America’s Hidden Diseases

Millions of poor Americans living in distressed regions of the country are chronically sick, afflicted by a host of hidden diseases that are not being monitored, diagnosed or treated, researchers say. More than 20 chronic diseases are promoting the cycle of poverty in conditions of inadequate sanitation, unsafe water supplies and rundown housing.

“These are forgotten diseases among forgotten people,” said Peter Hotez, a microbiologist at George Washington University, president of the Washington, D.C.-based Sabin Vaccine Institute and co-founder of the institute’s Global Network for Neglected Tropical Disease Control. “If these were diseases among middle-class whites in the suburbs, we would not tolerate them. They are among America’s greatest health disparities, and they are largely unknown to the U.S. medical and health communities.”

Over the course of the 20th century, deaths from infectious diseases declined rapidly in the U.S., and polio, tuberculosis, typhoid fever and malaria no longer represent a serious health threat here. But diseases that are common and chronic among the poor of Africa, such as Chagas, a leading cause of heart failure and stroke among Latinos; cysticercosis, which causes convulsions; and ascariasis, which causes abdominal pain and fever, also likely afflict millions of people living in the American South, in Appalachia and along the U.S.-Mexico border. These illnesses are spread, respectively, by parasites in insects, tapeworms in raw pork and roundworms in soil.

Based in part on blood donor data the agency estimates that 300,000 Americans are afflicted with Chagas, and that between 60 and 300 babies are born with the disease in the U.S every year. trichomoniasis, or “trich,” one of the most common sexually transmitted diseases in the world, afflicts up to 29 percent of African-American women in the South and impoverished inner cities of North, approaching rates in Nigeria, where 38 percent of women are infected. People with trichomoniasis are more susceptible to HIV. About 880,000 African-American women in the U.S. are infected with the parasite that causes trichomoniasis. CMV, or cytomegalovirus, a congenital virus that infects an estimated 10,000 infants in America yearly. Babies with CMV develop hearing and vision loss, sometimes years later. Along the U.S.-Mexico borderlands and in the Gulf Coast region up to 200,000 people living in poverty may be infected with dengue fever, a viral disease that is transmitted by mosquitoes. Dengue can lead to failure of the circulatory system. 30 percent of rural black children in the South tested positive for toxocariasis, or roundworm, a parasitic disease that is transmitted through the feces of dogs and cats. Toxocariasis causes abdominal pain, swollen glands and vision loss and may be linked to the rise in asthma among inner-city children. Extrapolating from old data estimates shows that between 1.3 million and 2.8 million poor Americans are infected with toxocariasis today.

“These are not even rare diseases,” Hotez said. “Yet there’s so little research on them, we don’t know the full extent of their impact, how they are transmitted, or how they contribute to disability. We do not have good diagnostic methods. We can’t even begin to think about controlling these diseases.” Drugs are available to treat a number of the neglected diseases, he said, but doctors are not trained to diagnose them. None are tracked by the U.S. Centers for Disease Control and Prevention.

“There’s an information gap,” Susan Montgomery, an epidemiologist with the CDC’s Division of Parasitic Diseases and Malaria "These are diseases that are disproportionately affecting parts of our population who are living in poverty...The states have not determined that those are diseases that they want the CDC to conduct surveillance for. They are not being monitored in the public health system. They may be diseases that physicians are not aware of and don’t think to test for.”