Publications by authors named "Neal Alexander"

Background: This systematic review investigates the relationship between malaria incidence, climate variables, and deforestation in Colombia, Latin America, and the Caribbean from 2000 to 2020. Malaria, a significant public health issue in these regions, is influenced by ecological factors including climatic conditions and environmental changes, such as deforestation.

Methods: The review employs a comprehensive search strategy across PubMed, Web of Science, Embase, Scopus, Cochrane, and Scielo databases.

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Article Synopsis
  • - This study evaluated the effectiveness of standard treatments for cutaneous leishmaniasis in rural Colombia, using a community-based approach and the Guaral+ST mobile health app to assist in patient care and data collection from January 2018 to September 2021.
  • - A total of 231 participants received varous antileishmanial treatments, with cure rates at 90 to 180 days being: 86.3% for miltefosine, 77.6% for meglumine antimoniate, and 73.1% for pentamidine; adverse drug reactions were noted in 32% of patients.
  • - Findings indicate that standard treatments are effective in rural endemic areas, and that mobile health
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Background: A better understanding of SARS-CoV-2 infection risk among Hispanic and Latino populations and in low-resource settings in the United States is needed to inform control efforts and strategies to improve health equity. Puerto Rico has a high poverty rate and other population characteristics associated with increased vulnerability to COVID-19, and there are limited data to date to determine community incidence.

Objective: This study describes the protocol and baseline seroprevalence of SARS-CoV-2 in a prospective community-based cohort study (COPA COVID-19 [COCOVID] study) to investigate SARS-CoV-2 infection incidence and morbidity in Ponce, Puerto Rico.

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Lymphatic filariasis (LF) is a leading cause of disability due to infectious disease worldwide. The Recife Metropolitan Region (RMR) is the only remaining focus of LF in Brazil, where the parasite Wuchereria bancrofti is transmitted solely by the mosquito Culex quinquefasciatus. This study reports the results of transmission assessment surveys and molecular xenomonitoring in the city of Olinda, RMR, after nearly 15 years (2015-2016) of interventions for LF elimination.

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  • Cutaneous leishmaniasis (CL) is a persistent global health issue with lengthy treatment and follow-up periods, leading to significant patient loss to follow-up and uncertainty about treatment effectiveness.
  • A study in rural Colombia tested a mobile health (mHealth) intervention to track treatment adherence, side effects, and patient outcomes, finding that it significantly improved follow-up rates from 4.2% to 82.5% compared to standard care.
  • Although patients and health workers found the app user-friendly and valuable for improving healthcare access, challenges like low connectivity impacted data transmission in real-time.
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Background: Despite the importance of social determinants of health, studies on the effects of socioeconomic, sanitary, and housing conditions on Indigenous child health are scarce worldwide. This study aims to identify patterns in housing, water & sanitation, and wealth (HSW) in the first Indigenous birth cohort in Brazil-The Guarani Birth Cohort.

Methods: Cross-sectional study using baseline data from The Guarani Birth Cohort.

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Dengue virus (DENV) is an arbovirus whose transmission cycle involves disparate hosts: humans and mosquitoes. The error-prone nature of viral RNA replication drives the high mutation rates, and the consequently high genetic diversity affects viral fitness over this transmission cycle. A few studies have been performed to investigate the intrahost genetic diversity between hosts, although their mosquito infections were performed artificially in the laboratory setting.

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Background: In Latin America, cutaneous leishmaniasis primarily affects dispersed rural communities, that have limited access to the public health system and medical attention. Mobile health (mHealth) strategies have shown potential to improve clinical management and epidemiological surveillance of neglected tropical diseases, particularly those of the skin.

Methods: The Guaral +ST app for Android was designed to monitor cutaneous leishmaniasis treatment and assess therapeutic response.

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  • The study evaluated the effectiveness of two rapid diagnostic tests (RDTs) for syphilis (Bioline and Determine) specifically in people living with HIV (PLWH) in Cali, Colombia.
  • A total of 244 participants were studied, revealing high sensitivity for Bioline and variability in Determine's performance based on sample type and ART status.
  • Despite the overall excellent performance of the RDTs for screening syphilis in PLWH, concerns were noted regarding the lower sensitivity of Determine on capillary blood compared to serum samples.
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Background: Treatment guidance for children and older adult patients affected by cutaneous leishmaniasis (CL) is unclear due to limited representation of these groups in clinical trials.

Methods: We conducted a collaborative retrospective study to describe the effectiveness and safety of antileishmanial treatments in children ≤ 10 and adults ≥ 60 years of age, treated between 2014 and 2018 in ten CL referral centers in Latin America.

Results: 2,037 clinical records were assessed for eligibility.

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Objectives: To determine SARS-CoV-2 seroprevalence over time and risk factors among pregnant women at delivery in São Paulo, Brazil; and to evaluate the suitability of pregnant women as a sentinel population for SARS-CoV-2 serosurveillance.

Methods: Unselected consecutive pregnant women presenting at the labor ward of a single large hospital between July 20th 2020 to February 21st 2021 were enrolled and tested for SARS-CoV-2 serology using two assays: the rapid chromatic Wondfo One Step (for total IgA and IgG detection) and Roche Elecsys assay (detecting anti-nucleoprotein [N] IgG). SARS-CoV-2 seroprevalence was computed as smooth spline function over time with 95% confidence intervals (CI).

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Background: Improved education on water-related diseases in schools could help to reduce disease burden. This paper presents specific results on knowledge, attitudes and practices (KAP) of a cluster-randomized controlled trial to reduce diarrheal disease and dengue entomological risk factors in rural primary schools in Colombia. The aim was to investigate whether enhanced educational interventions on dengue and diarrheal disease in schools could improve KAP scores related to these diseases in students and teachers in rural primary schools, as well as the students' parents.

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Studies reported post-COVID-19 fatigue in the general population, but not among pregnant women. Our objectives were to determine prevalence, duration, and risk factors of post-viral fatigue among pregnant women with SARS-CoV-2. This study involved 588 pregnant women with SARS-CoV-2 during pregnancy or delivery in Brazil.

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The Chikungunya virus (CHIKV) is a mosquito-borne alphavirus that affects the world's popula-tion with chikungunya disease. Adaptation of the viral life cycle to their host cells' environment is a key step for establishing their infection and pathogenesis. Recently, the accumulating evidence advocates a principal role of extracellular vesicles (EVs), including exosomes, in both the infection and pathogenesis of infectious diseases.

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Cutaneous leishmaniasis (CL) primarily affects people in remote settings with limited access to health services. mHealth tools offer an opportunity to overcome knowledge gaps about clinical response to treatment. We evaluated the validity of the Guaral+ST mobile application for the remote assessment of therapeutic response in patients with CL, through photographs of lesions captured with the app by community health volunteers.

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Scrub typhus is a common bacterial infection in Asia caused by . This serological cohort study estimated the incidence of infection in a rural population in South India. Participants were enrolled through systematic sampling in 46 villages at baseline, and revisited the following year.

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Article Synopsis
  • The COVID-19 pandemic significantly strained global healthcare systems, complicating the diagnosis and management of other infectious diseases like dengue, especially due to overlapping symptoms.
  • The iDEM project in Malaysia aimed to combat dengue through Integrated Vector Management, which included strategies like targeted outdoor spraying and community engagement, starting before strict COVID-19 measures were put in place.
  • Despite challenges such as ensuring worker safety and maintaining activities during the pandemic, the project adapted by implementing safety measures and continuing operations with some delays.
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Background: Following earlier trials indicating that their potential in dengue vector control was constrained by housing structure, a large-scale cluster-randomized trial of insecticide treated curtains (ITCs) and water jar covers (ITJCs) was undertaken in Venezuela.

Methods: In Trujillo, Venezuela, 60 clusters (6223 houses total) were randomized so that 15 clusters each received either PermaNet insecticide-treated window curtains (ITCs), permanent insecticide-treated water storage jar covers (ITJCs), a combination of both ITCs and ITJCs, or no insecticide treated materials (ITMs). A further 15 clusters located at least 5km from the edge of the study site were selected to act as an external control.

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Background: Visceral leishmaniasis (VL) in patients with human immunodeficiency virus (HIV) presents an increasingly important patient cohort in areas where both infections are endemic. Evidence for treatment is sparce, with no high-quality studies from the Indian subcontinent.

Methods: This is a randomized, open-label, parallel-arm, phase 3 trial conducted within a single hospital in Patna, India.

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Background: The city of Manaus, north Brazil, was stricken by a second epidemic wave of SARS-CoV-2 despite high seroprevalence estimates, coinciding with the emergence of the Gamma (P.1) variant. Reinfections were postulated as a partial explanation for the second surge.

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Background: Brazil is one of the countries worst affected by the COVID-19 pandemic with over 20 million cases and 557,000 deaths reported by August 2021. Comparison of real-time local COVID-19 data between areas is essential for understanding transmission, measuring the effects of interventions, and predicting the course of the epidemic, but are often challenging due to different population sizes and structures.

Methods: We describe the development of a new app for the real-time visualisation of COVID-19 data in Brazil at the municipality level.

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Titration assays can be used to define positivity either in terms of a change over time, i.e. seroconversion, or relative to a fixed threshold.

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Objective: The clinical and serological characteristics of spotted fever group rickettsial (SFGR) infections in South Asia are poorly understood. We studied the clinical presentation and the IgM/IgG response in cases enrolled at two health care centres in South India.

Method: We enrolled 77 patients.

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Dengue is hyperendemic in most Southeast Asian countries including Thailand, where all four dengue virus serotypes (DENV-1 to -4) have circulated over different periods and regions. Despite dengue cases being annually reported in all regions of Thailand, there is limited data on the relationship of epidemic DENV infection between humans and mosquitoes, and about the dynamics of DENV during outbreaks in the northeastern region. The present study was conducted in this region to investigate the molecular epidemiology of DENV and explore the relationships of DENV infection in humans and in mosquitoes during 2016-2018.

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