Research Article: Neglected Diseases and Poverty in “The Other America”: The Greatest Health Disparity in the United States?

Date Published: December 26, 2007

Publisher: Public Library of Science

Author(s): Peter J. Hotez

Abstract: None

Partial Text: Michael Harrington’s The Other America: Poverty in the United States was first published almost fifty years ago. His landmark book exposed to a wide audience the previously unseen poverty then rampant in many poor rural areas of the United States and in some of America’s inner cities. Harrington was a widely read political writer and democratic socialist, and his manifesto on poverty was instrumental in stimulating President Lyndon B. Johnson’s War on Poverty legislation and his Great Society programs.

Toxocariasis is a soil-transmitted helminth infection that can result in visceral larva migrans, visual impairment from ocular larval migrans, or a condition that resembles asthma, known as covert toxocariasis [12]. Urban playgrounds in the US have recently been shown to be a particularly rich source of Toxocara eggs [13], and inner-city children are at high risk of acquiring the infection. In inner-city areas of Bridgeport and New Haven, Connecticut, for example, the overall seroprevalence when measured during the 1990s was found to be 10% [14], but during the 1970s up to 30% of socioeconomically disadvantaged African Americans showed evidence of infection [15]. Based on both the published [12]–[15] and non-published literature (including a recent presentation by the Division of Parasitic Diseases of the US Centers for Disease Control and Prevention [CDC] at the 56th Annual Meeting of the American Society of Tropical Medicine and Hygiene held in November 2007, showing that the national seroprevalence of toxocariasis among the poor is 23%), I believe it is likely that hundreds of thousands of inner-city children (most of them African American and Hispanic children) are exposed regularly to this parasite. Because of its possible links to asthma, it would be important to determine whether covert toxocariasis is a basis for the rise of asthma among inner-city children in the northeastern US [14].

Cysticercosis is another very serious parasitic worm infection and NTD, caused by the tapeworm Taenia solium, that results in seizures and other neurological manifestations. It is estimated that 1,000 to 2,000 new cases of neurocysticercosis are diagnosed annually in the US [16],[17]. At a reported incidence rate of eight to ten per 100,000 per year among Hispanic populations [17], as well as more recent data from a Hispanic community in Ventura County, California showing that the seroprevalence among adult Latinos is 2.8% [18], and considering that there are approximately 35 million Hispanics living in the United States, the number of actual cases may be much greater, possibly in the tens of thousands. In the hospitals of Los Angeles, California, neurocysticercosis currently accounts for 10% of all seizures presenting to some emergency departments [19]. Because cysticercosis is emerging as the leading cause of epilepsy among Hispanic populations, there is an urgent and important need for active surveillance studies of this infection.

Toxoplasmosis is an important parasitic infection among Mexican Americans and African Americans [20]. If a pregnant mother becomes infected with Toxoplasma during her pregnancy, the newborn infant is at risk for congenital toxoplasmosis, a syndrome that can include mental retardation as well as vision and hearing loss. The US CDC estimates that approximately 400 to 4,000 infants are born with congenital toxoplasmosis annually in the United States [21]. Every one of these toxoplasmosis-infected infants represents a tragedy that could have been prevented, given the existence of studies showing that early diagnosis and treatment with antiparasitic drugs could improve outcome [22] and the availability of a newborn screening test, which is similar to the type used for the screening of phenylketonuria and other genetic disorders [23]. Currently only the states of Massachusetts and New Hampshire conduct newborn screening for toxoplasmosis.



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