US Gulf Coast states: The rise of neglected tropical diseases in "flyover nation"

In 2016, as Zika virus infection spread north from Brazil into Venezuela, Colombia, Central America, and the Caribbean, there were concerns that it would emerge in states on the United States Gulf Coast, especially in the urban centers of South Texas and Florida. The vulnerability of this region to Zika stemmed from the presence of recent and previous arbovirus outbreaks during the 2000s in South Texas and Florida, together with a persistent warm and subtropical climatic region with significant poverty. New mapping data indicate that population densities of the mosquito Aedes aegypti, the leading arthropod vector transmitting this virus, are highest on the Gulf Coast relative to other regions of the continental US [1]. Despite the possibility of an imminent threat of Zika virus, transmission on the Gulf Coast, and significant risks to pregnant women living in poverty, US Congressional action through emergency funding from supplemental appropriations for state and local health authorities was delayed until the fall of 2016—well past the summer, when arbovirus transmission historically is at its peak on the Gulf Coast. Zika virus transmission ensued in both South Texas and Florida, continuing through the winter months in the former. Some critics of the US Government’s lack of a timely response suggested in public testimony before congressional committees and in the media that the US Government was slow in acting because Zika mostly threatened the urban disadvantaged people living on the Gulf, a neglected population living in a “flyover nation.” This term refers to the interior of the nation ignored by a government and media biased in favor of urban centers in the Northeast, Southern California, or Silicon Valley [2]. Further analysis reveals that the US Gulf Coast is not only vulnerable to Zika but also to a range of neglected tropical diseases (NTDs). NTDs are illnesses that impact disproportionately in impoverished populations and actually perpetuate poverty because of chronic, deleterious effects on wage-earning and productivity and maternal and child health and development. Shown in Table 1 are new estimates for the most common NTDs now pervasive in the 5 US Gulf states—Texas, Louisiana, Mississippi, Alabama, and Florida—states composed of communities with the current and historically highest rates of poverty in America in a region most affected by economic declines and environmental, climate, and industrial disasters [3–12]. Parasitic and vector-borne diseases are believed to be widespread on the US Gulf Coast, but the true prevalence and incidence estimates of these conditions should be considered preliminary and based on minimally available data. For example, the Centers for Disease Control and Prevention (CDC) found through national surveys that approximately 1 in 5 African Americans is seropositive for toxocariasis, a zoonosis caused by Toxocara canis and T. cati, with people living in poverty in the southern US at greatest risk. Similarly, trichomoniasis exhibits its highest prevalence among African American women living in poverty,