Hookworm, a parasitic gastrointestinal disease rife in areas of extreme poverty, has long been thought to be eradicated in the US.
But in the most poverty-stricken areas of the country, tropical diseases like hookworm continue to affect millions of Americans.
Especially at-risk are low-income residents of southern states like Alabama.
In Alabama’s Lowndes County, a historically poor and racially discriminatory rural area, one out of every three people tested positive for genetic traces of Necator americanus, a type of hookworm, according to a study published on Tuesday.
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The study is the first of its kind in the modern century, conducted by Baylor College of Medicine’s National School of Tropical Medicine and a non-profit organization focused on poverty, the Alabama Center for Rural Enterprise (ACRE).
Hookworm infects 430 million people worldwide, mostly in areas of extreme poverty where people are exposed to untreated sewage. But because of public health improvements in the US throughout the 20th century, the disease was not suspected to exist in the world’s richest country.
“Hookworm is a 19th-century disease that should by now have been addressed, yet we are still struggling with it in the United States in the 21st century,” Catherine Flowers, ACRE’s founder, told The Guardian.
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Since none of the Alabama participants in the study traveled abroad, lack of sanitation and proper waste management systems are the supposed causes for the presence of hookworm, according to the study.
Torrential rains and flooding cause broken septic tanks to wash raw sewage back into people’s homes. Some 73% of residents in the Baylor study reported that this had happened to them.
Additionally, children playing near open ponds of sewage and drinking water pipes located close to broken waste pipes can lead to cases of caseworm, according to the study.
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Houston scientists, alarmed by the study’s findings, want to expand the research to more people and more counties.
An estimated 12 million Americans are affected by neglected tropical diseases like hookworm in the South and Midwest, according to Dr. Peter Hotez, dean of the National School of Tropical Medicine and one of the leaders of the study in Lowndes County.
The disease was widespread through the deep South in the early 1900s, affecting mostly children — both wealthy and poor, black and white.
Hookworm eggs are passed through an infected person’s feces. When that feces is not properly expelled through a working sanitation system, the eggs in the human waste can travel into the soil. Walking barefoot on contaminated soil is the most common way the matured larvae attach to the skin and enter into the body. The worm then attaches itself to the small intestine and sucks its host’s blood.
In the body, hookworm causes lethargy, iron deficiency anemia, impaired mental function and weight loss, among other gastrointestinal problems.
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Throughout the course of the century, cases of hookworm dropped as sewage disposal systems and waste eradication programs improved, until scientists believed the disease was finally gone for good.
Despite improvements in public health, the US still tolerates poverty-related diseases at high levels and has the highest wealth inequality of 55 developed countries, according to one study.
At the start of this decade, 1.65 million US households (with 3.5 million children) were living on less than $2 a day.
In Lowndes County, nearly one-third of the population lives below the US poverty line, and the average income of the county is a just over $18,000 a year, the Guardian reported.
“Our billionaire philanthropists like Bill Gates fund water treatment around the world, but they don’t fund it here in the US because no one acknowledges that this level of poverty exists in the richest nation in the world,” Flowers told The Guardian.
Only time will tell just how many people living in poverty in the US are also living with diseases not thought possible in the world’s wealthiest country.