LAUSR

The Global Guinea Worm Eradication (Dracunculiasis) Programme has made spectacular progress since it began in the 1980’s. The numbers of individuals afflicted by Guinea Worm disease has declined from an estimated 3.5 million cases in 1986 to only 25 cases in 2016 [1,2]. The disease is caused by infection with Dracunculus medinensis and acquired by ingestion of infected water fleas, Cyclops and Mesocyclops species. The objective of the programme is the Global Eradication of the infection; WHO defines eradication as “the permanent reduction to zero of the worldwide incidence of infection caused by a specific pathogen as a result of deliberate efforts with no risk of reintroduction”. It is important to emphasise the total absence of global transmission of the infection and that no specific host is specified in the definition [3]. The programme was initiated in 1980 just before the International Water and Sanitation Decade (1981–1990) recognizing that although rare animal infections had been recorded only human hosts of D. medinensis were considered significant [4]. Animal infections have disappeared following cessation of human transmission [5]. The eradication of the infection was thus considered technically feasible using public health measures, despite the absence of any suitable medical intervention, as it was considered there was no animal reservoir. Because Guinea worm disease was not well known as a condition there was a need for advocacy to communicate the severe impact of the infection on the poorest individuals and remotest communities. Since 1986, the engagement of former U.S. President Jimmy Carter and the involvement of the Carter Center provided significant momentum for the eradication programme. The Carter Center, working with WHO, UNICEF and the United States Centers for Disease Control and Prevention (CDC) has been a critical leadership, advocacy and fund raising force which brought Guinea worm disease and the eradication programme to the attention of policy makers and eradication is now within our grasp [5,6]. The eradication programme has been based on simple principles-provision of improved water sources, use of water filtration using different types of cloth or filament filters, health education to inform populations of how the infection is acquired and can be prevented, control of the intermediate host copepod using the larvicide, Abate, (temephos), containment of cases before they have an opportunity to contaminate water sources, active surveillance in endemic or previously endemic villages, provision of rewards to increase awareness and encourage reporting and the rapid (within 24 hours) follow up of any rumours and a robust and regular reporting system [6,7]. Twenty-one countries were endemic in the 1980s. (Until South Sudan gained its independence on 9 July 2011, it was part of Sudan; thus, between the 1980s and 2011, 20 countries were endemic for the disease.) The global incidence in these countries was estimated to be 3.5 million in 1986 [1,6]. However, in 1989, almost 900,000 cases were detected by country surveys in villages in endemic countries.