Fighting neglected tropical diseases in the southern United States

The neglected tropical diseases are a group of chronic parasitic and related infections such as hookworm, schistosomiasis, lymphatic filariasis, Chagas disease, and leishmaniasis that often affect the “bottom billion” in Africa, Asia, and Latin America.1 Extreme poverty, defined by the World Bank as average daily consumption of $1.25 (£0.8; €1.0) or less, is the main social factor associated with a high prevalence of these diseases.1 The World Health Organization, the World Bank, and professionals have advocated strongly for global programmes to deliver packages of essential drugs to treat the tropical diseases with the highest prevalence, such as tuberculosis and malaria, while simultaneously developing new or improved drugs and vaccines.2 Diseases such as Chagas disease, cysticercosis, leishmaniasis, and dengue are listed in the 17 tropical diseases being targeted by WHO for control or elimination in low and middle income countries.3 4 Others, such as toxocariasis, a chronic parasitic infection that causes asthma and epilepsy,5 6 and trichomoniasis, a sexually transmitted disease associated with vaginal HIV-1 shedding,7 are not. That these diseases affect literally millions of Americans living in poverty,8 with prevalence rates of selected tropical diseases in some areas of the US comparable to rates in low and middle income countries, is less well known.9

Roughly 15% of …