Wednesday, September 9, 2015

Guinea Worm Disease, next in line for eradication?

Guinea worm disease, caused by the parasite Dracunculus medinensis, has affected millions of people for thousands of years – it was even found in mummified remains in the pyramids of Egypt. IDM has recently helped the eradication initiative to eliminate this ancient debilitating disease and help drive D. medinensis to extinction.

Guinea worm infection occurs through drinking water contaminated larvae. Once ingested, the weeks old larvae mature inside the human host for one year, growing into a meter long worm. The female worm emerges, typically through the foot, which causes a burning sensation – thereby inducing the person to submerse their foot in water, and the annual life cycle continues. Removing the worm is excruciating and may take several weeks of gently pulling and wrapping the worm around a small stick. Infection creates no immunity to future infections, and the disease does not prefer a particular gender or age. As a result, children, cattle herders and fishermen are the most common victims since their habits and occupations result in frequently drinking stagnant water.

Thanks to funding by the Bill and Melinda Gates Foundation and efforts by The Carter Center, the CDC, the WHO, and countless local organizations, eradication of Guinea worm disease is nearly complete. Only 124 cases in 2014 and 9 so far this year have been confirmed. Further, only four countries remain classified as endemic (South Sudan, Chad, Ethiopia and Mali), and Mali has yet to report a case in 2015. Based on this progress, Guinea worm disease is poised to be the first human disease eradicated since small pox.

Challenges still remain, however. Chad has recently seen a peculiar and still not understood transmission patterns involving dogs. The possibility that dogs are involved in the transmission of Guinea worm has not been definitively ruled out. Also, the status of the disease in the DRC is unknown due to poor health care coverage and lack of Guinea worm surveillance in recent years. Discovery of Guinea worm in the DRC may result in a significant setback to the eradication timeline.

IDM’s involvement in Guinea worm disease has dealt with both financial and epidemiological aspects of the eradication effort. We have completed a comprehensive forecast of the costs of eradication which includes the potential expense of containment failures, possible delays, and issues of dogs and the DRC. We will also support the program by studying the performance of the current disease surveillance system, looking for possible improvements in sensitivity and reductions in costs. Going forward, we will continue to help as best we can the Carter Center and the other Guinea worm eradication partners.