World moves closer to eradicating ancient worm disease

A neglected tropical disease that has afflicted people since ancient times has moved a step closer towards eradication. In early March, twelve more countries were declared Guinea Worm Free by the International Commission for the Certification of Dracunculiasis (Guinea Worm Disease) Eradication. If progress continues at this rate, in less than 2 years Guinea Worm could become the second disease after Smallpox to be pushed into oblivion.

In the early 1980s, an estimated 3 million people in more than 20 countries were affected by Dracunculiasis, more commonly referred to as Guinea Worm Disease. Today, that number has significantly dropped to about 25 000 cases in 9 countries. "This is the culmination of years of effort by local and international groups to see this disease eradicated," says Dr Lorenzo Savioli, Director of Neglected Tropical Diseases at the World Health Organization. Since its creation in 1995, the Commission has certified 180 countries as free of Guinea Worm . The Commission is now moving closer to its 2009 deadline for eradication of the disease worldwide.

The Sixth Meeting of the International Commission for the Certification of Dracunculiasis Eradication held 5-7 March at World Health Organization Headquarters in Geneva, brought together representatives from a range of organizations, including the Austrian government, the Carter Center, the Centers for Diseases Control and Prevention, the International Federation of Red Cross and Red Crescent Societies and UNICEF to discuss and certify 12 more countries.

In 1995, WHO created the International Commission for the Certification of Dracunculiasis Eradication as an independent body consisting of scientific experts from all over the world. The group meets periodically to assess global progress towards the eradication of Guinea Worm Disease in countries where it remains endemic and to review the list of countries applying for certification - the WHO stamp of approval that declares them free of GWD transmission.

For countless generations, people have suffered from Guinea Worm Disease (GWD). The disease was found in Egyptian mummies and is thought to be the "fiery serpent" often referred to in texts from pharaonic Egypt and Assyrian Mesopotamia.

GWD is endemic in some villages of sub-Saharan Africa. The worm is spread through contaminated water. The effects of the disease are crippling. Its victims develop large ulcers, usually in the lower leg. The ulcers swell, at times to the size of a tennis ball, and burst - releasing a spaghetti-like parasitic worm ranging in length from 550-800 millimetres (0.8 meters).

Victims experience a pain so excruciating that they say it feels as if their leg is on fire. The searing pain compels people to jump into water, often the community's only source of drinking water, to relieve the pain. When the infected person immerses their leg in the water, the worm in their leg releases thousands of larvae. The larvae are then ingested by water fleas that live in the water. Thus the cycle begins again--- when a person drinks the water, they are in effect drinking in the disease.

The socio-economic effects of the disease are numerous. The disability caused by the disease is seasonal, usually re-emerging during harvest season in the villages, which is why it is often called "the disease of the empty granary." As a result of the pain associated with GWD, farmers are left incapacitated and unable to harvest their crops, contributing to malnutrition in children since the primary caregivers, the infected parents, are in such physical agony that they cannot properly provide for their young. Children affected by GWD miss school for months at a time, hindering their educational growth. The disease keeps its victims imprisoned in a cycle of pain and poverty.

There are a number of low-cost methods to prevent people from becoming infected:

• Providing safe drinking water supplies
• Filtering drinking water using fine-mesh cloth
• Intensifying case containment (health worker can clean the ulcer, gradually pulling out the worm, disinfecting and bandaging the lesion to prevent secondary bacterial infection)
• Preventing infected persons from wading into water sources to relieve the pain
• Intensifying health education and social mobilization
• Treating ponds (water sources) with Abate (which kills the water fleas)

Eradicating GWD in the countries where it is still endemic remains the most challenging task. The Commission urged partners to endorse the need for a more aggressive approach towards the eradication of GWD pushing for a higher profile in WHO. For decades, an army of health workers from WHO and various organizations all over the world dedicated to this cause have been deployed and work round-the-clock to ensure that prevention methods are carried out and existing cases are monitored. "This disease can be arrested easily, and with a more stream-lined approach to transmission control and the priority that the Director-General has given to neglected tropical diseases, we are on our way to eradicating this disease for good," says Dr Abdul Rahman Al-Awadi, the Chairman of the International Commission.

The Commission concluded that eradication remained an achievable goal. The recent commitment of the Director-General to address the neglected tropical diseases as part of poverty-reduction strategies, giving particular attention to Africa, provides the window of opportunity desperately needed to achieve this goal.