Eradicating dracunculiasis: Angola confirms second human case, strengthens surveillance
14 March 2019 | Geneva −− A second human case of dracunculiasis (guinea-worm disease) has been confirmed in Angola; the first human case was reported in April 2018. This second case was detected in January 2019 in a 48-year-old woman from Ndeleme village in the municipality of Cuvelai in the Cunene province of southern Angola.
“As soon as the suspected case was located, health officials – both local and provincial – conducted a preliminary investigation within 24 hours and were later joined by staff from the national level of the Ministry of Health and the WHO Country Office,” said Dr Dieudonne Sankara, Team Leader of WHO’s global dracunculiasis eradication programme. “With this second confirmed case, we are strengthening our surveillance activities in anticipation of accelerated case-finding in the area to which access is somewhat restricted due to security issues.”
WHO’s Country Office in Luanda has formally requested the Ministry of Health to initiate measures to expand surveillance. Following a formal request from The Carter Center – WHO’s main partner in the global eradication campaign - Angola has accepted support for community and village-based active surveillance in and around Cunene province and elsewhere in the country, as and where the need arises. The first human case in Angola was in Namacunde municipality, which is also part of Cunene Province, bordering Namibia.
Namibia initiates surveillance and other measures
“We are also in discussion with the Namibian authorities to increase awareness about the disease in the northern border areas and train local health staff to be ready to investigate every rumour that may arise,” said Dr Andrew Korkor, Medical Officer for Guinea Worm Eradication in WHO’s Regional Office for Africa. “The objective is to actively search for cases, determine the risks of infection and spread, and strengthen the capacity of health workers to manage rumours and cases of the disease.”
WHO certified Namibia as free of dracunculiasis transmission in 2000.
From 25 February to 8 March 2019, and with support from WHO’s Regional Office for Africa, 10 field epidemiologists from the Ministry of Health were trained by WHO and partners to conduct active case searches in Omusati and Ohangwena regions of Namibia along the Angolan border.
Since the beginning of this year and until 2 March, a total of four human cases have been reported to WHO (Angola -1; Chad-3)
Chad and Ethiopia conduct high-level political visits to affected areas
Recent high-level visits to endemic areas have added visibility and momentum to long-running eradication campaigns in Chad and Ethiopia; both countries are witnessing last-mile challenges.
In February 2019, Dr Amir Aman, Federal Minister of Health of Ethiopia, led a high-level advocacy mission to the Abobo district of Gambela region to assess the situation of safe water on at least three commercial farms that employ seasonal farm workers from throughout Ethiopia. In 2017, an outbreak of the disease from commercial farms resulted in 15 human cases. No human case was reported in 2018.
Also last month, Mr Aziz Mahmet Saleh, Minister of Health of Chad, visited villages in the Chari Baguirmi region where dracunculiasis is endemic to promote the national “ABC Strategy” (comprising Abate [temephos] larviciding of surface water bodies, burial of fish guts and containment of infections in animals and humans) in order to contain infection in dogs. Increased larviciding of water bodies with Abate is also being carried out; more work is required to cover all areas where transmission is occurring.
Mali has reported zero human cases since 2016; the last human case was reported in November 2015. Ethiopia reported its last human case in December 2017.
Case totals in 2018
In 2018, a total of 28 human cases were reported to WHO from Angola (1), Chad (17), Ethiopia (0), Mali (0) and South Sudan (10).
Chad reported the largest number of animal infections, with a total of 2044 worms from 1040 dogs and 25 infected cats.
Mali reported animal infections in 18 dogs and 2 cats.
Ethiopia reported animal infections in 11 dogs, 5 cats and one baboon.
Dracunculiasis is a crippling parasitic disease caused by Dracunculus medinensis, a long thread-like worm. The disease is transmitted exclusively when people drink water contaminated with parasite-infected water fleas.
WHO is advocating for stronger surveillance, even by national eradication programmes in countries already certified free of dracunculiasis transmission by the Organization.