It begins with an itch in your foot; it ends with anemia, cognitive dysfunction, and stunted growth in children. Hookworm is a disease mostly associated with impoverished countries, yet a resurgence of hookworm in Alabama has brought back questions about the relationship between hookworm and poverty in the US, and how we can solve a problem thought to have already been solved.
Alabama's history with hookworm is storied and certainly not over – despite what doctors once thought. Due to the extreme poverty in certain parts of rural Alabama, hookworm has come back with a vengeance, infecting about 34% of those living in these rural towns (according to a study using a sample size of 55 people). In order to figure out how to truly eradicate this disease, it is crucial to dive into the issues of poverty and lack of infrastructure at the core of hookworm's spread – until those issues are solved, hookworm will continue to plague Southern communities.
Doctors Are Shocked By The Resurgence, Given That They Thought It Was Eradicated In The US
Hookworm was a huge issue in the South for decades, but by the 1980s, scientists and doctors were proud to report the disease had been eradicated. Unfortunately, they were wrong. A 2017 study conducted in Alabama with a sample size of 55 people turned up shocking results: 19 out of 55 tested positive for hookworm DNA.
Dr. David Diermert, an expert on hookworm, was floored. He said:
"I was very surprised by this. There has not been any documentation of people being infected in the U.S. for the past couples of decades; we thought there was no more local transmission in the U.S."
So what happened? Lowndes County in Alabama is one of the poorest in the country, and this leaves the majority of its inhabitants without proper sewage systems. Hookworms thrive on fecal matter, and the problems in proper septic maintenance left the people of Lowndes county incredibly susceptible to the disease.
As Public Health Improved In The Late 20th Century, People Thought Hookworm Was Gone
The study that brought the contemporary prevalence of hookworm in rural Alabama to light was published in September 2017 in the American Journal of Tropical Medicine and Hygiene. It focused on Lowndes County, Alabama, and confirmed that hookworm was, in fact, still running rampant in the United States. The study concluded that none of the people found infected had traveled outside the US – still, "parasitic exposure was prevalant." This meant that any claims the disease had been eradicated were simply wrong, and it indicted those who turn a blind eye to the extreme poverty in some parts of the US.
At some point between the 1950s and 80s, thanks to increases in healthy food, indoor plumbing, and agricultural advances, hookworm "had all but disappeared in the South." This is one of the reasons the results of the study were so shocking: the consensus was that the country was moving forward, not backward.
Hookworms Enter Through Your Feet And Literally Travel Through Your Entire Body, Attaching Where They Will
Hookworms are small, but powerful. One worm does not necessarily pose a threat: 100, however, can leave a person anemic and, in extreme cases, they can lead to death.
The worms live in fecal matter and latch on to humans through the skin in our feet. An article from Steemit describes the process:
"Once in your foot, the hookworm larvae finds its way into your bloodstream and travels around your body until it gets to your lungs. Once there, it squirms into your lungs, crawls up your trachea and then back down your esophagus, through your stomach and eventually into your intestines."
Part of the reason poverty contributes so substantially to keeping hookworm rampant in these communities is that with proper sewage, the worms never get the opportunity to latch on to human skin. However, with fecal matter running freely down soil, the worms can travel up to several feet to find a human to crawl inside.
Part Of The Problem? No One Wants To Believe This Kind Of Poverty Is Present In The United States
The shocking study was inspired by a woman named Catherine Flowers, who grew concerned about the poverty level and amount of open sewage in Lowndes County, where she grew up. She chalks the problem up to denial about poverty in the US.
"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... 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."
Dr. Peter Hotez called the outbreak an "inconvenient truth that nobody in America wants to talk about." This lack of conversation is concerning considering the only way hookworm can be eradicated is if the issues of poverty causing the outbreaks are addressed.