L
B01AC06 NU-SEALS G Acetylsalicylic acid - 75mg 75mg Tablet, enteric coated 403,153 L.L
A07AA11 NORMIX TAB B Rifaximin alpha - 200mg 200mg Tablet, film coated 827,807 L.L
J05AP08 NUCLEOBUVIR G Sofosbuvir - 400mg 400mg Tablet, film coated 50,670,440 L.L
C04AX21 NAFTIPRAX B Naftidrofuryl hydrogen oxalate - 200mg 200mg Tablet, film coated 614,328 L.L
L02BB06 NUBEQA B Darolutamide - 300mg Tablet, film coated 239,808,442 L.L
A11DB NEURORUBINE-FORTE G Vitamin B12 - 1mg, Vitamin B6 - 50mg, Vitamin B1 - 200mg Tablet, film coated 262,049 L.L
C10AB05 NANOFIB G Fenofibrate - 145mg 145mg Tablet, film coated 1,371,615 L.L
A03AB06 NOSPAZM G Otilonium bromide - 40mg 40mg Tablet, film coated 282,207 L.L
M01AE01 NORFEN 400 G Ibuprofen - 400mg 400mg Tablet, film coated 173,356 L.L
M01AE01 NEURALGINE EXTRA IBU-LYSINAT B Ibuprofen (DL Lysine) - 400mg (684mg) 684mg Tablet, film coated 833,182 L.L
M01AE02 NOPAIN DS G Naproxen (sodium) - 500mg 500mg Tablet, film coated 235,172 L.L
L01EX02 NEXAVAR B Sorafenib - 200mg 200mg Tablet, film coated 86,139,938 L.L
M01AE17 NORMODEX G Dexketoprofen - 25mg 25mg Tablet, film coated 279,519 L.L
A04AA01 NOZENTRIX G Ondansetron - 8mg 8mg Tablet, film coated 1,151,865 L.L
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