Peter Hotez on neglected diseases of poverty in U.S.

Peter Hotez has noticed very high rates of parasitic infections diseases among the poorest people in the U.S. He calls them “neglected” diseases of poverty.

Peter Hotez, president of the Sabin Vaccine Institute at George Washington University, wants to raise consciousness about the neglected diseases of poverty in the United States. He spoke with EarthSky about parasitic infections – which are common among the poorest people in developing countries – that are now being diagnosed among the 36 to 40 million Americans who live in poverty.

Doctors had considered these diseases largely non-existent in the U.S. Hotez wants people to understand that they do indeed affect the poor in the U.S.

Peter Hotez: There’s something about poverty that is making these people susceptible to these parasitic infections. What we’ve identified in particular are six infections, and what we find are really high rates of infection among African Americans and Hispanics living in the poorest parts of our country.

Hotez gave the example of a disease called toxocariasis, a parasitic worm infection spread through dog feces. He said the infection leads to asthma or developmental delays. Hotez estimates it affects more than a million people in the U.S., the majority being African Americans. But he said, because so few doctors have learned about the disease, it frequently goes undiagnosed.

Peter Hotez: We’re not in a position at this point to know, when a child comes in with asthma, what the likelihood is that person has asthma because of toxocariasis or another source.

He said neglected diseases of poverty are spread through poor living conditions, lack of sanitation, and poor nutrition. Hotez is working on developing vaccines and new diagnostic kits, and raising awareness that these diseases exist and disproportionately hit America’s poorest.

Hotez added that the category of neglected diseases of poverty has been “grossly understudied” and consistently under-funded. But he pointed to a study he published in 2008 in the journal PLoS Medicine, which he said was the first to consider neglected diseases of poverty as clusters of disease among the poor in the U.S. and to point out their hidden impacts and role in U.S. health disparities.

Peter Hotez: What we noticed was very high rates of parasitic infections diseases among those poorest people. They disproportionately affect children and women, particularly among minority populations, African Americans and Hispanic American minorities. So we call these neglected diseases of poverty. They are extremely common.

He said it’s impossible to know whether these diseases are newly appearing in the U.S., or if they have always existed but – until recently – gone undiagnosed. However, he suspects the latter.

Peter Hotez: I don’t think they are new. They’ve been around in the United States for decades or longer, it’s just that they’ve gone unstudied or unnoticed. I think part of the reason is because of the people they’re affecting.

Hotez believes that these diseases are determined by poverty, and one of their larger effects is to keep people in poverty. For example, if a child is infected with toxocariasis, and the parasite travels to their brain, it causes developmental delays that will affect the course of their lives.

Peter Hotez: These infections not only occur in the setting of poverty, but they are actually causing poverty. They’re basically preventing poor people from achieving their full potential, because of the impact on child development, pregnancy outcome, and worker productivity.

Hotez said that in some cases, there are simple treatments for the parasitic infections, but health care providers are not trained to identify the disease when the symptoms are so similar to other, more recognizable diseases.

Peter Hotez: Often, it’s only after an exhaustive, evaluative work up are the presence of these parasites revealed. We need more public awareness, and we need ways to make people think about these early on in diagnosis of these conditions.

He said the fact that poor people are the ones affected probably prevents these diseases from getting the attention they deserve.

Peter Hotez: I think if we had a brain parasitic infection to this extent among wealthy people in the suburbs – or heart disease, or asthma – we would have never tolerated it. It would be in the newspapers, on radio and TV. But because these are forgotten diseases among forgotten people, our society somehow tolerates it.

Lindsay Patterson