Neglected Infections of Poverty in the United States of America

Abstract

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.

Seroprevalence, Seroconversion, and Risk Factors for Toxoplasmosis among Pregnant Women in Taipei, Taiwan

“…Nevertheless, immigrant pregnant women may have been infected before they came to Taiwan and should not be ignored. Of note, toxoplasmosis is considered an infection associated with poverty even in the United States (26). A considerable number of studies have indicated that several factors can explain the wide variation in the the seroprevalence of toxoplasmosis in humans between countries and often within a specific country or between different communities in the same region, including dietary habits, socioeconomic status, cultural habits, quality of water, and sanitation coverage (7,27).…”

How does cytomegalovirus factor into diseases of aging and vaccine responses, and by what mechanisms?

“…CMV infection has been considered a disease of poverty and continues to be strongly patterned by socioeconomic status in the US and globally (Hotez 2008;Manicklal et al 2013). Indeed, there is a substantial body of evidence suggesting that CMV is socioeconomically (e.g., educational attainment and income) patterned across the life course.…”

“…The associations may reflect increased exposure to CMV among individuals who are living in disadvantaged settings, which may be more likely to be characterized by overcrowding, lack of access to hygiene and sanitation resources, and increased use of daycare at earlier ages, which have all been implicated in increased transmission of CMV as well as many other infectious diseases (Hotez 2008;Manicklal et al 2013). At the same time, there is evidence that individuals of lower socioeconomic status are burdened by a higher force of CMV infection at earlier ages, measured by the instantaneous per capita rate of CMV acquisition by age (Colugnati et al 2007).…”

The Medical Biochemistry of Poverty and Neglect

“…With respect to the concept of NTDs disproportionately affecting the poor living in wealthy countries, I have noted a high level of these diseases concentrated in areas of extreme poverty in the United States, especially the southern United States and the U.S. Gulf Coast (22,23). For instance, today NTDs such as Chagas disease, cysticercosis, dengue fever and toxocariasis can be found in U.S. areas of poverty, where they disproportionately affect people of color (22,23).…”

“…For instance, today NTDs such as Chagas disease, cysticercosis, dengue fever and toxocariasis can be found in U.S. areas of poverty, where they disproportionately affect people of color (22,23). Some of them may be adversely affecting childhood cognitive development among the poor, thereby reinforcing poverty (24).…”