Neglected Tropical Diseases Part II: Infections in the U.S.

July 27th, 2010, by PETER J. HOTEZ

In my previous guest blog post for this site I described a hidden burden of poverty and illness resulting from neglected tropical diseases (NTDs) in the world’s poorest countries. In addition to representing the most common infections of the “bottom billion” — people who live on less than $1.25 per day — I revealed that NTDs are also historically connected to slavery. Today, some of the most common NTDs in Latin America and the Caribbean were brought over by captives from West Africa during 400 years of the Middle Passage.

Although these NTDs of slavery are no longer endemic in the United States, we nonetheless have great pockets of poverty here and with it high rates of parasitic infections that resemble the NTDs. In a paper published in 2008 in the Public Library of Science Neglected Tropical Diseases, I reported on surprisingly high rates of parasitic infections among the poor, particularly among minority populations, in the U.S.

Given the upcoming fifth anniversary of Hurricane Katrina, it is sad to point out that poverty is still very much with us in Louisiana and elsewhere in the Mississippi Delta region. Along with it are high rates of these parasitic infections, which I call the neglected infections of poverty. Almost one million African American women in the American South and inner cities suffer from a parasitic infection of their genital tract known as trichomoniasis. Young African American women are also as much as 50 fold times more at risk for acquiring a viral infection known as cytomegalovirus (CMV) infection. When CMV is passed down to the unborn fetus, the baby can be born with severe hearing loss and mental retardation.

(To watch the full episode of Tavis Smiley Reports “New Orleans: Been in the Storm Too Long,” click here.)

More than 20% of poor African Americans show evidence of exposure to a parasitic Toxocara worm transmitted from dogs. The parasitic worm infection, known as toxocariasis when it occurs in humans, has been associated with asthma and developmental delays. The parasitic heart infection known as Chagas disease was also recently determined to occur in New Orleans. And now that dengue fever, and its dreaded complication dengue hemorrhagic fever, is widespread in the Caribbean and Central America, recent observations of a dengue outbreak in the Florida Keys should be a wake-up call that the entire Gulf coast of the U.S. is vulnerable especially in areas with poor housing where Aedes mosquitoes can breed and transmit this disease.

We now believe that millions of African Americans suffer from neglected infections of poverty, but sadly we do not know much more than that. I have worked with Congressman Hank Johnson, Jr. of Georgia and his staff, as well as some other scientists and activists committed to better understanding of these diseases. After a summit held on this topic in Washington D.C., Congressman Johnson is hoping to introduce new legislation for increased research on the subject.

I believe that there is an urgent need to obtain better information about these conditions in terms of how widespread they are in areas of poverty and to determine exactly how they are transmitted. We need new and better insight in how to prevent and treat the neglected infections of poverty in the U.S. In some cases we need better drugs, vaccines, and diagnostics. To address this, I’m working with colleagues in Washington D.C. to develop a new and improved diagnostic method for toxocariasis, which can be made more widely available.

One of the reasons the neglected infections of poverty are so “neglected” is that they disproportionately occur among the poor. While the depth of poverty in the U.S. is not as extreme as it is in Haiti and West Africa, it is still substantial and capable of harboring several important neglected infections. These are not rare diseases; they are just hidden from view because they occur among the poor.

As Gandhi once said, “a civilization is to be judged by the treatment of its minorities.” We need to heed this statement and launch an assault on neglected infections of poverty in the Gulf Coast, our Southern cities and wherever the poor live.

Dr. Peter Hotez is President of the Sabin Vaccine Institute and Distinguished Research Professor at The George Washington University.  He is also the author of Forgotten People, Forgotten Diseases.

Last modified: May 9, 2011 at 4:15 pm