Death of the Guinea worm draws near

As a child in Togo, Kpandja Djawe saw his sister, several cousins and other people from his village hauled off to clinics, quarantined for weeks while meter-long worms slowly and painfully emerged from blisters on their skin. Sometimes afflicted by multiple worms, sufferers could miss months of work while they battled the debilitating bug known as the Guinea worm.

“During the infection, you have to stop working because it’s a very painful condition and you cannot do anything during that time,” said Djawe, now an epidemiologist who studies Guinea worm infections with the Centers for Disease Control and Prevention. “You cannot go to school.”

In 1986, roughly 3.5 million people in 21 countries across Africa and Asia contracted Guinea worm. That was the year The Carter Center launched a global campaign to eradicate the disease, which is spread through contaminated water. Last year, thanks largely to the efforts of the center, the CDC and the World Health Organization, there were 542 reported cases. Thus far this year, the tally is seven.

As Djawe saw over and over, the nematode ringworm Dracunculus medenisis not only ravages bodies, it alters fates and stymies economic progress.

“In many ways, it’s a social justice issue,” said Dr. Sharon Roy, head of the CDC’s WHO Collaborating Center for Research, Training, and Eradication of Dracunculiasis.

When adults in a family are unable to work or farm because of the worm, they may pull their children out of school in order to tend to those duties. And so, the cycle of poverty continues.

There is no medicine to treat the disease or vaccine to prevent it, so The Carter Center and its partners have turned to a different solution: education. They’ve taught people how to filter their drinking water and use a larvicide to kill the worm in ponds and lakes.

“If everybody had good safe drinking water, nobody would have Guinea worm disease,” Roy said.

Nematode larvae infect water fleas, and people ingest the fleas by drinking unfiltered water. The larvae then mate inside the person’s abdomen and the female worms spend the next 10 to 14 months growing to nearly a meter long.

Once fully matured, the female Guinea worm migrates to places such as an arm or leg and forms a painful, burning blister — the first clue that the human host is infected. It’s through that blister the worm emerges, a process that can take as long as a month.

Removal methods are equally horrifying. They typically involve wrapping the worm around an object such as gauze to manually extract it. (One must be careful not to sever the worm because of the risk of secondary infection inside the body.)

An important aspect of the educational campaign is teaching people who are infected not to ease their pain by bathing their blisters in ponds or lakes. That self-soothing act perpetuates the cycle of disease by introducing a fresh crop of larvae into the water, where they infect the fleas.

By 2015, The Carter Center expects to have invested roughly $375 million in the eradication project. If it succeeds, Guinea worm disease will become only the second human disease, after smallpox, to have been eliminated from the Earth.

Last year, only four countries reported cases of the illness: South Sudan, Mali, Ethiopia and Chad. South Sudan had the bulk of the cases, more than 500.

The greatest challenges remain in countries with civil or political unrest, such as South Sudan and Mali, said Dr. Donald Hopkins, The Carter Center’s vice president of health programs. He just returned from a meeting in Ouagadougou to assess Guinea worm eradication efforts.

For a country to be deemed free of the disease, it must be certified to have adequate surveillance and go three years without a reported case, he said. Hopkins believes the last few nations could qualify in the next few years, but even now success is not assured.

“As in any eradication program, it’s not over until it’s over,” he said. “There’s always potential for a setback because of bad luck or an unfavorable political development as we have in Mali,” he said.

Hopkins said the program’s success has implications for battling other diseases — and other social ills — as well.

“There’s the phenomenon that if you help people rid themselves of this infection, that’s very empowering,” he said. “Once communities have had that experience, they trust (trained health volunteers) and have more confidence in themselves to consider other things they can do.”

That can help public health officials combat more life-threatening diseases such as malaria, he said.

That’s something Djawe can appreciate. As awful as the Guinea worm is, he said, scourges such as Malaria and HIV are even more feared.

In his work as a “disease detective,” he’s had the opportunity to observe how educational efforts are paying off.

“I have noticed that people are very careful now, in terms of getting exposed to something that is going to lead to a development of disease. (To ward off) malaria, people use more mosquito nets than they did before,” he said. “And with the Guinea worm, farmers are more likely to tell you more about it than they did in the past. They’re more aware of the conditions.”

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