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), Dahr Bacheq Governmental Hospital, Ain Wa Zen Hospital, Notre Dame de Secours Hospital - In the mohafazas of Bekaa and Baalbeck/Hermel: Zahleh Governmental Hospital and Khoury Hospital - In the mohafazas of North and Akkar: Tripoli Governmental Hospital and Mounla Hospital - In the mohafazas of South and Nabatieh: Saida Governmental Hospital, Hammoud Hospital and Nabih Berry / Nabatieh Governmental 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 - Link to WHO Flunet 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