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Dracunculiasis (Guinea-worm disease) Dracunculiasis, commonly known as Guinea-worm disease, is a parasitic infection caused by the nematode Dracunculus medinensis. The disease primarily affects humans, leading to painful symptoms as the adult female worm emerges through the skin, typically from the lower limbs. The disease is preventable and has been the target of global eradication efforts, with significant reductions in cases over recent decades. However, it remains a public health concern in certain endemic regions, particularly in parts of sub-Saharan Africa.

Background Guinea-worm disease has affected humans for millennia, with evidence of its existence dating back to ancient Egypt. The disease is caused by the parasitic worm Dracunculus medinensis, which lives in the human body for several months before emerging from the skin in a painful process. The disease primarily affects rural populations who have limited access to clean drinking water, where the parasite’s larvae are transmitted through contaminated water sources, usually from water infested with copepods (water fleas) that harbor the larvae.

Once inside the human body, the larvae mature into adult worms, which can grow up to 80 cm in length. After approximately a year, the female worm slowly emerges from the skin, usually in the lower limbs, causing intense pain and secondary infections.

Epidemiology Guinea-worm disease is endemic in parts of sub-Saharan Africa and Asia. The disease is most common in rural areas where people drink water from ponds, rivers, or wells that are contaminated with copepods, which host the larvae of the Dracunculus medinensis worm. Historically, Guinea-worm disease was widespread, with millions of cases reported each year.

In the 1980s, there were over 3.5 million cases annually. However, extensive eradication efforts led by organizations like the World Health Organization (WHO), the Carter Center, and various governments have dramatically reduced the number of cases.

As of 2021, only a few countries remain endemic, primarily South Sudan, Chad, Ethiopia, and Mali. In these regions, Guinea-worm disease is reported in limited numbers, with fewer than 15 cases annually worldwide, a stark contrast to the previous decades.

Statistics Global decline: The number of cases has decreased by more than 99% since 1986.

2019 statistics: Only 54 cases were reported worldwide, with a decline to 27 cases in 2020, and 15 cases in 2021.

Affected regions: Most cases are now confined to South Sudan, Chad, Ethiopia, and Mali.

Transmission Dracunculiasis is transmitted through the ingestion of contaminated water containing infected copepods, which are tiny water fleas. The copepods carry the larvae of the Dracunculus medinensis worm. Once a human drinks contaminated water, the larvae are released into the stomach and intestines. The larvae mature into adult worms, which can grow up to 1 meter in length.

The adult female worm then migrates to the skin, typically on the lower limbs, where it forms painful blisters. After about a year of development, the female worm slowly emerges from the skin, releasing thousands of larvae into the water source. This cycle completes itself when other people drink contaminated water.

Prevention Strategies Preventing Guinea-worm disease requires efforts to break the transmission cycle, which is heavily dependent on water sources. Key prevention strategies include:

Access to Clean Drinking Water: Providing access to safe, clean drinking water is one of the most effective measures for preventing Guinea-worm disease. This is achieved through the construction of protected wells, boreholes, and piped water systems.

Water Filtration: The use of water filters, particularly fine mesh filters, can help remove copepods from drinking water sources. Educating communities to filter their water before drinking is a vital intervention.

Health Education: Public health education is critical in raising awareness about the disease and its transmission. Communities are taught to filter water, avoid drinking from contaminated sources, and seek early treatment if they suspect they have Guinea-worm disease.

Active Case Detection and Containment: Surveillance systems monitor affected communities for new cases of Guinea-worm disease. When a case is reported, immediate measures are taken to contain it by ensuring that the affected individual does not contaminate water sources.

Eradication Campaigns: The Carter Center, WHO, and other organizations have conducted mass education and eradication campaigns, which have included house-to-house visits to identify cases and improve water sources.

Treatment There is no specific drug to kill the Guinea-worm, and treatment primarily involves manual removal of the adult worm, which is a slow and painful process. The worm is typically wound around a stick and pulled out a few centimeters per day to avoid breaking it. Other medical interventions are aimed at managing secondary infections and relieving pain.

Global Eradication Efforts The World Health Organization (WHO), the Carter Center, and other international bodies have worked together since the 1980s to eradicate Guinea-worm disease. A large part of the success has been due to the community-based approach to eradication, which involves local health workers and volunteers in the identification and monitoring of cases.

In 2018, WHO officially declared Guinea-worm disease a candidate for eradication. By 2023, the disease is expected to be eradicated if current efforts continue and case reporting remains accurate.

See Also Dracunculus medinensis

Carter Center

Eradication of Guinea-worm Disease

Zoonotic diseases

Waterborne diseases

References World Health Organization (WHO). Guinea-worm disease (Dracunculiasis). Retrieved from https://www.who.int/news-room/fact-sheets/detail/guinea-worm-disease

The Carter Center. Global Eradication of Guinea-Worm Disease. Retrieved from https://www.cartercenter.org/health/guinea_worm/index.html

Centers for Disease Control and Prevention (CDC). Dracunculiasis (Guinea-Worm Disease). Retrieved from https://www.cdc.gov/parasites/guineaworm/index.html

Richards, F., et al. (2011). Guinea worm disease: The potential for eradication. The Lancet, 378(9794), 327–335. doi: 10.1016/S0140-6736(11)61160-1

Hotez, P. J., et al. (2016). The global fight to eradicate Guinea worm disease. Global Health Action, 9(1), 1–5. doi: 10.3402/gha.v9.31453