Twenty-eight years ago efforts to eradicate guinea worm began in earnest. It was the UN Water Decade, and there was optimism that guinea worm could be the test case for success of the global effort to guarantee adequate and safe water for all.
As can be seen in the CDC infographic, we have gone from 3.5 million cases to 148 during this time. As we reach toward the tail end of the worm, we find some challenges remain.
On the list of currently endemic countries one finds Chad. Chad was supposed to be in the pre-certification phase, but new cases appeared a few years ago.
Sudan was the most highly endemic country until South Sudan gained independence and took the guinea worm cases with it. Recently a few cases have also appeared again in the Sudan itself seen in charts derived from CDC’s newsletter, Guinea Worm Wrap-Up.
Looking at the most recent data from early 2014, one can see that Mali is back to reporting no cases as have Ethiopia and Sudan for 2014. Caution is needed since transmission is more likely in the upcoming rainy season months than in the current dry period.
What is common in these areas is either being in a state of conflict or bordering a conflict zone. This makes efforts to detect cases and put interventions in place in a timely manner to prevent the next season’s transmission very difficult.
Unlike some other diseases, guinea worm has some relatively simple, epidemiologically appropriate and less expensive interventions like cloth water filters, abate/temephos for water source treatment and case containment. Of course investments in improved water supplies will also solve the problem. But without easy access to the communities where transmission is occurring, the disease will persist at this incredibly low level.
Other disease elimination programs are equally affected by the problems of access and conflict, polio being a good example. We know that malaria is also exacerbated in conflict situations, but in the locations where pre-elimination is near, like Swaziland, Botswana, South Africa and Namibia, the main concern is ensuring a strong health system to handle the additional surveillance tasks. Still we should not be complacent, because malaria is also endemic in these very sites where guinea worm stubbornly lingers.