International Notes Update: Dracunculiasis Eradication -- Worldwide, 1989

Dracunculiasis (guinea worm disease) is a disabling infection transmitted through drinking water containing cyclopoid copepods (water fleas) harboring infective larvae of the parasite Dracunculus medinensis. However, because the disease is contracted only by persons who drink contaminated water, infection can be completely prevented by providing safe sources of potable drinking water, by filtering drinking water through a cloth, by boiling the water, or by treating the water with temephos (Abate((R))).* Because transmission can be interrupted, the potential exists for eradication of guinea worm disease.

Dracunculiasis occurs in 16 African countries and in parts of India and Pakistan (Figure 1). An estimated 120 million persons in Africa and 10 million in Asia are at risk for the infection (1). An estimated 10 million persons are affected by the disease each year. This report updates the progress of international efforts to eradicate the disease in the 1990s.

Global initiatives to eradicate dracunculiasis were given impetus by resolutions adopted in April 1981 and November 1987 by the steering committee of the International Drinking Water Supply and Sanitation Decade (1981-1990). The committee called for elimination of dracunculiasis in each country with endemic dracunculiasis.** Collaborative efforts have involved several agencies and organizations, including the World Health Organization (WHO), Global 2000, Inc., of Emory University Carter Center, Inc., the United Nations International Children's Emergency Fund (UNICEF), the U.N. Development Programme (UNDP), the U.S. Peace Corps, and CDC. In May 1989, the 42nd World Health Assembly adopted a resolution calling for the elimination of dracunculiasis as a public health problem during the 1990s.

National dracunculiasis eradication programs were initiated in India in 1980, Pakistan and Ghana in 1987, and Nigeria in 1988. Benin, Burkina Faso, Cameroon, and Togo have also instituted programs to combat the disease. During 1989 and 1990, surveys to determine the extent of dracunculiasis are planned in Benin, Burkina Faso, Ghana, Mauritania, and Senegal. Repeat surveys will be carried out in India and Nigeria. Pakistan conducts monthly surveys for cases in all villages with endemic dracunculiasis. The number of cases reported by India and Pakistan suggest progress in the elimination programs in those countries (Table 1).

In July 1989, $9.6 million was pledged for dracunculiasis eradication at a donors' conference in Lagos, Nigeria. Donors included Global 2000, the Bank of Credit and Commerce International, the government of Nigeria, UNDP, and UNICEF. Support from UNDP and UNICEF will ensure that each African country with endemic dracunculiasis can conduct a national assessment of the extent of the disease and prepare, by 1991, a national plan for eradication of the disease. The U.S. Peace Corps, with support from the U.S. Agency for International Development (USAID), plans to provide up to 10 volunteers in each of 10 African countries to work on dracunculiasis eradication. More recently, the USAID mission to Ghana approved assistance for that country's dracunculiasis eradication program. WHO will convene an international meeting in Geneva during February 1990 to develop consensus criteria for certifying that transmission no longer occurs in a country formerly endemic for dracunculiasis. Reported by: WHO Collaborating Centre for Research, Training, and Control of Dracunculiasis. Global 2000, Inc, Emory University Carter Center, Inc, Atlanta, Georgia. Div of Parasitic Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Larvae of D. medinensis are liberated in the stomach or duodenum following ingestion of contaminated water. During an incubation period of approximately 1 year, the larvae develop into worms 20 cm to 120 cm in length. Emergence of the worm(s) through the skin (usually the lower part of the legs) causes severe local pain and can incapacitate the patient for 1-3 months. Although dracunculiasis rarely kills and recovery is generally complete, the disease has serious effects on the health, agricultural production, and school attendance of affected populations. No practical treatment is available.

Since early in the 20th century, human dracunculiasis has spontaneously disappeared from several countries where it was formerly endemic, e.g., Egypt and Iraq; similarly, the disease disappeared from several countries of mainland South America and the West Indies, where it was introduced during the African slave trade (2). The disease was eliminated by intervention from the southern Union of Soviet Socialist Republics in the 1930s (3) and Tamil Nadu state in India in 1984 (4). Other countries (Central African Republic, Gambia, Guinea, Iran, Saudi Arabia, Somalia, and Yemen) also have reported that the disease no longer occurs within their national territory.

Strategies required to eradicate dracunculiasis in the 1990s include the needs to: 1) conduct national epidemiologic assessments to ascertain the extent of the problem in countries with endemic dracunculiasis that have not yet done so; 2) develop national plans of action in each of the remaining countries with endemic dracunculiasis; 3) mobilize funding and other support to implement national elimination programs; and 4) enhance funding for an international headquarters to provide leadership, guidance, and coordination for national programs (Global 2000/WHO Collaborating Centre for Research, Training, and Control of Dracunculiasis, unpublished data). In addition, interventions against dracunculiasis can be integrated with other related activities, such as rural water supply projects, community development, health education, agricultural development, and primary health care.

Because the principal requirement for eradication is the provision of clean drinking water, there are no substantial technical barriers to achieving dracunculiasis eradication. However, a major problem in some countries endemic for dracunculiasis is political instability (violence and social upheaval) that disrupts traditional sanitary conditions, spreads disease to new areas, and impedes implementation of preventive measures to affected populations. Important remaining barriers to eradication may include inadequate recognition of the opportunity for eradication and insufficient funding of eradication activities.

References

1. Watts SJ. Dracunculiasis in Africa: its geographic extent, incidence, and at-risk population. Am J Trop Med Hyg 1987;37:119-25.

2. Hoeppli R. Parasitic diseases in Africa and the western hemisphere: early documentation and transmission by the slave trade. Acta Tropica 1969;(suppl 10):124-32.

3. Litvinov SK, Lysenko A. Dracunculiasis: its history and eradication in the USSR. In: National Science Foundation. Workshop on Opportunities for Control of Dracunculiasis. Washington, DC: National Science Foundation, 1982.

4. Kapali V, Sadanand AV, Prakasam J. Eradication of dracontiasis in Tamil Nadu state. J Commun Dis 1984;16:244-6. *Use of trade names is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services. **In 1980, several agencies, including the United Nations Development Programme, the World Health Organization, and the World Bank, declared 1981-1990 the "International Drinking Water Supply and Sanitation Decade." A major goal is the provision of safe drinking water to all countries.

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