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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
M03BA53 FLEXPRO EXTRA G Paracetamol - 500mg, Methocarbamol - 400mg Tablet, film coated 337,304 L.L
N02BE51 PANADOL COLD & FLU DAY B Paracetamol - 500mg, Caffeine - 25mg, Phenylephrine HCl - 5mg Caplet 284,895 L.L
A06AD61 SOFLAX G Lactose - less than 6g/100ml, Galactose - less than 11g/100ml, Lactulose - 67g/100ml Solution 258,018 L.L
A10BD20 EMPAZIMET G Metformin HCl - 1000mg, Empagliflozin - 12.5mg Tablet, film coated 1,840,168 L.L
B05BB02 DEXTROSE 5% & SODIUM CHLORIDE 0.3% G Sodium chloride - 0.3g/100ml, Dextrose, H2O - 5g/100ml Injectable solution 220,643 L.L
M03BA53 DISTEM G Paracetamol - 300mg, Methocarbamol - 380mg Tablet 978,317 L.L
N02BE51 PANADOL COLD & FLU ALL IN ONE B Paracetamol - 250mg, Guaifenesin - 100mg, Phenylephrine HCl - 5mg Tablet, film coated 342,680 L.L
A06AD65 FORTRANS POUDRE POUR SOLUTION BUVABLE B Potassium chloride - 0.750g, Sodium chloride - 1460g, Sodium bicarbonate - 1680g, Sodium sulfate anhydrous - 5700g, Macrogol 4000 - 64.000g Powder for solution 1,136,891 L.L
A10BD20 FLORIMET 12.5/1000 G Metformin - 1000mg, Empagliflozin - 12.5mg Tablet, film coated 1,836,585 L.L
M03BA53 METHOFEN PLATINUM G Ibuprofen - 200mg, Methocarbamol - 500mg Tablet 668,082 L.L
N02BE51 SOLPADEINE B Paracetamol - 500mg, Caffeine - 30mg, Codeine - 8mg Tablet 319,835 L.L
A02BC DANLOX QUICK G Omeprazole - 20mg, Sodium bicarbonate - 1680mg Powder 1,323,685 L.L
A06AD65 MOVICOL B Potassium chloride - 0.0466g, Sodium chloride - 0.3507g, Sodium bicarbonate - 0.1785g, Macrogol 3350 - 13.125g Powder for solution 853,340 L.L
M03BB52 TRANCODEX G Paracetamol - 450mg, Chlormezanone - 100mg Tablet 99,828 L.L
N02BE51 SOLPADEINE SOLUBLE B Paracetamol - 500mg, Caffeine - 30mg, Codeine - 8mg Tablet, effervescent 326,554 L.L
S01CA01 API-TOBRASON G Dexamethasone - 1mg/ml, Tobramycin - 3mg/ml Drops suspension 294,302 L.L
A06AD65 MOVICOL PEDIATRIC PLAIN B Potassium chloride - 23.3mg, Sodium chloride - 175.4mg, Sodium bicarbonate - 89.3mg, Macrogol 3350 - 6.563g Powder for solution 624,887 L.L
M03BB53 PARAXONE-JPI G Paracetamol - 300mg, Chlorzoxazone - 250mg Capsule 334,617 L.L
N02BE51 SOLPEX G Paracetamol - 500mg, Caffeine - 30mg, Codeine - 8mg Tablet 243,172 L.L
S01CA01 CO-AVAZIR G Tobramycin - 0.3%, Dexamethasone - 0.1% Drops suspension 193,513 L.L
A06AG11 MINILAX G Sodium citrate (dihydrate) - 900mg/10ml, Sodium lauryl sulfate - 150mg/10ml, Glycerol - 1200mg/10ml, Sorbic acid - 10mg/10ml, Sorbitol - 9.96mg/10ml Solution 474,824 L.L
J01DH51 CELLABAXIN G Imipenem (monohydrate) - 500mg, Cilastatin (sodium) - 500mg Injectable solution 10,699,559 L.L
M03BB53 RELAXON G Paracetamol - 300mg, Chlorzoxazone - 250mg Capsule 296,989 L.L
N02BE51 PANADOL COLD & FLU VAPOUR RELEASE + DECONGESTANT B Paracetamol - 600mg, Phenylephrine HCl - 10mg Powder for solution 460,938 L.L
S01CA01 DEXATOBRIN G Dexamethasone - 1mg/ml, Tobramycin - 3mg/ml Drops suspension 239,204 L.L
A06AX01 SUPPOSITOIRE GLYCERINE ENFANT G Glycerol Stearate USP - Suppository 179,179 L.L
A10BD20 EMPAZIMET G Metformin HCl - 1000mg, Empagliflozin - 5mg Tablet, film coated 1,840,168 L.L
J01DH51 CILANEM G Imipenem anhydrous - 500mg, Cilastatin (sodium) - 500mg Injectable solution 850,652 L.L
M03BC51 NORGESIC B Paracetamol - 450mg, Orphenadrine (citrate) - 35mg Tablet 412,560 L.L
N02BE51 MAXIFEN G Paracetamol - 325mg, Ibuprofen - 400mg Tablet, scored 225,254 L.L
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