{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:25:01Z","timestamp":1791599101952,"version":"4.3.4"},"reference-count":31,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11,8]]},"abstract":"<jats:p>Hookworm infection affects 430 million people worldwide, causing iron deficiency, impaired cognitive development, and stunting in children. Because of the environmental conditions needed for the hookworm life-cycle, this parasite is endemic to resource-limited countries. <jats:italic>Necator americanus<\/jats:italic> was endemic in the southern United States before improvement of sewage disposal systems and eradication programs. With continued poverty, poor sanitation, and an environment suitable for the hookworm life-cycle in some regions of the southern United States, a current prevalence study using modern molecular diagnostics is warranted. Lowndes County, Alabama, was chosen as the study site given previous high hookworm burdens, degree of poverty, and use of open-sewage systems. Participants were interviewed, and stool, serum, and soil samples were tested for nine intestinal parasites using a multiparallel quantitative real-time PCR (qPCR) and enzyme-linked immunosorbent assays. We found that, among 24 households, 42.4% reported exposure to raw sewage within their home, and from 55 stool samples, 19 (34.5%) tested positive for <jats:italic>N. americanus<\/jats:italic>, four (7.3%) for <jats:italic>Strongyloides stercoralis<\/jats:italic>, and one (1.8%) for <jats:italic>Entamoeba histolytica<\/jats:italic>. Stool tested positive for <jats:italic>N. americanus<\/jats:italic> contained low levels of parasite DNA (geometric mean 0.0302 fg\/\u03bcL). Soil studies detected one (2.9%) <jats:italic>Cryptosporidium<\/jats:italic> species, and <jats:italic>Toxocara<\/jats:italic> serology assay detected one (5.2%) positive in this population. Individuals living in this high-risk environment within the United States continue to have stool samples positive for <jats:italic>N. americanus<\/jats:italic>. Gastrointestinal parasites known to be endemic to developing countries are identifiable in American poverty regions, and areas with lower disease burden are more likely to be identified by using qPCR.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0396","type":"journal-article","created":{"date-parts":[[2017,9,6]],"date-time":"2017-09-06T07:00:32Z","timestamp":1504681232000},"page":"1623-1628","source":"Crossref","is-referenced-by-count":132,"title":["Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama"],"prefix":"10.4269","volume":"97","author":[{"given":"Megan L.","family":"McKenna","sequence":"first","affiliation":[{"name":"Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"McAtee","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia E.","family":"Bryan","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Jeun","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tabitha","family":"Ward","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Kraus","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria E.","family":"Bottazzi","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Hotez","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine C.","family":"Flowers","sequence":"additional","affiliation":[{"name":"Alabama Center for Rural Enterprise, Montgomery, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rojelio","family":"Mejia","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Int J Epidemiol","first-page":"816","article-title":"Multi-country analysis of the effects of diarrhoea on childhood stunting","volume":"37","author":"Checkley","year":"2008"},{"key":"b2","series-title":"Lancet","first-page":"1545","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990\u20132015: a systematic analysis for the Global Burden of Disease Study 2015","volume":"388","author":"GBD 2015 Disease and Injury Incidence and Prevalence Collaborators","year":"2016"},{"key":"b3","series-title":"PLoS Negl Trop Dis","first-page":"e0004922","article-title":"The global economic and health burden of human hookworm infection","volume":"10","author":"Bartsch","year":"2016"},{"key":"b4","series-title":"PLoS Negl Trop Dis","first-page":"e291","article-title":"Hookworm-related anaemia among pregnant women: a systematic review","volume":"2","author":"Brooker","year":"2008"},{"key":"b5","series-title":"Trop Med Int Health","first-page":"776","article-title":"Impact of hookworm infection and deworming on anaemia in non-pregnant populations: a systematic review","volume":"15","author":"Smith","year":"2010"},{"key":"b6","series-title":"N Engl J Med","first-page":"799","article-title":"Hookworm infection","volume":"351","author":"Hotez","year":"2004"},{"key":"b7","author":"CDC","year":"2013"},{"key":"b8","series-title":"Am J Public Health","first-page":"471","article-title":"Intestinal parasite survey in Alabama. A comparative study of two hookworm anthelmintics","volume":"27","author":"Smith","year":"1937"},{"key":"b9","series-title":"Health Aff","first-page":"1734","article-title":"How four once common diseases were eliminated from the American south","volume":"28","author":"Humphreys","year":"2009"},{"key":"b10","series-title":"Q J Econ","first-page":"73","article-title":"Disease and development: evidence from hookworm eradication in the American south","volume":"122","author":"Bleakley","year":"2007"},{"key":"b11","series-title":"Ann N Y Acad Sci","first-page":"38","article-title":"Hookworm and poverty","volume":"1136","author":"Hotez","year":"2007"},{"key":"b12","series-title":"J Med Assoc State Ala","first-page":"179","article-title":"Hookworm in Alabama","volume":"23","author":"Hosty","year":"1954"},{"key":"b13","author":"Badham","year":"1993"},{"key":"b14","series-title":"PLoS Negl Trop Dis","first-page":"e256","article-title":"Neglected infections of poverty in the United States of America","volume":"2","author":"Hotez","year":"2008"},{"key":"b15","series-title":"Am J Trop Med Hyg","first-page":"680","article-title":"Soil-transmitted helminthiasis in the United States: a systematic review-1940\u20132010","volume":"85","author":"Starr","year":"2011"},{"key":"b16","author":"ACRE","year":"2017"},{"key":"b17","author":"Winemiller","year":"2009"},{"key":"b18","author":"United States Census Bureau","year":"2010\u20132014"},{"key":"b19","series-title":"Am J Trop Med Hyg","first-page":"1041","article-title":"A novel, multi-parallel, real-time polymerase chain reaction approach for eight gastrointestinal parasites provides improved diagnostic capabilities to resource-limited at-risk populations","volume":"88","author":"Mejia","year":"2013"},{"key":"b20","series-title":"Pathog Glob Health","first-page":"238","article-title":"Prevalence of Strongyloides stercoralis in an urban USAIDS cohort","volume":"106","author":"Nabha","year":"2012"},{"key":"b21","series-title":"Parasit Vectors","first-page":"380","article-title":"Identification of human intestinal parasites affecting an asymptomatic peri-urban Argentinian population using multi-parallel quantitative real-time polymerase chain reaction","volume":"8","author":"Cimino","year":"2015"},{"key":"b22","series-title":"Can J Microbiol","first-page":"653","article-title":"Nonutility of routine testing of stool for ova and parasites in a tertiary care Canadian centre","volume":"58","author":"Mosli","year":"2012"},{"key":"b23","series-title":"Trop Biomed","first-page":"434","article-title":"Detection of selected intestinal helminths and protozoa at Hospital Universiti Sains Malaysia using multiplex real-time PCR","volume":"29","author":"Basuni","year":"2012"},{"key":"b24","series-title":"Am J Trop Med Hyg","first-page":"685","article-title":"Simultaneous detection and quantification of Ancylostoma duodenale, Necator americanus, and Oesophagostomum bifurcum in fecal samples using multiplex real-time PCR","volume":"77","author":"Verweij","year":"2007"},{"key":"b25","series-title":"Ann Pharmacother","first-page":"1992","article-title":"Manifestations, diagnosis, and treatment of Strongyloides stercoralis infection","volume":"41","author":"Segarra-Newnham","year":"2007"},{"key":"b26","series-title":"Am J Trop Med Hyg","first-page":"269","article-title":"Intestinal helminths in eastern Kentucky: a survey in three rural counties","volume":"14","author":"Fulmer","year":"1965"},{"key":"b27","series-title":"Arch Intern Med","first-page":"1257","article-title":"Clinical and epidemiologic features of strongyloidiasis. A prospective study in rural Tennessee","volume":"147","author":"Berk","year":"1987"},{"key":"b28","series-title":"Inter J Pubc Health","first-page":"15","article-title":"Toxocara infection in the United States: the relevance of poverty, geography and demography as risk factors, and implications for estimating county prevalence","volume":"56","author":"Congdon","year":"2011"},{"key":"b29","series-title":"PLoS Negl Trop Dis","first-page":"e2570","article-title":"NTDs V.2.0: \u201cBlue Marble Health\u201d-neglected tropical disease control and elimination in a shifting health policy landscape","volume":"7","author":"Hotez","year":"2013"},{"key":"b30","series-title":"PLoS Negl Trop Dis","first-page":"e0005634","article-title":"Hookworm infection is associated with decreased CD4+ T cell counts in HIV-infected adult Ugandans","volume":"11","author":"Morawski","year":"2017"},{"key":"b31","author":"Sullivan","year":"2017"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/97\/5\/article-p1623.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/97\/5\/article-p1623.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/97\/5\/article-p1623.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T22:52:18Z","timestamp":1722466338000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/97\/5\/article-p1623.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,8]]},"references-count":31,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.17-0396","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,8]]}}}