An International Certification Team (ICT) is currently in Kenya to assess the elimination of dracunculiasis (commonly known as guinea-worm disease) in the country. The team, led by Dr Joel Breman – a veteran epidemiologist and global health expert – comprises local and international experts. The evaluation mission will last 2 weeks during which time sub-teams will examine documented details of past cases and rumours in various regions of the country.
After arriving in Nairobi last week, the team held briefings with the Kenyan Guinea Worm Eradication Programme and ministry of health officials to develop selection criteria for areas to be visited. These include previous endemicity, record of reporting, proximity to borders, and the findings and recommendations of a previous external evaluation.
“Our mandate is to evaluate the reliability of Kenya’s report by interviewing health personnel and others and by examining records at both central and peripheral levels in order to ascertain that dracunculiasis transmission has been interrupted as claimed,” said Dr Joel Breman. “Due to the relatively short duration of our visit here, our objective is to assess the quality of the surveillance programme and its overall readiness, particularly areas where the last indigenous cases occurred such as Trans Nzoia, West Pokot and Turkana – specifically in areas bordering South Sudan, refugee camps, locations which are perceived to have had poor surveillance or from where rumours were reported.”
Other criteria for evaluation include level of awareness of the cash reward and the disease among the population; evidence of a strong and sustained surveillance system that has the ability to detect and respond to any case; areas with little progress in the provision of safe sources of drinking-water and, above all, proof of absence of transmission for a period of at least 3 consecutive years.
Sustained surveillance is an important component of the global guinea-worm eradication programme. We are aware of the excellent work involving community-based surveillance and the integrated surveillance response system. In addition, response to rumoured cases has been high, including house-to-house surveys.
“We’ve made great efforts in sustaining surveillance and in educating people,” said Dr Tatu Kamau, dracunculiasis focal point at the Ministry of Health. “A cash reward has encouraged many people to come forward and notify cases. But as it’s been such a long time since we had an indigenous case, most Kenyans do not recognize this disease.”
The ICT’s visit to Kenya comes after the country submitted a dossier to WHO asserting it has met all the criteria for verification. The ICT will submit its report to the International Commission for the Certification of Dracunculiasis Eradication (ICCDE) for a final decision.
Certification
Since 1995, the ICCDE 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.
Certification and risks
Of the countries that have been recently certified, 12 are in the African risk belt for dracunculiasis. Therefore, the risk of reinfection as a result of the poor water infrastructure and high population movement across the region is rated high. The countries include Burkina Faso, Benin, Cameroon, Central Africa Republic, Côte d’Ivoire, Ghana, Mauritania, Nigeria, Niger, Togo, Uganda and Senegal. Some of them, notably Burkina Faso, Cameroon, Central African Republic, Mauritania, Nigeria, Niger and Uganda, are at very high risk of reinfection because they neighbour endemic countries or host refugees from these neighbouring endemic countries.
WHO is assisting these countries to maintain dracunculiasis surveillance through the Integrated Disease Surveillance and Response (IDSR) system. Intelligence and alerts are maintained through reviews of weekly and/or monthly IDSR reports. All rumours reported are promptly followed up and investigated.
WHO is the only organization mandated to certify countries as free of transmission following the recommendations of the ICCDE.
The disease
Dracunculiasis is a crippling parasitic disease caused by infection with Dracunculus medinensis, a long thread-like worm. Infection occurs when people drink water contaminated with parasite-infected water fleas.
In 2016, there were 26 human cases of dracunculiasis. Active transmission of human cases is occurring only in Ethiopia and Chad. From January to October this year, these two countries have reported a total of 24 cases. The other two countries endemic for the disease – Mali and South Sudan – have reported no human cases.
When the eradication campaign began in 1986, there were an estimated 3.5 million cases.