Margarita Ramirez Silva, MPH

All Publications

• Building Programs to Eradicate Toxoplasmosis Part III: Epidemiology and Risk Factors. Current pediatrics reports Felín, M. S., Wang, K., Raggi, C., Moreira, A., Pandey, A., Grose, A., Caballero, Z., Rengifo-Herrera, C., Ramirez, M., Moossazadeh, D., Castro, C., Montalvo, J. L., Leahy, K., Zhou, Y., Clouser, F. A., Siddiqui, M., Leong, N., Goodall, P., Michalowski, M., Ismail, M., Christmas, M., Schrantz, S., Norero, X., Estripeaut, D., Ellis, D., Ashi, K., Dovgin, S., Dixon, A., Li, X., Begeman, I., Heichman, S., Lykins, J., Villalobos-Cerrud, D., Fabrega, L., Mendivil, C., Quijada, M. R., Fernández-Pirla, S., de La Guardia, V., Wong, D., de LadrónGuevara, M., Flores, C., Borace, J., García, A., Caballero, N., de Saez, M. T., Politis, M., Ross, S., Dogra, M., Dhamsania, V., Graves, N., Kirchberg, M., Mathur, K., Aue, A., Restrepo, C. M., Llanes, A., Guzman, G., Rebollon, A., Boyer, K., Heydemann, P., Noble, A. G., Swisher, C., Rabiah, P., Withers, S., Hull, T., Su, C., Blair, M., Latkany, P., Mui, E., Vasconcelos-Santos, D. V., Villareal, A., Perez, A., Galvis, C. A., Montes, M. V., Perez, N. I., Ramirez, M., Chittenden, C., Wang, E., Garcia-López, L. L., Muñoz-Ortiz, J., Rivera-Valdivia, N., Bohorquez-Granados, M. C., de-la-Torre, G. C., Padrieu, G., Hernandez, J. D., Celis-Giraldo, D., Acosta Dávila, J. A., Torres, E., Oquendo, M. M., Arteaga-Rivera, J. Y., Nicolae, D., Rzhetsky, A., Roizen, N., Stillwaggon, E., Sawers, L., Peyron, F., Wallon, M., Chapey, E., Levigne, P., Charter, C., De Frias, M., Montoya, J., Press, C., Ramirez, R., Contopoulos-Ioannidis, D., Maldonado, Y., Liesenfeld, O., Gomez, C., Wheeler, K., Holfels, E., Frim, D., McLone, D., Penn, R., Cohen, W., Zehar, S., McAuley, J., Limonne, D., Houze, S., Abraham, S., Piarroux, R., Tesic, V., Beavis, K., Abeleda, A., Sautter, M., El Mansouri, B., El Bachir, A., Amarir, F., El Bissati, K., de-la-Torre, A., Britton, G., Motta, J., Ortega-Barria, E., Romero, I. L., Meier, P., Grigg, M., Gómez-Marín, J., Kosagisharaf, J. R., Llorens, X. S., Reyes, O., McLeod, R. 2022; 10 (3): 109-124

  Abstract

  Review comprehensive data on rates of toxoplasmosis in Panama and Colombia.Samples and data sets from Panama and Colombia, that facilitated estimates regarding seroprevalence of antibodies to Toxoplasma and risk factors, were reviewed.Screening maps, seroprevalence maps, and risk factor mathematical models were devised based on these data. Studies in Ciudad de Panamá estimated seroprevalence at between 22 and 44%. Consistent relationships were found between higher prevalence rates and factors such as poverty and proximity to water sources. Prenatal screening rates for anti-Toxoplasma antibodies were variable, despite existence of a screening law. Heat maps showed a correlation between proximity to bodies of water and overall Toxoplasma seroprevalence. Spatial epidemiological maps and mathematical models identify specific regions that could most benefit from comprehensive, preventive healthcare campaigns related to congenital toxoplasmosis and Toxoplasma infection.

  View details for DOI 10.1007/s40124-022-00265-0

  View details for PubMedID 37744780

  View details for PubMedCentralID PMC10516319

• Building Programs to Eradicate Toxoplasmosis Part II: Education. Current pediatrics reports Felín, M. S., Wang, K., Moreira, A., Grose, A., Leahy, K., Zhou, Y., Clouser, F. A., Siddiqui, M., Leong, N., Goodall, P., Michalowski, M., Ismail, M., Christmas, M., Schrantz, S., Caballero, Z., Norero, X., Estripeaut, D., Ellis, D., Raggi, C., Castro, C., Rengifo-Herrera, C., Moossazadeh, D., Ramirez, M., Pandey, A., Ashi, K., Dovgin, S., Dixon, A., Li, X., Begeman, I., Heichman, S., Lykins, J., Villalobos-Cerrud, D., Fabrega, L., Montalvo, J. L., Mendivil, C., Quijada, M. R., Fernández-Pirla, S., de La Guardia, V., Wong, D., de Guevara, M. L., Flores, C., Borace, J., García, A., Caballero, N., de Saez, M. T., Politis, M., Ross, S., Dogra, M., Dhamsania, V., Graves, N., Kirchberg, M., Mathur, K., Aue, A., Restrepo, C. M., Llanes, A., Guzman, G., Rebellon, A., Boyer, K., Heydemann, P., Noble, A. G., Swisher, C., Rabiah, P., Withers, S., Hull, T., Frim, D., McLone, D., Su, C., Blair, M., Latkany, P., Mui, E., Vasconcelos-Santos, D. V., Villareal, A., Perez, A., Galvis, C. A., Montes, M. V., Perez, N. I., Ramirez, M., Chittenden, C., Wang, E., Garcia-López, L. L., Muñoz-Ortiz, J., Rivera-Valdivia, N., Bohorquez-Granados, M. C., de-la-Torre, G. C., Padrieu, G., Hernandez, J. D., Celis-Giraldo, D., Dávila, J. A., Torres, E., Oquendo, M. M., Arteaga-Rivera, J. Y., Nicolae, D. L., Rzhetsky, A., Roizen, N., Stillwaggon, E., Sawers, L., Peyron, F., Wallon, M., Chapey, E., Levigne, P., Charter, C., De Frias, M., Montoya, J., Press, C., Ramirez, R., Contopoulos-Ioannidis, D., Maldonado, Y., Liesenfeld, O., Gomez, C., Wheeler, K., Zehar, S., McAuley, J., Limonne, D., Houze, S., Abraham, S., Piarroux, R., Tesic, V., Beavis, K., Abeleda, A., Sautter, M., El Mansouri, B., El Bachir, A., Amarir, F., El Bissati, K., Holfels, E., Penn, R., Cohen, W., de-la-Torre, A., Britton, G., Motta, J., Ortega-Barria, E., Romero, I. L., Meier, P., Grigg, M., Gómez-Marín, J., Kosagisharaf, J. R., Llorens, X. S., Reyes, O., McLeod, R. 2022; 10 (3): 93-108

  Abstract

  Review work to create and evaluate educational materials that could serve as a primary prevention strategy to help both providers and patients in Panama, Colombia, and the USA reduce disease burden of Toxoplasma infections.Educational programs had not been evaluated for efficacy in Panama, USA, or Colombia.Educational programs for high school students, pregnant women, medical students and professionals, scientists, and lay personnel were created. In most settings, short-term effects were evaluated. In Panama, Colombia, and USA, all materials showed short-term utility in transmitting information to learners. These educational materials can serve as a component of larger public health programs to lower disease burden from congenital toxoplasmosis. Future priorities include conducting robust longitudinal studies of whether education correlates with reduced adverse disease outcomes, modifying educational materials as new information regarding region-specific risk factors is discovered, and ensuring materials are widely accessible.

  View details for DOI 10.1007/s40124-022-00267-y

  View details for PubMedID 36969368

  View details for PubMedCentralID PMC10035399

• Building Programs to Eradicate Toxoplasmosis Part I: Introduction and Overview. Current pediatrics reports Felín, M. S., Wang, K., Moreira, A., Grose, A., Leahy, K., Zhou, Y., Clouser, F. A., Siddiqui, M., Leong, N., Goodall, P., Michalowski, M., Ismail, M., Christmas, M., Schrantz, S., Caballero, Z., Norero, X., Estripeaut, D., Ellis, D., Raggi, C., Castro, C., Moossazadeh, D., Ramirez, M., Pandey, A., Ashi, K., Dovgin, S., Dixon, A., Li, X., Begeman, I., Heichman, S., Lykins, J., Villalobos-Cerrud, D., Fabrega, L., Montalvo, J. L., Mendivil, C., Quijada, M. R., Fernández-Pirla, S., de La Guardia, V., Wong, D., de Guevara, M. L., Flores, C., Borace, J., García, A., Caballero, N., Rengifo-Herrera, C., de Saez, M. T., Politis, M., Wroblewski, K., Karrison, T., Ross, S., Dogra, M., Dhamsania, V., Graves, N., Kirchberg, M., Mathur, K., Aue, A., Restrepo, C. M., Llanes, A., Guzman, G., Rebellon, A., Boyer, K., Heydemann, P., Noble, A. G., Swisher, C., Rabiah, P., Withers, S., Hull, T., Su, C., Blair, M., Latkany, P., Mui, E., Vasconcelos-Santos, D. V., Villareal, A., Perez, A., Galvis, C. A., Montes, M. V., Perez, N. I., Ramirez, M., Chittenden, C., Wang, E., Garcia-López, L. L., Muñoz-Ortiz, J., Rivera-Valdivia, N., Bohorquez-Granados, M. C., de-la-Torre, G. C., Padrieu, G., Hernandez, J. D., Celis-Giraldo, D., Dávila, J. A., Torres, E., Oquendo, M. M., Arteaga-Rivera, J. Y., Nicolae, D. L., Rzhetsky, A., Roizen, N., Stillwaggon, E., Sawers, L., Peyron, F., Wallon, M., Chapey, E., Levigne, P., Charter, C., De Frias, M., Montoya, J., Press, C., Ramirez, R., Contopoulos-Ioannidis, D., Maldonado, Y., Liesenfeld, O., Gomez, C., Wheeler, K., Holfels, E., Frim, D., McLone, D., Penn, R., Cohen, W., Zehar, S., McAuley, J., Limonne, D., Houze, S., Abraham, S., Piarroux, R., Tesic, V., Beavis, K., Abeleda, A., Sautter, M., El Mansouri, B., El Bachir, A., Amarir, F., El Bissati, K., de-la-Torre, A., Britton, G., Motta, J., Ortega-Barria, E., Romero, I. L., Meier, P., Grigg, M., Gómez-Marín, J., Kosagisharaf, J. R., Llorens, X. S., Reyes, O., McLeod, R. 2022; 10 (3): 57-92

  Abstract

  Review building of programs to eliminate Toxoplasma infections.Morbidity and mortality from toxoplasmosis led to programs in USA, Panama, and Colombia to facilitate understanding, treatment, prevention, and regional resources, incorporating student work.Studies foundational for building recent, regional approaches/programs are reviewed. Introduction provides an overview/review of programs in Panamá, the United States, and other countries. High prevalence/risk of exposure led to laws mandating testing in gestation, reporting, and development of broad-based teaching materials about Toxoplasma. These were tested for efficacy as learning tools for high-school students, pregnant women, medical students, physicians, scientists, public health officials and general public. Digitized, free, smart phone application effectively taught pregnant women about toxoplasmosis prevention. Perinatal infection care programs, identifying true regional risk factors, and point-of-care gestational screening facilitate prevention and care. When implemented fully across all demographics, such programs present opportunities to save lives, sight, and cognition with considerable spillover benefits for individuals and societies.The online version contains supplementary material available at 10.1007/s40124-022-00269-w.

  View details for DOI 10.1007/s40124-022-00269-w

  View details for PubMedID 36034212

  View details for PubMedCentralID PMC9395898

• Building Programs to Eradicate Toxoplasmosis Part IV: Understanding and Development of Public Health Strategies and Advances "Take a Village". Current pediatrics reports Felin, M. S., Wang, K., Moreira, A., Grose, A., Leahy, K., Zhou, Y., Clouser, F. A., Siddiqui, M., Leong, N., Goodall, P., Michalowski, M., Ismail, M., Christmas, M., Schrantz, S., Caballero, Z., Norero, X., Estripeaut, D., Ellis, D., Raggi, C., Castro, C., Moossazadeh, D., Ramirez, M., Pandey, A., Ashi, K., Dovgin, S., Dixon, A., Li, X., Begeman, I., Heichman, S., Lykins, J., Villalobos-Cerrud, D., Fabrega, L., Montalvo, J. L., Mendivil, C., Quijada, M. R., Fernandez-Pirla, S., de La Guardia, V., Wong, D., de Guevara, M. L., Flores, C., Borace, J., Garcia, A., Caballero, N., Rengifo-Herrera, C., de Saez, M. T., Politis, M., Ross, S., Dogra, M., Dhamsania, V., Graves, N., Kirchberg, M., Mathur, K., Aue, A., Restrepo, C. M., Llanes, A., Guzman, G., Rebellon, A., Boyer, K., Heydemann, P., Noble, A. G., Swisher, C., Rabiah, P., Withers, S., Hull, T., Frim, D., McLone, D., Su, C., Blair, M., Latkany, P., Mui, E., Vasconcelos-Santos, D. V., Villareal, A., Perez, A., Galvis, C. A., Montes, M. V., Perez, N. I., Ramirez, M., Chittenden, C., Wang, E., Garcia-Lopez, L. L., Padrieu, G., Munoz-Ortiz, J., Rivera-Valdivia, N., Bohorquez-Granados, M. C., de-la-Torre, G. C., Hernandez, J. D., Celis-Giraldo, D., Davila, J. A., Torres, E., Oquendo, M. M., Arteaga-Rivera, J. Y., Nicolae, D. L., Rzhetsky, A., Roizen, N., Stillwaggon, E., Sawers, L., Peyron, F., Wallon, M., Chapey, E., Levigne, P., Charter, C., De Frias, M., Montoya, J., Press, C., Ramirez, R., Contopoulos-Ioannidis, D., Maldonado, Y., Liesenfeld, O., Gomez, C., Wheeler, K., Zehar, S., McAuley, J., Limonne, D., Houze, S., Abraham, S., Piarroux, R., Tesic, V., Beavis, K., Abeleda, A., Sautter, M., El Mansouri, B., El Bachir, A., Amarir, F., El Bissati, K., Holfels, E., Frim, D., McLone, D., Penn, R., Cohen, W., de-la-Torre, A., Britton, G., Motta, J., Ortega-Barria, E., Romero, I. L., Meier, P., Grigg, M., Gomez-Marin, J., Kosagisharaf, J. R., Llorens, X. S., Reyes, O., McLeod, R. 2022: 1-30

  Abstract

  Purpose of Review: Review international efforts to build a global public health initiative focused on toxoplasmosis with spillover benefits to save lives, sight, cognition and motor function benefiting maternal and child health.Recent Findings: Multiple countries' efforts to eliminate toxoplasmosis demonstrate progress and context for this review and new work.Summary: Problems with potential solutions proposed include accessibility of accurate, inexpensive diagnostic testing, pre-natal screening and facilitating tools, missed and delayed neonatal diagnosis, restricted access, high costs, delays in obtaining medicines emergently, delayed insurance pre-approvals and high medicare copays taking considerable physician time and effort, harmful shortcuts being taken in methods to prepare medicines in settings where access is restricted, reluctance to perform ventriculoperitoneal shunts promptly when needed without recognition of potential benefit, access to resources for care, especially for marginalized populations, and limited use of recent advances in management of neurologic and retinal disease which can lead to good outcomes.Supplementary Information: The online version contains supplementary material available at 10.1007/s40124-022-00268-x.

  View details for DOI 10.1007/s40124-022-00268-x

  View details for PubMedID 35991908