Neglected diseases at the APHA conference

Professor Peter Hotez told
some shocking truths in his talk about neglected tropical diseases at the APHA
conference in San Diego
this week. Some of these diseases are taking hold in the southern USA.

There are 14 neglected
tropical diseases according to the Global
network for neglected diseases
. But PLoS Neglected Diseases
lists 37. These chronic, disfiguring, disabling diseases affect 1.2 billion poor
people worldwide, according to Hotez. Ascariasis, trichuriasis, hookworm,
schistosomiasis, lymphatic filariasis, onchocerciasis and the bacterial disease
trachoma are the 7 major neglected diseases. They are part of a vicious circle
with poverty, they cause poverty and poverty promotes them. Many of the world’s
poor have mutiple infections with these diseases, and the result can be growth
failure, loss of IQ, memory, and reduced school performance. These diseases sap
earning power. As an example, Hotez quoted one study that found hookworm reduced
earning capacity by 40%. Poverty causes these diseases too when it goes hand in
hand with poor housing, poor sanitation and agricultural work.

Hotez and co-workers have
developed a one stop treatment which could be administered annually at a cost
of only 50 US cents per head and treat many of these diseases in one go. The
rapid impact package deals with all 7 listed above.

It is bad enough that the
diseases exist in the developing world but the shocking thing for me was that
neglected tropical diseases are on the up in one of the most ‘developed’
countries – the USA, in Appalachia, the cotton belt, the Mississippi region and
the Texas/Mexican border.

Hotez quoted some examples of the neglected diseases
now emerging in the Southern States:

Cycstercercosis is
the leading cause of epilepsy in Hispanics in the south west USA

Chagas’ disease (American
trypanosomiasis) could be affecting up to a million people in the USA and causes
heart disease.

Toxacariasis, has
recently been suggested to cause asthma in children and developmental delays.

African Americans in the south
are disproportionately affected. How can the USA overlook this? US doctors go overseas
to help those developing countries, there is an invisible developing country
right at home.

Something Hotez didn’t touch
on was preventive measures. A shot of drugs only solves the problem for a
while, the benefit is dependent on the continuing supply of drugs. To prevent
these diseases should we be looking at sanitation, hygiene, bednets? Ascariasis,
trichuriasis, hookworm are organisms that live in the soil  and are spread by faecal
contamination of food and water so improved sanitation would prevent the spread of these parasites.

Is it a case of drug
treatments being more glamorous, easier to get funding for?

Peter Hotez is chairman of the
Department of Microbiology, Immunology, and Tropical Diseases at George Washington University Washington D.C., and is the editor in chief of the scientific journal, PLoS Neglected Tropical Diseases
and a prime mover in the Global network for neglected tropical diseases.

For more about the neglected
tropical diseases see the Global
network for neglected diseases

Global Health also has many
records on these diseases.

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