Neglected Infections of Poverty in the United States of America [2008-06-25; Peter J. Hotez, PLoS]

Neglected Infections of Poverty in the United States of America [2008-06-25; Peter J. Hotez, PLoS]

In the United States, there is a largely hidden
burden of diseases caused by a group of chronic and
debilitating parasitic, bacterial, and congenital infections
known as the neglected infections of poverty. Like their
neglected tropical disease counterparts in developing
countries, the neglected infections of poverty in the US
disproportionately affect impoverished and under-represented
minority populations. The major neglected infections
include the helminth infections, toxocariasis, strongyloidiasis,
ascariasis, and cysticercosis; the intestinal
protozoan infection trichomoniasis; some zoonotic bacterial
infections, including leptospirosis; the vector-borne
infections Chagas disease, leishmaniasis, trench fever, and
dengue fever; and the congenital infections cytomegalovirus
(CMV), toxoplasmosis, and syphilis. These diseases
occur predominantly in people of color living in the
Mississippi Delta and elsewhere in the American South, in
disadvantaged urban areas, and in the US–Mexico
borderlands, as well as in certain immigrant populations
and disadvantaged white populations living in Appalachia.
Preliminary disease burden estimates of the neglected
infections of poverty indicate that tens of thousands,
or in some cases, hundreds of thousands of poor
Americans harbor these chronic infections, which represent
some of the greatest health disparities in the United
States. Specific policy recommendations include active
surveillance (including newborn screening) to ascertain
accurate population-based estimates of disease burden;
epidemiological studies to determine the extent of
autochthonous transmission of Chagas disease and other
infections; mass or targeted treatments; vector control;
and research and development for new control tools
including improved diagnostics and accelerated development
of a vaccine to prevent congenital CMV infection
and congenital toxoplasmosis.