Looking for life, destroying life: Dracunculiasis

Dracunculiasis is Latin for “affliction with little dragons." This parasitic infection, more commonly known as Guinea-worm disease, is contracted when a human drinks water contaminated with copepods (water fleas) that contain worm larvae. Usually, the infected person remains asymptomatic for a year. Then, the adult worm begins to emerge out of the host’s skin by forming a blister. In the days before the worm’s exit, the patient can experience pain, swelling and fevers.As the worm emerges from the skin, the subject experiences a severe burning sensation and could even fall victim to a secondary infection. This process can render a person bedridden for weeks or months.

Now, imagine drinking this contaminated water every single day. Think of the number of repeat infections that could occur. Consider the lifelong implications of this disease — how people are in physical pain because they cannot access clean water.

In 1986, there were 3.5 million new cases of dracunculiasis reported globally. That number, now? It’s 28. Yes, you read that correctly. In 2018, the international incidence of dracunculiasis was 28 human cases. The almost-eradication of Guinea-worm disease reveals how powerful interventions can be. In fact, the 20-year campaign that is responsible for this immense success only cost about $225 million dollars.

A combined effort from former President Jimmy Carter, NGOs like the World Health Organization and the Centers for Disease Control and Prevention and local governments ignited the global eradication effort.In order to ensure success, the leadership looked to both private and public sectors. The Carter Center created a system for internal village surveillance, which monitored incidence and prevalence of disease. Surveillance is an integral component of any public health intervention, for it reveals fluctuations in case counts and points to the success or failure of a program.

Additionally, they mobilized village volunteers and educated them on how to filtrate water and remove worms from patients, which is essentially wrapping the emerging worm around a stick and taping said stick to the host’s body until the worm has completely exited the subject. There was also widespread distribution of nylon filters which could actually remove copepods from the water, thus making it more potable and safer to drink. Education on how to use these nylon filters facilitated behavior changes within communities, which is often required when trying to mitigate disease. Other interventions included financial incentives for reporting and for compliant individuals and pond monitors who controlled the usage of water from natural open sources.

This program is evidence that behavior change to eradicate disease is possible. Today, America pours money into the research and development of vaccines (for Ebola, Zika, and the flu) and drugs.The almost-eradication of dracunculiasis required absolutely no vaccine or magical drug. Cost-effective global health interventions are attainable, and when done correctly, they can give low-resource communities the autonomy to control their own health. Now, we have evidence that low-income communities can slay their own dragons. And that is the magic of public health.