After reporting zero human cases for more than two years, Ethiopia has recorded six suspected new human cases1 of dracunculiasis (guinea-worm disease) over the past two weeks. All of them are from Gog district in the region of Gambella.
“All the six suspected new cases of infection are people who used water from farm side-ponds and all of them are now being followed-up in a containment centre2” said Dr Zeyede Kebede, Acting NTD Programme Coordinator, WHO Country Office, Ethiopia. “Four of the suspected cases were detected from Dulli farm side village and two others from two different villages namely - Metaget Dipach and Wadmaro in Gog Dipach Kebele”.
Besides the six-suspected new infection, a further 40 suspected cases are also being followed up in the Guinea Worm Case Containment Center. Furthermore, an estimated 200 households have been visited and 1254 people interviewed and provided with health education.
The Ethiopian Dracunculiasis Eradication Programme (EDEP) is scheduled to continue the larviciding of ponds in the area; further assess the utilization of filters by residents and devise a mechanism to maximize and maintain its utilization. The EDEP also plans to work with relevant stakeholders to provide safe water to the villages with suspected cases.
“Despite redeployment of health staff due to COVID-19, response to this outbreak was swift and in accordance with established protocols” said Mr Kassahun Demissie, National Programme Coordinator for Guinea Worm Eradication, Ethiopian Public Health Institute. “Preliminary investigations were carried out and immediate intervention measures taken, including active case search in seven villages where the suspected cases were detected and in nearby at-risk villages.”
Other measures that have been immediately implemented include:
- treatment of more than 41 ponds in the vicinity with the larvicide Temephos3. This is in addition to the regular cycle of larviciding of all ponds in the area;
- assessment of water filter utilization and their replacement;
- delivery of health education in all villages that were visited.
A visit is also scheduled to the region by WHO’s National Programme Officer and the acting National Coordinator from 24 April to 1 May to monitor containment and prevention activities and provide overall support as part of outbreak response.
Dracunculiasis eradication in Ethiopia
Since Ethiopia established its national dracunculiasis eradication programme in 1994 considerable progress has been made to reduce the number of human cases, with most of them focused in Gambella.
For the past decade, the region consistently reported low level transmission, including few infections in animals. In 2019, health and rural development officials in the region announced a series of measures aimed at ending transmission of dracunculiasis. It included a high-level advocacy mission led by the Federal Minister of Health and the announcement of a Board to oversee the functioning of the eradication programme in the region.
To increase the sensitivity of the surveillance system, the authorities have also introduced a cash reward for the voluntary reporting of dracunculiasis cases.
Human cases in 2019
In 2019, a total of 54 human cases were reported to WHO, with Chad reporting 48 out of the 54 cases. Chad is also reporting a high number of animal infections.
The other three countries that reported human cases last year were Angola (1 case) and South Sudan (4 cases), and Cameroon (1 case which is likely a spillover from neighbouring endemic villages in Chad). Mali, where animal infections are occurring, has not reported any human case since 2016.
The disease
Dracunculiasis is a crippling parasitic disease caused by infection with D. medinensis, a long, thread-like worm. It is usually transmitted when people drink stagnant water contaminated with parasite-infected water fleas.
During the 1980s, dracunculiasis was endemic in 20 countries.
Finding and containing the last remaining cases, particularly in settings where there are security concerns and displaced populations, are the most difficult stages of the eradication process.
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1The six cases are macroscopically consistent with guinea worm disease and are pending laboratory confirmation.
2Containment centres have been set up in chosen locations in
endemic regions of countries reporting active transmission of
dracunculiasis. The centres are equipped to provide treatment and
support to infected people to prevent them from contaminating drinking
water sources.
3Temephos is a cyclopicide. It is used to kill water fleas (cyclops) that carry the infective guinea-worm larvae.