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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
A08AA01 LOMAIRA B Phentermine Hydrochloride - 8mg 8mg Tablet 6,138,673 L.L
C03CA01 LASIX B Furosemide - 500mg 500mg Tablet 1,454,038 L.L
R03DC03 LEUKOTRIS G Montelukast - 5mg 5mg Tablet 979,085 L.L
R03DC03 LEUKOTRIS G Montelukast - 4mg 4mg Tablet 783,268 L.L
L01ED05 LORBRENA B Lorlatinib - 100mg 100mg Tablet L.L
G04BE09 LEVIDOR G Vardenafil (HCl) - 20mg 20mg Tablet 774,053 L.L
G04BE09 LEVIDOR G Vardenafil (HCl) - 5mg 5mg Tablet 876,185 L.L
N03AX09 LAMICTAL B Lamotrigine - 100mg 100mg Tablet 2,741,209 L.L
N03AX09 LAMICTAL B Lamotrigine - 25mg 25mg Tablet 1,088,270 L.L
L01ED05 LORBRENA B Lorlatinib - 25mg 25mg Tablet 134,559,469 L.L
N03AX09 LAMICTAL LIQUI-TABS B Lamotrigine - 5mg 5mg Tablet 361,046 L.L
L01ED05 LORBRENA B Lorlatinib - 100mg 100mg Tablet 403,677,371 L.L
M01AB16 LOFLAM G Aceclofenac - 100mg 100mg Tablet 767,334 L.L
N03AX09 LAMICTAL B Lamotrigine - 50mg 50mg Tablet 1,753,895 L.L
C09DA01 LOSANET-H G Losartan potassium - 50mg, Hydrochlorothiazide - 12.5mg Tablet 395,474 L.L
C10AB05 LIPAFIB G Fenofibrate - 160mg 160mg Tablet 627,127 L.L
C10AB05 LIPAFIB G Fenofibrate - 160mg 160mg Tablet 627,127 L.L
C09DA01 LOSANET-H FORTE G Losartan potassium - 100mg, Hydrochlorothiazide - 12.5mg Tablet 395,474 L.L
J01MA12 LEVOMED G Levofloxacin (hemihydrate) - 500mg 500mg Tablet 849,820 L.L
C10BA05 LIPONORM PLUS 10/10 G Atorvastatin - 10mg, Ezetimibe - 10mg Tablet 974,286 L.L
C10BA05 LIPONORM PLUS 20/10 G Atorvastatin - 20mg, Ezetimibe - 10mg Tablet 1,226,928 L.L
A03CA02 LIBROCOL G Chlordiazepoxide - 5mg, Clidinium bromide - 2.5mg Tablet 338,648 L.L
J01MA14 LOXIMED G Moxifloxacin (HCl) - 400mg 400mg Tablet 851,100 L.L
J01MA14 LOXIPHAR G Moxifloxacin (HCl) - 400mg 400mg Tablet 1,063,555 L.L
N03AX14 LEPITAM G Levetiracetam - 250mg 250mg Tablet 700,078 L.L
N03AX14 LEPITAM G Levetiracetam - 500mg 500mg Tablet 1,100,671 L.L
N03AX18 LACOSAMIDE/GENEPHARM G Lacosamide - 50mg 50mg Tablet 614,136 L.L
D01BA02 LAMIFEN G Terbinafine HCl - 250mg 250mg Tablet 245,923 L.L
N03AX18 LACOSAMIDE/GENEPHARM G Lacosamide - 100mg 100mg Tablet 4,856,647 L.L
D01BA02 LAMINOX G Terbinafine HCl - 250mg 250mg Tablet 725,675 L.L
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