Dracunculiasis eradication: intensifying surveillance amid continued zero human cases in Ethiopia and Mali

<p class="section_head1">A total of 54 human cases of dracunculiasis (guinea-worm disease) were reported to the World Health Organization (WHO) in 2019, with Chad reporting 48 out of the 54 cases.</p><p>In Chad, Ethiopia, Mali and South Sudan, trained volunteers are supporting surveillance and detection of infections in domestic dogs and cats. Surveillance has been heightened, as evidenced by the increase in reports of rumoured human cases which in 2019 peaked at 108 207 out of which 106 678 were investigated within 24 hours.</p><p><em>&ldquo;We are working with the broader scientific community to understand the epidemiology of animal infections, mainly in dogs in Chad, where the highest number of human cases were reported in 2019</em>,&rdquo; said Dr Dieudonn&eacute; Sankara, who leads WHO&rsquo;s eradication and elimination team in the Department of Control of Neglected Tropical Diseases. <em>&ldquo;Interestingly, there have been no human cases in Ethiopia and Mali, and 4 human cases in South Sudan in 2019, compared with 10 in 2018</em>.&rdquo;</p><p>In Mali, the number of animals infected with <em>Dracunculus medinensis </em>(the guinea-worm) has decreased from 20 animals in 2018 to 8 dogs and 1 cat in 2019. However, insecurity remains a challenge to freely accessing some endemic areas in Mali.</p><p>Conversely, Chad reported 1935 infections in dogs and 46 in cats in 2019, an increase of 85% from 2018, and a 176% increase among humans.</p><p>Angola reported only 1 human case in 2019. Community-based surveillance is being reinforced mainly in Cunene Province where a case was reported in 2018.</p><p>In South Sudan, integrated surveillance activities have been carried out with the trachoma and onchocerciasis control programmes, in accordance with WHO&rsquo;s recommendation that programmes collaborate, integrate and co-implement activities, whenever possible, to strengthen surveillance. </p><p>In order to strengthen cross-border surveillance, WHO led a mission to Cameroon in November 2019 to investigate circumstances around an "imported" case in the country&rsquo;s Far North Region. Discussions were held with the health authorities to establish active surveillance in all villages in the area, including training for application of temephos.<a target=”_blank” href="file:///C:/Users/tissotp/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/1MRXGCOA/DRA_MAR%202020_FINAL.docx#_ftn1" name="_ftnref1">[1]</a> &nbsp;</p><p>Also, in 2019, and with the support of trained field workers, vector control was intensified to larvicide ponds and water sources in more than 400 villages, compared with 72 villages in 2018.</p><p>In late 2019, WHO supported cross-border meetings with officials of national dracunculiasis eradication programmes from Mali, Burkina Faso and C&ocirc;te d&rsquo;Ivoire in West Africa; between Ethiopia and South Sudan in East Africa, and between Angola and Namibia in Southern Africa, to share experiences and plan joint surveillance activities across the borders to prevent transmission of the disease. <br /></p><p><strong>The disease</strong></p><p>Dracunculiasis is a crippling parasitic disease caused by infection with <em>D. medinensis</em>, a long, thread-like worm. It is usually transmitted when people drink stagnant water contaminated with parasite-infected water fleas.</p><p>WHO works with Member States and in partnership with The Carter Center and the United Nations Children’s Fund to support efforts to eradicate the disease. WHO provides technical guidance, works with national programmes to coordinate surveillance in dracunculiasis-free areas, and monitors and reports on the progress achieved.</p><p>WHO is the only Organization mandated to certify countries as free of transmission of the disease following the recommendations of the International Commission for the Certification of Dracunculiasis Eradication. </p><p>Since 1995, WHO has certified a total of 199 countries, territories and areas, including 187 Member States, as free of dracunculiasis transmission.</p><div><div id="ftn1"><p><a target=”_blank” href="file:///C:/Users/tissotp/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/1MRXGCOA/DRA_MAR%202020_FINAL.docx#_ftnref1" name="_ftn1">[1]</a> Temephos is a cyclopicide used to kill water fleas (cyclops) that carry the infective guinea-worm larvae.</p></div></div><div><p><span>&nbsp;</span></p></div>

Building Health Lab

Architect since 2002, experienced in healthcare environment design. Master in public health sciences from the Charité Medical University in Berlin. Evidence-based Design researcher at TU-Berlin, helping ensure that urban & architectural design projects build positive health effectively. Founder of the Building Health Lab. BHL Building Health Lab Is a think tank that develops urban concepts for neighborhoods as strategy to build a sustainable healthy city. Our mission is to help government, industry, and citizens develop projects with social impact that protect people and planet health. With our expertise in health and design, we support health promotion and disease management through people-centred and climate adaptive designs.