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Out There
The Worm and I (continued)

WORMS REALLY aren't funny, of course. They infect one-fifth of the world's population, quietly sponging off their hosts. Tapeworms, for example, live in the gut and can grow up to 85 feet without calling much attention to themselves, aside from the fact that—being parasites—they steal your caloric supplies, kind of like a deadbeat neighbor tapping into your cable-TV line.

My hookworm was similarly nonlethal: A. braziliense lacks the necessary enzymes to bore deep into the human body, scientists believe. But hookworms in general are serious threats.

One species is called Necator americanus—"American killer" in Latin, so named for the damage it did in the American South after the Civil War. Necator and related hookworms have largely been eliminated from the U.S. and other industrialized nations, but they still thrive in underdeveloped countries where the climate is warm. Peter Hotez, chair of the microbiology and tropical-medicine department at George Washington University, in Washington, D.C., says hookworm infestation, then and now, is "a disease of poverty, a rural disease."

The near-invisible larvae lurk in warm, moist soil or sand, infecting their host by penetrating the skin, usually through the soles of the feet. They travel through the bloodstream to the lungs, then they're coughed up, swallowed, and wind up in the small intestine. There they suck blood, grow into adults, and produce massive amounts of eggs.

"The worm causes blood loss in the intestines," says Hotez, who is developing a hookworm vaccine in partnership with the Sabin Vaccine Institute, in New Canaan, Connecticut. Health problems get particularly nasty, he says, when people harbor "a heavy load," or between 40 and 160 worms. "When you lose enough blood, you get anemic, you experience fatigue," Hotez explains. Communities where hookworm is prevalent tend to be economically disadvantaged, at least partly because of the debilitating effects.

"I CAN'T STAND IT," my wife said. "I've never found ANYTHING IN MY LIFE SO DISGUSTING. Please, get rid of it. I'm begging you."

The worms also have terrible impacts on children, in whom a heavy load can create protein and iron deficiencies that retard growth and intellectual development. In places where walking barefoot is common but indoor plumbing is not, it's easy for kids to get infected. The eggs travel from the intestine to the ground and thrive as larvae in feces, which eventually get stepped on.

In the early 20th century, the hookworm plague in the U.S. was eradicated with help from a legendary public-health campaign led by John D. Rockefeller, the oil baron, in an effort that pounded home the virtues of sanitation. Hotez hopes to accomplish the same thing on a global scale with his vaccine, which is being heavily funded by another charitable industrialist, Bill Gates. The vaccine will be a two-stage antigen "cocktail" that triggers an immune response in the host. Clinical trials could start as early as next year.

"Hookworm is an international health problem of tremendous significance—some studies show that, in terms of numbers, only malaria causes more misery," Hotez says. But because it's primarily a Third World disease—and anti-worm vaccines and medications aren't likely to make huge profits—the drug industry hasn't paid much attention. "As with so many other diseases, there's no incentive for a drug company to make a product, and for one reason: It doesn't affect Americans."

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