Open Access Highly Accessed Research article

Improvements in pandemic preparedness in 8 Central American countries, 2008 - 2012

Lucinda EA Johnson1, Wilfrido Clará2, Manoj Gambhir3, Rafael Chacón- Fuentes4, Carlos Marín-Correa5, Jorge Jara4, Percy Minaya5, David Rodríguez6, Natalia Blanco4, Naomi Iihoshi7, Maribel Orozco8, Carmen Lange9, Sergio Vinicio Pérez7, Nydia Amador10, Marc-Alain Widdowson1, Ann C Moen1 and Eduardo Azziz-Baumgartner1*

  • * Corresponding author: Eduardo Azziz-Baumgartner

  • † Equal contributors

Author Affiliations

1 Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA

2 Influenza Program, Centers for Disease Control and Prevention Regional Office for Central America, San Salvador, El Salvador

3 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

4 Center for Health Studies, Universidad del Valle, Guatemala City, Guatemala

5 Training of Epidemiology and Public Health Intervention Network, Atlanta, GA, USA

6 General Directorate of Health Surveillance, Ministry of Health of El Salvador, San Salvador, El Salvador

7 National Epidemiology Center, Ministry of Health of Guatemala, Guatemala City, Guatemala

8 Council of Ministers of Health of Central America and the Dominican Republic, San Salvador, El Salvador

9 Department of Epidemiology, Ministry of Health of Panama, Panama City, Panama

10 General Directorate of Health Surveillance, Ministry of Health of Costa Rica, San José, Costa Rica

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BMC Health Services Research 2014, 14:209  doi:10.1186/1472-6963-14-209

Published: 9 May 2014



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.


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.


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).


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.

Pandemic; Influenza; Preparedness; IHR; Central America; Capacity-building; Technical assistance