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Neglected Tropical Diseases Are Increasingly Common In Impoverished Areas Of U.S.: Sen. Booker Reintroduces A Bill To Help Eliminate Such Diseases

Senator Cory Booker (D-NJ) is reintroducing a bill aimed at helping to eliminate neglected diseases ... [+] of poverty; the STOP (Study, Treat, Observe, and Prevent) Neglected Diseases of Poverty Act (Photo by Samuel Corum/Getty Images)

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Last week, Senator Cory Booker (D-NJ) reintroduced legislation aimed at helping to eliminate what he calls "neglected diseases of poverty." If passed and enacted, The STOP (Study, Treat, Observe, and Prevent) Neglected Diseases of Poverty Act would facilitate research into diagnostics and treatments, and focus on improving disease surveillance systems and educational programs, as well as prevention, diagnosis, and treatment efforts targeting neglected diseases of poverty.

Neglected diseases of poverty are a group of chronic and disabling illnesses, such as Chagas disease, hookworm, and Dengue fever, that primarily impact extremely impoverished people. The diseases are caused by parasites, bacteria, viruses, protozoa, and other pathogens, and disproportionally impact the most vulnerable, which contributes to and exacerbates existing social and health disparities. An estimated 12 million Americans are affected by these debilitating diseases.

Many of these diseases are what scientists and policymakers have been calling neglected tropical diseases (NTDs) since Peter Hotez and colleagues coined the term 20 years ago. NTDs are a heterogeneous group of infections which are highly prevalent in developing regions of Africa, Asia, and the Americas. They include, among others, onchocerciasis (river blindness), African trypanosomiasis, leishmaniasis, cholera, Chagas disease, and Dengue fever.

Diseases are said to be neglected if they are (often) overlooked and therefore underfunded by drug developers, owing to a lack of commercial prospects. Historically, the pharmaceutical industry has allocated less than 0.5 percent of global drug investment to NTDs. Despite attempts in recent years to incentivize R&D for drugs targeting NTDs, new approvals continue to be a trickle compared to what is happening elsewhere in drug development.

NTDs impact more than one in six people worldwide, often the poorest, causing significant mortality and morbidity, including an estimated 35,000 deaths per day worldwide.

Although still far more common in low- and middle-income countries, NTDs are now also frequently detected among underserved populations living in high-income countries such as the U.S., especially, but not exclusively, in Southern states and regions, such as Texas and the Gulf Coast. Here, NTD incidence is rising as a result of pockets of extreme poverty, climate change, urbanization, and human migration.

Peter Hotez, Professor and Dean of the National School of Tropical Medicine at Baylor College of Medicine, is one of the world's preeminent authorities on the topic of NTDs. He's researched and written extensively on numerous NTDs. He's called NTDs "the most important diseases you've never heard of."

No longer rare in the U.S., these diseases are in fact "common, but seldom diagnosed, treated or prevented because they occur almost exclusively in Americans living in extreme poverty," according to Hotez.

The types of infections often seen in Texas and Gulf Coast areas include extrapulmonary and latent tuberculosis, strongyloidiasis, Chagas disease, and schistosomiasis. They often go underrecognized and therefore underdiagnosed. For example, strongyloides stercoralis is endemic in many parts of the U.S., including the Gulf Coast and Appalachia. However, in spite of the likely large burden of such an endemic disease, no comprehensive national or even large regional seroprevalence studies or screening guidelines exist.

Lack of adequate national disease surveillance is one of the issues Senator Booker's proposed bill would address. Ideally, Booker's legislation would provide the necessary tools to address, and ultimately eliminate, a disease like strongyloides stercoralis.

In announcing the bill, Booker said: "People who live in extreme poverty are suffering from diseases that many thought had been eradicated because their communities lack the proper resources. We need to address this challenge by raising awareness and boosting investment in research and monitoring."

The STOP (Study, Treat, Observe, and Prevent) Neglected Diseases of Poverty Act would:

Create an Interagency Task Force that provides recommendations to the Secretary of Health and Human Services (HHS) and to Congress to prevent, diagnose, and treat neglected diseases of poverty. When developing recommendations, the task force must consult with states, local communities, scientists, health professionals, and other entities with expertise regarding neglected diseases of poverty.

Provide resources to states to implement a public health surveillance system to help determine the prevalence and distribution of these illnesses, and to federally qualified health centers to help prevent, diagnose, and treat those who are suffering from or at risk of developing a neglected disease of poverty.

Require the HHS Secretary to develop and implement educational programs to raise awareness of neglected diseases of poverty, including risk factors and symptoms, among healthcare providers and the public.

Facilitate research that can help lead to the development of new and affordable diagnostic tools and treatments for neglected diseases of poverty. This would include support for one or more centers of excellence for neglected diseases of poverty.

The bill is endorsed by The National School of Tropical Medicine at Baylor College of Medicine and the Drugs for Neglected Diseases initiative (DNDi).

Affecting a sub-population that is already experiencing health and economic disparities, neglected diseases of poverty perpetuate a vicious cycle for those living in extreme poverty. Booker's proposed Act constitutes a call to action to tackle this long-standing problem.

Neglected Tropical Diseases

Our expertise in taxonomy, systematics, field trials and treatment programmes is driving live-saving research into neglected tropical diseases (NTDs) such as schistosomiasis, soil-transmitted helminths, dengue fever and food-borne trematodiases.

The Museum's extensive collection of parasites and vectors is critical to this research.

One sixth of the world's population suffer from one or more neglected tropical diseases and children are often the most affected. Most can be prevented or eliminated but the scale of the problem is vast.

What Is Tropical Medicine

Tropical medicine is the study of the world's major tropical diseases and related conditions, which include a group of 17 neglected tropical diseases (sometimes referred to as 'NTDs') such as hookworm infection, schistosomiasis, river blindness, elephantiasis, trachoma, Chagas disease, Buruli ulcer, and leishmaniasis, as well as HIV/AIDS, tuberculosis, and malaria. The field also includes related disorders in malnutrition and even some non-communicable diseases.

Diseases of Poverty

First and foremost, tropical diseases are diseases of poverty. They are the most common afflictions of the "bottom billion" the 1.3 billion people who live below the World Bank poverty level. Although tropical diseases are generally thought of as exclusively occurring in developing countries, new evidence indicates that the poor living in wealthy countries also are affected by tropical diseases. For instance, in the United States, tropical diseases such as Chagas disease, cysticercosis, dengue, toxocariasis, and West Nile virus infection are now widespread.

Tropical Medicine's Role

Tropical medicine is an important component of global health, but it is more focused on the specific tropical infections that occur in resource poor settings, with detailed emphasis on the pathogens, their vectors, how they are transmitted (their epidemiology), their treatment and prevention, and even how to develop new control tools to combat tropical diseases, including new drugs, insecticides, diagnostics, and vaccines.

Neglected Tropical Diseases

The neglected tropical diseases (NTDs) are a group of 17 most common chronic parasitic and other infectious diseases, such as hookworm, schistosomiasis, river blindness, leishmaniasis, and Chagas disease, which represent the most common infections in the developing countries of Africa, Asia, and the Americas.

Almost all of the world's poor are affected by at least one NTD, and these conditions have been shown to be a stealthy reason why the bottom billion cannot escape poverty. This is especially true for "the bottom billion," the 1.4 billion people who live below the World Bank's poverty level of US$1.25 per day. In addition to the NTDs, malaria remains a devastating tropical infection in the world's low- and middle-income countries with an estimated 500 million cases annually and more than 800,000 deaths.

What's new in tropical medicine?

Keep up to date on the latest developments in the field by following Dr. Peter Hotez, dean of the BCM National School of Tropical Medicine.

There are also high rates of neglected infections of poverty (NIoPs) in the United States, especially among African American and Hispanic Americans living on the Gulf Coast, the border with Mexico, Appalachia and U.S. Inner cities.

Among the most endemic "tropical" infections are Chagas disease, cysticercosis, and toxocariasis. U.S. Citizens are also increasingly exposed to foreign NTDs due to expanded globalization. The enormous impact of NTDs and NIoPs on global health and economics is dramatically disproportionate to the existence of NTD/NIoP-specific research and educational opportunities.

Who is affected by the Neglected Tropical Diseases and Neglected Infections of Poverty?

Three populations are especially vulnerable to tropical infections and the NTDs and NIoPs:

Children suffer from developmental delays, growth failure and reductions in intelligence and cognitive abilities, especially from the high prevalence NTDs such as hookworm and other soil-transmitted helminthiases and schistosomiasis. Malaria ranks among the top three killers of children under the age of five.

Women suffer as a result of tropical infections during pregnancy, including hookworm, malaria, and Chagas disease with harmful effects for both mother and child. Female genital schistosomiasis is a devastating NTD among both girls and women and a stealth co-factor in Africa's HIV/AIDS epidemic.

Adult Agricultural Workers suffer from diminished productivity as a result of lymphatic filariasis (LF), onchocerciasis, hookworm anemia, and Chagas disease. India alone loses almost $1 billion in economic losses annually from LF.

Why the National School of Tropical Medicine?

Our school is the only school in North America solely focused on tropical medicine. It was launched in 2011 and is intended to provide a North American alternative to some of the excellent tropical medicine schools and institutes in the UK (e.G., Liverpool School of Tropical Medicine and London School of Hygiene and Tropical Medicine) or some of the European institutes of tropical diseases located in Amsterdam (Holland), Antwerp (Belgium), Barcelona (Spain), Basel (Switzerland), and Hamburg (Germany). We run a tropical medicine clinic to treat patients with tropical infections that are widespread and endemic in Texas. We also house one of the only tropical disease vaccine product development partnerships.

Baylor College of Medicine makes an ideal location for the new National School of Tropical Medicine.

Baylor College of Medicine is located in Houston, an international city on the 30th parallel north of the equator. Sharing this parallel with us are three of the world's largest cities Delhi, Shanghai and Cairo each with over 10 million people and with a combined population of 50 million people, not to mention some other important places in the world, including Jerusalem, Islamabad, Benghazi, Tripoli, Marrakech, Wuhan, Kathmandu, Chihuahua, Riyadh, Shiraz and Baghdad, each within just one, two or three degrees latitude from Houston. New evidence indicates a hidden burden of NTDs in the poorest parts of the United States but especially in Texas and the surrounding Gulf Coast. Among the NTDs now endemic to Texas are Chagas disease, cysticercosis, dengue, leishmaniasis and toxocariasis.

This location combined with a multi-cultural population – one in five Houstonians were born outside of the United States – makes Houston an international city. Houston's entrepreneurial spirit has made it the energy capital of the world and given rise to global companies in a wide array of industries.

As home to the largest health care complex in the world, the Texas Medical Center, Houston is also an international destination for medicine and research drawing patients, doctors and scientists from throughout the world.

Baylor and Texas Children's Hospital have launched extraordinary initiatives in global health including the Baylor International Pediatric AIDS Initiative at Texas Children's, launched in 1996 under the leadership of Dr. Mark Kline and the Texas Children's Center for Global Health led by Dr. Michael Mizwa.

Baylor Global Initiatives further broadens a worldwide presence by expanding academic partnerships across the globe and providing a centralized infrastructure for global health clinical, educational and research activities throughout the College.

Beyond Baylor College of Medicine and Texas Children's, the National School of Tropical Medicine's location in Houston will also support affiliations with other Texas organizations including Texas A&M University; University of Houston, Rice University, and The University of Texas.

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