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Research Articles

Vol. 4 No. 1 (2024): GSRJ Spring 2024

Assessment of State-level Operational Policies and Programs for Selected Neglected Tropical Diseases (NTDs) in the United States

August 29, 2023




Neglected tropical diseases (NTDs) affect over one billion people worldwide. Although the prevalence of these diseases are concentrated in low- and middle-income countries, especially in tropical and subtropical regions, they can also affect vulnerable individuals and communities within high-income countries including the United States (US).  Past research on NTDs in the US suggests that there is an unmet need for diagnosis and treatment within at-risk populations and limited information on existing operational policies and programs is publicly available. 


Methodology/Principle Findings: 

This study aimed to analyze state-level operational policies and programs for five NTDs previously reported in the US and known to have local transmission: Chagas disease, cysticercosis, soil-transmitted ​​helminthiasis, dengue, and rabies. Departments of Health in 34 states considered to be at higher risk of these NTDs were contacted to ascertain willingness to provide information on policies and programs related to surveillance, notification, diagnosis, and treatment of each of these five diseases. Thirteen state departments of health completed a questionnaire. 

Responses show substantial variations between states.  A majority of states reported operational policies in place for dengue and rabies, focused on mandated health provider-to-state reporting as well as guidelines or recommendations on screening, testing, and treatment. State policies and guidelines were less consistently reported for Chagas disease and cysticercosis and only one state reported any surveillance efforts for soil-transmitted helminths. Differences in types of surveillance systems were also found between each disease and each state. Results highlight the fragmentation of the US public health system with respect to NTD management.


Variability in state policies and reporting in addition to lack of active surveillance hinders the accurate measurement of NTD prevalence in the US and as a result, limits the equitable and appropriate distribution of resources. The creation of consistent policy guidelines will reduce inconsistencies in reporting and possibly prevent missed cases of NTDs in high-risk US populations. Greater domestic engagement and prioritization in NTD management should not compromise US support for international NTD control efforts, but rather could be leveraged to demonstrate greater US commitment and solidarity with partner countries.