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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
L04AD02 ADVAGRAF B Tacrolimus monohydrate - 5mg 5mg Capsule, prolonged release 85,485,667 L.L
L04AD02 ADVAGRAF B Tacrolimus monohydrate - 0.5mg 0.5mg Capsule, prolonged release 13,297,758 L.L
L04AD02 ADVAGRAF B Tacrolimus monohydrate - 1mg 1mg Capsule, prolonged release L.L
L04AD02 ADVAGRAF B Tacrolimus monohydrate - 3mg 3mg Capsule, prolonged release L.L
D07AC14 ADVANTAN B Methylprednisolone aceponate - 1mg/g 1mg/g Ointment 385,683 L.L
D07AC14 ADVANTAN B Methylprednisolone aceponate - 1mg/g 1mg/g Cream 385,683 L.L
M01AE01 ADVIL B Ibuprofen - 200mg 200mg Tablet 321,178 L.L
M01AE51 ADVIL COLD & SINUS B Ibuprofen - 200mg, Pseudoephedrine HCl - 30mg Caplet, coated 288,926 L.L
M01AE01 ADVIL LIQUI-GELS B Ibuprofen - 200mg 200mg Capsule 464,970 L.L
M01AE01 ADVIL LIQUI-GELS EXTRA STRENGTH B Ibuprofen - 400mg 400mg Capsule 575,165 L.L
R06AX27 AERIALLERG G Desloratadine - 5mg 5mg Tablet, film coated 400,465 L.L
R06AX27 AERIALLERG G Desloratadine - 0.5mg/ml 0.5mg/ml Syrup 200,233 L.L
R06AX27 AERIUS B Desloratadine - 5mg 5mg Tablet, film coated 430,030 L.L
R06AX27 AERIUS B Desloratadine - 5mg 5mg Tablet, film coated 430,030 L.L
R06AX27 AERIUS B Desloratadine - 0.5mg/ml 0.5mg/ml Solution 403,153 L.L
R03AK13 AEROCORT-A HFA G Salbutamol - 100mcg/dose, Beclometasone - 50mcg/dose Metered dose inhaler 541,569 L.L
R03AC13 AEROFOR G Formoterol fumarate - 12mcg 12mcg Capsule, inhalation 897,687 L.L
R03AC13 AEROFOR G Formoterol fumarate - 12mcg 12mcg Capsule, inhalation 1,709,368 L.L
R03BA02 AERONIDE G Budesonide - 200mcg 200mcg Capsule, inhalation 1,150,329 L.L
R03BA02 AERONIDE G Budesonide - 400mcg 400mcg Capsule, inhalation 2,116,552 L.L
C05BB02 AETHOXYSKLEROL B Polidocanol (Lauromacrogol 400) - 0.5% 0.5% Injectable solution 1,441,943 L.L
C05BB02 AETHOXYSKLEROL B Polidocanol (Lauromacrogol 400) - 1% 1% Injectable solution 1,732,213 L.L
C05BB02 AETHOXYSKLEROL B Polidocanol (Lauromacrogol 400) - 3% 3% Injectable solution 2,576,146 L.L
L01EG02 AFINITOR B Everolimus - 5mg 5mg Tablet 154,115,122 L.L
L01EG02 AFINITOR B Everolimus - 10mg 10mg Tablet 221,857,193 L.L
B01AC17 AGGRASTAT B Tirofiban hydrochloride monohydrate - 0.25mg/ml 0.25mg/ml Injectable concentrated solution 18,280,324 L.L
B01AC04 AGGRIX 75 G Clopidogrel besylate - 75mg 75mg Tablet, film coated 1,204,083 L.L
N02CD01 AIMOVIG BioTech Erenumab - 70mg/ml 70mg/ml Injectable solution 35,423,371 L.L
R03DC03 AIRFAST G Montelukast (sodium) - 10mg 10mg Tablet, film coated 802,274 L.L
R03DC03 AIRFAST PEDIATRICS G Montelukast (sodium) - 4mg 4mg Granules for solution 880,217 L.L
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