Hookworm is thriving in impoverished and isolated parts of the southern United States

That statement might suprise you - or, like me, completely floor you. After all, Hookworm is a parasitic infection born of extreme poverty - levels of poverty that are systemic in nature rather than temporary or individualized.

Hookworm is a parasite which only spreads through direct exposure to human fecal matter. The worm has been a plague to humanity for much of history, and remains a substantial cause of physical impairment for over 400 million people around the world.

So lets dive right in. First we'll discuss the organism itself. Then we'll discuss the Southern US's history of hookworm, followed by the new research hinting at the hookworm's resurgence there.

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By any objective measure of the word, hookworms are disgusting creatures.

There are two primary species of "hookworm" that create the bulk of human infections: Ancylostoma duodenale and Necatur americanus.

Both species are parasitic organisms which live inside the digestive tract of infected humans and rely on a life cycle of infection, maturation, reproduction, defecation and re-infection in order to thrive.

Take a look at the photo above of a hookworm's life cycle. Mature hookworms lay eggs inside of the digestive tracts of infected humans. These eggs are carried in the human's feces. Once deposited by the human, the eggs hatch and develop into immature hookworms.

It is at this point that the trappings of systemic poverty come into play to assist in transmission of the parasite. The immature hookworm is capable of travelling several feet in search of bare human skin to penetrate. In a modern system of sanitation, where waste is safely transported to a central treatment facility some distance away, the hookworms never have the opportunity to encounter bare human skin. Subsequent waste treatment kills the worms or they die after some time without finding a host.

However, in areas with poor sanitation - usually involving open air communal defecation- i.e. "make sure everybody poops on the grass by the poop tree" - the hookworms have a much higher chance of encountering bare skin.

When this encounter occurs the immature hookworm pierces the host's skin - usually through the bare foot. This begins what I think is one of the most horrendous internal journeys in nature.

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 - aka "home sweet home."

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Hookworms were once endemic in the American South

For generations hookworm infections ran rampant throughout the Southern US - from Texas to the coast. One of the many symptoms of hookworm infection is an intense malaise (in addition to anemia, diarrhea, cramping, nausea and fever). At one point hookworms were so prevalent in the US south that denizens of the south gained a national reputation for laziness - a laziness caused by widespread infection with hookworm..

There was an initial assault on the hookworm problem before the civil war, involving the digging of deeper latrines and outhouses to prevent the larvae from reaching new hosts. But the civil war saw a resurgence in hookworm infections, mostly due to the destruction of infrastructure.

By 1909 they were back in a big way. It took a concerted national effort to curb the progress of hookworms in the South - including widespread treatment and public information campaigns. In the end it took another 60 to 80 years before the problem was truly under control - and that thanks to mass production of quality food stuffs and the expansion of quality plumbing and waste removal from homes.

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#A modern resurgence

Nowadays, if Americans think of hookwarm at all, they think of faraway places steeped in crushing poverty. Places like sub-saharan Africa or rural India. Conventional wisdom holds that hookworm is not a problem in the western world.

But new research has found this simply isn't true.. By studying the fecal samples of a small cross section of US citizens in rural Alabama, researchers discovered that 34% tested positive for the presence of hookworm DNA.

This coincided with repeated reports from 73% of study participants that many of them had experienced sewage backup into their homes - either into their drinking water supply or onto the floors of their homes. Some even reported seeing identifiable human feces wash up into their homes periodically due to poor plumbing and waste removal systems.

Now keep in mind that this was a small study, only 55 people were actually tested in this community. However, this may not bode well for the future of hookworm in these communities. The researchers themselves concede that the number of participants was much lower than anticipated. In part this is due to a distrust of the research team in general.

But it is also largely due to the widespread adaptation of an illegal system of waste disposal in these communities - "straight pipe" systems. A straight pipe system is exactly what it sounds like - a pipe leading out from a house which simply uses gravity to carry human waste some distance, often only a few meters, and dump it on the ground.

Many people apparently refused to participate in the study because of a fear of being penalized for using a "straight pipe" system. However, it is precisely arrangements like a straight pipe system which allows for hookworm transmission and sewage back up in the first place.

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As is often the case, this research is a beginning, not an end.

But though the scope of the hookworm problem in the rural south may not be comprehensively cataloged in this study, it certainly serves as an alarm bell that the problem is real.

Until problems of systemic waste disposal are rectified, and at risk communities are properly engaged, diagnosed and treated, hookworm will remain a problem - not only in the "developing world" but in the "developed" one as well.

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Information Source:

[1]The American Society of Tropical Medicine and Hygiene,
"Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama" Megan L. McKenna, Shannon McAtee, Patricia E. Bryan, Rebecca Jeun, Tabitha Ward, Jacob Kraus, Maria E. Bottazzi, Peter J. Hotez, Catherine C. Flowers and Rojelio Mejia
[2]CDC page on hookworm
[3]PBS Article on the history of hookworms in the Southern US
[4]Hookworm infection wikipedia article

Picture Source:

[1]See page for author [CDC Public domain], via Wikimedia Commons
[2]CDC Public Domain via wikimedia commons
[3]Public Domain via wikimedia commons
[4]Susana secretariat CC-2.0-SA via wikimedia commons