29 August 2012

Guinea Worm Nears Eradication

Cases of Guinea worm are down by 50% of 2012. With just under 400 total cases and the majority concentrated in one country, South Sudan, the end appears to be near.

The decline in cases of Guinea worm has been remarkable. According to the WHO there were 3.5 million cases in 1986 which fell to 829,055 cases in 1986 and declined further to 25,217 by 2006. The rapid rate of decline continues to today and is well on its way to zero.

396 reported cases in the first half of 12 is more than half the number of cases during the same period last year. Eradication will be conferred on countries that do not have new cases for at least three years. Three countries stand on the precipice of eradication, Mali, Ethiopia and Chad, while South Sudan still has a little bit to go.

What makes Guinea worm unique is the fact that there is no vaccine. Donald Hopkins, director of health programs at the Carter Center in Atlanta, explained the challenge to the Washington Post. “In an immunization program, as soon as you vaccinate, you protect. It’s ‘touch and leave,’ ” he said. “For Guinea worm, the only thing you can do is persuade people — many who are very isolated and tradition-bound — to change their behavior.”

The Carter Center has been a leader in the campaign to eradicated Guinea worm. It started working on the under-address problem in 1986 by partnering with governments and NGOs. While it is not deadly, the worm, caught by drinking stagnant water contaminated with tiny water fleas carrying Guinea worm larvae, can cause enough damage to prevent people from functionally normally.

More specifically, the worm tends to move towards the foot inflicting significant pain. It can prevent a farmer from participating in planting crops or a child from going to school. The solutions are tied closely to development interventions such as hygiene awareness and improving access to safe water.

An important aspect of the Cater Center programs is its use of community based health workers to spread information and help to identify cases. It means that more people are being reached who would have otherwise been neglected and that the information about the number of cases is stronger than it was when eradication efforts began a quarter of a century ago.

“This is the last stage, the hardest time of all, because there are so many competing health priorities in countries battling Guinea worm,” said Sharon Roy, a CDC medical epidemiologist to the Washington Post. “When you’re getting down to just a few cases, it takes a great deal of political will to keep the momentum to get to the very last worm.”

The last mile problem is a particular challenge, but the relatively low cost of eradication, ~$375 million over the next two years, combined with the approach that maximizes coverage means that eradication may very well become a reality in the near future.