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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
N03AX11 TOPIRAMATE ARROW G Topiramate - 200mg 200mg Tablet, film coated 1,440,599 L.L
N03AX11 TOPIRATE 200 BENTA G Topiramate - 200mg 200mg Tablet, film coated 7,039,175 L.L
C07AB03 TENORMIN B Atenolol - 100mg 100mg Tablet, film coated 279,519 L.L
J01MA12 TAVAQUIN 500MG G Levofloxacin - 500mg 500mg Tablet, film coated 787,492 L.L
J01MA12 TAVAQUIN G Levofloxacin (hemihydrate) - 750mg 750mg Tablet, film coated 1,389,533 L.L
L01EH01 TYKERB B Lapatinib ditosylate - 250mg 250mg Tablet, film coated 101,971,611 L.L
L04AA29 TOLVAR G Tofacitinib - 5mg 5mg Tablet, film coated 48,411,736 L.L
L04AA29 TRIJAN G Tofacitinib - 5mg 5mg Tablet, film coated 54,863,315 L.L
L04AA29 TRIJAN G Tofacitinib - 10mg 10mg Tablet, film coated 84,793,962 L.L
N03AX18 TREPADIO G Lacosamide - 50mg 50mg Tablet, film coated 606,073 L.L
C07BB03 TENORETIC B Chlortalidone - 25mg, Atenolol - 100mg Tablet, film coated 291,614 L.L
N03AX18 TREPADIO G Lacosamide - 100mg 100mg Tablet, film coated 5,202,014 L.L
N03AX18 TREPADIO G Lacosamide - 150mg 150mg Tablet, film coated 7,555,604 L.L
N03AX18 TREPADIO G Lacosamide - 200mg 200mg Tablet, film coated 8,876,013 L.L
N06AB10 TIOPRAM G Escitalopram (oxalate) - 10mg 10mg Tablet, film coated 671,921 L.L
B01AC04 THROMBO G Clopidogrel - 75mg 75mg Tablet, film coated 764,646 L.L
B01AC04 TROKEN G Clopidogrel (Bisulfate) - 75mg 75mg Tablet, film coated 1,148,985 L.L
J01MA12 TAVANIC B Levofloxacin - 500mg 500mg Tablet, film coated, scored 1,150,329 L.L
J01MA12 TAVANIC B Levofloxacin - 500mg 500mg Tablet, film-scored 1,150,329 L.L
J01AA02 TOLEXINE G Doxycycline (monohydrate) - 100mg 100mg Tablet, microgranules 589,947 L.L
C08DA51 TARKA B Verapamil - 240mg, Trandolapril - 4mg Tablet, modified release 3,797,532 L.L
N02AX02 TRAMAL RETARD B Tramadol HCl - 100mg 100mg Tablet, modified release 236,516 L.L
N02AX02 TRAMAL RETARD B Tramadol HCl - 150mg 150mg Tablet, modified release 356,118 L.L
N02AX02 TRAMAL RETARD B Tramadol HCl - 200mg 200mg Tablet, modified release 474,376 L.L
D01BA02 TERAFAN G Terbinafine HCl - 250mg 250mg Tablet, scored 725,675 L.L
N05BA12 TRANQUINAL 0.5 SUBLINGUAL G Alprazolam - 0.5mg 0.5mg Tablet, sublingual 459,594 L.L
N06AA02 TOFRANIL 10 B Imipramine HCl - 10mg 10mg Tablet, sugar coated 579,772 L.L
N06AA02 TOFRANIL 25 B Imipramine HCl - 25mg 25mg Tablet, sugar coated 1,002,123 L.L
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