The World Health Organization recently announced that the agency is ready to evaluate the request made by Kenya and Sudan to grant them certifications for interruption of transmission for Guinea worm disease.
Dr Dieudonné Sankara, leader for WHO’s dracunculiasis eradication unit said in a WHO official statement, “We stand ready to send an International Verification Team to evaluate both Kenya and Sudan, as both countries continue to implement heightened surveillance involving thousands of health workers through integrated disease surveillance programmes.”
Kenya and Sudan have formally requested WHO to verify that Guinea-worm disease (dracunculiasis) transmission has been interrupted in both countries after the fact that previously endemic countries for the disease have not reported any indigenous case for a period of more than three years.
The request was first made informally on May 25, 2016 during a meeting of health ministries. The meeting took place as a part of 69 World Health Assembly proceedings.
Both countries have been under active surveillance for a minimum period of three consecutive years and are at precertification stage right now.
Kenya has been actively working to control the guinea worm disease endemic in its country since 1994 when the last indigenous case was reported. Since then, fourteen reported cases have been investigated which eventually turned out to be false rumors.
Dr Dieudonné Sankara reports that there is an even active reward system in place which incentivizes and increases the chance of people voluntarily reporting the suspected cases of the disease. In 2012, Kenya announced a reward for 100,000 local shillings (1000 US dollars), for anyone who will report a confirmed case of dracunculiasis. In August 2015, Kenya also accelerated its national awareness and media campaign to focus on previously endemic regions like Turkana, West Pokot, and Trans Nzoia.
Sudan has also been actively working to end the disease. The last reported cases were in South Sudan near its border in 2013. The country is waiting for WHO teams to evaluate the measures implemented to disrupt disease transmission, efficiency of its surveillance system, and review of investigations conducted regarding rumored cases.
Previously 198 countries, territories and areas have been awarded the certificate for interruption of dracunculiasis transmission by WHO. 186 of these states are members of the international health agency.
WHO is the only health organization mandated to allow dracunculiasis free status certification to any country.
Country certification protocol for dracunculiasis free status requires certain steps and criterion before declaring interruption of transmission like:
- There should be zero instances of transmission for the last consecutive three years
- There should be an actively maintained surveillance program in the country for the last consecutive three years
- A team of health experts must visit the country to 1) assess adequacy of surveillance 2) review investigations conducted as a result of disease rumors 3) assess indicators for improved water sources especially in previously infected areas 4) risk assessment for any potential retransmission of disease
- A report must be submitted to ICCDE for further review
International Commission for the Certification of dracunculiasis Eradication (ICCDE) is the main body on which the decision of WHO’s certification rests. The commission has met for a total of eleven times since 1995. The commission panel consists of nine members which now meet annually to decide which country should be awarded the disease free status.
dracunculiasis is an infection of a nematode worm. The disease is acquired when drinking water is contaminated with water fleas and a person ingests the dracunculus (worm) larvae. The larvae once ingested grow into adult worms which can crawl through the skin of the infected person causing intense pain.
Symptoms like oedema, blister, ulcer, fever, nausea, and vomiting are often seen in such patients. The crawling larvae can come out eventually to start a new life cycle once they find a water source. It takes 10 to 14 months for the Guinea worm to complete its life cycle and emerge from the body.
This disease is rarely fatal. No drugs are available to treat this disease and the prevention measures can include ensuring safe water consumption by using filtration techniques and other methods.
Guinea worm disease is on the verge of eradication and last year in 2015, only 22 human cases of the disease were reported from all over the world.
Potential challenges which hinder the complete eradication of the disease from the world include 1) cases occurring in remote and difficult to reach areas 2) insecurity and expenses due to lack of access to disease endemic areas 3) difficulty in controlling dogs infected by the worm.
Since 1986, The Carter Center is on forefront of the eradication efforts being made for the disease. A nonprofit founded by the former President of the United States, Jimmy Carter and his wife, the organization works closely with WHO and UNICEF to eliminate dracunculiasis from across the world.