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Peter Hotez, M.D, Ph.D.

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A New Tropical Medicine Clinic for 'Third World America'

Posted: 10/27/2011 12:42 pm

Poor economic conditions have long been known to increase the risk of disease. But only recently have diseases of poverty, mostly associated with countries outside the United States, been recognized as a growing problem here at home.

Neglected tropical diseases (NTDs) might sound foreign, but they can actually be found in pockets of poverty across the U.S., most prominently in what Arianna Huffington recently called "Third World America." These diseases cause profound disability and disfigurement, and can impair physical, intellectual and cognitive growth in children, trigger adverse pregnancy outcomes and reduce worker productivity. Our studies indicate that some of the highest rates of NTDs occur in Texas and states along the Gulf Coast. One in five people in this region, most of whom are African American or Hispanic, live in poverty -- making them even more vulnerable to these diseases.

Indeed, the prevalence rates of some of these conditions, such as toxocariasis (roundworm) and trichomoniasis (commonly called trich) are as high among African Americans in the U.S. as they are in Nigeria, with more than one million cases in our country. Another growing problem is cysticercosis, a parasitic brain infection that is now a leading cause of epilepsy, especially among some Hispanic populations. The Gulf Coast is vulnerable to dengue fever with known outbreaks in South Texas and Florida over the last few years. It is important to stress that NTDs are not necessarily diseases brought to the U.S. by immigrants, but can be transmitted here at home.

Most alarmingly, hundreds of thousands of Americans, mostly Hispanic, suffer from Chagas disease, a serious infectious condition of the heart that is transmitted by a parasitic trypanosome, commonly known as the kissing bug. Chagas disease can lead to heart failure, digestive disorders and in some extreme cases, sudden death. Regrettably, it is still very difficult to accurately determine the precise number of people affected, nor how these diseases are transmitted.

Recognizing the need for more education regarding NTD treatment not just in the U.S., but around the globe, The Sabin Vaccine Institute and the Texas Children's Hospital Center for Vaccine Development, in partnership with the Baylor College of Medicine, opened the nation's first National School of Tropical Medicine to help physicians and other health care providers improve their ability to diagnose and treat NTDs. As part of this new effort to combat NTDs in the U.S., we also are working with Texas Medical Center to open a unique Tropical Medicine Clinic in Houston designed specifically to treat patients suffering with NTDs. Our hope is that the clinic will become a new center of excellence for diseases of American poverty. In its first few weeks of operation, we already have seen patients with Chagas disease and cysticercosis.

It is easy to think that NTDs are nothing more than ancient scourges, confined to the pages of medical history books or, at the very least, the far corners of the underdeveloped world.

But the truth is that nearly 1.4 billion people around the world are infected with these diseases and their occurrence in the United States is on the rise. We urgently need to raise awareness about NTDs and their impact on poor populations, especially in the U.S. We also need to conduct surveillance to accurately determine their prevalence, assess how they are transmitted in the U.S., and find innovative ways to control or eliminate these infections.

Peter Hotez, M.D., Ph.D. is the founding dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, Texas, and the author of "Forgotten People, Forgotten Diseases" (ASM Press).