Dracunculiasis

WHO certifies five more countries as free from dracunculiasis

Geneva, Switzerland
6 December 2013

The world is getting closer to becoming free from dracunculiasis (guinea-worm disease) with the decision today by WHO to certify five additional countries as free from this disease. The list now includes formerly endemic countries such as Côte d’Ivoire, Nigeria and Niger, and two others that have never reported any cases – Somalia and South Africa.

“This is the ultimate recognition of efforts led by national eradication programmes of these three formerly endemic countries and a huge public health success,” says Dr Lorenzo Savioli, Director of the Department of Control of Neglected Tropical Diseases. “This could not have been achieved without sustained, long-term commitment, the rigorous efforts of key partners and the result of a close collaboration among other disease control programmes including health education, and the provision of safe drinking-water.”

A long campaign

Since 1995, WHO has certified 197 countries, territories and areas. One of the largest and longest campaigns to eradicate dracunculiasis has been in Nigeria, which in 1988 was the most endemic country worldwide, reporting more than 650 000 cases annually from about 6000 endemic villages.

“The issue was to cover as much ground as possible, visiting 17 States, 60 local government areas and some 136 communities, therefore interviewing 1300 people,” says Professor David Molyneux, member of the International Commission for the Certification of Dracunculiasis Eradication and Leader of the International Certification Team for Nigeria. “That was really important so we got a representation, which was the representation of the geographical, ecological and environmental diversity of the country as well as the federal capital territory, which is the centre of the country where you have this mix of populations moving across the country.

We also had to face the challenge of finding a way to get into the States of the north-east while in a state of emergency, and we were very grateful to the Nigerian Red Cross who made out visit to those States actually possible.”

It took two and a half decades of committed hard work to achieve zero transmission in 2008.

A variety of health approaches including health education, the distribution, replacement and use of water filters, pond treatment with chemicals, active surveillance, advocacy events and the provision of safe drinking-water have all contributed to achieving the current status.

Furthermore, to be declared free from the disease, Nigeria had to maintain active surveillance and report zero cases for at least 3 consecutive years.

Preparing certification activities

“Surveillance is a core component of the guinea-worm eradication programme and it depends on the local teams’ effectiveness in detecting a case as early as possible and within 24 hours investigate and institute all containment measures.”

Dr Gautam Biswas, Team Leader of WHO’s dracunculiasis eradication unit.

Before embarking on field visits, the International Certification Team held briefings in Abuja with the Nigeria Guinea Worm Eradication Programme, the National Certification Commission and the Yakubu Gowon Centre.

The team developed selection criteria for the States to be visited based on data from the Federal Ministry of Health, such as previous endemicity, record of reporting, proximity to borders, and the findings and recommendations of external evaluation.

“Surveillance is a core component of the guinea-worm eradication programme and it depends on the local teams’ effectiveness in detecting a case as early as possible and within 24 hours investigate and institute all containment measures.” says Dr Gautam Biswas, Team Leader of WHO’s dracunculiasis eradication unit.

“Nigeria is a very large country in the context of sub-Saharan Africa and it depends on both the community-based surveillance, the integrated disease surveillance response system – but in addition to that they have also utilized the ongoing polio surveillance through the house-to-house surveys wherein they have also included seeking information on guinea-worm disease.“

Two separate teams led by Dr Joel Breman visited Côte d’Ivoire and Niger – the other two formerly endemic countries – that also met the criteria for certification. Both countries have reported zero indigenous cases for at least 3 consecutive years.

In Côte d'Ivoire, surveillance was stepped-up between 2007 and 2012 following political instability in the country.

During 2009 and 2013, a total of 495 rumoured cases were reported but none was confirmed as either indigenous or imported.

Niger reported its last indigenous case in 2008.

Certification of Niger follows 5 years of intense surveillance with zero indigenous cases detected.

A total of 817 rumours have been investigated over the past 3 years.

South Africa and Somalia

Somalia and South Africa – two countries that have never reported any case of guinea-worm disease – were also certified free.

To achieve global certification of dracunculiasis eradication, WHO must formally certify every individual country even if no transmission has ever taken place in that particular country.

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