Correspondence

Hookworm Infection

N Engl J Med 2005; 352:205January 13, 2005

Article

To the Editor:

Hotez et al. (Aug. 19 issue)1 suggest waiting for socioeconomic reforms to eliminate hookworm infection, a condition that afflicts 740 million persons. However, chronic anemia is an enormous handicap and limits the prospects of a better future. We should remember that the fight against hookworm infection began before the economic development of the southern United States in a large-scale philanthropic effort supported by the Rockefeller Foundation. In 1902, Dr. Charles Stiles stated that the poor whites of the South, long considered lazy, were simply enervated by hookworm infection and that “thymol and Epsom salts [magnesium sulfate] would make those men useful citizens in a few weeks.”2 In less than three years, the money ($1 million) used to hire sanitation directors to educate the public and to introduce dispensaries for public health reduced hookworm disease to a minor infection. More important, the locals set up mechanisms to perpetuate the work, and the foundation extended the fight to 52 other countries around the world. Sub-Saharan Africa might benefit from this experience.

Jorge Joven, M.D., Ph.D.
Hospital Universitari de Sant Joan, 43201 Reus, Spain
jjoven@grupsagessa.com

2 References

1. 1

   Hotez PJ, Brooker S, Bethony JM, Bottazzi ME, Loukas A, Xiao S. Hookworm infection. N Engl J Med 2004;351:799-807
   Full Text | Web of Science | Medline

2. 2

   Chernow R. Titan: the life of John D. Rockefeller, Sr. New York: Random House, 1998:487-91.
   

Author/Editor Response

Dr. Joven makes the important, and often underappreciated, point that waiting for long-term socioeconomic reforms to control hookworm infection is not a viable option. It was partly for this reason that the World Health Organization implemented its resolution to reduce morbidity from soil-transmitted helminth infections, including hookworm, through large-scale anthelmintic chemotherapy programs. The programs will be largely school-based in order to target schoolchildren at risk for infection. For reasons discussed in our article, we believe that this approach may not, by itself, control hookworm infection worldwide and that new and complementary tools will probably be required, which may include a first-generation recombinant anthelmintic vaccine.1

Peter J. Hotez, M.D., Ph.D.
George Washington University, Washington, DC 20037
mtmpjh@gwumc.edu

Simon Brooker, D.Phil.
London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom

Jeffrey Bethony, Ph.D.
George Washington University, Washington, DC 20037

1 References

1. 1

   Hotez PJ, Zhan B, Bethony JM, et al. Progress in the development of a recombinant vaccine for human hookworm disease: the Human Hookworm Vaccine Initiative. Int J Parasitol 2003;33:1245-1258
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   Aditya Reddy, Bernard Fried. (2009) An update on the use of helminths to treat Crohn’s and other autoimmunune diseases. Parasitology Research 104:2, 217-221
   CrossRef