WHO certifies seven more countries as free of guinea-worm disease
22 December 2009 | Geneva
22 December 2009 | Geneva
Heightened surveillance required as eradication efforts accelerate
The World Health Organization (WHO) has certified seven more countries as being free of guinea-worm disease (dracunculiasis). This brings the number of countries and territories now certified free of the disease to 187, compared with 21 in 1997.
During its 7th meeting held in Geneva on 21–23 October 2009, and based on the declarations of countries and careful examination of evidence, the International Commission for the Certification of Dracunculiasis Eradication recommended that Benin, Cambodia, Guinea, Mauritania, the Marshall Islands, Palau and Uganda be certified free of guinea-worm disease.
“Guinea-worm disease occurs in very remote rural areas that are often unreachable,” said Dr Gautam Biswas, Medical Officer in charge of the WHO Guinea-worm Eradication Programme. “Securing elimination, often under challenging circumstances, is a major achievement that brings us closer to the ultimate goal of globally eradicating the disease,” added Dr Biswas.
Two previously endemic countries (Niger and Nigeria) have completed a 12-month period without reporting any new indigenous cases. Nigeria – which had 640 000 dracunculiasis cases in 1989, the highest number of cases reported by any country and considered as one of the most highly endemic countries in the world – did not report a single case in 2009 up to the end of November 2009.
Ghana, another country where the prevalence of guinea-worm disease was high (179 000 cases in 1989), also reported zero guinea-worm cases in November 2009. Despite the progress that has been made, achieving interruption of transmission in Ethiopia, Ghana, Mali and Sudan by the end of this year may not be possible.
The main challenge remains in southern Sudan, where eradication efforts were stalled during an unstable security situation that lasted for almost two decades. The full scale of the eradication programme, which started only in 2006, has already produced significant results. The number of guinea-worm cases peaked at 20 582 in 2006 and decreased to 2690 between January and October 2009.
“As the number of cases continues to shrink, we are optimistic that we will soon be able to achieve interruption of transmission of guinea-worm disease,” said Dr Lorenzo Savioli, Director of WHO’s Department of Control of Neglected Tropical Diseases. “It is crucial that we enforce and maintain heightened surveillance and case containment. This involves an active mobilization of communities and the much needed funding to complete the eradication of guinea-worm disease” he added.
The Carter Center, one of WHO’s main partners in eradication of guinea-worm disease, provides technical and financial assistance to national eradication programmes to help interrupt transmission of the disease.
Other major partners include the Bill & Melinda Gates Foundation, which in November 2008 pledged a US$ 40 million challenge grant to the Carter Center and WHO. In September 2008, the Government of the United Kingdom also provided a UK£ 10 million (around US$ 16 million) grant from its Department for International Development.
However, it is estimated that an additional US$ 15 million will be needed to meet the funding requirements for the crucial final stages of the eradication programme between 2009 and 2013.
WHO established an independent International Commission for the Certification of Dracunculiasis Eradication in 1995. The Commission comprises 12 public health experts from all six WHO regions and meets once every two years. Its main objective is to evaluate claims of countries and the status of transmission in countries applying for certification of dracunculiasis eradication. Upon careful examination of evidence provided by countries – and sometimes with evaluation carried out by international certification teams – the Commission makes recommendations about whether a particular country should be certified free of transmission.
A country reporting zero cases over a period of 12 consecutive months is believed to have interrupted transmission of dracunculiasis and is classified as being in the pre-certification stage. Countries in the pre-certification stage include Burkina Faso, Chad, Côte d’Ivoire, Kenya and Togo. After at least three years of pre-certification and consistent reporting of zero indigenous cases, a country becomes eligible for certification.
Dracunculiasis, a water-borne disease found in the most deprived regions of Africa, is transmitted uniquely by drinking contaminated water. People affected by the disease are often unable to attend school, to farm or to do other work, resulting in increased poverty. The disease is easily prevented through simple measures such as filtering all drinking-water and educating infected people never to wade into water, which perpetuates the life-cycle of the disease.
When the eradication campaign began in 1986, there were an estimated 3.5 million cases of dracunculiasis. Some 20 countries in Africa and Asia have been known to be affected by guinea-worm disease. Today, active transmission occurs in four countries: Ethiopia, Ghana, Mali and Sudan.
Dracunculiasis is expected to become the second disease after smallpox to be eradicated – and the first disease to have been eradicated without the use of any drug or vaccine.