Brazzaville, 7 April 2014 - The above headline would have been unimaginable 30 years ago when Guinea-worm disease (GWD) was robust, alive and well in much of Africa.
At the start of the Guinea -worm Eradication Progrmme in the 1980s, about 20 African countries were endemic for the disease and the world counted 3.5 million cases of GWD annually. However, in 2014, all indications are that this ancient scourge is about to be consigned to history in Africa - and planet Earth - for good!
Specifically, as at 28 February 2014, only 3 cases were recorded globally. Are the days of GWD disease numbered ?
What is Guinea-worm disease ?
GWD is a painful, debilitating disease transmitted exclusively by drinking stagnant water (e.g. from ponds, pools, open wells) contaminated with fleas that carry infective guinea-worm larvae. At maturity, the larvae can grow up to 1 metre in length.
About 10-14 months after infection, an agonizingly painful blister forms - in any part of the body, but in most cases on the lower leg and one or more worms emerge through the skin, centimetre by centimetre, causing a burning sensation and excruciating pain.
The good news is that sufferers get quick relief from the burning sensation by immersing the infected part of the body into water. However, the bad news is that the female worm contracts and bursts whenever she senses water. Up to 3 million embryos can be released into the water source to start the cycle of contamination all over again
The disease does not kill but it can incapacitate people for months on end, rendering them unable to go to school, work or farm. In some parts of Africa, it is nicknamed ìthe disease of the empty granaryî because the peak transmission period tends to coincide with farming or harvest times, preventing people from working at one of the most critical times during the agricultural year.
There is no drug to treat the disease and no vaccine to prevent infection . WHO-recommended strategies include simple and effective preventive measures including health education, provision of clean water sources, use of cloth filters, key epidemiological surveillance and response to contain each case.
Road to Eradication
Dr Francis Kasolo, Director of the Disease Prevention and Control Cluster at the WHO Regional Office for Africa traces the road to GWD eradication to May 1981 when the Inter-Agency Steering Committee for Cooperative Action for the International Drinking Water Supply and Sanitation Decade proposed the elimination of GWD. The same year, the World Health Assembly (WHA) adopted a resolution recognizing that the International Drinking Water Supply and Sanitation Decade presented an opportunity to eliminate GWD.
In 1986, the Carter Center joined WHO, UNICEF and other partners in the fight against GWD. African health ministers added their voice to the chorus with the adoption, in 1988, of a resolution to eradicate GWD by 1995. As if to give an additional push, the WHA, in 2011, called on endemic countries to expedite the interruption of transmission and enforce nation-wide surveillance to ensure eradication. The resolve to make GWD history was further strengthened by resolutions adopted in 2013 by the WHA and the WHO Regional Committee for Africa.
In December 2013, Côte d'Ivoire, Nigeria , Niger, Somalia and South Africa joined the league of countries that have been declared free of GWD by the International Commission for the Certification of Dracunculiasis Eradication (ICCDE) , an independent jury convened by WHO.
Dr Kasolo explains that ICCDE had met nine times since its establishment in 1995, and that 39 countries in the WHO African Region were now among the 197 countries and territories, including 185 WHO Member States, that have been certified as Guinea-worm free as at 6 December 2013..
He also speaks of WHOís plan for the interruption of GWD transmission in the African Region.
ìOur target for 2015 is for transmission to be interrupted in Chad, Ethiopia, Mali and South Sudan, which are currently endemic; for Angola, Ghana, Kenya and the Democratic Republic of the Congo to be certified as guinea worm-free, and for all the remaining 39 countries, having been WHO- certified, to maintain their post-certification statusî, he says.
Prospects for 2014 and beyond
WHO records show that during 2013, substantial progress was made in GWD eradication globally. The annual incidence of the disease worldwide fell by 73% (148 cases in 2013, compared to 542 cases reported during 2012).
In 2012, South Sudan (the worldís largest reservoir of the disease) saw a 78% reduction in the number of cases, from 521 cases to 113 cases in 2013. As at 28 February 2014, only 3 cases were reported in the world: 2 cases from Chad and 1 from South Sudan.
Chad, Ethiopia and Mali -- the other countries where transmission is continuing, recorded an increase in number of cases in 2013 as compared to 2012. But countries and partners are working together to address this.
Indeed, intensive epidemiological investigation and further studies are underway in Chad where over 700 villages are currently under active surveillance. In 2013, transmission was reported to continue in Ethiopiaís Gambella region and the countryís Ministry of Health is redoubling efforts to end transmission in 2014.
In sum, WHO is working with countries and partners to ensure that the four endemic countries (which happen to be in the African Region) interrupt transmission, hopefully in 2014, so that ICCDE could proceed to certify global absence of transmission.
Describing Guinea-worm as one of the most endangered species now on Earth, Dr Kasolo says:
ìOverall, prospects for eradicating the disease in 2015 are bright, as cases have been brought to a historic low. This holds promise that the disease could be the second human disease to be eradicated after smallpox, and the first without a vaccine.î
He also apportions credit for the success achieved so far: ìCredit must go to endemic countries themselves, then to the army of volunteers and the large number of health agencies and initiatives, including The Carter Center, which are working to make guinea-worm eradication a reality. WHO, for its part, has helped to shape the agenda, gather technical expertise and provide technical guidance that have paved the way for other initiatives to move towards the common goal of GWD eradicationî.
However, in eradicating GWD, the proverbial ëlast mileí may prove to be the hardest ad the longest to travel. Finishing the job will require adequate and predictable funding; a resolve to fight complacency; political will to proceed in the face of competing demands for resources and attention; high levels of readiness to deal with the last few cases; a large pool of volunteers and other determined foot soldiers to hunt down the last remaining cases, and post-certification surveillance of interruption of transmission until WHO certifies global absence of the disease.
The expectation of all is that same collaborative work and partnerships that have brought the world to the brink of eradicating GWD should eventually help make GWD history.
Technical contact:
Dr Adiele Onyeze
onyezea@who.int
tel: + 47 241 39161
Media contact:
Samuel T. Ajibola
ajibolas@who.int
tel: +47 241 39370
