4 March 1998
109 COUNTRIES NOW DRACUNCULIASIS FREE
An additional 88 countries, territories and areas were recently certified as free of Dracunculiasis transmission by the Third meeting of the International Commission for the Certification of Dracunculiasis Eradication (ICCDE). This brings to 109 the total number of countries, territories and areas now certified as being free of dracunculiasis transmission.
Held at the World Health Organization (WHO), the third meeting of the ICCDE determined that countries, such as Egypt, which had once been endemic for Dracunculiasis, also known as Guinea Worm disease, are now free of transmission.
Sustained eradication efforts now mean that local transmission has been confined to 17 countries* , 16 of which are in Africa south of the Sahara. Yemen is the last country outside of Africa which still reported cases in 1997. India was endemic up to August 1996 when it interrupted transmission and since then has reported zero cases. Kenya is currently only reporting imported cases, but the risk of renewed local transmission remains.
The disease is caused by the parasitic worm Dracunculus medinensis or "guinea worm". This round worm is the largest of the tissue parasites affecting humans. The adult female, which carries from 1 to 3 million embryos, can measure up to 1 metre in length and 2 mm across. The parasite migrates through the victim's body causing severe pain, especially in the areas around the joints. The worm eventually emerges (from the feet in 90% of cases), causing an intensely painful sore, a blister and then an ulcer. When the worm perforates the skin, intolerable pain is accompanied by fever, nausea and vomiting. Partial or total disability can last from several weeks in isolated cases up to, in most cases, several months.
The disease is transmitted through contaminated water, and nine out of ten people living in the depressed areas of Africa south of the Sahara still have nothing else to drink but meagre quantities of impure water, thus exposing themselves to serious diseases such as dracunculiasis.
Water is rare in endemic countries; a single stagnant source is often used to supply the domestic requirements of an entire community. When an infected person steps into the local water hole, the terrible burning sensation caused by the emerging worm is relieved. As well as relieving the sufferer's pain, the cool water also induces a contraction of the female worm at the base of the ulcer causing the sudden expulsion of hundreds of thousands of embryos which are ingested by a tiny crustacean - the cyclop - which become infected. Acting as an intermediate host the cyclop is absorbed by human beings as they drink the contaminated water causing the disease to perpetuate.
The major elements of the strategy adopted by WHO to eradicate Dracunculiasis include: integrated community-based surveillance systems; intensified case-containment measures; targeting of appropriate water supply systems (including filtration and chemical treatment of water) and health education.
"Guinea worm causes dreadful suffering and disability among the world's most deprived people. The disease reappears each year during the agricultural season. It affects equally children, woman and men, handicapping farmers, hampering women in their daily chores and affecting children's schooling, but we can stop this disease from being a scourge," said Dr Kazem Behbehani, Director of WHO's Division of Control of Tropical Diseases (CTD).
*Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Côte d'Ivoire, Ethiopia, Ghana, Kenya, Mali, Mauritania, Niger, Senegal, Sudan, Togo, Uganda and Yemen.
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