GOOD AFTERNOON.

I AM DR. JOYCE HUNTER, DEPUTY

DIRECTOR OF THE NATIONAL

INSTITUTE ON MINORITY HEALTH AND

HEALTH DISPARITIES, AND I'D LIKE

TO WELCOME YOU TO THE JULY

INSTALLMENT OF THE HEALTH

DISPARITIES SEMINAR SERIES.

NIMHD SPONSORS THE MONTHLY

SEMINAR SERIES, AND IT ACTUALLY

IS A FORUM TO DISSEMINATE

INFORMATION ABOUT ADVANCES IN

HEALTH DISPARITIES RESEARCH.

THE PRESENTERS ARE OFTENTIMES

GRANTEES OF NIMHD AND THE NIH --

WE'VE ALSO HAD A NUMBER, AND

WE'LL CONTINUE TO HAVE A NUMBER

OF INTERNATIONAL PRESENTERS AS

WELL.

SO, I'D LIKE TO WELCOME YOU AND

AGAIN, EMPHASIZE THAT EACH

SEMINAR IS USUALLY FOCUSED ON A

SPECIFIC THEME.

AND AT THIS TIME, I WOULD LIKE

TO INVITE DR. JOHN RUFFIN, WHO

IS THE DIRECTOR OF THE NATIONAL

INSTITUTE ON MINORITY HEALTH AND

HEALTH DISPARITIES, TO COME UP

AND TELL YOU A LITTLE BIT ABOUT

OUR FAMOUS SPEAKER.

>> DR. JOHN RUFFIN:

GOOD AFTERNOON, AND WE HAVE A

VERY DISTINGUISHED SPEAKER HERE

TODAY, IN DR. PETER HOTEZ.

AND ACTUALLY, PETER, THIS FITS

VERY NICELY WITH SOME OF THE

SEMINARS THAT WE'VE HAD

PREVIOUSLY, IN THE SENSE THAT

MOST OF THESE SEMINARS ARE

BEGINNING TO REALLY DEMONSTRATE,

I THINK, TO PEOPLE WHO'VE BEEN

FOLLOWING THE SERIES, THE

COMPLEXITY OF HEALTH

DISPARITIES.

WE EMPHASIZE TO A GREAT EXTENT

THE BIOLOGICAL, BUT WE'VE BEEN

EMPHASIZING TO A GREAT EXTENT

THE NON-BIOLOGICAL ASPECT OF

HEALTH DISPARITIES, AND IF WE'RE

SERIOUS ABOUT IT, THE

ELIMINATION OF HEALTH

DISPARITIES, THEN WE'RE GOING TO

HAVE TO CONCENTRATE ON ALL OF

THOSE ISSUES.

WHAT I LIKE ABOUT TODAY'S TALK

IS THAT TO A GREAT EXTENT, WE

COULD SEE THE CORRELATION

BETWEEN BOTH, BECAUSE WHEN WE

TALK ABOUT THE NON-BIOLOGICAL

ASPECT OF HEALTH DISPARITIES, WE

SOMETIMES TALK ABOUT ISSUES,

SUCH AS POLITICS, ISSUES SUCH AS

RACISM, AND IN THIS CASE,

POVERTY.

SO YOU GET INTRODUCED, TO A

GREAT EXTENT TODAY, TO A NEW

CONCEPT TO SOME OF YOU, AND

PETER WILL GET A CHANCE TO

ELABORATE ON THE WHOLE CONCEPT

OF WHAT HE CALLS "NEGLECTED

INFECTIONS OF POVERTY."

THAT'S A VERY INTERESTING

CONCEPT BECAUSE THE SO-CALLED

"NEGLECTED INFECTIONS OF

POVERTY" ARE ENDEMIC TO MANY

AREAS OF THE U.S. WHERE EXTREME

POVERTY IS FOUND, INCLUDING

APPALACHIA AND THE MISSISSIPPI

DELTA AND LOUISIANA IN THE WAKE

OF HURRICANE KATRINA, ALONG THE

BORDERS WITH MEXICO AND TEXAS

AND PLACES LIKE THAT.

AND THE REASON THIS IS SO

INTERESTING TO US IS THAT THOSE

OF YOU WHO'VE FOLLOWED OUR

HISTORY, THE EVOLUTION OF OUR

HISTORY FROM AN OFFICE TO A

CENTER, ONE OF THE ISSUES WHEN

WE BECAME A CENTER IS THAT IT

BROADENED OUR BASE.

IT BROADENED OUR BASE IN THE

SENSE THAT NOT ONLY WERE WE

CONCERNED ABOUT ISSUES THAT

RELATE TO ETHNIC MINORITIES, BUT

WE WERE ALSO INVOLVING ISSUES

THAT RELATE TO OTHER PARTS,

GEOGRAPHICAL AREAS, DIFFERENT

GEOGRAPHICAL AREAS, AND SO

APPALACHIA AND KENTUCKY AND

TENNESSEE AND MANY OF THESE

PLACES THAT WE WOULD TALK -- AND

BY THE WAY, NOT ONLY IN THOSE

AREAS, BUT YOU MUST ALSO

RECOGNIZE, TOO, THAT SOME OF THE

INNER CITIES HAVE SOME OF THESE

SAME -- THESE SAME ISSUES.

SO TO BROADEN OUR AWARENESS AND

TO GIVE US THE FOCUS A LITTLE

BIT ON NEGLECTED INFLECTIONS OF

POVERTY AND THE EFFECT ON

DISADVANTAGED AMERICANS, WE'VE

INVITED PETER, WHO IS AN

INTERNATIONALLY-RECOGNIZED

CLINICIAN AND INVESTIGATOR IN

NEGLECTED TROPICAL DISEASES AND

VACCINE DEVELOPMENT.

PETER IS THE LEADER OF THE

WORLD-RENOWNED SABIN INSTITUTE,

WHICH IS NOW, HE TELLS ME,

MOVING TO TEXAS, I THINK, OR AT

LEAST A PART OF IT IS MOVING TO

TEXAS, THE TEXAS CHILDREN'S

HOSPITAL AND BAYLOR COLLEGE OF

MEDICINE, AND AT THE SABIN

INSTITUTE, HE OVERSEES THE HUMAN

HOOKWORM VACCINE INITIATIVE, A

PUBLIC-PRIVATE PARTNERSHIP

SUPPORTED BY MAJOR FUNDING FROM

THE BILL AND MELINDA GATES

FOUNDATION.

HE WAS ALSO INSTRUMENTAL IN THE

CREATION OF THE GLOBAL NETWORK

OF NEGLECTED TROPICAL DISEASES,

AN ADVOCACY AND RESOURCE

MOBILIZATION INITIATIVE THAT'S

DEDICATED TO RAISING THE

AWARENESS AND POLITICAL WILL

NEEDED TO ELIMINATE NEGLECTED

TROPICAL DISEASES AROUND THE

WORLD.

DR. HOTEZ, WHO IS PRESIDENT OF

THE AMERICAN SOCIETY OF TROPICAL

MEDICINE AND HYGIENE AND A

MEMBER OF THE INSTITUTE OF

MEDICINE, HAS BEEN THE VOICE

THAT BOTH THE MEDICAL COMMUNITY

AND THE MEDIA TURNS TO WHEN THE

SUBJECT IS NEGLECTED INFECTIOUS

DISEASES.

AND RECENTLY, HE HAS CALLED OUR

ATTENTION TO THE CLOSE

CONNECTION OF THE MANY OF THESE

DISEASES TO CONDITIONS OF WAR IN

PLACES LIKE THE SUDAN AND

AFGHANISTAN.

SO OUR SPEAKER TODAY IS A NATIVE

OF HARTFORD, CONNECTICUT,

OBTAINED HIS PH.D. FROM

ROCKEFELLER UNIVERSITY IN 1986,

AND HIS DOCTOR OF MEDICINE AT

CORNELL COLLEGE IN 1987.

HIS SEMINAR TODAY IS ENTITLED,

"LEFT BEHIND IN AMERICA: OUR

NATION'S NEGLECTED INFECTIONS OF

POVERTY."

PLEASE JOIN ME IN WELCOMING HIM

TO OUR SEMINAR SERIES.

[APPLAUSE]

>> DR. PETER HOTEZ:

THANK YOU, DR. RUFFIN, FOR THE

VERY KIND AND VERY GENEROUS

INTRODUCTION.

TODAY, TODAY, I'M GOING TO GO

OUTSIDE MY COMFORT ZONE, WHICH

-- [FEEDBACK]

OKAY, I HOPE THAT'S NOT TOO

ANNOYING FOR PEOPLE.

SHOULD I USE THE LAVALIER

INSTEAD?

GREAT, HOW DOES THAT -- NO, IT

DOESN'T LIKE ME.

>> MALE SPEAKER:

LET'S TRY THIS INSTEAD.

[LOW AUDIO]

[FEEDBACK]

>> DR. PETER HOTEZ:

HOW'S THAT NOW?

GOOD?

OKAY, GREAT, THANK YOU.

SO, AS I WAS SAYING, I'M GOING

TO BE -- GO OUTSIDE MY COMFORT

ZONE A LITTLE BIT TODAY, WHICH

I'VE DEVOTED MY WHOLE LIFE TO

THIS PROBLEM OF THE NEGLECTED

TROPICAL DISEASES AND MAKING

VACCINES FOR NEGLECTED TROPICAL

DISEASES; BUT WHAT I WANT TO

TALK ABOUT TODAY IS SOMETHING I

REALLY HAVEN'T SPOKEN ABOUT VERY

MUCH IN PUBLIC, ABOUT TURNING

THAT BLEND OF GLOBAL HEALTH ONTO

HEALTH DISPARITIES IN THE UNITED

STATES.

AND WE THINK WE'VE FOUND SOME

INTERESTING TRENDS.

WHAT I'M GOING TO EMPHASIZE

TODAY, JUST TO BE UPFRONT, IS

MORE HYPOTHESIS GENERATING THAN

HYPOTHESIS TESTING, BECAUSE

THESE DISEASES HAVE BEEN SO

PROFOUNDLY UNDERSTUDIED IN THE

UNITED STATES.

AND I'M GOING TO BE TALKING

ABOUT SOME DISEASES WHICH WE

THINK ARE EXTRAORDINARILY COMMON

AMONG, PARTICULARLY

UNDERREPRESENTED MINORITY

COMMUNITIES IN THE U.S., AND FOR

SOME OF THESE DISEASES, THERE

ARE ACTUALLY NO NIH GRANTS FOR

THEM.

SO I THINK SOME OF THE THINGS I

MIGHT SAY MIGHT SURPRISE YOU,

AND AS I SAID, TO BE TOTALLY

UPFRONT, SOME OF THE THINGS I'M

SAYING OR GOING TO SAY ARE

HALF-BAKED, MEANING THAT THEY'RE

NEW OBSERVATIONS, HYPOTHESIS

GENERATING, BUT THAT POINTS TO A

WAY FOR STUDYING FROM THE

FUTURE.

AND THEN MAYBE IF WE GET A

LITTLE TIME AT THE END, I'LL

TELL YOU ABOUT OUR MOVE TO HERE,

THIS IS NOT THE CITY OF HOUSTON;

THIS IS ACTUALLY TEXAS MEDICAL

CENTER, THE WORLD'S LARGEST

MEDICAL CENTER, WHICH IS ITS OWN

CITY.

AND I'LL TELL YOU ABOUT WHAT WE

PLAN TO DO THERE.

SO, THE WAY I GOT INTO THIS WAS

THROUGH THE LENS OF GLOBAL

HEALTH.

SO I'M GOING TO SAY A FEW

INTRODUCTORY COMMENTS ABOUT

NEGLECTED TROPICAL DISEASES IN

LOW INCOME COUNTRIES, AND THEN

LAUNCH INTO HOW WE GOT INVOLVED

IN LOOKING AT HEALTH DISPARITIES

IN THE UNITED STATES.

AND THE DISEASES THAT WE STUDY

ARE DISEASES OF A GROUP

SOMETIMES REFERRED TO AS THE

"BOTTOM BILLION."

THIS IS A TERM POPULARIZED BY A

MAN NAMED PAUL COLLIER, WHO IS

AN OXFORD ECONOMIST WHO

IDENTIFIED THIS GROUP OF 1.4

BILLION PEOPLE WHO LIVE ON NO

MONEY.

BUT THAT'S NOT THEY ACTUALLY

HAVE NO MONEY, THEY LIVE BELOW

THE WORLD BANK POVERTY FIGURE OF

A $1.25 A DAY, BUT FOR ALL

PRACTICAL PURPOSES, THEY LIVE ON

NO MONEY.

THEY'RE THE SUBSISTENCE FARMERS

OF THE WORLD AND THEIR FAMILIES,

AND THE URBAN SLUM DWELLERS.

COLLIER, IN HIS BOOK, ALSO TALKS

ABOUT A GEOGRAPHY TO EXTREME

POVERTY; IT'S NOT JUST BEING

DIRT POOR, BUT THE FACT THAT YOU

LIVE IN -- IF ANYBODY WANTS TO

JUST GO AHEAD AND FIND SEATS, I

WANT YOU TO BE COMFORTABLE.

THERE'S A BUNCH OF SEATS

SCATTERED ABOUT.

I'M JUST SO FLATTERED THAT

PEOPLE HAVE COME OUT IN THIS

HEAT AND HUMIDITY.

THERE'S A COUPLE OF CHAIRS UP

FRONT HERE, YOU MIGHT JUST WANT

TO PUT THEM IN FRONT, TOO.

JUST MOVE MY JACKET OVER HERE.

[LOW AUDIO]

GREAT.

YOU'VE GOT A SERIOUS FIRE

MARSHAL HERE AT THE NIH

[LAUGHS]

ALL RIGHT, SO, AS I WAS -- I

STARTED INTO -- WE'RE TALKING

ABOUT THIS GROUP OF PEOPLE WHO

ARE LIVING IN EXTREME POVERTY,

AND IT'S NOT JUST BEING POOR,

IT'S THE FACT THAT YOU LIVE IN A

NATION WHERE YOUR CHILDREN ARE

DESTINED TO BE POOR, AND YOUR

CHILDREN'S CHILDREN.

SO THERE'S A GEOGRAPHY TO THIS

POVERTY.

AND IN 2000, KOFI ANNAN, THE

SECRETARY GENERAL OF THE UNITED

NATIONS, DECIDED TO DO SOMETHING

ABOUT THIS, AND HE LAUNCHED WHAT

ARE NOW KNOWN AS THE MILLENNIUM

DEVELOPMENT GOALS, WHERE HE

BROUGHT ALL OF THE GLOBAL

LEADERS TO THE UNITED NATIONS

HEADQUARTERS TO SEE HOW WE CAN

ADDRESS THE PLIGHT OF THE BOTTOM

BILLION.

AND MANY OF YOU ARE FAMILIAR

WITH THESE.

IT'S ACTUALLY A VERY FORWARD

THINKING DOCUMENT.

IN FACT, UNLIKE SOME OF THE

UNITED NATIONS DOCUMENTS THAT I

THINK ARE FORGOTTEN ABOUT TODAY,

THEY'RE DRAFTED, THIS ONE HAS

STUCK, SO 11 YEARS LATER, WE'RE

STILL -- WHEN WE WANT TO THINK

ABOUT INTERNATIONAL DEVELOPMENT

PROBLEMS, WE'RE STILL PUTTING

THEM IN THE FRAMEWORK OF THESE

MILLENNIUM DEVELOPMENT GOALS.

FINALLY, SOMEBODY FIGURED OUT

WOMEN ARE GOING TO BE IMPORTANT

TO SOLVING INTERNATIONAL

DEVELOPMENT PROBLEMS, SO THERE'S

TWO THAT SPECIFICALLY ADDRESS

WOMEN'S HEALTH ISSUES, IMPROVING

MATERNAL HEALTH, PROVIDING

GENDER EQUALITY, EMPOWERING

WOMEN.

AND THERE'S ONE THAT

SPECIFICALLY ADDRESSES

INFECTIOUS DISEASES, AND THAT'S

TO COMBAT HIV/AIDS, MALARIA AND

SOMETHING CALLED "OTHER

DISEASES."

AND I THINK FROM MDG NUMBER SIX,

THERE'S PROBABLY BEEN MORE

ACTIVITY THAN FOR MANY OF THE

OTHER MILLENNIUM DEVELOPMENT

GOALS BECAUSE IT'S THIS THAT

HELPED LAUNCH PEPFAR, THE

PRESIDENT'S EMERGENCY PLAN FOR

AIDS RELIEF.

ANYBODY KNOW WHAT PEPFAR'S

FUNDED TO NOW?

WANT TO MAKE A GUESS?

IT'S CLOSE TO GETTING UP TOWARDS

$10 BILLION, I MEAN, A

SIGNIFICANT AMOUNT OF MONEY.

THE WHOLE NIH BUDGET IS AROUND

$30 BILLION, SO THIS A THIRD --

PRACTICALLY EQUIVALENT OF A

THIRD OF THE NIH BUDGET TO GET

PEOPLE LIVING IN POVERTY IN

SUB-SAHARAN AFRICA AND ELSEWHERE

AND ANTIRETROVIRALS, THIS

LAUNCHED THE GLOBAL FUND TO

FIGHT AIDS.

SOMEBODY ADDED TUBERCULOSIS AND

MALARIA, THE PRESIDENT'S MALARIA

INITIATIVE, AND THIS IS MAKING A

HUGE DIFFERENCE IN THE LIVES OF

THE WORLD'S POOREST PEOPLE; IT'S

STIMULATED A WHOLE GENERATION OF

ADVOCACY AMONG YOUNG PEOPLE, AND

IT'S GOT BONO AND BRAD PITT, AND

IF YOU GET BRAD, YOU GET

ANGELINA, AND IT'S CREATED THIS

WHOLE GROUNDSWELL OF EXCITEMENT.

THE PROBLEM IS, FOR THOSE OF US

WHO WORK ON OTHER DISEASES -- I

DON'T KNOW WHAT THEY WERE

THINKING, THEY ACTUALLY CALLED

THEM 'THE OTHER DISEASES' -- AND

THAT CREATED A HUGE ADVOCACY

PROBLEM BECAUSE YOU'RE NOT GOING

TO SEE BRAD GETTING UP THERE

TALKING ABOUT OTHER DISEASES.

AND SO WE WERE -- FOUND

OURSELVES ON THE OUTSIDE LOOKING

IN ON A NUMBER OF THESE

CONDITIONS, SO A GROUP OF US WHO

WERE WORKING ON THESE CONDITIONS

GOT TOGETHER AND BRANDED THEM

THE "NEGLECTED TROPICAL

DISEASES," OR THE NTDS,

RECOGNIZING NOW -- WE DID THIS

AROUND SIX, SEVEN YEARS AGO --

RECOGNIZING NOW THAT IT'S REALLY

NOT A GREAT NAME, BUT NOW THAT

PEOPLE ARE STARTING TO

UNDERSTAND WHAT WE'RE TALKING

ABOUT, WE'RE AFRAID TO MESS WITH

IT.

SO WE'RE KEEPING IT THE SAME. SO

THESE NEGLECTED TROPICAL

DISEASES REPRESENT THE MOST

PREVALENT INFECTIONS OF POOR

PEOPLE, ALL OF THE BOTTOM

BILLION IN LOW AND MIDDLE INCOME

COUNTRIES ARE INFECTED

WORLDWIDE, AND I'M GOING TO RANK

THEM FOR YOU.

SO THIS IS THE MOST COMMON

INFECTION OF POOR PEOPLE.

ANYBODY KNOW WHAT THAT IS?

IT'S ASCARIS ROUNDWORM; THIS

LITTLE BOY ON THE RIGHT FROM

HAITI HAS ASCARIS ROUNDWORM,

WHAT'S WRONG -- WHAT DO YOU SEE

THAT'S WRONG WITH HIM? YEAH,

HE'S GOT A BIG DIS -- BELLY,

HE'S STUNTED FOR HEIGHT AND

WEIGHT.

YOU CAN ACTUALLY RUN YOUR HAND

OVER THE SURFACE OF HIS ABDOMEN

AND PALPATE WORMS, SO A LOT OF

THESE ARE WORMY DISEASES.

SECOND MOST COMMON IS WHIPWORM

INFECTION, 600 MILLION, HOOKWORM

AROUND 576 MILLION.

I SEE DR. MILLER IN THE

AUDIENCE, AND MALARIA WOULD COME

SOMEWHERE BETWEEN

SCHISTOSOMIASIS AND HOOKWORM, SO

440 MILLION PEOPLE HAVE

SCHISTOSOMES IN THEIR

VASCULATURE, 120 MILLION PEOPLE

WITH FILARIAL WORMS IN THEIR

LYMPHATICS AND GENITALS, 40

MILLION -- THIS IS A NON-WORMY

INFECTION, TRACHOMA, RIVER

BLINDNESS, LEISHMANIASIS AND

CHAGAS DISEASE.

SOME OF THE MOST COMMON

INFECTIONS OF THE WORLD'S POOR,

AND THEY TEND TO CLUSTER IN LOW

AND MIDDLE INCOME COUNTRIES.

HERE'S WHERE MOST OF THE SEVEN

MOST COMMON NEGLECTED TROPICAL

DISEASES, ASCARIASIS,

TRICHURIASIS, HOOKWORM,

SCHISTOSOMIASIS, LYMPHATIC

FILARIASIS, ONCHOCERCIASIS, AND

TRACHOMA CLUSTER, IN PLACES LIKE

SUDAN, WHERE YOU HAVE ALL SEVEN

OF THEM, OR DR CONGO, SIX OF

THEM.

WHAT THAT MEANS, GENERALLY

SPEAKING, IS PEOPLE ARE

POLYPARASATISED.

THEY DON'T JUST HAVE ONE

INFECTION, THEY'LL HAVE

MULTIPLE, SO IF YOU HAVE ASCARIS

WORMS, YOU'LL ALSO HAVE RIVER

BLINDNESS, OR IF YOU HAVE

LYMPHATIC FILARIASIS, YOU MIGHT

ALSO HAVE TRACHOMA.

AND WE'VE BEEN NOW ADVOCATING

FOR A PACKAGE OF DRUGS TO

ADMINISTER TO LARGE POPULATIONS

THAT WE CALL THE RAPID IMPACT

PACKAGE, WHERE THERE'S BEEN

WIDESPREAD COVERAGE THROUGH MASS

DRUG ADMINISTRATION FOR

LYMPHATIC FILARIASIS AND

ONCHOCERCIASIS, AROUND 50

PERCENT COVERAGE, BUT FOR THE

SOIL TRANSMITTED

[UNINTELLIGIBLE], THE

ASCARIASIS, TRICHURIASIS AND

HOOKWORM, ONLY ABOUT 10 PERCENT

COVERAGE, AND SCHISTOSOMIASIS,

SO WE'RE TRYING TO CORRECT THAT.

THESE ARE NON-KILLER DISEASES,

AND SO WE CAN'T USE MORTALITY AS

A REASONABLE ESTIMATE TO CONVEY

THE IMPACT, SO WE'RE USING THIS

METRIC WITH SOME SUCCESS CALLED

THE DALY, THE

DISABILITY-ADJUSTED LIFE YEAR,

THE NUMBER OF HEALTHY LIFE YEARS

LOST EITHER FROM PREMATURE DEATH

OR DISABILITY, AND YOU CAN SEE

USING DALYS THE NEGLECTED

TROPICAL DISEASES ARE UP THERE

WITH AIDS AND TB AND MALARIA, SO

THAT RATHER THAN JUST TALKING

ABOUT THE BIG THREE, WE THINK

THERE'S AN IMPORTANT FOURTH LEG

TO THAT TABLE IN LOW INCOME

COUNTRIES.

AND THE VERY IMPORTANT FEATURE

ALSO IS THAT THEY NOT ONLY OCCUR

IN THE SETTING OF POVERTY, BUT

THESE NEGLECTED TROPICAL

DISEASES ACTUALLY CAUSE POVERTY.

SO FOR INSTANCE, HOOKWORM

INFECTION IS RESPONSIBLE FOR A

40 PERCENT REDUCTION IN FUTURE

WAGE EARNING.

THESE ARE STUDIES DONE BY HOYT

BLEAKLEY, AN INTERNATIONAL

DEVELOPMENT ECONOMIST,

UNIVERSITY OF CHICAGO, THAT

SEEMS TO BE HAPPENING BECAUSE

CHRONIC HOOKWORM INFECTION IN

CHILDHOOD NOT ONLY CAUSES

PHYSICAL GROWTH STUNTING, BUT IT

REDUCES IQ.

THE MORE HOOKWORMS YOU HAVE, THE

LOWER YOUR INTELLIGENCE.

THE MORE HOOKWORMS YOU HAVE, THE

WORSE YOU DO ON TESTS OF

COGNITION, MEMORY, SCHOOL

PERFORMANCE AND SCHOOL

ATTENDANCE.

SO THESE ARE NOT ONLY THE

WORLD'S MOST COMMON HEALTH

PROBLEMS, BUT THE WORLD'S MOST

COMMON EDUCATIONAL PROBLEMS, AND

THIS CONCEPT THAT HOOKWORM

REDUCES FUTURE WAGE EARNING

MEANS THAT THESE NEGLECTED

TROPICAL DISEASES ARE STEALTH

REASONS WHY THE BOTTOM BILLION

CAN'T ESCAPE POVERTY.

THEY ALSO CAUSE ADVERSE

PREGNANCY OUTCOMES, AND HUGE

IMPACT ON AGRICULTURAL WORKER

PRODUCTIVITY.

SO PEOPLE WHO HAVE THESE

CONDITIONS ARE TOO SICK

[UNINTELLIGIBLE] OCCURRING AMONG

THE SUBSISTENCE FARMERS OF THE

WORLD, THEY'RE TOO SICK TO WORK

IN THE FIELDS, SO INDIA LOSES A

BILLION DOLLARS A YEAR IN

ECONOMIC LOSSES ALONE FROM

ELEPHANTIASIS, FROM LYMPHATIC

FILARIASIS.

THIS CONCEPT THAT THEY ACTUALLY

CAUSE POVERTY.

SO THIS IS JUST A SUMMARY OF THE

MAJOR FEATURES, WHICH IS THAT

NEGLECTED TROPICAL DISEASES ARE

A GROUP OF 17 MAJOR CHRONIC

PARASITIC AND RELATED

INFECTIONS.

THE MOST COMMON INFECTIONS IN

DEVELOPING COUNTRIES, AFRICA,

ASIA AND LATIN AMERICA, THEY'RE

JUST THE OPPOSITE OF EMERGING

INFECTIONS.

YOU'VE HEARD OF EMERGING

INFECTIONS LIKE SARS OR AVIAN

FLU -- THESE ARE THE OPPOSITE;

THEY'VE BEEN AROUND FOREVER.

YOU CAN FIND DESCRIPTIONS OF

THESE DISEASES IN ANCIENT TEXTS

SUCH AS THE BIBLE AND THE TALMUD

AND THE QURAN AND THE VEDAS AND

THE WRITINGS OF HIPPOCRATES.

THEY DISPROPORTIONATELY AFFECT

THE WORLD'S POOREST PEOPLE,

SUBSISTENCE FARMERS, URBAN SLUM

DWELLERS AND THEIR FAMILIES,

HIGH MORBIDITY AND DISABILITY,

LOW MORTALITY CONDITIONS, AND

IMPAIR ECONOMIC DEVELOPMENT.

AND NOW WE'VE SHOWN A LOT OF

LINKS NOW WITH HIV/AIDS AND

MALARIA, FOR INSTANCE, WHAT WE

USED TO CALL URINARY TRACT

SCHISTOSOMIASIS, IT'S ONLY

CALLED URINARY TRACT

SCHISTOSOMIASIS BECAUSE IT TURNS

OUT NO ONE EVER BOTHERED DOING A

COLPOSCOPIC EXAM ON THE HUNDREDS

OF MILLIONS OF GIRLS AND WOMEN

IN AFRICA WITH THIS CONDITION.

UP TO 75 PERCENT OF THEM HAVE

LESIONS ON THEIR CERVIX AND

UTERUS AND LOWER GENITAL TRACT.

WHEN YOU INTERVIEW THEM, A

SOURCE OF HORRIFIC PAIN AND

BLEEDING AND DEPRESSION, AND

NOW, TWO STUDIES COMING OUT OF

ZIMBABWE AND TANZANIA SHOW UP TO

A FOUR-FOLD INCREASE IN

HORIZONTAL TRANSMISSION OF

HIV/AIDS.

SO THIS MAY BE THE MOST

IMPORTANT COFACTOR IN AFRICA'S

AIDS EPIDEMIC THAT YOU'VE NEVER

HEARD OF.

UROGENITAL SCHISTOSOMIASIS,

AGAIN, INCREDIBLY COMMON

THROUGHOUT, THROUGHOUT THE

COUNTRY.

AND WHAT WE'RE DOING AT THE

SABIN VACCINE INSTITUTE IN

ADDITION TO MASS TREATMENT, IS

TRYING TO LOOK AT MAKING

VACCINES FOR THESE CONDITIONS.

WE LIKE TO SAY WE MAKE THE

VACCINES THAT THE DRUG COMPANIES

CAN'T MAKE, SO WE'VE GOT -- WE

BELIEVE THAT JUST LIKE PEOPLE

HAVE A FUNDAMENTAL RIGHT OF

ACCESS TO FOOD, WATER AND

SHELTER AND MEDICINES, THEY ALSO

HAVE A FUNDAMENTAL RIGHT OF

ACCESS TO INNOVATION.

SO WE MAKE THESE VACCINES

BECAUSE THE DRUG COMPANIES

CAN'T.

IT'S NOT THAT THEY'RE BAD GUYS,

THEY'LL DONATE MEDICINES FOR

PEOPLE, FOR DRUGS THAT THEY'VE

DEVELOPED FOR ANOTHER PURPOSE,

THEY'RE DONATING ALBENDAZOLE,

THEY'RE DONATING FIBRONECTIN,

THEY'RE DONATING MEBENDAZOLE,

THEY'RE DONATING ZITHROMAX, BUT

YOU'RE NOT GOING TO INVEST --

GET THEM TO INVEST IN RESEARCH

AND DEVELOPMENT.

SO THAT'S WHAT WE DO IN OUR

LABORATORIES, WHICH ARE NOW

RELOCATING TO TEXAS.

I LIKE TO SAY, "THIS IS MY

PORTFOLIO OF MONEY-LOSING

PRODUCTS."

THIS IS OUR HUMAN HOOKWORM

VACCINE, WHICH IS A BIVALENT

VACCINE THAT'S NOW MOVING INTO

PHASE-ONE CLINICAL TESTING IN

BRAZIL.

WE ALSO HAVE A HUMAN

SCHISTOSOMIASIS VACCINE THAT IS

JUST FINISHING GMP MANUFACTURE,

AND WE HAVE TWO VACCINES IN AN

EARLIER STAGE FOR CHAGAS DISEASE

AND LEISHMANIASIS.

AND WE CAN DO THIS BECAUSE WE

HAVE SUPPORT FROM THE BILL AND

MELINDA GATES FOUNDATION, SOME

SUPPORT FROM THE NIH, THE DUTCH

MINISTRY OF FOREIGN AFFAIRS,

CARLOS SLIM INSTITUTE FOR HEALTH

-- CARLOS SLIM IS THE NEW

RICHEST MAN IN THE WORLD, AND

HE'S NOW BEGINNING TO SUPPORT US

-- AND OTHER PRIVATE SUPPORT.

WHAT WE DO A LOT IN OUR

LABORATORIES IS TRY TO BRIDGE

RESEARCH AND DEVELOPMENT WITH

GMP MANUFACTURE.

ONE OF THE THINGS THAT WE HAVE

TO LEARN -- I WAS AT, YOU KNOW,

AS OF 15 YEARS AGO, I WAS AN

ACADEMIC SCIENTIST WHO HAD THIS

MAGICAL THINKING, YOU DISCOVER A

GENE OR A PROTEIN AND SOMEHOW

YOU TAKE IT TO THE GMP

MANUFACTURE AND VOILA, A BOTTLE

OF VACCINE APPEARS. WE HAD TO

LEARN THIS VERY IMPORTANT

INTERMEDIATE STAGE OF SHOWING

THAT WE COULD SCALE IT UP AND

MAKE IT THE SAME WAY EVERY TIME,

AND AT SOME REASONABLE

FERMENTATION SCALE LEVEL. MOST

OF OUR VACCINES ARE RECOMBINANT

VACCINES, SO WE DO THIS AT THE

10 LITER, THE 30 LITER, THE 60

LITER SCALE. NOT TOO DIFFERENT

FROM WHAT THE MALARIA VACCINE

DEVELOPMENT BRANCH DOES FOR

MALARIA, WE DO THIS FOR

NEGLECTED TROPICAL DISEASES.

WE SPEND A LOT OF TIME DOING

TECHNOLOGY TRANSFER BECAUSE WE

DO OUR MANUFACTURING IN BRAZIL,

SO WE WORK WITH PUBLIC SECTOR

VACCINE MANUFACTURERS IN MIDDLE

INCOME COUNTRIES.

BRAZIL IS A FANTASTIC COUNTRY

BECAUSE IT HAS HIGH RATES OF

ENDEMIC TROPICAL DISEASES, SUCH

AS HOOKWORM AND SCHISTOSOMIASIS,

YET THEY HAVE A LOT OF

SOPHISTICATION.

SO WE WORK WITH THIS

ORGANIZATION HERE, INSTITUTO

BUTANTAN, WHICH HAS A SNAKE AS

ITS SYMBOL BECAUSE IT STARTED

MAKING SNAKE ANTIVENOMS  AT THE

TURN OF THE 20TH CENTURY, AND

NOW THEY MAKE MOST OF BRAZIL'S

VACCINES.

THE OTHERS ARE MADE BY FIOCRUZ

BIO-MANGUINHOS, AND WHAT'S GREAT

ABOUT BRAZIL IS THERE'S A LOT OF

INVESTMENT IN TRANSLATIONAL

RESEARCH.

THIS ENORMOUS BUILDING WAS THE

BRAINCHILD OF A MAN NAMED CARLOS

MOREL AT FIOCRUZ.

TWO FOOTBALL FIELDS IN LENGTH,

ALL FOR TRANSITIONING PRODUCTS

INTO THE CLINIC.

AND THEN WE DO OUR CLINICAL

TESTING IN THIS RURAL AREA OF

[UNINTELLIGIBLE] OF BRAZIL WHERE

68 PERCENT OF THE POPULATION'S

INFECTED WITH HOOKWORM AND 45

PERCENT WITH SCHISTOSOMIASIS, SO

BRAZIL'S A VERY INTERESTING

COUNTRY, WE SOMETIMES CALL IT AN

IDC, AN INNOVATIVE  DEVELOPING

COUNTRY, MEANING GREAT POCKETS

OF POVERTY, HIGH RATES OF

PARASITIC INFECTION AND

NEGLECTED TROPICAL DISEASES, BUT

A LOT OF BIOTECHNOLOGY

SOPHISTICATION AS WELL, SO WE

REALLY HAVE A CLOSE PARTNERSHIP

WITH THE BRAZILIANS.

JUST A WORD ABOUT OUR HOOKWORM

VACCINE.

YOU MIGHT SAY, "OH, HOW YOU MAKE

A VACCINE THAT'S SOMETHING THAT

LOOKS LIKE THIS?"

WHICH IS -- IT'S AN ANIMAL, IT'S

A WORM THAT'S A CENTIMETER LONG.

WELL, WE'VE BEEN WORKING ON THIS

FOR DECADES, TRYING TO IDENTIFY

A MAGIC BULLET THAT COULD TARGET

UNIQUE METABOLIC COMPONENTS OF

THE PARASITE, AND WE'VE SPENT A

LOT OF TIME LOOKING AT HOW WORMS

FEED ON BLOOD, SO WHAT HAPPENS

IS THESE WORMS HAVE DECIDED

[SPELLED PHONETICALLY]

ATTACHMENT, ARE CAUSING BLOOD

LOSS, THE BLOOD WILL BE INGESTED

BY THE WORM.

THIS IS SHOWING THE GUT

MICROVILLI OF THE WORM WHERE THE

BLOOD GETS TRAPPED IN

MICROVILLI.

THE WORM PRODUCES HEMOLYSINS

[SPELLED PHONETICALLY], AND THEN

LINING THE GUT OF THE WORM -- I

KNOW YOU'RE NOT LOOKING AT CAT

SCANS OF WORMS -- BUT LINING THE

GUT OF THE WORM ARE -- IS

STUDDED WITH ENZYMES INVOLVED IN

HEMOGLOBIN DIGESTION.

SO THE WORM IS FIRST AND

FOREMOST INTERESTED IN FEEDING

ON HEMOGLOBIN, AND IT DEGRADES

IT MUCH LIKE MALARIA PARASITES

DO WITH A SERIES OF PROTEOLYTIC

ENZYMES INCLUDING ASPARTATE

PROTEASE, A CYSTEINE PROTEASE,

AND A METALLOPROTEASE, AND THEN

THE AMINO ACIDS ARE TAKEN UP BY

A UNIQUE AMINO ACID TRANSPORTER,

AND THEN THE PARASITE HAS TO DO

SOMETHING WITH HEME.

AND WITH HEME, MALARIA PARASITES

DETOXIFY BY POLYMERIZING IT INTO

A PIGMENT; IN THE CASE OF

HOOKWORMS, THEY DETOXIFY IT BY

HAVING A SPECIALLY ADAPTED

GLUTATHIONE TRANSFERASE THAT

FORMS A HOMODIMER AND SUCKS UP

THE HEME, SO WHAT WE HAVE NOW,

OVER A PERIOD OF YEARS, WE'VE

CLONED AND EXPRESSED ALL OF THE

MAJOR COMPONENTS REQUIRED BY

PARASITE BLOOD FEEDING, AND

WE'VE FOUND THAT TWO MAKE VERY

PROMISING VACCINES.

THIS MOLECULE HERE THAT LOOKS

LIKE THE CONTINENT OF AUSTRALIA

IS AN ASPARTATE PROTEASE THAT'S

BEEN SPECIALLY MODIFIED BY

SITE-DIRECTED MUTAGENESIS  TO

INACTIVATE ITS ENZYMATIC

ACTIVITY, BUT KEEP ITS

CONFORMATIONAL STRUCTURE.

WHEN WE IMMUNIZE THIS --

LABORATORY ANIMALS WITH IT, WE

ELICIT HIGH ANTIBODY RESPONSES,

AND AS THE WORM IS FEEDING ON

BLOOD, IT PICKS UP THE ANTIBODY.

WHAT I'M SHOWING YOU HERE IS THE

ANTIBODY LOCALIZES TO THE GUT OF

THE WORM AND DESTROYS THE WORM

INTESTINES SO IT CAN NO LONGER

FEED ON BLOOD, SO WE GET VERY

IMPRESSIVE PROTECTION, BOTH IN

TERMS OF REDUCING WORM NUMBERS

AND REDUCING BLOOD LOSS.

WE ALSO FOUND AN EQUAL EFFECT

WITH THIS HEME DETOXIFIER, THE

GLUTATHIONE TRANSFERASE, SO WHAT

WE HAVE NOW IS ALSO FOUND IS

THAT IN THE DISEASE-ENDEMIC

AREAS, THERE'S A SUBSET OF

PEOPLE WHO NATURALLY MAKE IGG

ANTIBODIES AFTER PROLONGED

EXPOSURE TO THIS PARASITE, AND

THEY SEEM TO BE NATURALLY

PROTECTED AGAINST INFECTION, SO

IT'S ALMOST LIKE THE WORM

EQUIVALENT OF HIV

NONPROGRESSORS, SO WE'VE NOW GOT

-- OUR CLINICAL DEVELOPMENT PLAN

LOOKS LIKE THIS, OUR FIRST

ANTIGEN NOW IS MOVING INTO

PHASE-ONE CLINICAL TRIALS, THEN

WE'RE GOING TO HAVE THE SECOND

AND THEN HAVE SOME PROOF OF

CONCEPT FOR PROTECTION,

HOPEFULLY BY 2017.

WE'VE ALSO FOUND THAT WHEREVER

YOU HAVE HOOKWORM, YOU HAVE

SCHISTOSOMIASIS, IT TURNS OUT

THE TWO GO HAND IN HAND.

HOOKWORM INCREASES THE

SUSCEPTIBILITY TO

SCHISTOSOMIASIS.

THE GREAT THING ABOUT

SCHISTOSOMES IS THROUGH NIAID

FUNDING, THERE'S A COMPLETED

GENOME PROJECT, AND ALEX LOUKAS,

WAS WITH US, AND NOW RETURNED

BACK TO AUSTRALIA, HE HAS

IDENTIFIED THIS VERY PROMISING

TRYPTOPHAN SURFACE ANTIGEN OF

THE WORM, WHICH IS A VERY POTENT

VACCINE PROTECTIVE MOLECULE.

WHAT'S NICE ABOUT HOOK --

SCHISTOSOMES IS YOU CAN DO RNAI,

MEANING YOU CAN FEED ANTISENSE

RNA, AND IT ACTUALLY BLOCKS THE

WHOLE DEVELOPMENT OF THE SURFACE

OF THE WORM, AND HERE'S WHERE

THE MOLECULE IS LOCATED ON THE

SURFACE.

WE'RE GETTING VERY HIGH LEVELS

OF PROTECTION IN LABORATORY

ANIMALS, AND ALSO SHOWING THAT

PEOPLE WHO ARE NATURALLY

RESISTANT TO THE INFECTION AFTER

PROLONGED EXPOSURE UNIQUELY HAVE

IGG1 AND IGG3 ANTIBODIES TO

THIS, TO THESE INFECTIONS, SO

THAT WHAT WE ENVISION, THEN, IS

A MULTIVALENT ANTHELMINTIC

VACCINE, COMBINING THE HOOKWORM

AND THE SCHISTOSOME ANTIGENS,

WHICH WILL HAVE A HUGE IMPACT ON

REDUCING UP TO 26 MILLION DALYS,

DOING A LOT OF WORK IN BRAZIL,

AND THEN LOOKING AT HOW WE'RE

GOING TO LINK THIS VACCINE ONCE

IT'S MADE INTO DRUGS, IN THIS

INTEGRATIVE FRAMEWORK.

SO, NOW I'M GOING TO TELL YOU

WHAT I CAME HERE TO TELL YOU

ABOUT.

SO WHEN WE WERE WORKING ON THIS

HOOKWORM VACCINE AND

SCHISTOSOMIASIS VACCINE, I HAD

ALWAYS BEEN INTRIGUED BY A MAP

OF THE DISTRIBUTION OF THESE

DISEASES, AND MOST OF THE

NEGLECTED TROPICAL DISEASES IN

THE AMERICAS HAVE THIS KIND OF

CURIOUS DISTRIBUTION, WHICH IS

THAT YOU HAVE LOTS OF DISEASE IN

SUB-SAHARAN AFRICA, INCLUDING

WESTERN AFRICA, AND THEN YOU

INVARIABLY SEE THIS FINE RIM OF

DISEASE ALONG THE EASTERN

SEABOARD OF BRAZIL, GOING UP

ALONG THE NORTHEAST COAST OF

BRAZIL AND THEN INTO THE

CARIBBEAN ISLANDS, PARTICULARLY

HAITI AND PUERTO RICO, AND THIS

IS TRUE SCHISTOSOMIASIS, IT'S

TRUE OF HOOKWORM, IT'S TRUE OF

OTHER NEGLECTED TROPICAL

DISEASES, AS WELL SO --

PARTICULARLY FOR NIKATOR

AMERICANAS [SPELLED

PHONETICALLY] INFECTIONS.

SO I GOT REALLY CURIOUS, WHERE

DID THAT COME FROM?

SO WHERE DID -- HOW DID THESE

DISEASES GET INTRODUCED INTO THE

NEW WORLD?

[LOW AUDIO]

WHAT'S THAT?

[LOW AUDIO]

THE MIDDLE PASSENGER, OR THE

MIDDLE PASSAGE OF THE ATLANTIC

SLAVE TRADE, WE THINK.

AND WHAT YOU CAN SEE IS THAT

GENETICALLY THE PARASITES LOOK

ALMOST IDENTICAL TO WHAT'S IN

WEST AFRICA.

SO I GOT FASCINATED BY THE

HISTORY OF THE ATLANTIC SLAVE

TRADE AND STARTED READING ABOUT

IT.

AND BECAUSE, IN A SENSE, IF YOU

THINK ABOUT THESE DISEASES,

THEY'RE ACTUALLY LIVING LEGACIES

OF THE ATLANTIC SLAVE TRADE.

THERE ARE HEALTH DISPARITIES

THROUGHOUT THE AMERICAS.

AND THERE ARE HOLDOVERS FROM

SLAVERY.

SO ONE OF THE THINGS THAT I AM

-- AND I'M SURE THIS IS ALREADY

VERY WELL KNOWN TO MANY OF YOU

-- BUT I WAS SURPRISED TO LEARN

ABOUT 45 PERCENT OF CAPTIVES

FROM THE MIDDLE PASSAGE CAME

FROM WHAT WAS THEN CALLED THE

BIGHT OF BENIN AND WEST CENTRAL

AFRICA, WHICH IS GOING UP TO

MODERN ANGOLA AND PART OF

NIGERIA.

AND AROUND 45 PERCENT WENT TO

BRAZIL.

BRAZIL WAS ACTUALLY THE LAST

COUNTRY TO ERADICATE -- OUTLAW

SLAVERY IN THE WESTERN

HEMISPHERE.

ANYBODY KNOW WHEN THAT WAS?

[LOW AUDIO]

1888, RIGHT.

AND SO THEY WERE THE LAST

COUNTRY.

AND THEN ANOTHER -- SO ABOUT 45

PERCENT WENT TO BRAZIL.

FORTY-FIVE PERCENT WENT TO THE

BRITISH, FRENCH, AND SPANISH

CARIBBEAN SUGAR PLANTATIONS.

AND THESE ARE WHERE THESE

NEGLECTED TROPICAL DISEASES ARE.

THIS IS WHERE HOOKWORM IS.

THIS IS WHERE SCHISTOSOMIASIS

IS.

AND TO THIS DAY, WHEN WE

ACTUALLY DID THE NUMBERS,

THEY'RE STILL HIGHLY ENDEMIC IN

THE WESTERN HEMISPHERE.

AND THESE ARE SOME OF THE

99 MILLION CASES OF WHIPWORM, 84

MILLION CASES OF ASCARIS, 50

MILLION CASES OF HOOKWORM, SEVEN

MILLION CASES OF

SCHISTOSOMIASIS.

ALL OF THESE BROUGHT PROBABLY

FROM THE MIDDLE PASSAGE, WITH

THE EXCEPTION OF CHAGAS DISEASE,

AND SOME PEOPLE SUGGESTED MAYBE

TRACHOMA AS WELL.

BUT ELEPHANTIASIS IS, RIVER

BLINDNESS.

AND WHEN YOU LOOK AT THE

DISABILITY-ADJUSTED LIFE YEARS

IN THE -- THIS IS JUST IN THE

AMERICAS, IT ACTUALLY EXCEEDS

THAT OF MALARIA, WHEN YOU LOOK

AT THE NEGLECTED TROPICAL

DISEASES.

SO THERE'S SOME EXTRAORDINARY

NUMBERS IN HAITI. POPULATION OF

EIGHT MILLION PEOPLE.

THIS IS ELEPHANTIASIS HERE.

LYMPHATIC FILARIASIS: AROUND

560,000 CASES OF LF.

ALMOST A MILLION CASES OF

HOOKWORM.

IN THE DR, YOU STILL HAVE

ENDEMIC SCHISTOSOMIASIS,

HOOKWORM, AND LYMPHATIC

FILARIASIS, AS WELL.

BRAZIL SEEMS TO BE GROUND ZERO

FOR NEGLECTED TROPICAL DISEASES.

EVEN THOUGH BRAZIL'S THE BIGGEST

COUNTRY, IT'S STILL

DISPROPORTIONATELY REPRESENTED

BY NEGLECTED TROPICAL DISEASES.

SO BRAZIL HAS AROUND 93 PERCENT

OF THE CASES OF LEPROSY, 83

PERCENT OF THE CASES OF

SCHISTOSOMIASIS, VISCERAL

LEISHMANIASIS, 65 PERCENT OF THE

HOOKWORM, 63 PERCENT OF THE

DENGUE, 50 PERCENT OF THE

ASCARIASIS.

AND YOU CAN SEE WHERE IT CAME

FROM, BECAUSE THESE DISEASES ARE

STILL TODAY ENDEMIC THROUGHOUT

WEST AFRICA.

SO THE ORIGINAL PORTS OF

DEPARTURE FROM THE MIDDLE

PASSAGE ARE REALLY GROUND ZERO

IN THE WORLD FOR HOOKWORM,

SCHISTOSOMIASIS, AND OTHERS.

ELEVEN MILLION CASES OF HOOKWORM

IN ANGOLA, SIX MILLION CASES OF

SCHISTOMIASIS.

I MEAN, REALLY EXTRAORDINARY

NUMBERS.

WE'RE TALKING ABOUT MOST OF THE

POPULATION OF ANGOLA, CīTE

D'IVOIRE, GHANA, AND NIGERIA

AFFECTED BY ONE OF MORE OF THESE

NEGLECTED TROPICAL DISEASES.

SO LET'S TURN TO THE UNITED

STATES.

SO IN THE U.S., SOME ESTIMATES

SAY THAT FEWER THAN FOUR PERCENT

OF CAPTIVES FROM THE MIDDLE

PASSAGE WENT TO THE BRITISH

MAINLAND COLONIES IN NORTH

AMERICA.

AT THAT TIME IT ACCOUNTED FOR

LESS THAN FOUR PERCENT OF THE

ATLANTIC SLAVE TRADE.

BUT IN THE EARLY PART OF THE

20TH CENTURY, WE WERE BASICALLY

BRAZIL, OR WE WERE THE

CARIBBEAN.

SO THESE ARE SOME MAPS SHOWING

THE DISTRIBUTION OF NEGLECTED

TROPICAL DISEASES IN THE U.S. AT

THE TURN OF THE 20TH CENTURY.

YOU HAD ENDEMIC LYMPHATIC

FILARIASIS IN CHARLESTON, SOUTH

CAROLINA.

THIS IS A MAP OF HOOKWORM

INFECTION, PARTICULARLY IN THE

SOUTHEASTERN PART OF THE UNITED

STATES.

FLORIDA WASN'T STUDIED IN THIS,

BUT THESE ARE RECONSTRUCTED

ESTIMATES OF WHERE HOOKWORM WAS

IN THE U.S.

AND THEN YOU HAVE MALARIA.

YOU HAD VIVAX MALARIA IN THE

OHIO RIVER VALLEY, AND THEN

FALCIPARUM MALARIA THROUGHOUT

THE SAME PLACES WHERE YOU HAVE

HOOKWORM.

SO YOU HAVE HIGH RATES OF

FALCIPARUM MALARIA, HOOKWORM

INFECTION, LYMPHATIC FILARIASIS.

AND THEN IT DISAPPEARED.

SO WE REALLY HAVE NO LONGER

ENDEMIC FALCIPARUM MALARIA.

YOU DON'T GET ELEPHANTIASIS WHEN

YOU GO VISIT CHARLESTON.

AND WE DON'T REALLY HAVE VERY

MUCH HOOKWORM LEFT ANYWHERE.

WHAT MADE IT GO AWAY?

[LOW AUDIO]

SO, SOME PEOPLE SAY THE

ROCKEFELLER FOUNDATION.

PROBABLY NOT.

SO --

[LOW AUDIO]

WELL, IT'S ACTUALLY A TRICK

QUESTION.

NOBODY KNOWS.

BUT THERE'S A FABULOUS BOOK BY A

MEDICAL HISTORIAN NAMED MARGARET

HUMPHREYS, WHO IS AT DUKE

UNIVERSITY.

AND SHE WRITES A BOOK CALLED

"MALARIA, RACE, AND POVERTY,"

WHERE SHE TRACES THE RATES OF

MALARIA IN THE UNITED STATES.

AND IT BASICALLY IS PRACTICALLY

SUPERIMPOSABLE [SPELLED

PHONETICALLY] ON THE HOOKWORM

AND EVERYTHING ELSE.

AND WHAT IT SHOWS IS IT'S

STARTING TO GO DOWN AT THE EARLY

PART OF THE 20TH CENTURY.

AND THEN THE BOTTOM FALLS OUT

AROUND 1936, 1937, 1938.

AND HER HYPOTHESIS IS THAT IT

WAS THE ECONOMIC STIMULUS

PACKAGE OF THE DAY, THE NEW DEAL

LEGISLATION, THAT GOT POOR

PEOPLE OFF THE LAND, POOR

SHARECROPPERS OFF THE LAND INTO

HIGHER QUALITY DWELLINGS, AWAY

FROM SWAMPS, WORKING IN

FACTORIES, WIDESPREAD

URBANIZATION.

AND THERE WAS ONE ACT IN

PARTICULAR, THE AGRICULTURAL

ADJUSTMENT ACT, THAT PROBABLY

HAD THE BIGGEST IMPACT.

SO IT'S NOT JUST GIVING

MEDICINES, CERTAINLY THERE WERE

NO BED NETS THEN.

OR IT WASN'T JUST SANITATION.

IT WAS THE OVERALL ELEVATION OF

ECONOMIC DEVELOPMENT AND

URBANIZATION IN THE AMERICAN

SOUTH THAT SEEMED TO HAVE A BIG

IMPACT.

AND THAT'S AN IMPORTANT LESSON

THAT WE'VE LEARNED FOR OTHER

PLACES IN THE WORLD.

FOR INSTANCE, IN CHINA WE'VE

SEEN DRAMATIC DECREASES IN

EASTERN CHINA, PLACES THAT

BEFORE WE HAD THIS INTENSE

AGRARIAN SITUATION WHERE HIGH

RATES OF HOOKWORM INFECTION AND

OTHER NEGLECTED TROPICAL

DISEASES, AND NOW IT'S

PRACTICALLY GONE.

YOU CAN EVEN SEE A KENTUCKY

FRIED CHICKEN THERE.

AND YOU CAN SEE A -- WHERE

FORMERLY YOU HAD JUST PEOPLE

WORKING IN THE FIELDS.

BUT ECONOMIC DEVELOPMENT IS NOT

SOMETHING THAT'S GOING TO HAPPEN

QUICKLY IN SUB-SAHARAN AFRICA

AND SOUTH ASIA AND CERTAIN PARTS

OF LATIN AMERICA.

SO THAT'S WHY WE NEED THE OTHER

INTERVENTIONS.

AND SURE ENOUGH IF YOU LOOK AT

THE UNITED STATES OVER THE LAST

100 YEARS, THESE ARE MORTALITY

RATES FROM INFECTIOUS DISEASES

FROM A PAPER IN JAMA.

AND YOU CAN SEE, EXCEPT FOR THAT

SPIKE IN 1918 FROM PANDEMIC FLU,

THAT THERE'S BEEN A MASSIVE

DECREASE FROM IT.

HAVING SAID THAT, POVERTY HASN'T

DISAPPEARED IN THE UNITED

STATES.

AND ONE OF THE THINGS THAT WE'VE

LEARNED OVER THE YEARS IN

WORKING IN AFRICA AND LATIN

AMERICA AND IN CHINA AND

SOUTHEAST ASIA, IS THAT YOU SHOW

ME EXTREME POVERTY AND I'LL SHOW

YOU NEGLECTED TROPICAL DISEASES.

THE TWO GO HAND IN HAND.

SO THESE NEGLECTED TROPICAL

DISEASES ARE POVERTY-PROMOTING

CONDITIONS.

SO I ASKED THE QUESTION, OKAY,

WE'VE HAD THE DISAPPEARANCE OF

LF, LYMPHATIC FILARIASIS.

WE'VE HAD THE DISAPPEARANCE OF

HOOKWORM.

WE'VE HAD THE DISAPPEARANCE OF

OTHER NEGLECTED TROPICAL

DISEASES.

BUT WE STILL HAVE POVERTY. AND

I'M WILLING TO BET THAT IN THOSE

POCKETS OF POVERTY IN THE UNITED

STATES THERE MIGHT STILL BE

PARASITIC DISEASES.

SO I STARTED READING ABOUT

POVERTY IN THE UNITED STATES.

AND I'M SURE MANY OF YOU IN THIS

ROOM ARE FAMILIAR WITH THIS

BOOK.

THIS IS A BOOK I ACTUALLY READ

IN HIGH SCHOOL.

BUT I TOTALLY FORGOT ABOUT IT

UNTIL I STARTED GETTING

INTERESTED AGAIN.

I REREAD IT.

AND IT'S A WONDERFUL BOOK CALLED

"THE OTHER AMERICA," WRITTEN IN

1962 BY THIS SOCIAL ACTIVIST

MICHAEL HARRINGTON.

IT ACTUALLY WAS THE BOOK THAT

BOTH PRESIDENT KENNEDY AND

PRESIDENT JOHNSON READ THAT

HELPED STIMULATE THE WAR ON

POVERTY.

AND HE EXPRESSES POVERTY IN THE

UNITED STATES IN A VERY ELOQUENT

WAY.

AND I LOVE THIS BRIEF PARAGRAPH,

WHICH IS FROM THE BEGINNING OF

HIS BOOK.

HE SAYS, "TO BE SURE, THE OTHER

AMERICA IS NOT IMPOVERISHED IN

THE SAME SENSE AS THOSE POOR

NATIONS, WHERE MILLIONS CLING TO

HUNGER AS A DEFENSE AGAINST

STARVATION, THIS COUNTRY HAS

ESCAPED SUCH EXTREMES. THAT DOES

NOT CHANGE THE FACT THAT TENS OF

MILLIONS OF AMERICANS ARE AT

THIS VERY MOMENT MAIMED IN BODY

AND SPIRIT, EXISTING AT LEVELS

BENEATH THOSE NECESSARY FOR

HUMAN DECENCY.

THEY ARE WITHOUT ADEQUATE

HOUSING AND EDUCATION AND

MEDICAL CARE."

AND IF YOU LOOK AT THE RATES OF

POVERTY IN THE UNITED STATES,

THEY'VE KIND OF STAYED CONSTANT,

IN TERMS OF THE NUMBERS OF

PEOPLE LIVING IN POVERTY.

SO IT'S KIND OF HOVERED BETWEEN

30 AND 40 MILLION PEOPLE WHO

LIVE IN POVERTY IN THE UNITED

STATES.

I HAVE THIS MAP UP TO ABOUT

2003.

OF COURSE, NOW WE'VE HAD A BIG

JUMP IN POVERTY WITH THE RECENT

RECESSION, GOING UP TO AROUND 44

MILLION PEOPLE LIVING IN

POVERTY.

SO THAT IF YOU LOOK AT THE

POVERTY RATES IN THE UNITED

STATES, AROUND 40 MILLION

AMERICANS NOW LIVE IN POVERTY.

PRE-RECESSION IN 2008, 36.5

MILLION.

AND THAT INCLUDED 16 MILLION

PEOPLE LIVING IN ABJECT POVERTY,

WHO HAD NO MORE THAN $50 A WEEK

FOR FOOD.

THE NEW 2009 CENSUS THAT JUST

CAME OUT RECENTLY SHOWS 44

MILLION AMERICANS LIVING IN

POVERTY.

WE, THE UNITED STATES, HAS THE

HIGHEST RELATIVE POVERTY RATE

ANYWHERE IN THE DEVELOPING

WORLD.

THE OFFICIAL POVERTY RATE

PRE-RECESSION IS AROUND 12

PERCENT.

NOW IT'S UP TO 14 PERCENT.

AND OF COURSE, NOT SURPRISINGLY,

U.S. POVERTY RATES DIFFER WIDELY

BY AGE, RACE, ETHNICITY, GENDER,

AND LOCATION, WITH A POVERTY

RATE AMONG 20 PERCENT AMONG

AFRICAN AMERICANS AND HISPANICS,

BUT ESPECIALLY AMONG GREATER

THAN 40 PERCENT AMONG BLACK OR

HISPANIC FEMALE HOUSEHOLDERS

WITH NO HUSBAND PRESENT AND WITH

CHILDREN.

SO WE'RE TALKING, YOU KNOW,

SINGLE MOMS, INCREDIBLY HIGH

POVERTY RATES AMONG THE

AFRICAN-AMERICAN AND HISPANIC

COMMUNITY.

AND THEN, THIS HAS BEEN NOW

GROUPED BY A FEW INTERESTING

DEMOGRAPHERS.

AND THE POINT IS, POVERTY

CLUSTERS, JUST LIKE IT DOES IN

DEVELOPING COUNTRIES, IT

CLUSTERS IN THE U.S. CHRIS

MURRAY, FROM THE INSTITUTE FOR

HEALTH METRICS, HAS LOOKED AT

POVERTY IN THE U.S.

AND HE WRITES THIS VERY NICE

PAPER FROM THE AMERICAN JOURNAL

OF PREVENTIVE MEDICINE, WHERE HE

REPORTS ON THE "EIGHT AMERICAS."

HE SAID THAT AMERICA IS REALLY A

MOSAIC OF EIGHT DIFFERENT SMALL

COUNTRIES, WHICH INCLUDES

POCKETS OF GREAT WEALTH AND ALSO

POCKETS OF ENORMOUS POVERTY.

AND HE TALKS ABOUT FOUR

SOCIOECONOMICALLY DISADVANTAGED

GROUPS, AND PROVIDES NUMBERS OF

THE PEOPLE LIVING IN THOSE

GROUPS.

SO AMERICA FOUR, WHICH ARE POOR

WHITES IN APPALACHIA AND THE

MISSISSIPPI VALLEY.

AMERICA FIVE, NATIVE AMERICANS

LIVING ON RESERVATIONS IN THE

WEST.

AMERICA SEVEN, POOR BLACKS

LIVING THE RURAL SOUTH.

AND AMERICA EIGHT, BLACKS LIVING

IN HIGH-RISK URBAN ENVIRONMENTS.

AND THIS IS A MAP OF POVERTY IN

THE UNITED STATES.

AND WHEN YOU LOOK AT IT FROM THE

30,000-FOOT AERIAL VIEW YOU SEE

THAT THE SOUTH IS RED, WHICH IS

VERY HIGH RATES OF POVERTY AND

EXTREME POVERTY.

THE NORTH IS MORE BLUE EXCEPT

FOR SOME OF THE TRIBAL LANDS.

BUT IT'S VERY HARD TO GET MUCH

OUT OF THIS UNTIL YOU CAN DIVIDE

IT A LITTLE FINER.

WHEN YOU LOOK AT THE AREAS OF

EXTREME POVERTY IN THE U.S.,

HERE'S WHERE IT IS.

IT'S IN THE BOOT HILL OF

MISSOURI, THE MISSISSIPPI DELTA,

AND POST-KATRINA LOUISIANA, WHAT

SOME PEOPLE WOULD CALL THE OLD

COTTON BELT, APPALACHIA, THE

BORDER WITH MEXICO, AND TRIBAL

LANDS.

SO I WAS VERY CURIOUS ABOUT THE

PARASITIC AND NEGLECTED TROPICAL

DISEASES THAT STILL MIGHT REMAIN

IN THESE POCKETS OF INTENSE

POVERTY IN THE UNITED STATES.

BEFORE I GO INTO THAT, THERE'S

BEEN SOME NEW NUMBERS COMING

FROM -- LOOKS AT THE U.S. GULF

COAST, FOCUSING ON LOUISIANA,

ALABAMA, AND MISSISSIPPI.

AND THIS SEEMS TO BE

PARTICULARLY GROUND ZERO FOR

POVERTIES.

THE NATIONAL CENTER FOR CHILDREN

IN POVERTY OF COLUMBIA

UNIVERSITY, FIND THAT IN THE

AFTERMATH OF KATRINA, MORE THAN

40 PERCENT OF BLACK CHILDREN IN

EACH OF THESE STATES CURRENTLY

LIVE IN POOR FAMILIES.

MORE THAN 12 PERCENT OF CHILDREN

FROM LOUISIANA, MISSISSIPPI LIVE

IN EXTREME POVERTY.

I MEAN, IT'S INCREDIBLE THAT

THIS IS OUR COUNTRY.

FAMILIES WITH INCOMES LESS THAN

HALF THE FEDERAL POVERTY LEVEL,

SO 12 MILLION PEOPLE IN

LOUISIANA, MISSISSIPPI, AND

ALABAMA WITH THE LOWEST INCOMES,

LOWEST EDUCATIONAL ATTAINMENT,

SHORTEST LIFE EXPECTANCY; AND

THE GULF COAST STATES HAVE THE

NATION'S LOWEST HUMAN

DEVELOPMENT INDICES, SO MUCH SO

THAT THE AMERICAN HUMAN

DEVELOPMENT PROJECT HAS PROPOSED

LAUNCHING A MARSHAL PLAN FOR THE

GULF, REFERRING TO THE MARSHAL

PLAN IN THE YEARS AFTER WORLD

WAR II, TO RESTORE ECONOMIC

SURVIVAL TO EUROPE.

WE NEED TO DO THE SAME THING FOR

THE GULF COAST.

SO IT'S WITH THAT THAT I DID A

LITERATURE REVIEW.

AND I DID A 25-YEAR LITERATURE

REVIEW, LOOKING AT THE -- DOING

SOMETHING VERY SIMPLE, ACTUALLY

-- LOOKING AT THE LIST OF

NEGLECTED TROPICAL DISEASES, AND

I USED OUR JOURNAL, OUR OPEN

ACCESS JOURNAL PLOS NEGLECTED

TROPICAL DISEASES WITH THE NTDS

THAT WE PUT ON THAT WEBSITE, AND

THEN OVERLAID THAT WITH AREAS OF

THE UNITED STATES THAT I JUST

OUTLINED.

USING PREVALENCE RATES AMONG

SELECTED COMMUNITIES MULTIPLIED

BY PUBLISHED ESTIMATES OF

AT-RISK POPULATIONS.

IN OTHER WORDS, WHAT I WOULD DO

IS I WOULD FIND SPECIFIC RATES

IN POCKETS OF NEGLECTED TROPICAL

DISEASES IN THOSE AREAS AND THEN

MULTIPLY IT TIMES THE NUMBER OF

PEOPLE AT RISK, MEANING IN ONE

OF FOUR OF THE AMERICAS, AMERICA

FOUR, FIVE, SIX, SEVEN, AND

EIGHT, TO GET A SENSE, BECAUSE

NONE OF THESE ARE REPORTABLE

DISEASES BY THE CDC, THAT I KNOW

OF.

AND THE FACT THAT THERE'S VERY

LITTLE ACTIVE SURVEILLANCE GOING

ON FOR ANY OF THESE DISEASES.

SO THAT'S WHY WE HAVE PRETTY

WIDE CONFIDENCE INTERVALS WHEN

YOU LOOK, SO IT'S UNKNOWN

NUMBERS.

IDENTIFYING SPECIFIC PERCENTAGES

AND MULTIPLYING TIMES THE

POPULATION IN AMERICA FOUR,

AMERICA FIVE, AMERICA SIX,

AMERICA SEVEN, AMERICA EIGHT.

MEANING HYPOTHESIS-GENERATING TO

GET A SENSE OF WHAT'S THERE.

AND WHAT CAME OUT WAS KIND OF

INTERESTING.

WE CAME OUT WITH AROUND SEVEN

DISEASES THAT ARE INCREDIBLY

COMMON AMONG AFRICAN-AMERICAN

AND HISPANIC-AMERICAN MINORITY

COMMUNITIES.

AND I CALL THEM THE THREE C'S

AND THE THREE T'S.

AND THEN THERE'S DENGUE, WHICH

ISN'T A C OR A T, SO I HAVE TO

MAKE THAT SEPARATE.

SO AMONG THE THREE C'S ARE:

CYSTICERCOSIS, CHAGAS DISEASE,

WHICH ARE HIGH RATES AMONG THE

IMPOVERISHED HISPANIC-AMERICAN

COMMUNITIES.

THE THIRD C, INCREDIBLY HIGH

RATES AMONG IMPOVERISHED

AFRICAN-AMERICAN COMMUNITIES,

CONGENITAL CMV.

AND THE THREE T'S, TWO OF THE

T'S ARE VERY HIGH RATES AMONG

AFRICAN-AMERICAN COMMUNITIES:

TOXOCARIASIS, TRICOMONIASIS, AND

THEN THERE'S TOXOPLASMOSIS.

AND THEN THERE'S DENGUE.

WHAT I'D LIKE TO DO NOW IS GO

INTO SOME INTO-THE-WEEDS ABOUT A

COUPLE OF THESE DISEASES,

BECAUSE THEY'RE NOT ONES YOU

ORDINARILY THINK ABOUT, I HAVE

TO BELIEVE.

SO LET'S TALK ABOUT

TOXOCARIASIS, WHICH I ESTIMATE

AT AROUND THREE MILLION

AFRICAN-AMERICANS HAVE THIS

INFECTION.

THESE ARE NOT SMALL NUMBERS IF

THEY'RE TRUE, MEANING THAT

THEY'RE NOT GOING TO EVEN

QUALIFY FOR THE ORPHAN DISEASE

ACT, BECAUSE THEY'RE MORE THAN

200,000 PEOPLE.

THESE ARE COMMON DISEASES.

IT'S JUST THAT THEY'RE GOING

SIGHT UNSEEN BECAUSE THEY ARE

DISPROPORTIONATELY INFECTING THE

MINORITY COMMUNITIES IN THE

UNITED STATES.

SO THIS TOXOCARIASIS -- HOW MANY

PEOPLE HAVE HEARD OF

TOXOCARIASIS?

SO, NOT A LOT.

AND IT'S A ZOONOTIC INFECTION

TRANSMITTED FROM DOGS.

SO WHAT YOU HAVE IS DOGS IN OUR

INNER CITY PLAYGROUNDS IN THE

RURAL SOUTH DEFECATING.

ALMOST 100 PERCENT OF PUPPIES

HAVE WORMS IN THEIR INTESTINES

THAT LOOK LIKE ASCARJS WORMS,

LOOK LIKE THAT LITTLE BOY FROM

HAITI, BUT THEY'RE IN PUPPIES.

AND WHAT HAPPENS IS HUMANS COME

INTO CONTACT WITH THE EGGS, BOTH

FROM TOXOCARA CANIS, THE DOG

ROUNDWORM, AND TOXOCARA CATI.

AND WHAT HAPPENS IS YOU SWALLOW

THOSE EGGS, THE EGGS HATCH, THEY

GET RISE TO LARVAL STAGES, AND

THEN THEY GO INTO THE PORTAL

CIRCULATION MIGRATING THROUGH

THE LIVER AND THE LUNGS, CAUSING

A DISEASE SYNDROME, WHICH IS NOT

VERY COMMON, KNOWN AS VISCERAL

LARVA MIGRANS.

AND THIS IS A COMMON, THIS IS AN

INFECTION SEEN IN YOUNG

TODDLERS, AGE 1 TO 3.

AND THERE'S ALSO ANOTHER FORM

CALLED OCULAR LARVA MIGRANS,

WHICH OCCURS IN OLDER CHILDREN.

WHAT IS INCREDIBLY COMMON,

THOUGH, IS A FORM CALLED COVERT

TOXOCARIASIS, THIS IS NOT THE

FULL-BLOWN SYNDROME OF VISCERAL

LARVA MIGRANS, WHERE THE LARVAE

MIGRATE THROUGH THE LUNG, AND

CAUSE AN EOSINOPHILIC

PNEUMONITIS.

THEY CAUSE PATCHY INFILTRATE

FROM THE LUNG AND VERY HIGH

EOSINOPHIL COUNTS IN THE

PERIPHERAL BLOOD CIRCULATION.

THEY ALSO CAUSE WHEEZING AND

ASTHMA.

AND STUDIES DONE IN EUROPE HAVE

SHOWN NOW A NICE LINK BETWEEN

TOXOCARA AND ASTHMA.

SO THE QUESTION WE WERE

INTERESTED IN IS COULD THIS BE

AN IMPORTANT FACTOR IN THE RISE

OF ASTHMA AND DEVELOPMENTAL

DELAYS, BECAUSE THEY ALSO

MIGRATE THROUGH THE BRAIN TO

CAUSE A CEREBRITIS AMONG THE

AFRICAN-AMERICAN COMMUNITIES.

SO FOR THE NUMBERS WE USED SOME

OF THE NHANES SURVERY BY THE CDC

THAT FOUND AN AGE-ADJUSTED

SERAOPREVALENCE IN NON-HISPANIC

BLACKS OF AROUND 21 PERCENT,

WITH THE HIGHEST RATES IN THE

AMERICAN SOUTH.

THE RISK FACTORS BEING LOW

HOUSEHOLD EDUCATION, POVERTY,

ELEVATED LEAD LEVELS, WHICH

WE'LL COME BACK TO, AND

TOXOPLASMOSIS AS WELL.

SO JUST LIKE PEOPLE GET EXPOSED

TO TOXOPLASMA FROM CATS, THEY'RE

GETTING EXPOSED TO TOXOCARA

CATI, THE CAT FORM.

SO THE 21 PERCENT AMONG

AFRICAN-AMERICAN POPULATIONS AT

RISK COME OUT TO BE A NUMBER OF

AROUND 2.8 MILLION

AFRICAN-AMERICANS WHO ARE

EXPOSED OR INFECTED.

WHAT'S INTERESTING IS NO ONE

QUITE UNDERSTANDS WHAT BEING

SEROPOSITIVE MEANS.

CERTAINLY IT MEANS BEING EXPOSED

TO THE PARASITE IN THE PAST.

BUT THERE'S SOME EVIDENCE THAT

SUGGESTS THAT AFTER YOU

SELFLIMIT THE INFECTION, THE

ANTIBODY TITERS GO DOWN.

SO THAT SOME PEOPLE THINK THAT

BEING SERA POSITIVE IS AN

INDICATOR OF ACTIVE INFECTION,

THAT THE LARVAE ARE ALWAYS

MIGRATING THROUGH THE LUNGS,

THEY GO THROUGH THIS PERIOD OF

DORMANCY.

SO YOU HAVE THIS LINK BETWEEN

TOXOCARA AND ASTHMA.

IN EUROPE YOU HAVE THE HIGH

PREVALENCE AMONG THE

AFRICAN-AMERICAN COMMUNITIES.

IN THE UNITED STATES THERE'S

KNOWN ASSOCIATION BETWEEN ASTHMA

AND DEVELOPMENTAL DELAYS.

WHAT'S THE CONTRIBUTION TO THIS

IN THE AFRICAN-AMERICAN

COMMUNITY?

SO, HOW MANY NIH GRANTS HAVE

BEEN GIVEN, ARE OUT ON TOXOCARA

RIGHT NOW?

[LOW AUDIO]

THAT'S RIGHT.

AS FAR AS I KNOW, IT'S ZERO.

SO AGAIN, THREE MILLION

AFRICAN-AMERICANS POSSIBLY

INFECTED.

LINK WITH ASTHMA AND

DEVELOPMENTAL DELAYS.

AND NO NIH GRANT.

SO AGAIN, THIS IS A

HYPOTHESIS-GENERATING TYPE OF

TALK.

SHOULDN'T WE BE DOING SOME

SURVEILLANCE AND DOING SOME

CLINICAL STUDIES TO LOOK AT

THIS?

TRICHOMONAS INFECTION, THE

ESTIMATES I CAME UP WITH ARE

PROBABLY LOW: 880 -- THIS IS

ANOTHER T -- 880,000 CASES AMONG

AFRICAN-AMERICAN WOMEN.

IT'S A PARASITIC

SEXUALLY-TRANSMITTED DISEASE.

AND IT LOOKS AS THOUGH

AFRICAN-AMERICAN WOMEN HAVE A

10-FOLD HIGHER PREVALENCE THAN

OTHER POPULATIONS.

SOME VERY HIGH RATES KNOWN IN

LOUISIANA, BECAUSE THERE'S A

GYNECOLOGIST INTERESTED IN

STUDYING THIS PROBLEM.

WITH THE EMERGENCE OF

METRONIDAZOLE RESISTANCE, HIGH

RATES IN NEW ORLEANS, AND THE

RISK FACTORS, AGAIN, BLACK RACE,

ETHNICITY, LOW EDUCATION LEVEL,

POVERTY.

WHAT SHE HAS FOUND IS THAT IN

NEW ORLEANS AND ELSEWHERE, THAT

WOMEN WITH TRICHOMONAS HAVE AN

INCREASED RATE OF HIV VIRAL

SHEDDING AND POSSIBLY INCREASED

SUSCEPTIBILITY AS WELL.

SO THIS MAY BE AN IMPORTANT

COFACTOR IN THE AFRICAN-AMERICAN

COMMUNITY.

CONGENITAL CYTOMEGALOVIRUS.

SO IF YOU GO INTO INSTITUTIONS

OF THE MENTALLY DISABLED, WHAT

YOU'LL SEE ARE KIDS WHO ARE

THERE BECAUSE OF HEARING LOSS

AND INTELLECTUAL DEFICITS.

AND THIS IS FROM CONGENITAL CMV

INFECTIONS, CYTOMEGALOVIRUS

INFECTION, 27,000 NEW CMV

INFECTIONS AMONG SERA-NEGATIVE

PREGNANT WOMEN EVERY YEAR.

AND THIS WAS A SHOCKER FOR ME,

WHICH IS THAT SOME STUDIES

SHOWING A 50-FOLD INCREASE IN

RISK AMONG PREGNANT

AFRICAN-AMERICAN TEENAGERS,

FOUR-FOLD INCREASE IN RISK

OVERALL, MEANING THAT WHEN YOU

GO INTO INSTITUTIONS OF THE

MENTALLY DISABLED, WHAT YOU'RE

SEEING IS LOTS OF LITTLE

AFRICAN-AMERICAN KIDS WITH

HEARING LOSS AND CONGENITAL CMV

INFECTION.

WE HAVE A VACCINE THAT'S BEEN

DEVELOPED FOR CMV.

IT'S USED FOR TRANSPLANT

PATIENTS.

WHO IS ACCELERATING USE OF THE

VACCINE FOR AFRICAN-AMERICAN

WOMEN TO PREVENT VERTICAL

TRANSMISSION?

THERE'S NOT A LOT OF, THERE'S

NOT A BIG EFFORT, A BIG PUSH

RIGHT NOW FOR THAT PURPOSE.

SO AGAIN, IT'S IN MY OPINION AN

IMPORTANT HEALTH DISPARITY.

MALE SPEAKER:

[INAUDIBLE]

DR. PETER HOTEZ:

THERE IS?

GOOD.

AND I WON'T BELABOR THIS TOO.

I JUST WANT TO GO THROUGH A

COUPLE OF MORE DISEASES.

CYSTICERCOSIS.

SOME PEOPLE SAY IT'S ONE OF THE

LEADING CAUSES OF EPILEPSY AMONG

HISPANIC-AMERICANS.

IT'S CAUSED BY A PARASITIC WORM

THAT YOU GET BY INGESTING THE

EGGS.

AND THE EGGS GIVE BIRTH TO

LARVAE THAT FORM THESE CYSTS IN

THE BRAIN.

WHAT YOU'LL HAVE IS A CHILD

COMING INTO THE EMERGENCY ROOM

IN STATUS EPILEPTICUS.

AND YOU GET THAT CHILD INTO THE

CT SCANNER, AND YOU'LL SEE THIS

RING-ENHANCING LEGION, WHICH IS

A RESULT OF INFLAMMATION AROUND

A DEAD AND DYING CYSTICERCUS.

BUT THERE'S A 1.8 SERA

PREVALENCE IN VENTURA COUNTY,

CALIFORNIA AMONG HISPANICS

LIVING THERE.

AND THESE ARE THE NUMBERS THAT I

COME UP WITH, BETWEEN 40 AND

169,000 CASES OF CYSTICERCOSIS

IN THE UNITED STATES AMONG THE

HISPANIC COMMUNITY, THAT'S

RESPONSIBLE NOW FOR ABOUT 10

PERCENT OF SEIZURES PRESENTING

TWO EMERGENCY DEPARTMENTS IN LOS

ANGELES.

SO ALL THE CITIES NEAR THE

MEXICAN BORDER, TUCSON, ARIZONA

AND PHOENIX AND SAN ANTONIO AND

HOUSTON, THIS IS NOW A MAJOR

CAUSE OF SEIZURES AND POSSIBLY

DEVELOPMENTAL DELAYS.

CHAGAS DISEASE.

THERE'S THIS PHENOMENON --

ANOTHER C -- THIS PHENOMENON OF

THE GLOBALIZATION OF CHAGAS

DISEASE, WHERE THE CDC NOW

ESTIMATES AROUND 300,000 CASES

OF CHAGAS DISEASE IN THE U.S. SO

COMING FROM PLACES LIKE BOLIVIA,

CENTRAL AMERICA, AND MEXICO.

MY NUMBERS CAME OUT WITH HUGE

CONFIDENCE INTERVALS, ANYWHERE

FROM 3,000 UP TO ONE MILLION

CASES.

THE INTERESTING FEATURES ABOUT

THIS IS THAT WE USED TO ALWAYS

SAY IT'S ONLY AN IMPORTED

DISEASE.

SO MY COLLEAGUE, SHIBA MEYMANDI,

FINDS THAT A LOT HIGH RATES OF

THIS INFECTION AMONG

UNDOCUMENTED PEOPLE COMING FROM

CENTRAL AMERICA AND MEXICO.

AND ON HER OWN, SHE STARTED A

CHAGAS DISEASE CLINIC.

SHE HAS ABOUT 50, 60 PATIENTS.

JUST OPENED THE DOORS RECENTLY

IN CHURCHES AROUND LOS ANGELES.

SO IT'S A CAUSE OF SUDDEN

CARDIAC DEATH.

IT'S A CAUSE OF WHAT PEOPLE

WOULD ORDINARILY THINK OF AS A

HEART ATTACK.

THAT'S BECAUSE A LOT OF

CARDIOLOGISTS IN THE UNITED

STATES ARE NOT TRAINED TO THINK

ABOUT CHAGAS DISEASE.

IT'S TRANSMITTED BY THIS

WONDERFUL-LOOKING KISSING BUG

HERE, WHAT LOOKS LIKE A

COCKROACH THAT FEEDS ON BLOOD,

OFTENTIMES AT NIGHT, AND

DEFECATES AS IT FEEDS.

AND CHILDREN RUB MUCOUS

MEMBRANES INTO THE EYES AND RUB

THE BUG FECES INTO THE MUCOUS

MEMBRANES OF THE EYES OR IN THE

MOUTH.

SO IT'S A DISEASE OF EXTREMELY

POOR QUALITY DWELLINGS.

WHAT'S INTERESTING NOW IS FOR

THE FIRST TIME THAT WE'RE

DESCRIBING ACTUAL TRANSMISSION

OF THIS DISEASE IN THE UNITED

STATES, IN VERY POOR QUALITY

DWELLINGS IN LOUISIANA,

MISSISSIPPI, AND TEXAS.

NOT A LOT OF CASES, ABOUT SEVEN

OR EIGHT CASES.

BUT NO ONE'S LOOKING.

SO THE POINT BEING THAT WE HAVE

THE KISSING BUGS PRESENT IN THE

UNITED STATES.

THESE ARE SOME OF THE SPECIES

THAT ARE FOUND.

WE KNOW THAT DOGS HAVE HIGH

RATES OF THIS INFECTION.

IT'S WELL KNOW THAT IN LATIN

AMERICA ZOONOTIC TRANSMISSION

OCCURS FROM DOGS.

THERE'S LIMITED PHYSICIAN

AWARENESS.

AND THIS IS A MAP GENERATED BY A

COLLEAGUE OF MINE IN VIRGINIA

TECH UNIVERSITY, WHERE HE'S

LOOKED AT WHERE SOME OF THE

TRIATOMINE SAMPLING, THESE ARE

WHERE THE KISSING BUGS ARE.

AND THE RED TRIANGLES ARE THE

CASES THAT ARE KNOWN TO HAVE

OCCURRED AMONG PEOPLE WHO'VE

NEVER LEFT THE UNITED STATES.

BUT AGAIN, THERE'S NOT AN ACTIVE

PROGRAM OF SURVEILLANCE TO MY

KNOWLEDGE OF LOOKING AT THAT THE

TRUE EXTENT OF INDIGENOUS

TRANSMISSION.

BECAUSE ONE OF THE THINGS THAT

HAPPENED WHEN I STARTED WRITING

ABOUT THESE NEGLECTED INFECTIONS

OF POVERTY IS PREDICTABLY THE

ANTI-IMMIGRANT BLOGS STARTED

LIGHTING UP.

THEY SAID, YOU KNOW, THEY WOULD

SAY, SEE, ANOTHER REASON WHY WE

SHOULD BUILD THE WALL HIGHER.

BUT THE POINT BEING THAT MOST OF

THESE DISEASES I'M TALKING ABOUT

TODAY, THERE'S ACTUALLY

TRANSMISSION IN THE UNITED

STATES.

AND SO DR. COLVERAS [SPELLED

PHONETICALLY] HAS DEVELOPED A

RISK MAP OF CHAGAS DISEASE IN

THE UNITED STATES AND HE IS

LOOKING AT SOME GLOBAL WARMING

TRENDS AS WELL.

WE'RE ACTUALLY NOW SUPPORTED BY

CARLOS SLIM [SPELLED

PHONETICALLY] TO MAKE A

RECOMBINANT CHAGAS DISEASE

VACCINE USING THESE TWO ANTIGENS

THAT GIVE HIGH RATES OF

PROTECTION.

THE PROBLEM THAT WE'RE GOING TO

FACE IS THAT WE KNOW WE NEED TO

FIND A TOXIC T LYMPHOCYTES AND

CDA-POSITIVE CELLS TO GET

PROTECTIVE IMMUNITY AND

RECOMBINANT PROTEIN ANTIGENS

TEND NOT TO BE VERY SUCCESSFUL

IN DOING THIS.

SO WE'RE LOOKING AT A NUMBER OF

OTHER TECHNOLOGY PLATFORMS.

AND ONE OF THE EXCITING PARTS

ABOUT MOVING TO TEXAS IS THAT

THERE IS A LARGE CENTER FOR

NANOTECHNOLOGY THERE ASSOCIATED

WITH RICE UNIVERSITY.

AND WE'RE NOW PUTTING THESE

ANTIGENS INTO NANOPARTICLES,

PAIRING IT WITH

POLY-[UNINTELLIGIBLE].

AND THIS IS WORK DONE, PIONEERED

BY MICHAEL HEFFERNAN [SPELLED

PHONETICALLY], WHO I THINK IS

HERE TODAY.

I SAW HIM EARLIER.

WHO'S GOING TO BE COMING DOWN

WITH US TO TEXAS?

THERE'S STILL SEEMS TO BE

STRONGYLOIDES IN APPALACHIA,

ABOUT A ONE TO FOUR PERCENT IN

THE RURAL AREAS OF APPALACHIA,

OUR ESTIMATE AROUND 60 TO

100,000 CASES.

AND OF COURSE DENGUE.

AND DENGUE NOW, AS YOU KNOW, HAS

EMERGED IN THE UNITED STATES.

WE HAVE DENGUE TYPE 2 IN SOUTH

TEXAS.

WE HAVE DENGUE TYPE 1 IN

FLORIDA.

WHAT PEOPLE ARE MOST CONCERNED

ABOUT IS THE POSSIBILITY OF THE

TWO MEETING.

BECAUSE WHEN YOU HAVE MORE THAN

ONE DENGUE SEROTYPE, YOU HAVE

THE RISK OF DENGUE HEMORRHAGIC

FEVER.

SO WHAT'S QUITE INTERESTING IS

THAT IN THE STUDIES THAT HAVE

BEEN DONE IN TEXAS AND MEXICO,

THE DENGUE IS PARTICULARLY

ASSOCIATED WITH POVERTY, SO MUCH

HIGHER PREVALENCE RATES

ASSOCIATED WITH POVERTY, LOW

FAMILY INCOME, PROBABLY BECAUSE

THEY'RE CREATING NICHES FOR THE

AEDES-AEGYPTI MOSQUITO TO BREED:

LACK OF INDOOR SCREENING, AIR

CONDITIONING, GARBAGE PICKUP.

SO WE'RE INTERESTED IN MAKING A

DENGUE RISK MAP, LOOKING AT THE

AREAS OF EXTREME URBAN POVERTY

ALONG THE GULF COAST, AND

LOOKING TO SEE WHAT THE SAMPLING

IS OF AEDES-AEGYPTI MOSQUITO TO

GET A SENSE THAT IF YOU WERE

GOING TO WORRY ABOUT THE

EMERGENCE OF DENGUE HEMORRHAGIC

FEVER, WHERE WOULD IT HAPPEN.

I MEAN, INTUITIVELY YOU WOULD

THINK NEW ORLEANS, MOBILE, AND

MAYBE HOUSTON.

BUT I THINK THAT STUDY STILL

NEEDS TO BE DONE.

SO THESE ARE JUST A COMPARISON

RATES LOOKED AT FOR SOME

NEGLECTED INFECTIONS OF POVERTY.

IT'S A PAPER CALLED "ONE WORLD

HEALTH: NEGLECTED TROPICAL

DISEASES IN A FLAT WORLD," USING

TOM FRIEDMAN'S  METAPHOR, WHERE

YOU CAN SEE THIS IS THE RATE OF

TRICHOMONAS AMONG

AFRICAN-AMERICAN COMMUNITIES IN

THE U.S. VERSUS NIGERIA.

TOXOCARA BETWEEN

AFRICAN-AMERICAN COMMUNITIES IN

THE U.S. AND NIGERIA.

JUST FOR COMPARISON I JUST

THOUGHT I'D SHOW HIV/AIDS.

THIS IS CYSTICERCOSIS IN

HISPANICS VERSUS MEXICO, STILL A

LOT LOWER, BUT OF CONCERN AND

DENGUE AS WELL.

SO WHAT ARE THE URGENT NEEDS? I

THINK WE CLEARLY NEED TO DO A

BETTER JOB ASSESSING THE

NEGLECTED DISEASE BURDEN IN THE

UNITED STATES.

THERE IS NO REAL PROGRAM OF

ACTIVE SURVEILLANCE FOR MOST OF

THESE DISEASES.

WE NEED TO DETERMINE THE EXTENT

OF TRANSMISSION IN THE UNITED

STATES.

WE KNOW THEY'RE OCCURRING, BUT

WE REALLY KNOW VERY LITTLE ABOUT

THE ECOLOGY OF THESE DISEASES.

AND THEN IMPLEMENTING SIMPLE AND

COST-EFFECTIVE PUBLIC HEALTH

SOLUTIONS: SCREENING CLINICS AND

TREATMENTS.

WHAT WE'VE NOW BEEN DOING IS

WORKING WITH REPRESENTATIVE HANK

JOHNSON OF GEORGIA, WHO THIS

YEAR HAS INTRODUCED A BILL THAT

WE HELPED TO WORK ON, CALLED THE

NEGLECTED INFECTIONS OF

AMERICA'S MOST IMPOVERISHED

AMERICANS' ACT OF 2011, FOCUSED

VERY MUCH ON THE THREE C'S AND

THE THREE T'S.

AND THERE'S NO MONEY APPENDED TO

THIS BILL, WHICH IS PROBABLY OUR

ONLY HOPE THAT IT MIGHT GO

ANYWHERE, WHICH SAYS BASICALLY

NOT LESS THAN 12 MONTHS AFTER

THE DATE OF THE ENACTMENT, THE

SECRETARY SEBELIUS SHALL REPORT

TO CONGRESS ON THE EPIDEMIOLOGY

OF, IMPACT OF, AND APPROPRIATE

FUNDING REQUIRED TO ADDRESS

NEGLECTED DISEASES OF POVERTY.

KNOWING FULL WELL THAT PROBABLY

THE DATA'S NOT THERE.

MEANING THAT THERE'S JUST NOT A

LOT OF ACTIVE SURVEILLANCE OF

THIS DISEASE.

HOPEFULLY THE REPORT WOULD COME

BACK SOMETHING TO THE EFFECT

WELL, WE THINK IT COULD BE AN

IMPORTANT PROBLEM.

AND WE KNOW THAT MARK EBERHARD,

WHO HEADS PARASITIC DISEASE AT

THE CDC, HAS BEEN WORKING REALLY

HARD TO GET SOME ATTENTION ON

THESE DISEASES FOR A NUMBER OF

YEARS. AND THEN MAYBE THEN IT

WILL LEAD TO THE NEXT STEP WHERE

SOME MONEY COULD BE AUTHORIZED

OR APPROPRIATED FOR OUR PURPOSES

OF LOOKING INTO IT.

WE HAVE A HUGE RESEARCH AND

DEVELOPMENT AGENDA; THE

DIAGNOSTICS THAT WE USE FOR THE

MOST OF THESE NEGLECTED

INFECTIONS OF POVERTY IN THE

U.S. WERE DEVELOPED IN THE

PLEISTOCENE ERA; MEANING, THAT

FOR TOXOCARIASIS, FOR INSTANCE,

THE TEST THAT'S DONE TODAY    IT

TO -- WE HAVE A COLLECTION OF

LIVING TOXOCARA LARVAE AND

COLLECT THE WORM'S SECRETORY

PRODUCTS, COLLECT THE WORM SPIT,

PUT IT ONTO AN ELISA PLATE, AND

THEN LOOK FOR ANTIBODIES.

AND SINCE NOT MANY PLACES HAVE

THE WORMS, THE CDC ONE OF THE

FEW OF THEM, THAT DOES NOT

IS NOT A TEST YOU CAN JUST SEND

OUT TO QUEST DIAGNOSTICS LABS

FOR. SO YOU HAVE TO SEND IT TO

THE CDC, SAME WITH

STRONGYLOIDES, CYSTICERCOSIS;

BUT WE REALLY DON'T HAVE MODERN

DIAGNOSTICS FOR A LOT OF THESE

CONDITIONS.

WE COULD DEVELOP THEM THROUGH

DNA AND RECOMBINANT DNA

ENGINEERING, BUT THERE'S NO

THERE'S NO SUPPORT FOR DOING

THAT --AND LOOKING FOR THE

ACCELERATED DEVELOPMENT IN NEW

DRUGS AND VACCINES: DRUGS FOR

CHAGAS DISEASE, VACCINE FOR

CHAGAS, MAYBE A TRICHOMONIASIS

VACCINE, CMV TO PREVENT

CONGENITAL INFECTION.

SO I'LL-- IT'S 3:00, AND I'LL

END THERE; AND I'LL JUST END BY

ONE OF MY FAVORITE WRITERS IS

GANDHI, WHO SAYS A CIVILIZATION

IS JUDGED BY THE TREATMENT OF

ITS MINORITIES.

YOU KNOW WHAT I'D LIKE TO SAY,

IF, YOU KNOW, WE HAD THESE RATES

OF CONGENITAL CYTOMEGALOVIRUS

AND TOXOCARA AND CYSTICERCOSIS

AMONG WEALTHY WHITE PEOPLE IN

THE SUBURBS, WE'D NEVER HEAR THE

END OF IT; IT WOULD BE ON--IT

WOULD ON SANJAY GUPTA'S PROGRAM

EVERY NIGHT; IT WOULD BE ON

OPRAH; IT WOULD BE ON, YOU KNOW,

YOU NAME IT; BUT BECAUSE THESE

DISEASES ARE CURRENTLY AMONG THE

POOREST DISENFRANCHISED PEOPLE

IN THE UNITED STATES, IT GOES

SIGHT UNSEEN.

SO, YOU KNOW, I GET VERY

FRUSTRATED WHEN I SEE THIS

OVEREMPHASIS ON THINGS LIKE

VACCINES ON AUTISM AND YOU NAME

IT, THIS OBSESSION THAT THE U.S.

PRESS HAS WHICH -- WHAT I -- IN

MY MOMENTS OF FRUSTRATION CALL

THE "IMAGINARY DISEASES OF WHITE

PEOPLE," WHEN WE HAVE THIS

INCREDIBLE SUFFERING AMONG

WHAT I THINK IS INCREDIBLE

SUFFERING; WE DON'T KNOW FOR

SURE -- AMONG HISPANIC AND

AFRICAN AMERICAN COMMUNITIES IN

THE UNITED STATES.

SO I'LL STOP THERE AND SEE IF WE

CAN TAKE A FEW QUESTIONS.

[APPLAUSE]

FEMALE SPEAKER:

THANK YOU. WE'D LIKE TO THANK

DR. HOTEZ FOR THAT WONDERFUL

PRESENTATION.

AND WHAT I'D LIKE TO DO RIGHT

NOW IS OPEN THE FLOOR FOR

QUESTIONS.

SO WE'LL TAKE QUESTIONS AT THIS

POINT.

ANDREW DO WE HAVE A MICROPHONE?

OKAY. THANK YOU.

OKAY.

DON'T BE SHY; ALL AT ONCE.

WE HAVE A QUESTION OVER HERE TO

THE LEFT, TO MY LEFT.

ILEANA HERRELL:

HELLO. I'M ILLEANA HERRELL, AND

I'M WITH NIMHD.

I HAVE TWO QUESTIONS.

ONE OF THEM IS CAN YOU TELL ME

WHAT WOULD HAPPEN IF THE

STATISTICS FOR PUERTO RICO WERE

INCLUDED WHEN LOOKING AT THE

HISPANIC AMERICAN POPULATION;

AND WOULD THERE BE DIFFERENCES

BETWEEN THE EASTERN SEABOARD

HISPANIC COMMUNITIES, PUERTO

RICO, AND THE U.S. MEXICO BORDER

COMMUNITIES?

AND THE SECOND ONE IS RELATED TO

DENGUE: WHAT WOULD HAPPEN WHEN

DENGUE IN PUERTO RICO WERE TO BE

ADDED TO THIS    TO THE

STATISTICS TO DENGUE CASES IN

THE U.S., AS WELL AS TAKING INTO

CONSIDERATION THAT ONE OF THE

PREVENTIVE TECHNIQUES THAT WERE

USED IN THE PAST IN POOR

COMMUNITIES IS NO LONGER

AVAILABLE, WHICH IS THE

INSECTICIDE SPRAYING?

DR. PETER HOTEZ:

SO THESE ARE ALL GREAT QUESTIONS

WHICH I WISH I HAD THE ANSWER

TO.

WHEN I WAS -- I'M FROM HARTFORD,

CONNECTICUT, WHICH HAS ONE OF

THE LARGEST PUERTO RICAN

POPULATIONS IN THE CONTINENTAL

UNITED STATES -- AND WHEN I WAS

AT YALE, BEFORE COMING TO

WASHINGTON, I TRIED TO DO A

TOXOCARA STUDY; AND NO QUESTION

THAT THE HIGHEST RATES OF

TOXOCARA WERE AMONG THE PUERTO

RICAN POPULATIONS IN

CONNECTICUT.

WHAT -- ONE THING I    AND THEN

WHEN YOU LOOK AT THE LEVELS OF

TOXOCARA IN PUERTO RICO, IT'S

REALLY VERY HIGH; IT'S PROBABLY

HIGHER THAN ANY STATE IN THE

UNITED STATES; SO I APPRECIATE

YOUR POINTING THAT OUT.

SO ONE OF THE THINGS I DON'T

KNOW IS, YOU KNOW, WHEN YOU

INTERVIEWED FAMILIES, YOU KNOW,

AND YOU TALKED TO THE KIDS, AND

YOU SAY, WELL, YOU KNOW, WHERE

DO YOU LIVE?

I LIVE IN HARTFORD. BUT THEY GO

VISIT "POPPY" EVERY SUMMER IN

PUERTO RICO, SO WE DON'T KNOW IF

THEY'RE GETTING THE INFECTION IN

PUERTO RICO OR WHETHER THERE'S

TRANSMISSION IN HARTFORD.

SO I THINK TOXOCARA IS A VERY

IMPORTANT ONE; DENGUE IS CLEARLY

VERY IMPORTANT.

WHAT ARE THE RATES OF

CYSTICERCOSIS AND CHAGAS IN

PUERTO RICO?

I SUSPECT LOW, BUT I DON'T KNOW.

FEMALE SPEAKER:

YOU HAVE ANOTHER QUESTION? UP

HERE.

FEMALE SPEAKER:

YOU SPOKE A LOT ABOUT THE NIH

NOT FUNDING SOME OF THESE

DISEASES, BUT WHERE DOES MOST OF

THE RESEARCH RELATED TO TROPICAL

DISEASES OCCUR?

DR. PETER HOTEZ:

OH, THE NIH DOES AN

EXTRAORDINARY JOB FUNDING

TROPICAL DISEASES, YOU KNOW, IN

TERMS OF MALARIA; AND THEY

FUNDED US, AND    BUT I DON'T

THINK THERE'S A LOT OF GRANTS

RIGHT NOW GOING FOR SOME OF THE

SPECIFIC NEGLECTED INFECTIONS OF

POVERTY IN THE UNITED STATES.

SO THE U.S.

--  THE NIH IS ONE OF THE

BIGGEST FUNDERS OF TROPICAL

DISEASES ANYWHERE IN THE WORLD,

MORE FOR BASIC RESEARCH THAN

PRODUCT DEVELOPMENT.

BUT THIS ONE -- YOU KNOW, I

THINK GLOBALLY THESE DISEASES

HAVE FALLEN THROUGH THE CRACKS A

BIT.

FEMALE SPEAKER:

HI.

I HAVE A COUPLE OF QUESTIONS,

PETER.

ONE -- IS    I BELIEVE IN THE

PAPER ABOUT NATIVE AMERICANS,

THEY REALLY DIDN'T SAY MUCH

ABOUT HISPANIC AMERICANS AND THE

HISPANIC POPULATIONS; IN FACT,

ALMOST NOTHING AT ALL. SECONDLY,

THE DATA IN THE MAPS YOU SHOWED

REALLY DIDN'T SAY MUCH ABOUT

CALIFORNIA, AND THAT SEEMS TO BE

SORT OF AN UNEXPLORED TERRITORY.

DR. PETER HOTEZ:

YEAH.

FEMALE SPEAKER:

AND, THIRDLY, YOU KNOW, THE U.S.

ARMY IS VERY INTERESTED IN THESE

DISEASES BECAUSE OF DEPLOYMENT

OF TROOPS; SO THEY'VE BEEN VERY

INTERESTED IN DENGUE AND

ARE YOU ABLE TO ENLIST THEM IN

SOME OF YOUR EFFORTS AS THE R&D

COMMAND?

DR. PETER HOTEZ:

I HAVEN'T REALLY ENGAGED DOD,

ALTHOUGH WE DO A LOT OF THINGS

WITH WALTER REED FOR OUR VACCINE

DEVELOPMENT. THEY--

FEMALE SPEAKER:

[INAUDIBLE]

DR. PETER HOTEZ:

BUT -- YEAH, I KNOW. I KNOW, BUT

FOR OUR VACCINE DEVELOPMENT

PROGRAM, THERE IS -- I DIDN'T

LIST IT HERE, BUT THERE IS A

I'M PRETTY CERTAIN THERE WAS A

HISPANIC GROUP REPRESENTED AS

WELL, AND -- BUT I HAVE TO

REMEMBER WHERE I GOT THE

DENOMINATOR FOR THE HISPANIC

POPULATIONS IN THE UNITED

STATES.                       I

THINK WHAT I REMEMBER DOING IS

DOING IT STATE BY STATE, AND

THEN PULLING IT ALL TOGETHER. SO

IT WAS HARD TO TEASE OUT THE

INFORMATION.

FEMALE SPEAKER:

I THINK WE GOT A QUESTION.

[UNINTELLIGIBLE]; IS THAT

CORRECT?

FEMALE SPEAKER:

YES.

MALE SPEAKER:

THANK YOU. I'VE HEARD THAT MUCH

OF THE DECREASE IN TROPICAL AND

INFECTIOUS DISEASES THAT YOU

SHOWED EARLY IN THE TALK IN THE

SOUTHEASTERN U.S. WAS ALSO

CULTURAL; IN ADDITION TO THE

GENERAL DECREASE IN POVERTY,

PEOPLE STARTED USING MORE

BARRIER -- MORE BARRIERS SUCH AS

SHOES, GLOVES, LONG PANTS, ET

CETERA, WHEN THEY WERE IN THE

FIELDS AND IN CONTACT WITH

INFECTIOUS AGENTS.

I WAS WONDERING IF YOU HAD AN

OPINION OF THAT [INAUDIBLE]?

DR. PETER HOTEZ:

YEAH. IT MIGHT HAVE HAD SOME

IMPACT, BUT THE FACT THAT IT

DROPPED OFF SO PRECIPITOUSLY

OVER A PERIOD OF JUST A FEW

YEARS IN THE 1930S MAKES ME

THINK THAT IT'S SOMETHING ELSE

IS GOING ON BESIDES SOMETHING

LIKE THAT.

AGAIN, IT'S AN UNKNOWN; BUT NOW

WE'VE -- WE'VE ALSO SEEN A

SIMILAR PHENOMENON IN POST WORLD

WAR II JAPAN AND KOREA, AS WELL

AS IN EASTERN CHINA NOW WHERE

YOU HAVE RAPID ECONOMIC

DEVELOPMENT, AND THEN WITH THE

RATES OF INFECTION START GOING

DOWN; AND THE TWO SEEM TO BE

MUTUALLY REINFORCING AS WELL.

ALTHOUGH, I ACTUALLY THINK

POVERTY IS THE MOST -- ONE OF

THE MOST IMPORTANT DETERMINANTS

FOR TROPICAL DISEASES; AND

ALTHOUGH PEOPLE DON'T LIKE TO

HEAR IT, I SAY POVERTY TRUMPS

CLIMATE CHANGE AND --

FEMALE SPEAKER:

I HAVE A QUESTION ABOUT THE

NATIVE AMERICAN POPULATION.

DR. PETER HOTEZ:

[AFFIRMATIVE]

FEMALE SPEAKER:

IT IS, ESPECIALLY IN THE

RESERVATIONS, ONE OF THE FEW

PLACES IN WHICH A PRETTY

COMPREHENSIVE MEDICAL CARE

SYSTEM HAS MAINTAINED IN A

POPULATION WITH EXTREME POVERTY.

DR. PETER HOTEZ:

[AFFIRMATIVE]

FEMALE SPEAKER:

AND I WONDERED IF YOU SAW ANY

DIFFERENTIATION BETWEEN CERTAIN

DISEASES THAT SEEM TO BE WELL

COMBATED BY THAT VERSUS OTHERS

THAT ARE STILL RAMPANT?

DR. PETER HOTEZ:

AND, ACTUALLY, THEY'VE ALSO

BEEN, BY FAR AND AWAY, THE BEST

STUDY BECAUSE DR. SANTOSHAM AT

JOHNS HOPKINS HAS HAD THIS

AMAZING CENTER FOR NATIVE

AMERICAN HEALTH FOR MANY YEARS

AND HAS COMPREHENSIVELY LOOKED

AT THE -- SO I COULDN'T FIND A

LOT OF INFORMATION ON THE

NEGLECTED, AND SAID "THE THREE

C'S AND THE THREE T'S."

THE ONE THING WE DID FIND

LITERATURE ON WERE HIGH RATES OF

BACTERIAL RESPIRATORY

INFECTIONS, INCLUDING

PNEUMOCOCCAL, PNEUMONIA,

HAEMOPHILUS INFLUENZAE TYPE B;

AND NOW WITH THE H.I.

--  HIB [SPELLED PHONETICALLY]

VACCINE, AN EMERGENCE OF

HAEMOPHILUS INFLUENZAE TYPE A;

BUT THAT'S SOMETHING THAT NEEDS

PROBABLY A GREATER LOOK AT.

ONE OF THE THINGS WE HAVE FOUND

IS AMONG NATIVE AMERICAN

POPULATIONS IN THE CANADIAN

ARCTIC, WE FOUND SELECTED HIGH

RATES OF FOOD-BORNE NEGLECTED

INFECTIONS OR HIGH RATES OF

TOXOPLASMOSIS, HIGH RATES OF

TRICHINELLA INFECTION; AND, IN

SOME CASES, ECHINOCOCCOSIS AS

WELL AND ASSOCIATED WITH HERDING

OF REINDEER.

SO THERE APPEAR TO BE SOME

ZOONOSIS AMONG THE INOUYE

POPULATIONS IN THE CANADIAN

ARCTIC IN ALASKA.

FEMALE SPEAKER:

DR. HOTEZ, THANK YOU FOR COMING

TO SPEAK WITH US TODAY.

I WAS CURIOUS IF YOU COULD TALK

TO THE EFFECT OF EARLY ORIGINS

OF DISEASE, ON THE EFFECT OF

NEGLECTED VIEWS OF THE HEALTH

DISPARITY.

FOR EXAMPLE, AN IMPOVERISHED

MOTHER'S POOR DIET, HOW THAT CAN

AFFECT HER UNBORN CHILD TO BE

MORE SUSCEPTIBLE TO THESE

DISEASES [UNINTELLIGIBLE].

DR. PETER HOTEZ:

WELL, WE KNOW THAT IN PLACES

LIKE SUB-SAHARAN AFRICA THAT WE

CAN GET VERY HIGH RATES OF

NEGLECTED TROPICAL DISEASES

AMONG WOMEN IN PREGNANCY; SO WE

HAVE ESTIMATED ABOUT UP TO A

THIRD OF PREGNANT WOMEN IN

SUB-SAHARAN AFRICA ARE AFFECTED

BY HOOKWORM; AND THEN WHAT YOU

GET IN PLACES LIKE AFRICA IS

WHAT I LIKE TO CALL "THE PERFECT

STORM OF ANEMIA" BECAUSE YOU GET

HOOKWORM SUPERIMPOSED ON MALARIA

WITH MALARIA CAUSING HEMOLYTIC

ANEMIA AND HOOKWORM CAUSING

INTESTINAL BLOOD LOSS.

SO THAT THE -- THESE WOMEN IN

SUB-SAHARAN AFRICA START OUT

WITH TWO STRIKES AGAINST THEM IN

THE SENSE THAT THEIR HEMOGLOBIN

COUNTS ARE ALREADY LOW, EVEN

BEFORE DELIVERY SO THAT IF

THERE'S ANY BLEEDING DURING

PREGNANCY, WHICH THERE OFTEN IS,

THIS COULD BE CATASTROPHIC SO

IT'S ASSOCIATED WITH VERY HIGH

MORBIDITY AND MORTALITY EVEN.

BUT WE DIDN'T HAVE THE

INFORMATION ABOUT THESE DISEASES

IN THE UNITED STATES TO MAKE

THOSE KINDS OF ANALYSIS.

FEMALE SPEAKER:

[INAUDIBLE] DO YOU HAVE A

QUESTION [INAUDIBLE]?

MALE SPEAKER:

SO THESE ARE RELATIVELY CONSTANT

PRESSURES IN TERMS OF THE

ENVIRONMENT, AT LEAST IN -- FOR

COMMUNITIES.

HAVE YOU -- YOU MENTIONED

EARLIER THAT YOU HAVE FOUND

SPECIFIC GROUPS, I BELIEVE IT

WAS FOR EITHER HOOKWORM OR

SCHISTOSOMIASIS, WHO HAVE

PRESENTED WITH RESISTANCE

ANTIBODIES; HAVE YOU LOOKED INTO

GENOTYPING OF SPECIFIC SMALLER

GROUPS WITHIN THIS POPULATION

FOR RESISTANCE GENES OR--

DR. PETER HOTEZ:

SO WE HAVEN'T, BUT THERE'S BEEN

A COUPLE OF GROUPS THAT HAVE.

SO ALAIN DESSEIN IN UNIVERSITY

OF MARSEILLE HAS IDENTIFIED

[UNINTELLIGIBLE] SCHISTOSOMA

HAEMATOBIUM WHAT HE THINKS COULD

BE SOME GENES, YOU KNOW

IDENTIFY SOME GENETIC LOCI.

MALE SPEAKER:

[AFFIRMATIVE]

DR. PETER HOTEZ:

--   ASSOCIATED WITH RESISTANCE;

AND ALSO SARAH WILLIAMS

BLANGERO'S GROUP AT THE

SOUTHWEST FOUNDATION, WHICH THEY

RECENTLY JUST CHANGED THEIR

NAME; I FORGET WHAT IT IS    HAS

BEEN LOOKING AT THIS FOR

INTESTINAL WORMS AS WELL.

MALE SPEAKER:

[AFFIRMATIVE]

DR. PETER HOTEZ:

-- SO THERE IS SOME GENETIC

BASIS OF IT. AND IT IS KNOWN

THAT AMONG WORMY POPULATIONS,

THAT IN ANY GIVEN WORMY

POPULATION, YOU SEE ROUGHLY 70

PERCENT OF THE POPULATION HAS

LIGHT WORM BURDENS AND ABOUT 30

PERCENT HAS MODERATE OR HEAVY

WORM BURDENS.

MALE SPEAKER:

YEAH.

DR. PETER HOTEZ:

-- AND IF YOU DEWORM THEM AND

LOOK FOR THEIR    TO GET

REACQUIRE THE INFECTIONS, THE

LIGHTLY INFECTED ONES TEND TO

REACQUIRE LIGHT INFECTIONS;

HEAVY REACQUIRE HEAVY.

THERE APPEAR TO BE SOME GENETIC

PREDISPOSITION. NOW, WHAT THE

MECHANISM IS BY WHICH THOSE

GENES ARE OPERATING IS STILL

IS STILL NOT KNOWN.

FEMALE SPEAKER:

WE HAVE A QUESTION UP HERE IN

THE MIDDLE.

FEMALE SPEAKER:

HI, PETER, THANK YOU FOR THE

TALK.

DR. PETER HOTEZ:

THANK YOU.

FEMALE SPEAKER:

YOU HAD MENTIONED -- TALKED

ABOUT THE SIGNIFICANT AMOUNT OF

FUNDING THAT'S GOING TOWARDS

MALARIA AND TB; AND NEGLECTED

TROPICAL DISEASES USUALLY DO NOT

GET THAT AMOUNT OF FUNDING FOR

TREATMENT.

AND I'M WONDERING WHETHER

PERHAPS -- I MEAN, MOST OF THESE

DISEASES ARE -- AN ARGUMENT IS

MADE FOR THE FACT THAT PERHAPS

TACKLING THE SOCIAL DETERMINANTS

DUE TO AN ECONOMIC CONDITION MAY

BE ONE OF THE PRIORITY AREA IN

WHICH TO GO TO.

HAVE YOU GOTTEN THAT ARGUMENT

SAYING THAT, YOU KNOW, YOU NEED

TO TACKLE THOSE ECONOMIC

CONDITIONS, BECAUSE A LOT OF

THIS DEALS WITH POVERTY AND POOR

SANITARY CONDITIONS.

DR. PETER HOTEZ:

RIGHT; RIGHT; RIGHT.

FEMALE SPEAKER:

-- AN UNCLEAN ENVIRONMENT, AND

--

DR. PETER HOTEZ:

NO, SURE. I MEAN, IF YOU CAN

IMPLEMENT POVERTY REDUCTION IN

ANGOLA AND DEMOCRATIC REPUBLIC

OF CONGO, THAT WOULD -- THAT

WOULD DO A TREMENDOUS AMOUNT TO

REDUCE THE RATES OF THESE

INFECTIONS. BUT THAT'S NOT

EASILY DONE, AND THAT'S

SOMETHING THAT WE HAVE A WHOLE

ORGANIZATION FOCUSED ON -- THAT

-- IT'S CALLED THE WORLD BANK

THAT'S TASKED WITH DOING THAT,

AND YOU CAN IMAGINE IT'S A

IT'S SLOW GOING AND HARD

SLOGGING.

BUT, SURE; I MEAN, SOCIAL

DETERMINANTS FOR ALL DISEASES,

INCLUDING MALARIA AND HIV/AIDS

ARE OF CRITICAL IMPORTANCE.

FEMALE SPEAKER:

YEAH; WE -- I WORK FOR NHLBI. WE

HAVE A DATABASE OF ABOUT 5,000

AFRICAN AMERICANS IN

MISSISSIPPI; AND WE HAVE

DETAILED PULMONARY FUNCTION

TESTS.

DR. PETER HOTEZ:

[AFFIRMATIVE]

FEMALE SPEAKER:

IF WE WANTED TO RUN -- I WAS

VERY INTERESTED IN WHAT YOU SAID

ABOUT TOXOCARIASIS, ESPECIALLY

IN THE RURAL SOUTH.

DR. PETER HOTEZ:

RIGHT.

FEMALE SPEAKER:

MANY OF THOSE PEOPLE GREW UP IN

THE DELTA.

WOULD I HAVE TO GO TO CDC TO GET

THE SEROLOGY DONE OF THOSE.

DR. PETER HOTEZ:

THAT'S PROBABLY WHAT YOU'D HAVE

TO DO.

FEMALE SPEAKER:

DO YOU HAVE--

DR. PETER HOTEZ:

WORK WITH PATTY WILKINS AT THE

CDC.

FEMALE SPEAKER:

   WILKINS?

DR. PETER HOTEZ:

YEAH. I MEAN, SHE'S THE ONE WHO

DID THE [UNINTELLIGIBLE]

SEROLOGY.

FEMALE SPEAKER:

OKAY.

DR. PETER HOTEZ:

   WE'RE TRYING TO -- WE'RE

TRYING TO REPRODUCE IT NOW;

WE'RE WORKING WITH HER TO

REPRODUCE IT USING A RECOMBINANT

ANTIGEN RATHER THAN USING WORM

SECRETORY PRODUCTS.

BUT THAT WOULD BE TERRIFIC TO DO

THAT, TO LOOK AT THAT SAME

POPULATION TO SEE IF YOU COULD

OVERLAY IT WITH SEROLOGY TO

TOXOCARA.

THAT'S FANTASTIC WHEN YOU CAN DO

THAT.

FEMALE SPEAKER:

OKAY. I'LL GET IN TOUCH WITH

HER. THANKS.

DR. PETER HOTEZ:

YEAH. I CAN GIVE YOU THE

CONTRACT INFO, TOO, YEAH.

FEMALE SPEAKER:

OKAY. WE'LL TAKE ONE MORE

QUESTION.

DR. PETER HOTEZ:

AND THAT'S THE KIND OF THING I

WAS HOPING, THE KIND OF FEEDBACK

I WANTED TO GET TO SAY, "OH,

YEAH, WE HAVE THIS --" AND THEN

EXACTLY, YEAH.

FEMALE SPEAKER:

THANK YOU VERY MUCH FOR A VERY

GOOD TALK.

NOW THAT THERE'S THIS NEW LINK

BETWEEN MALARIA AND HIV, WHAT

KINDS OF PRECAUTIONS DO YOU

THINK CAN BE PUT IN PLACE FOR

SUCH TRANSMISSIONS

[UNINTELLIGIBLE]?

DR. PETER HOTEZ:

[AFFIRMATIVE] I -- AND I THINK

IN SUB-SAHARAN AFRICA, THE

IMPORTANCE OF CO INFECTIONS AND

ITS ROLE IN AFRICA'S AIDS

EPIDEMIC CAN'T BE -- CAN'T BE

OVERESTIMATED.

SO MALARIA IS CLEARLY AN

IMPORTANT FACTOR IN AFRICA'S

AIDS EPIDEMIC.

AND NOW WE'RE LOOKING AT

SCHISTOSOMIASIS: THE WHOLE STORY

OF FEMALE GENITAL

SCHISTOSOMIASIS.

THERE'S ALSO NOW A NEW COCHRANE

ANALYSIS SHOWING THAT PEOPLE WHO

HAVE INTESTINAL WORMS HAVE

HIGHER VIRAL -- HIV VIRAL LOADS

AND LOWER CD4 COUNTS AS WELL, SO

THESE ARE -- AND THERE'S A

REASON WHY HIV/AIDS HAS BEEN

SPREADING THROUGHOUT SUB-SAHARAN

AFRICA; AND I -- AND I THINK

IT'S THE UNDERLYING CO

INFECTIONS HAVE TO BE AN

IMPORTANT PART OF THAT STORY.

FEMALE SPEAKER:

OKAY. WE'D LIKE TO THANK DR.

HOTEZ AGAIN FOR THAT WONDERFUL

PRESENTATION.

DR. PETER HOTEZ:

THANK YOU SO MUCH.

[APPLAUSE]

FEMALE SPEAKER:

AND I'D JUST LIKE TO REMIND

EVERYONE THAT OUR NEXT SEMINAR

IS AUGUST 24; IT WILL BE HERE IN

NATCHER AT 2 P.M.; AND THE

SPEAKER IS DR. DENNIS ANDRULIS

FROM THE UNIVERSITY OF TEXAS

SCHOOL OF PUBLIC HEALTH.

HIS PRESENTATION WILL BE ON

CULTURAL COMPETENCE AND ITS

CONTRIBUTION TO ELIMINATING

RACIAL AND ETHNIC HEALTH

DISPARITIES.

SO AS I ALWAYS SAY IN CLOSING,

PLEASE COME BACK AND VISIT US;

AND BRING TWO FRIENDS AND HAVE

THEM BRING TWO FRIENDS.

THANK YOU VERY MUCH.

[APPLAUSE]