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Germicidal UV-C Disinfection Modules Equipped with four powerful UV-C lamps, Abatement Technologies irradiate, disinfect and kill dangerous infectious pathogens. Each module generates 156 watts of germicidal UV energy to clean and sterilize the air. Testing and Certification by Independent National Laboratories Abatement Technologies HEPA filters are tested and certified for performance specifications in accordance with Institute of Environmental Sciences and Technology IEST-RP-CC001.3 and MIL-STD 282. HEPA-CARE true 99.99% HEPA filters are constructed with extruded anodized aluminum frames, have a UL900 Class I flammability rating, and meet IEST and MIL standards, including 100% efficiency testing. The unique silicone gel seal provides a more secure, bypass-free seal than other designs. About Abatement Technologies Protecting patients and staff from potentially hazardous airborne particles is a crucial component of the infection control program for every medical facility. Abatement Technologies has led the way with innovative and effective infection-control solutions since 1986. Contact Abatement Technologies for additional information on their state-of-the-art Products for Healthcare Facilities to create patient isolation rooms and provide isolation surge capacity. 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. Conclusions Central America has made significant improvements in influenza pandemic preparedness between 2008 and 2012. 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. Background In 2006, the World Health Organization (WHO) published the revised International Health Regulations (IHR) (2005) in response to an increase in global travel and trade and the emergence and re-emergence of infectious diseases, such as avian influenza []. These regulations provided an updated legal framework to guide the international community in the prevention and mitigation of acute public health risks, including pandemic influenza. The revised IHR became legally binding in June 2007 with the expectation that Member States would implement the recommendations within five years. ![]() In the intervening period, the world experienced its first influenza pandemic in over 30 years with the global circulation of Influenza A (H1N1)pdm09 virus []. Low and middle-income countries face greater challenges in preparing for pandemic influenza than high-income countries [] and, in the event of a pandemic, they are thought to be at risk of higher mortality rates [,]. Central America is a region of middle-income countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama. Since 2006, these seven countries, together with the Dominican Republic, have been the recipients of technical assistance and funding from the U.S. Centers for Disease Control and Prevention (CDC) to develop their influenza surveillance capacity and pandemic preparedness. In addition, the WHO has published a number of strategy and guidance documents to support countries in their efforts to develop and strengthen pandemic preparedness [-]. These documents include the Pan American Health Organization (PAHO) and CDC generic protocol for influenza surveillance, published in 2006 to specifically help countries in the Latin American region standardize their surveillance systems []. In 2008, CDC published an assessment tool to help countries determine the status of their influenza pandemic preparedness across twelve capabilities; functions, resources or activities identified as critical to pandemic preparedness and response []. WHO describes preparedness as the ability to detect zoonotic and human influenza viruses, respond to widespread disease should it occur, and minimize the impact of disease on the economy and society []. The content of the tool was developed during 2006 and 2007, in the context of WHO recommendations for national pandemic preparedness, including the IHR (2005), as well as the best available science and practice standards for preparedness at the time. The principle aim of the tool has been to help countries and their donor partners identify opportunities for improvement so that funding and technical assistance can be targeted to further develop and enhance pandemic preparedness. The purpose of this study was to measure changes in pandemic preparedness in Central America using evaluations conducted in eight countries which took place in 2008, 2010 and 2012. We also explored factors associated with these changes including the 2009 influenza pandemic and, U.S. CDC technical assistance and funding provided to the region since 2006. Data collection Each country’s level of influenza pandemic preparedness was measured in 2008, 2010 and 2012. Implementation of the tool requires the participation of persons responsible for pandemic preparedness in a country; participants were identified by the ministry of health from each country in partnership with CDC. They included, among others: epidemiologists, influenza laboratory staff, risk communication experts, emergency and disaster response personnel, health-care providers, and animal and environmental health experts, as well as, partners such as WHO, the World Bank, the U.S. Agency for International Development and local non-government organizations. The self-assessment process was facilitated by a CDC representative and took place over one to two days. The 12 capabilities were discussed among the participants until a consensus was reached regarding the score to assign to each of the 48 corresponding indicators per country. If necessary, participants accessed country-specific data sources such as their national pandemic preparedness plans or laboratory reports, to assist with their decision-making. Prior to their participation, countries were informed that the evaluations were voluntary and that data collected through the tool would only be published anonymously or in aggregate. Pandemic tool data analyses Scores for each capability were calculated by taking the sum of their four respective indicators. Pandemic preparedness scores for each country were calculated as a percentage by summing the scores for each of the 12 capabilities and dividing the totals by the maximum score possible (12 capabilities × 4 indicators × maximum indicator score of 3 = 144). Percentage scores by capability were determined by calculating the median score for the eight countries for each capability, and dividing by the maximum score possible for a capability (4 indicators × maximum indicator score of 3 = 12). Missing data were given a score of zero. Higher percentage scores denote greater levels of preparedness. Scores were compared across years using the Wilcoxon rank-sum test. Linear regression was used to explore associations between funding and pandemic preparedness scores. All statistical analysis was performed using Stata MP Version 11 (StataCorp LP, College Station, U.S.). Funding and technical assistance data analyses We accessed data from the CDC-Central America Regional Office to determine the allocation of budgeted influenza and pandemic preparedness funds and provision of technical assistance to the eight countries between 2006 and 2012. We used linear regression to analyze the association between cumulative funding and pandemic preparedness scores for each country. To account for the likely delay between preparedness budgeting and expenditure, we regressed 2006-2007, 2006-2009 and 2006-2011 funding data against 2008, 2010 and 2012 scores, respectively. Technical assistance was calculated by summing the months of service provided by cooperative agreement-funded staff to each country, pro rata. We used linear regression to analyze the association between cumulative technical assistance and pandemic preparedness scores for each country; technical assistance up to and including the month prior to an evaluation was regressed against the score for each evaluation. WHO FluNet data analyses We extracted data from the WHO influenza virological surveillance database, FluNet, to determine the number of influenza specimens reported from Central America between January 1, 2008 and December 31, 2012 []. The Wilcoxon Rank Sum test was used to compare changes in the number of specimens reported over time. Linear regressions were performed to establish the relationship between 2008 pandemic scores and FluNet specimens reported in 2007-8, 2009-10 and 2011-12, respectively, with the aim of evaluating the association between baseline scores and a measurable outcome of influenza-related activity (i.e. Increased reporting being indicative of influenza testing capacity which is, in turn, representative of preparedness). Median influenza pandemic preparedness scores by capability for 2008, 2010 and 2012 In 2012, countries scored routine influenza surveillance (median 100%, [IQR 98–100]), communications (median 92%, [75–92]), national respiratory disease surveillance (median 88%, [81-94]) and outbreak response (median 88%, [73–94]) capabilities as most developed and resources for containment (median 58%, [56–73], research (median 50%, [25–77]) and health sector response (median 40%, [33–63]) capabilities as least developed (Figure, Table ). The highest preparedness score for a country in 2012 was 90% and the lowest was 59%. Increases in median scores were observed for all 12 capabilities between 2008 and 2012 and were statistically significant for eight of these: country planning (p. Funding, technical assistance and pandemic preparedness From 2006 to 2011, the eight countries we studied were allocated a median of 335,000 [IQR 253,000-360,000] USD per year in cooperative agreement funding from CDC. This funding was distributed among surveillance activities (49%), laboratory activities (8%), research (18%) and other preparedness activities (26%). We found a positive association between pandemic scores in 2008, 2010 and 2012 and cumulative funding from 2006-2007, 2006-2009 and 2006-2011, respectively (R 2 = 0.5 (i.e. 50% of the variance in scores was explained by cumulative funding) p. Laboratory capabilities in 2012 Between 2008 and 2012, two national laboratories were designated as WHO National Influenza Centres (NICs), bringing the total to six NICs in six countries for the region in 2012 (Table ). The national laboratories of all eight countries utilize indirect fluorescent antibody (IFA) assays to detect influenza and seven have introduced quantitative reverse transcription polymerase chain reaction (qRT-PCR) testing since 2006 (Table ). Seven countries use IFA testing to detect influenza at local hospitals, three of which also use qRT-PCR (Table ). In 2012, six of the eight countries we studied were performing virus isolation and characterization (Table ). Conclusions Central American countries have made significant improvements in pandemic preparedness between 2008 and 2012. Donor funding and technical assistance for influenza surveillance and pandemic preparedness, provided to the region since 2006 is likely to have contributed to these changes, suggesting that bilateral support for Central America in this area of public health has been important and successful. The gains in preparedness we observed may also be attributed to increased activity associated with the 2009 influenza pandemic although there is evidence that some improvements preceded this event. The participation of the region in WHO GISRS, as evidenced by increased reporting to FluNet and NIC attainment during the study period, demonstrates the commitment of Central American countries to the IHR (2005). While progress in pandemic preparedness has been made in Central America in recent years, there is a need to determine the degree to which these gains are sustainable and the impact they may have on influenza morbidity and mortality. In view of ongoing pandemic threats such as the recent human cases of novel avian influenza A(H7N9) in China, it is important that Central American countries continue to invest in pandemic preparedness activities.
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