The World Health Organization (WHO) has received confirmation of a human case of dracunculiasis (guinea-worm disease) in Angola – a country not known to have had any cases in the past.
The patient is an 8-year-old girl from Cunene Province. Signs of worm emergence in April this year were characteristic of guinea-worm disease and the worm appeared identical to Dracunculus medinensis. The case-management protocol was observed, including the preservation of the worm specimen, and we are investigating further to determine the extent of transmission and burden of the disease.
The case was detected through a nationwide guinea-worm case search during the national immunization campaign against measles and rubella. The specimen was sent to the WHO Collaborating Center for Dracunculiasis Eradication at the United States Centres for Disease Control and Prevention, where a polymerase chain reaction (PCR)1 test confirmed the worm as Dracunculus medinensis2.
“This is the first confirmed case of human infection in Angola. The discovery is part of measures taken by the Ministry of Health, following a WHO evaluation mission to Angola in 2016 to assess the country’s level of readiness to finalize its dossier requesting a WHO certification,” said Dr Dieudonné Sankara, Team Leader of WHO’s guinea-worm eradication programme.
After the evaluation mission of 2016, the International Commission for the Certification of Dracunculiasis Eradication recommended that Angola should use all available opportunities to gather robust evidence of absence of guinea-worm disease in the country before submitting its certification request.
WHO supporting Angola through all its three levels
WHO is supporting Angola through all three of its operating levels – Country Office, Regional Office and Headquarters – to implement its roadmap for certification of dracunculiasis-free status.
“With the discovery of this new case, measures are being put up to strengthen surveillance, reporting and investigation of all suspicious cases through the country’s Integrated Disease Surveillance and Response,” said Dr Nzuzi Katondi, Field Officer, WHO Country Office, Angola. “Intelligence and alerts are being reported and rumours are being followed up and investigated.”
Efforts are also being made through the country’s broader mapping exercise of other neglected tropical diseases.
To achieve global certification of dracunculiasis eradication, WHO must formally certify every individual country even if no transmission has ever taken place in that particular country.
Status elsewhere
Confirmation of the first case in Angola comes as the global guinea-worm eradication programme is tackling Dracunculus medinensis infection in both humans and dogs, mainly in Chad.
From 1 January to 31 May 2018, Chad reported 3 human cases and 534 infected dogs. Ethiopia and Mali, two other countries with recent cases, reported zero human cases. South Sudan, which reported its last human case in November 2016, declared interruption of dracunculiasis transmission in March 2018.
The latest confirmation from Angola brings the global total, so far this year, to 4 human cases.
The disease
Dracunculiasis is a crippling parasitic disease caused by a long thread-like worm. The infection is transmitted mostly when people drink water contaminated with parasite-infected water fleas.
When the eradication campaign began in 1986, there were an estimated 3.5 million cases.
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1PCR is a technique used in medical and biological research laboratories. It is used in the early stages of processing DNA for sequencing, for detecting the presence or absence of a gene to help identify pathogens during infection, and when generating forensic DNA profiles from tiny samples of DNA.
2Dracunculus medinensis, a nematode (worm), is the causative agent of guinea-worm disease.