Guinea Worm Disease
“[I want the] last guinea worm to die before I do.” Jimmy Carter may soon get his wish. The former President of the United States has spent the last 30+ years on a number of humanitarian missions through his namesake nonprofit—The Carter Center—but people may undoubtedly see one particular mission as ranking among its magna opera. That mission is to eradicate Guinea worm disease (GWD), and frankly, those worms are unpleasant at best.

What is Guinea Worm Disease?

GWD is a parasitic infection in which extremely small worms enter the human body through contaminated water, leading to crippling, painful blisters about a year later when the matured female worm emerges. It has been infecting people since ancient times, and in the mid-1980s, an estimated 3.5 million cases existed across at least 20 countries, including 17 in Africa. In 2019, however, there were only 54 cases in humans.

Success in Reducing GWD

This is thanks largely to the efforts of The Carter Center, in partnership with the World Health Organization (WHO) and UNICEF. This partnership has been leading the charge against the disease both in introducing preventative measures in hotspots on the ground in Africa and by raising awareness in the developed world since 1986. Since no vaccine or other modern treatment exists for Guinea worm disease, The Carter Center’s strategies most often include working with health ministries and community-based volunteer groups in order to stop the spread of GWD and bring attention to it via health education.

The attention is important because of the rapid ability of the disease to spread. One missed case can lead to 80+ new infections over one year and delay a country’s ability to control the disease for just as long. This is partly why the WHO has strict criteria when assessing the disease in a given area.

When Can One Consider a Country Free of GWD?

A country must have zero new cases for at least three years for it to receive a declaration of being free of GWD. Despite the rigorous criteria, some countries continue to encounter problems confronting the disease. Chad, for example, has reported almost 2,000 infections in dogs in 2019—a testament to the disease’s stealth and endurance over the years.

In fact, “years” may be an understatement—GWD has emerged in Medieval Middle Eastern and Ancient Egyptian texts under a variety of labels, with some Egyptian mummies even showing evidence of the worm’s presence in their remains. The Old Testament even refers to it as a ‘fiery serpent’ (citing the on-fire feeling when the creature emerges through the skin).

The Correlation Between GWD and Sanitation

In more recent years, the disease received highlight in the early ‘80s as an international threat to clean water—which is where the fight to eliminate the disease originated. Even today, GWD exists primarily in countries—notably Chad and Ethiopia—that consistently rank among the poorest in the world (and are thus most lacking in access to clean water).

The Carter Center has sought to combat this shortfall as well, specifically by introducing a straw-like pipe filter that allows people in affected countries to drink from any water source without fear of contamination.

The eradication of the disease would mean the end of widespread, debilitating illness across several predominantly African nations. Although the fight has gone on for decades, the organizations working to eliminate it now say that the end is in sight. Even Jimmy Carter made his wish—that GWD would go before him—as he was battling cancer a few years ago.

Now, the eradication of all diseases of this sort will be the target of the U.S.’s End Neglected Tropical Diseases Act, which entered into law earlier in 2020. The goal of the act is to facilitate and coordinate an effective, research-based international effort to end neglected tropical diseases, such as GWD, with special emphasis on impoverished nations.

If the world meets international goals, GWD would become the second human disease (behind smallpox) and the first parasitic disease to experience eradication. It would also be the first disease to disappear without the use of a vaccine or medicine.

– Bardia Memar
Photo: Flickr

Disease in South Sudan

South Sudan is the youngest country in the world and with this has come significant growing pains. Despite the ongoing civil war, the alleviation of disease in South Sudan is quickly becoming one of its positive developments. The most recent example was the announcement of the eradication of the guinea worm within the country’s borders.

What is the Guinea Worm and Who Does it Affect?

According to the Centers for Disease Control (CDC), guinea worm disease only affects the poorest 10 percent of the world’s population. Specifically, it occurs in people who do not have access to clean water or health care.

The disease takes hold when the worms swim around stagnant ponds and find their way into people who drink water from contaminated ponds. The disease takes a year to manifest, and once it shows, patients have severe flu-like symptoms and blisters that cause intense pain and disability. The most efficient way for subjects to relieve the pain is to dunk the affected area, almost always the foot or leg, into water. In the water, the worms spawn thousands of larvae, thus restarting the cycle.

Eradication of the Disease in South Sudan

Dr. Riek Gai Kok, South Sudan’s health minister, announced the end of the guinea worm disease in South Sudan at the Carter Center in Atlanta at the end of March. The Carter Center, a philanthropic organization started by former president Jimmy Carter, has provided much assistance to the world’s youngest nation.

In efforts to help eradicate guinea worm, the Carter Center has distributed a pesticide to one volunteer in each Sudanese village affected by the parasitic worm. The volunteer then pours the pesticide into all the ponds in and around their town.

It has been 15 months since the last case of guinea worm disease in South Sudan, longer than the incubation period for the worm, but still short of the three year period required by the World Health Organization to officially declare the guinea worm extinct in the area. Still, Dr. Kok thanked the organization and the thousands of volunteers it trained.

This year will be an important one to identify the benefits of eliminating the disease in South Sudan. Most cases appear in July, which is a crucial time for the agrarian population in the country, and the worm can cripple entire villages.

Why Eradication is Important

Even though guinea worm disease seldom ends in death, the disease is still debilitating. It handicaps its victims on average for around two months, but sometimes the incapacitation is permanent. More than 90 percent of South Sudanese citizens depend on labor occupations like fishing, herding or farming for sustenance and employment. So, when disability removes the victim from the workforce, there are devastating results.

To compound this, a workforce shortage resulting from the mass exodus during the civil war forced children into the fields. According to the CDC’s statistics, in villages where guinea worm disease is most prevalent, over 60 percent of children miss school.

This is the main reason why eliminating guinea worm disease in South Sudan is so important. The connection between the disease and poverty is circular. While the illness is a result of living in destitute conditions, it also is a significant cause of poverty when it keeps its victims and their families from completing their jobs or from going to school.

As a result, government officials are pleased about eradicating the disease in South Sudan because it is a boon to their public health system and long-term economy. Furthermore, in one of the most food insecure countries, the ability to have an entire harvesting season unabated by a preventable disease could be a major step toward ending famine and alleviating poverty in South Sudan.

– David Jaques

Photo: Flickr

guinea-worm-carter-comic-book-horizontal-large-galleryBack in 1999, Nigerian farmer Abdullahi Rabiu faced an agonizing reality. An estimated 84 worms, narrow in form and each of them two to three feet in length, had painfully ruptured through his skin. And there was nothing he could do to stop it.

Rabiu, who eventually recovered from the ordeal, contracted a waterborne parasitic disease called Guinea Worms by drinking contaminated pond water.

It’s a cycle: an infected person seeks relief from the painful rupturing of the worms by entering the water. There, the worms release hundreds of thousands of larvae. The larvae are then eaten by tiny water flies barely visible to the human eye. Finally, people who drink from that pond run the risk of consuming the flies and becoming infected with the worm.

In 1986, an estimated 3.5 million cases of guinea worm were reported across 21 countries in Africa and Asia. Since then, the Carter Center, founded by former President Jimmy Carter, has led an international campaign to eradicate the disease.

And they are winning.

After visiting more than 26,300 villages, mostly in sub-Saharan Africa, and training people in health education, the eradication of the guinea worm is not only possible — it’s in sight. Between Jan. 1 and Aug. 31 of this year, only 15 cases were reported across four countries.

“The potential for disease eradication to permanently improve quality of life worldwide is tremendous,” said Dr. Donald Hopkins, vice president for Carter Center health programs. Once a disease that incapacitates people like Rabiu is eradicated, the health of individuals improve and economies benefit from increased productivity.

Eradication of the guinea worm would make it the first human disease to have been wiped out since smallpox in 1980. It stands to be the first disease to be eliminated without a vaccine or medicine.

In the case of guinea worms, the key was as simple as education. People in these communities have learned to filter water, making it safe for drinking. Those who have become infected know not to enter the water.

While it is impossible to predict exactly when guinea worms will be completely eradicated, there is hope to see it gone in the next two to three years at the latest.

Now facing terminal cancer, Jimmy Carter was recently asked what he would like to accomplish before dying. His response: “I would like the last guinea worm to die before I do.”

Kara Buckley

Sources: The Carter Center 1, BBC 1, BBC 2, The Carter Center 2, The Carter Center 3
Photo: CNN