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

Neglected tropical diseases (NTDs) affect over one billion people worldwide. Although these diseases are most prevalent 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 there is limited information available on existing state operational policies and programs. 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, which 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 soiltransmitted helminths. Differences in types of surveillance systems were also found between each disease and each state. Results highlighted 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 could reduce inconsistencies in reporting and prevent missed cases of NTDs in high-risk US populations. Additionally, greater domestic prioritization of NTD management should not compromise US support for international NTD control efforts, but rather should be leveraged to demonstrate greater US commitment and solidarity with partner countries.