Neglected tropical diseases

Dracunculiasis eradication: WHO ready to verify Kenya and Sudan


14 June 2016 | Geneva −− Two countries that were formerly endemic for dracunculiasis (guinea-worm disease) and where no indigenous cases have been reported for more than 3 years have announced they will formally request WHO to verify interruption of transmission.

Kenya and Sudan are currently in the precertification stage, which means that both countries have reported zero cases of indigenous transmission and have maintained active surveillance for a minimum of 3 consecutive years.

We stand ready to send an International Verification Team to evaluate both Kenya and Sudan, as both countries continue to implement heightened surveillance involving thousands of health workers through integrated disease surveillance programmes” said Dr Dieudonné Sankara, who leads WHO’s dracunculiasis eradication unit. “They have a cash reward system in place, which encourages people to voluntarily come forward to report any suspected cases of guinea-worm disease.”

In 2012, Kenya increased its cash reward to 100 000 Kenyan shillings (approximately US$ 1000) to any person who reports a confirmed case. An accelerated national awareness and media campaign, focused in and around the country’s formerly endemic Trans Nzoia, Turkana and West Pokot counties, started in August 2015. Kenya’s last indigenous case occurred in 1994. Since then, not a single case has been reported. Last year, the national dracunculiasis eradication programme investigated 14 rumours. None was confirmed to be guinea-worm disease.

Sudan, which reported indigenous cases in 2013 near its border with South Sudan also plans to request WHO to send international experts to assess the adequacy of its surveillance system, review records of investigations pertaining to rumoured cases and evaluate if appropriate measures have been implemented to ensure the absence of transmission.

The announcement from both countries was made on 25 May 2016 during an informal meeting of health ministers of countries affected by dracunculiasis during the Sixty-ninth World Health Assembly (Geneva, 18–26 May 2016).

In her opening remarks, Dr Matshidiso Moeti, WHO Regional Director for Africa, spoke of the unprecedented progress achieved and the need to maintain strong political commitment until the very last case is detected and contained.

Challenges

Besides finding and containing the last remaining cases, which are the most difficult stages of the eradication process, detecting D. medinensis infection in dogs poses another challenge.

This unusual epidemiology has mainly occurred in Chad, where a large number of infected dogs are being reported. Infected dogs have also been reported in Ethiopia but to a lesser extent.

WHO and its main partners - The Carter Center and the United States Centers for Disease Control and Prevention - are working together to implement the recommendations of a March 2016 scientific meeting to address D. medinensis infection in dogs. These include:

  • conducting case–control studies of (post-containment) infected dogs, and appropriate paired controls, using novel technologies including GPS tracking and stable isotope analyses, to understand foraging, ranging and other correlates of infection risk;
  • preparing the case for a serological assay to detect D. medinensis antibodies in dogs and humans; and
  • developing and implementing serological protocols to evaluate disease transmission dynamics in dogs and humans, identify potential new areas of exposure to D. medinensis and monitor intervention responses .

Certification

Since 1995, the International Commission for the Certification of Dracunculiasis Eradication has met 11 times and, on its recommendation, WHO has certified 198 countries, territories and areas (belonging to 186 Member States) as free of dracunculiasis transmission.

Currently, the Commission comprises nine public health experts. It now meets annually to evaluate the status of transmission in countries applying for certification of dracunculiasis-free status and to recommend to WHO whether a particular country should be certified as free of transmission.

WHO is the only organization mandated to certify countries as free of transmission of the disease following the recommendations of the Commission.


Ashok Moloo

WHO/HTM/NTD
Telephone: +41 22 791 1637
Mobile phone: +41 79 540 50 86
molooa@who.int