title: Improvements in pandemic preparedness in 8 Central American countries, 2008-2012.
abstract: BACKGROUND
  In view of ongoing pandemic threats such as the recent human cases of novel avian influenza A(H7N9) in China, it is important that all countries continue their preparedness efforts. Since 2006, Central American countries have received donor funding and technical assistance from the U.S. Centers for Disease Control and Prevention (CDC) to build and improve their capacity for influenza surveillance and pandemic preparedness. Our objective was to measure changes in pandemic preparedness in this region, and explore factors associated with these changes, using evaluations conducted between 2008 and 2012.
  
  
  METHODS
  Eight Central American countries scored their pandemic preparedness across 12 capabilities in 2008, 2010 and 2012, using a standardized tool developed by CDC. Scores were calculated by country and capability and compared between evaluation years using the Student's t-test and Wilcoxon Rank Sum test, respectively. Virological data reported to WHO were used to assess changes in testing capacity between evaluation years. Linear regression was used to examine associations between scores, donor funding, technical assistance and WHO reporting.
  
  
  RESULTS
  All countries improved their pandemic preparedness between 2008 and 2012 and seven made statistically significant gains (p < 0.05). Increases in median scores were observed for all 12 capabilities over the same period and were statistically significant for eight of these (p < 0.05): country planning, communications, routine influenza surveillance, national respiratory disease surveillance, outbreak response, resources for containment, community interventions and health sector response. We found a positive association between preparedness scores and cumulative funding between 2006 and 2011 (R2 = 0.5, p < 0.01). The number of specimens reported to WHO from participating countries increased significantly from 5,551 (2008) to 18,172 (2012) (p < 0.01).
  
  
  CONCLUSIONS
  Central America has made significant improvements in influenza pandemic preparedness between 2008 and 2012. U.S. donor funding and technical assistance provided to the region is likely to have contributed to the improvements we observed, although information on other sources of funding and support was unavailable to study. Gains are also likely the result of countries' response to the 2009 influenza pandemic. Further research is required to determine the degree to which pandemic improvements are sustainable.
authors.forename: Lucinda E A
authors.initials: LE
authors.lastname: Johnson
authors.forename: Wilfrido
authors.initials: W
authors.lastname: Clará
authors.forename: Manoj
authors.initials: M
authors.lastname: Gambhir
authors.forename: Rafael
authors.initials: R
authors.lastname: Chacón-Fuentes
authors.forename: Carlos
authors.initials: C
authors.lastname: Marín-Correa
authors.forename: Jorge
authors.initials: J
authors.lastname: Jara
authors.forename: Percy
authors.initials: P
authors.lastname: Minaya
authors.forename: David
authors.initials: D
authors.lastname: Rodríguez
authors.forename: Natalia
authors.initials: N
authors.lastname: Blanco
authors.forename: Naomi
authors.initials: N
authors.lastname: Iihoshi
authors.forename: Maribel
authors.initials: M
authors.lastname: Orozco
authors.forename: Carmen
authors.initials: C
authors.lastname: Lange
authors.forename: Sergio Vinicio
authors.initials: SV
authors.lastname: Pérez
authors.forename: Nydia
authors.initials: N
authors.lastname: Amador
authors.forename: Marc-Alain
authors.initials: MA
authors.lastname: Widdowson
authors.forename: Ann C
authors.initials: AC
authors.lastname: Moen
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA. eha9@cdc.gov.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Azziz-Baumgartner
mesh_terms: D057191:Capacity Building; D002489:Central America; D016208:Databases, Factual; D004189:Disaster Planning / Q000592:standards* / Q000639:trends; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification; D007251:Influenza, Human / Q000517:prevention & control; D058873:Pandemics / Q000517:prevention & control*; D058996:Quality Improvement / Q000639:trends*