A One Health Approach for Guinea Worm Disease Control: Scope and Opportunities

Abstract

Guinea worm disease (GWD) is a neglected tropical disease that was targeted for eradication several decades ago because of its limited geographical distribution, predictable seasonality, straightforward diagnosis, and exclusive infection of humans. However, a growing body of evidence challenges this last attribute and suggests that GWD can affect both humans and animal populations. The One Health approach emphasizes the relatedness of human, animal, and environmental health. We reviewed epidemiological evidence that could support the utility of a One Health approach for GWD control in the six countries that have reported human GWD cases since 2015—Angola, Cameroon, Chad, Ethiopia, Mali, and South Sudan. Human GWD cases have dramatically declined, but recent years have seen a gradual increase in human case counts, cases in new geographies, and a rapidly growing number of animal infections. Taken together, these suggest a need for an adjusted approach for eradicating GWD using a framework rooted in One Health, dedicated to improving disease surveillance and in animals; pinpointing the dominant routes of infection in animals; elucidating the disease burden in animals; determining transmission risk factors among animals and from animals to humans; and identifying practical ways to foster horizontal and multidisciplinary approaches.

Surveillance of Human Guinea Worm in Chad, 2010–2018

“… 21 , 31 Some scholars have called for a One Health approach to eradication, including the need to rigorously surveil all hosts, characterize spatial and temporal overlap of infection in all hosts, and determine risk factors for transmission from animals to humans. 31 , 32 In this analysis we explore the human epidemiology of the Guinea worm in detail without considering the full context of canine and feline hosts, largely because data about worms extracted from different hosts were collected independently, devoid of linking identifiers between datasets. Therefore, at present there is no way to accurately link human case-patients with owners of infected dogs or owners of infected dog with owners of infected cats.…”

Reaching the “Last Mile”: Fresh Approaches Needed for Guinea Worm Eradication

“…For integration and horizontalization of Guinea worm in Chad in particular, considering the constraints to passive surveillance noted by Guagliardo et al, 6 one place to start may involve training rabies vaccination teams to identify symptoms and preserve worm samples from dogs outside of areas where proactive case searches are routinely conducted. 11 In the context of a global pandemic, eradication efforts for a highly localized disease may seem like an abstract wish untethered to reality. They linger between the priorities of a global crisis and the often more pressing realities of inadequate health systems and more prevalent infectious disease threats.…”

“…For integration and horizontalization of Guinea worm in Chad in particular, considering the constraints to passive surveillance noted by Guagliardo et al, 6 one place to start may involve training rabies vaccination teams to identify symptoms and preserve worm samples from dogs outside of areas where proactive case searches are routinely conducted. 11 …”

One Health and Neglected Tropical Diseases—Multisectoral Solutions to Endemic Challenges

“…For example, in their review of rabies as a historical public health concern in India, Radhakrishnan and colleagues [ 4 ] note conflicting perspectives on the importance of animal welfare with respect to management of feral dogs, a major source of human rabies in the country. Finally, the work presented in Boyce et al [ 5 ] demonstrates how a lack of holistic understanding about transmission pathways can complicate control or prevention of a disease. In Chad, increasing numbers of Guinea worm disease cases detected in dogs pose a major obstacle for elimination of the disease in humans, although the exact pathways by which dogs are exposed and/or contribute to onward transmission is still under debate.…”

“…Similarly, toxocariasis and giardiasis are not officially recognized as NTDs by WHO, despite having many of the same characteristics and impacts, not to mention the potential benefits for increased scientific attention, funding, and prioritization that could come with being grouped with the NTDs [ 7 , 8 ]. Finally, as mentioned above, existing eradication approaches for Guinea worm disease have been focused solely on humans; recognition of its zoonotic nature is required to ensure future success [ 5 ]. We hope that these studies encourage us to re-examine the power wielded by semantics in public health, and also to think about how we might loosen the grip that official designations such as “NTD”, “endemic”, and “zoonotic” have on global health resource allocation.…”