Can America cope with a resurgence of tropical disease?

Public healthCan America cope with a resurgence of tropical disease?

By Carrie Arnold

Published 2 September 2015

Having stamped out a number of tropical diseases — including malaria — decades ago, is America today complacent about a rising wave of infectious disease? It is the nature of these diseases — neglected diseases, diseases of poverty, call them what you like — that they can go unnoticed for years, chewing away at the health of individuals and communities. As poverty, geography, climate, and social factors combine to bring tropical diseases out of hiding once again in the U.S. South, physicians, politicians, and the general public have to take the warning signs seriously and recognize that the tools available for tackling tropical diseases are sorely lacking. Despite tremendous advances in other types of illness in recent decades, tropical medicine remains stubbornly stuck in the 1950s, leaving the United States as unprepared as low-income nations to treat any significant number of cases. With diseases like Chagas now known to be prevalent and transmissible within the United States, better awareness, better tests, and better treatments are all urgently required. Otherwise, the number of people affected and infected will only continue to rise as this perfect storm grows ever stronger.

Having stamped out a number of tropical diseases — including malaria — decades ago, is America today complacent about a rising wave of infectious disease?

One rainy Friday morning in March 2015, Dr. Laila Woc-Colburn saw two patients with neurocysticercosis (a parasitic infection of the brain) and one with Chagas disease, which is transmitted by insects nicknamed “kissing bugs.” Having attended medical school in her native Guatemala, she was used to treating these kinds of diseases. But she was not in Guatemala any more — this was Houston, Texas.

For half a day each week, one wing of the Smith Clinic’s third floor in Houston is transformed into a tropical medicine clinic, treating all manner of infectious diseases for anyone who walks through the door. Since it opened in 2011, Woc-Colburn and her colleagues have treated everything from dengue and chikungunya to river blindness and cutaneous leishmaniasis. Their patients are not globetrotting travelers, bringing exotic diseases back home. The Smith Clinic is a safety net provider, the last resort for healthcare for people on low incomes and without insurance. Many of their patients haven’t left the Houston area for years.

This suggests that what Woc-Colburn sees in the clinic may be just the leading edge of a gathering crisis. Diseases once associated with “elsewhere” are increasingly being found in the southern states of the United States. Infectious disease physician Peter Hotez was so concerned that he founded a school of tropical medicine at the Baylor College of Medicine in Houston, well within the territory that Hotez argues is one of the world’s ten hotspots for so-called neglected tropical diseases.

“While we were calling them neglected tropical diseases, the ‘tropical’ part is probably a misnomer,” says Hotez. “Most of the world’s neglected tropical diseases are in wealthy countries. It’s the poor living among the wealthy.”

Poverty is a critical factor. But the American South’s hot and humid climate, the influx of insects that carry diseases, and the ever-increasing movement of humans have combined with the region’s high poverty levels to create a perfect storm of disease. While we might already have seen some of the storm’s effects, the worst has yet to arrive.

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