Dracunculiasis (guinea worm disease): eradication without a drug or a vaccine

Abstract

Dracunculiasis, commonly known as guinea worm disease, is a nematode infection transmitted to humans exclusively via contaminated drinking water. The disease prevails in the most deprived areas of the world. No vaccine or medicine is available against the disease: eradication is being achieved by implementing preventive measures. These include behavioural change in patients and communities—such as self-reporting suspected cases to health workers or volunteers, filtering drinking water and accessing water from improved sources and preventing infected individuals from wading or swimming in drinking-water sources—supplemented by active surveillance and case containment, vector control and provision of improved water sources. Efforts to eradicate dracunculiasis began in the early 1980s. By the end of 2012, the disease had reached its lowest levels ever. This paper reviews the progress made in eradicating dracunculiasis since the eradication campaign began, the factors influencing progress and the difficulties in controlling the pathogen that requires behavioural change, especially when the threat becomes rare. The challenges of intensifying surveillance are discussed, particularly in insecure areas containing the last foci of the disease. It also summarizes the broader benefits uniquely linked to interventions against dracunculiasis.

Catastrophe and Conflict: Disaster Diplomacy and Its Foreign Policy Implications

“…Guinea worm is a parasite that enters people when they drink contaminated water. The eradication campaign started in the early 1980s with the key step being to provide safe drinking water, but monitoring and surveillance are important too which incorporates working with infected people to rid themselves of the parasite without re-introducing it into water supplies (Biswas et al, 2013). From the World Health Organization (http://www.who.int/dracunculiasis/en), cases are declining quickly.…”

“…Studies directly link violent and political conflict to infectious disease outbreaks (for example, Beyrer et al, 2007) including dracunculiasis (Hopkins et al, 2000). Biswas et al (2013) identify conflicts as restricting access for health workers addressing dracunculiasis and forcing people to flee the fighting, potentially bringing dracunculiasis to other locations and across international borders. They further highlight the importance of a ceasefire in Sudan, labelled as both 1995 (p. 6) and 1996 (p. 9), as being a turning point for identifying cases in that country.…”

Vaccine refusal and the endgame: walking the last mile first

“…Unlike other methods of infectious disease prevention, vaccines do not typically require drastic and costly changes in human behaviour, sanitation practices or sexual networks. Enabling the human body to defend itself is unarguably one of the most sustainable prevention methods in public health (however, also see articles on polio and guinea worm in this issue [9,10]). Among children, vaccination against common communicable diseases through the Expanded Programme on Immunization (EPI) is one of the most cost-effective, large-impact methods for global reduction of disease mortality and morbidity [11,12].…”

Neurologic manifestations of the neglected tropical diseases

“…An aggressive eradication campaign has reduced the number of cases of dracunculiasis from 3.5 million in 1988 to just 148 in four countries within 25 years [53]. This was accomplished through case containment, improved access to safe drinking water and filters for water treatment, vector control (such as treating water sources with the larvicidal temephos), and community health education [53,54]. Dracunculiasis most commonly manifests as an ulcerated blister from which the worm emerges.…”