GUINEA WORM ERADICATION

Wednesday, 16th of May 2012

GUINEA WORM ERADICATION

Full text is at http://www.who.int/wer/2012/wer8719.pdf

Editorial noteThe percentage reduction in the annual incidence of cases from the previous year is encouraging but efforts need to be further accelerated as noted by the WHA to reach the goal of eradication at the earliest. While the foci of transmission are further localized, the identification of transmission sources in these last remaining areas remains a challenge due to population movements, temporary and mobile settlements such as cattle camps and insecurity.

One of the primary reasons for not meeting the criteria of containment in 2011 was the delay in detection of the cases within 24 hours of emergence of worms. To ensure all cases of dracunculiasis are detected within 24 hours of worm emergence and preferably at the blister stage, all available opportunities in addition to the integrated disease surveillance that may be available for surveillance – including community-based, schoolbased and other field-based programmes like polio surveillance or large-scale preventive chemotherapy or screening campaigns – should be utilized in a coordinated manner.

The information on the reward scheme should be more widely publicized. Once a case is detected, all efforts should be made to contain the case completely including the application of temephos in the drinking-water sources that are likely to have been contaminated by the patient. Districts (including those across national borders near areas where cases are still being reported) need to be on high alert against importation of dracunculiasis cases. Regular exchange of information on occurrence of cases or movement of population across the border including joint investigations should be undertaken.

Each case needs to be thoroughly investigated epidemiologically to identify its source of transmission and intensify the interventions for its containment. Periodic focal and sometimes widespread insecurity, especially in Chad, Ethiopia, Mali and South Sudan, remain the only constraints beyond the scope of eradication programmes for surveillance and interrupting transmission in these foci. In addition, there is an urgent need to supply adequate safe drinking-water to communities in which the disease is endemic.

Eventual certification of countries will be based on the evidence that an optimal surveillance system is in place, able to detect any case of dracunculiasis. Countries need to emphasize the importance of keeping records of programme interventions as well as surveillance data including reporting of zero dracunculiasis cases as areas and countries become free of the disease.