South Sudan has announced success in interrupting transmission of dracunculiasis (guinea-worm disease) in humans – more than 12 years after becoming the last country to implement the global dracunculiasis eradication programme.
Our health workers and thousands of volunteers have done exemplary work in eliminating this disease across the country, and I have no doubt that the World Health Organization will grant certification in due time.
Last month, WHO congratulated South Sudan for having reported zero human cases in 2017. If South Sudan continues to maintain zero case reporting for a period of three consecutive years, it can submit a dossier to the Organization to assess its claim of having interrupted transmission and its readiness for verification. Once this dossier is studied, WHO will send an International Certification Team to evaluate South Sudan’s claim by examining records in order to ascertain that transmission has indeed been interrupted.
Other criteria for evaluation include level of awareness of the cash reward and of the disease among the population; evidence of a strong and sustained surveillance system that has the ability to detect and respond to any case; good progress in the provision of safe sources of drinking-water; and, above all, proof of absence of transmission.
The report of the International Certification Team is reviewed by the International Commission for the Certification of Dracunculiasis Eradication (ICCDE), which then makes its recommendations to the Director-General of WHO.
Animal infection
Chad became the epicentre of a dracunculiasis outbreak in 2010 after having reported zero cases for almost a decade. Since 2012, an unusual epidemiology has been observed in dogs whereby emerging worms are found to be genetically undistinguishable from those emerging in humans. Animal infections have been detected mostly in villages along the Chari River. A few cases have also been detected in other animals (cats and baboons).
In Chad in particular, implementing more aggressive vector control alongside other eradication strategies through the treatment of all water bodies with the cyclopicide temephos in order to kill water fleas (Cyclops) that carry the infective Dracunculus medinensis larvae will be key to interrupting transmission.
According to WHO, the goal of eradicating dracunculiasis can be achieved if countries where the disease is endemic maintain robust surveillance and implement prompt control measures, awareness creation and case containment strategies.
Certification
Since 1995, the ICCDE has met 12 times and, on its recommendation, WHO has certified 199 countries1, territories and areas (belonging to 187 Member States) as free of dracunculiasis transmission. Kenya is the latest country certified by WHO in February 2018.
Only seven countries now remain to be certified. WHO is the only Organization mandated to certify countries as free of transmission following the recommendation of the ICCDE.
The disease
Dracunculiasis is a crippling parasitic disease caused by infection with D. medinensis, a long thread-like worm. Infection occurs when people drink water contaminated with parasite-infected water fleas.
In 2017, there were 30 human cases of dracunculiasis. Active transmission of human cases is occurring only in Chad and Ethiopia.
Mali, the other country endemic for the disease, has reported no human cases.
When the eradication campaign began in 1986, there were an estimated 3.5 million cases.
------------------------------
1Chad, Ethiopia and Mali are still endemic for the disease. South Sudan and Sudan are now in the precertification phase. Angola and the Democratic Republic of the Congo, which have had no history of the disease since the 1980s, also need to be certified.
