Intended for healthcare professionals


Hookworm: a neglected resurgent infection

BMJ 2017; 359 doi: (Published 24 October 2017) Cite this as: BMJ 2017;359:j4813
  1. Marco Albonico, consultant1,
  2. Lorenzo Savioli, former director2
  1. 1Centre for Tropical Diseases, S Cuore Hospital, Negrar, Verona, Italy
  2. 2Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
  1. doc.albonico{at}

Past and present control strategies and new challenges

Hookworms are a group of soil transmitted helminths included in the World Health Organization’s portfolio of neglected tropical diseases. Ancylostoma duodenale and Necator americanus infect humans. In addition, the primarily canine hookworm, Ancylostoma ceylanicum, is now recognised as an important cause of zoonotic disease, particularly in South East Asia.

Hookworm infection is a precipitating factor for iron deficiency anaemia as a result of blood loss proportional to the number of adult worms in the gut.1 The prevalence of infection increases with age, typically levelling off in late adolescence, while its intensity—the number of worms in a given person—generally increases throughout adulthood. Regular anthelmintic treatment of populations where hookworm is endemic increases individuals’ haemoglobin concentrations, especially when coupled with treatment of iron deficiency anaemia.2

Globally, an estimated 472 million people are infected with hookworm, causing 4 million disability adjusted life years (DALYs), mainly from iron deficiency anaemia and its consequences, with economic productivity losses of up to $139bn (£105bn; €118bn) annually.3


There have been reports of a possible resurgence in hookworm infection in the US, with 34% of African American …

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