Breed­ing in Amer­ica: Ne­glected trop­i­cal dis­eases tak­ing hold in U.S.

In the U.S., many of the na­tion’s 45 mil­lion im­pov­er­ished Amer­i­cans live in warm, hu­mid South­ern states where mosquitoes, of­ten the car­ri­ers of these dis­eases, thrive.

Modern Healthcare - - NEWS - By Steven John­son

As public health of­fi­cials con­tinue to make con­nec­tions be­tween health and so­ci­etal fac­tors, there’s mount­ing ev­i­dence that dis­eases once con­sid­ered ex­otic are tak­ing root in the poor­est ar­eas of the U.S.

“We al­ready have dengue (and chikun­gunya) in Texas and in the Gulf Coast, and I think we’ll start to see trans­mis­sion of both dis­eases in the com­ing years,” said Dr. Peter Hotez, found­ing dean of the Na­tional School of Trop­i­cal Medicine at Bay­lor Univer­sity’s Col­lege of Medicine.

Hotez es­ti­mated that as many as 12 mil­lion peo­ple in the U.S. live with a ne­glected trop­i­cal dis­ease, de­fined by the Cen­ters for Dis­ease Con­trol and Preven­tion as a group of par­a­sitic and bac­te­rial dis­eases that cause ill­ness in as many as 1 bil­lion peo­ple world­wide.

Re­ferred to as ne­glected be­cause they have been around for years with­out much at­ten­tion to­ward their preven­tion or treat­ment, ne­glected trop­i­cal dis­eases can go un­no­ticed with few or mild symp­toms and low rates of mor­tal­ity. But they can also be de­bil­i­tat­ing and could im­pair phys­i­cal and cog­ni­tive de­vel­op­ment in chil­dren who may al­ready be fac­ing other chal­lenges.

Hotez’s in­sti­tu­tion ad­dresses how poor hous­ing con­di­tions, in­ad­e­quate san­i­ta­tion and con­tam­i­nated en­vi­ron­ments make im­pov­er­ished com­mu­ni­ties more sus­cep­ti­ble to ne­glected trop­i­cal dis­eases.

A 2014 study au­thored by Hotez and pub­lished in the jour­nal PLOS found that trop­i­cal dis­ease was preva­lent among the poor­est pop­u­la­tions liv­ing in the world’s top 20 ma­jor economies.

In the U.S., many of the na­tion’s 45 mil­lion im­pov­er­ished Amer­i­cans live in warm, hu­mid South­ern states where mosquitoes, of­ten the car­ri­ers of these dis­eases, thrive, said Dr. Su­san McLel­lan, as­so­ciate pro­fes­sor of trop­i­cal medicine at Tu­lane Univer­sity

Dr. Peter Hotez es­ti­mated that as many as 12 mil­lion peo­ple in the U.S. live with a ne­glected trop­i­cal dis­ease.

School of Medicine.

Since 2006, the U.S. has helped fund a global ef­fort to do­nate drugs that pre­vent or treat the seven most preva­lent ne­glected trop­i­cal dis­eases, in­clud­ing hook­worm, tra­choma, river blind­ness and ele­phan­ti­a­sis.

The pro­gram also ad­dresses en­vi­ron­men­tal fac­tors, such as ac­cess to clean wa­ter.

But many of those ap­proaches are not em­ployed in the U.S., where there’s a lack of aware­ness of the preva­lence of trop­i­cal dis­eases and the dev­as­ta­tion felt in im­pov­er­ished ar­eas.

Cases of chikun­gunya, for which there is no vac­cine or cure, have been steadily ris­ing in the U.S. since the first con­firmed case in the Western Hemi­sphere was iden­ti­fied in 2013. En­demic in Africa and Asia for decades, the num­ber of U.S. cases reached more than 2,700 last year, ac­cord­ing to the CDC. As of last week, 39 states had re­ported a to­tal of 510 cases this year.

Dengue fever, a dis­ease that’s af­fected 300 mil­lion peo­ple in South­east Asia and Latin Amer­ica, has been of par­tic­u­lar con­cern to U.S. epi­demi­ol­o­gists.

Florida and Texas have had in­creased sight­ings of the mos­quito type known as the pri­mary car­rier of the dis­ease— Aedes ae­gypti. That means there’s a greater chance it will be­come na­tive in warm cli­mates through­out the U.S., where stag­nant bod­ies of wa­ter cre­ate the per­fect breed­ing ground for mosquitoes.

And ex­perts say that as dis­eases mu­tate, mosquitoes more com­mon through­out other parts of the coun­try can be­come car­ri­ers.

Hotez said the Ebola out­break last year spot­lights the need for more for­ward think­ing in ad­dress­ing po­ten­tial dis­ease threats. Crit­ics have said the re­lief ef­fort in West Africa was in­suf­fi­cient and late in pre­vent­ing the spread of the epi­demic. Oth­ers have crit­i­cized drug­mak­ers for not quickly de­vel­op­ing an Ebola vac­cine, which is still un­der­go­ing clin­i­cal tri­als.

And then there’s the is­sue of hos­pi­tal pre­pared­ness, another cri­tique of the Ebola re­sponse. It was a Dal­las hos­pi­tal that was ac­cused of not fol­low­ing the right pro­to­col to keep hos­pi­tal staff safe. In fact, many hos­pi­tals in high-risk ar­eas have few re­sources to deal with public-health crises such as trop­i­cal dis­ease.

The same is true of state public health de­part­ments.

A 2014 re­port from the Robert Wood John­son Foun­da­tion found that only half of states scored ad­e­quately on their abil­ity to de­tect, di­ag­nose, pre­vent and re­spond to a dis­ease threat.

In Louisiana, which re­ported 10 cases of chikun­gunya and one case of dengue fever last year, the av­er­age an­nual amount spent on public health for each res­i­dent is about $15. That ranks the state 39th in the U.S., ac­cord­ing to the Amer­i­can Public Health As­so­ci­a­tion.

How­ever, all signs seem to in­di­cate more at­ten­tion is be­ing placed on trop­i­cal dis­ease out­breaks in the U.S. The world’s top in­fec­tious dis­ease ex­perts will gather this month for the an­nual meet­ing of the Amer­i­can So­ci­ety of Trop­i­cal Medicine and Hy­giene. They are ex­pected to present break­throughs in im­prov­ing the abil­ity to un­der­stand how dis­eases work and ways the global com­mu­nity can pre­pare for the next po­ten­tial pan­demic.

Hotez said trop­i­cal dis­eases re­main largely ne­glected in the U.S. be­cause they still mostly af­fect the poor­est in­di­vid­u­als. He says a call for ac­tion may come only when such dis­eases be­come wide­spread.

“It’s an in­con­ve­nient truth many peo­ple don’t want to rec­og­nize,” Hotez said.

Cases chikun­gun­yabeen ris­ingsince steadi­lythein of the first U.S. have con­firmedthe Western case in Hemi­sphere was iden­ti­fied in 2013. The num­ber of U.S. cases reached more than 2,700 last year. As of last week, 39 states had re­ported a to­tal of 510 cases this year.

A 2014 re­port from the Robert Wood John­son Foun­da­tion found that only half of states scored ad­e­quately on their abil­ity to de­tect, di­ag­nose, pre­vent and re­spond to a dis­ease threat.

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