Author: Bruce Y. Lee

Three guesses on which blood suckers are costing the world somewhere between $2.5 billion to $138 billion each year. Vampires? Well, the Twilight novel and movie series portrays vampires as a bit more “emo” and “preppy” than vicious. How about vampires? No, there have been limited vampire economic studies. Vampires? No, repeating the same guess won’t make it correct.

The answer is hookworms. The numbers come from our study, which quantified the economic burden of this blood-sucking parasite across different countries and was just published in PLOS Neglected Tropical Diseases. Currently, hookworm affects approximately over 500 million people around the world (the Centers for Disease Control and Prevention (CDC) says an estimated 576-740 million people), and 5.1 billion remain at risk for getting infected. Why the range of costs? Well, every year is different and the bottom end of the range may be a very, very conservative underestimate.

Yes, hookworms suck…in many ways. They do not make good pets, roommates or party guests. Hookworms bear some resemblance to the “graboids” in the movie Tremors (you know the movie with Kevin Bacon in it). There are differences in appearance, and hookworms are much, much smaller (usually less than 1 cm long). Here’s an Animal Planet segment on hookworms:

Also, the life cycle of hookworms is different and a little more similar to the Alien movie series. Hookworms live in moist soil in warmer areas. After hookworm eggs hatch in the dirt, the larvae can burrow into your skin. For example, if you walk barefoot on soil with hookworm larvae, they may enter through your feet. The larvae then continue to burrow into your blood vessels and then ride your blood to your lungs. Then they move up your lungs through your windpipe into your throat. You then swallow the worms so that they go down into your intestines. They then lodge their mouths onto the walls of your intestines and begin sucking your blood, which they can do for years. While in your intestines, they also lay eggs (up to 30,000 per day), which can produce more hookworms. Your poop then contains hookworm eggs, which can lead to hookworm larvae that can infect others.

Here’s more trouble. People often do not know that they are infected with hookworms. You may not see blood or eggs in your stool. The steady blood sucking may make you feel weaker, more tired or abdominal pain or have difficulty thinking but these symptoms develop slowly and insidiously. Many people with hookworm infection never even see a doctor.

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In a new PLOS blog publication (link) Peter Hotez and Jennifer Herricks write about diseases that cause the most child (>5 years) deaths. Nutritional deficiencies still kill more than 200,000 young children annually, many of them from protein-energy malnutrition, but there are other causes including severe anemia that results from hookworm infection, together with other parasitic diseases. Our Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development is developing a new human hookworm vaccine in collaboration with a HOOKVAC consortium based in Europe and supported by the European Union and Dutch Government, which if successful could reduce the number of deaths from malnutrition.

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The Health Affairs posted a blog written by Peter Hotez and Remko van Leeuwen that describes the role of HOOKVAC in vaccinating against Iron-Deficiency Anemia (IDA). As they explain: “While several factors contribute to IDA, including dietary deficiencies and iron losses through menstruation and pregnancy, human hookworm infection has been identified as one of the leading causes in impoverished countries, especially in sub-Saharan Africa, Southeast Asia, and Oceania. Hookworms are parasitic worms that attach to the inside of the intestines of children and women. Hookworms are long-lived parasites, extracting blood every day to produce sufficient blood loss that results in IDA”. Read the complete blog here: http://healthaffairs.org/blog/2015/02/19/vaccinating-against-iron-deficiency-anemia-a-new-technology-for-maternal-and-child-health/

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The Delegation of European Union to India and EuropeAid have awarded partners in the HOOKVAC consortium a grant to develop a EU-India research and innovation partnership. The following objectives are part of the grant:

1. To establish an EU-India academic, cluster partnership to facilitate a long-term manufacturing partnership for the human hookworm vaccine and other NTD vaccines.
2. To transfer technology from European manufacturers to Indian manufacturers for NTD vaccines
3. To improve manufacturing methods to create efficiency and economy of scale
4. To establish a creative environment environment for joined development of new innovative and low cost vaccines for NTDs and other poverty related diseases.
5. To set-up individual mobility schemes for researchers and innovators from the HOOKVAC consortium (EU/US/ based institutes) working in research and innovation to move from the Europe cluster to India. The individual mobility schemes will be an integral component of the cluster-to-cluster partnerships.
6. To support and encourage visibility, mutual understanding and awareness for low-cost vaccine development for neglected tropical diseases via meetings and workshops.

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The Sabin Vaccine Institute (Sabin) today announced that its product development partnership (Sabin PDP) successfully completed a Phase 1 clinical trial in Brazil of Na-GST-1/Alhydrogel^®, a vaccine candidate for human hookworm, one of the most pervasive neglected tropical diseases (NTDs) affecting the world’s poor. The Sabin PDP is based at Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development at Baylor College of Medicine in Houston, Texas. …read the whole press release here

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As some of the world’s most urgent health threats, diseases such as polio, Ebola and influenza have of late received much publicity. Nevertheless, recent studies reveal that anaemia is also emerging as a worrying health disparity, especially among women and children living in poverty. Although perhaps not as dramatic as the infections mentioned above, anaemia has been shown to have devastating and long-term effects on childhood cognition and intellect, and to increase the risk of maternal morbidity and mortality.

Remko van Leeuwen, Martin Grobusch and Peter Hotez briefly explain why the HOOKVAC programme is now needed more than ever in the article [pdf] Tackling hookworm head-on published in ‘[pdf] Progress through Partnership: The UvA and Africa‘.

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Read more on this story from the Huffingtonpost.

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Hookworm

A new study published in Nature Genetics, led by a team of researchers at the Washington University School of Medicine in St. Louis, reveals that the hookworm’s genome has been decoded.  These new developments will greatly aid scientists dr. Peter Hotez and dr. Bin Zhan at the Sabine Vaccine Institute, who focus on how different hookworm genes are responsible for invading humans, feeding on human blood and bypassing the host’s immune system. These findings have the potential to lead to new advancements and are welcome given how human hookworm, a neglected tropical disease (NTD), plagues nearly 700 million of the world’s poorest people. [Read More at the Sabine Vaccine Institute Blog]

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HOOKVAC will be developing the first and only vaccine for human hookworm infection. A bivalent, low-cost vaccine candidate will be clinically tested for the first time in an African disease endemic population. This will be done in Gabon in a very typical setting within the Central African rainforest belt, where the incidence of hookworm infections is 30%. Inspired by preparatory research, HOOKVAC believes that it can develop the vaccine with at least 80% efficacy against moderate and heavy hookworm infections that lasts at five years after immunization. Cost effectiveness modelling has shown that such a vaccine will significantly improve the efficacy of the current mass drug administration programs. HOOKVAC will play a crucial role in advancing toward large scale efficacy studies in African endemic areas.

Read more about the Human Hookworm Vaccine Project.

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