Dracunculiasis eradication: 7 suspect cases with emerging worms and about 50 people under observation in Ethiopia

A seventh person is undergoing treatment for emerging worms at a containment centre in Ethiopia following an outbreak of dracunculiasis (guinea-worm disease) in Gambella region last month-transmission from all 7 suspect cases is being contained.This latest suspect case – in addition to six others initially identified with emerging worms1  - involves individuals from   few villages sharing the same unsafe water source.“Many suspect cases have been cleared and we now have  around 50 people with guinea worm suspected signs and symptoms in our case containment centre – all of them brought  here as a result of exposure-tracing and investigation which were carried out immediately after the suspect human cases were identified,” said Kassahun Demissie, Coordinator of the Ethiopian Dracunculiasis Eradication Programme (EDEP). “All used unsafe drinking‐water from the same ponds, like the seven other people with emerging worms, and are under observation.” On 3 April 2020, WHO was notified of an outbreak in Duli village of Gog district in Gambella region detected on 2 April 2020 by EDEP community health workers. Five additional provisional cases were subsequently detected. Measures to contain transmission from these suspect cases started immediately. All of the infected had used farm side ponds – the water sources that might have been associated with an infected baboon in June 2019 in the same village.In response, a team from the EDEP within the Ethiopian Public Health Institute, the Gambella Regional Health Bureau and The Carter Center – WHO’s main partner for the global eradication programme – conducted preliminary investigations and immediate intervention measures.“Worm specimens have already been extracted from all suspect cases and are ready for shipment to the WHO collaborating centre at CDC Atlanta for laboratory confirmation2” said Dr Zeyede Kebede, Acting NTD coordinator, WHO Country Office, Ethiopia. “Interruption of courier services due to COVID-19 has somewhat delayed the process.”<h3>Case searches and contact tracing</h3>All villages and hamlets have already been put under active surveillance in Abobo and Gog woredas by the EDEP with support from The Carter Center.  Active case searches are being intensified in seven villages where suspect cases were detected and/or where people are at greater risk of contracting the disease due to social ties with villages reporting cases. During investigation, a total of 217 households were visited and 1254 people were interviewed and provided with health education. With the support of WHO, the EDEP has reinforced surveillance in cross-border areas, particularly in and around refugee camps in the Gambella and Benishangul Gumuz regions to prevent any spread of the disease to South Sudan. To kill water fleas that act as intermediate hosts to the guinea-worm larvae, several ponds have been treated with the larvicide Temephos and pipe and cloth filters distributed to villagers3.Further training and guidance have been provided to volunteers and health care workers to conduct field activities in the context of the currentCOVID-19 pandemic. <h3>Dracunculiasis in Ethiopia</h3>The EDEP started in 1994 when the country reported more than 1100 cases annually. Implementation of eradication activities over the decades drastically reduced the number of human cases. In 2017, an outbreak on a farm in the Gambella region resulted in 15 cases. Subsequently, no human cases were reported for more than two consecutive years, although sporadic indigenous dracunculiasis infections have been reported in animals (in dogs and in baboons) since 2013. Gambella is the only region in Ethiopia with low levels of guinea-worm disease transmission. With the latest cases reported from Gog district, heightened surveillance is in force in other districts and refugee camps in the region that host more than 272 000 nationals from South Sudan. Regular cross-border population movement between Ethiopia and South Sudan (due to insecurity in South Sudan and activities of nomadic pastoralists) poses a risk of the disease spreading in the area.<div><div id="ftn1"></div><div id="ftn3"></div></div>——————————- 1The worms that have emerged are morphologically consistent with Dracunculus medinensis, although laboratory confirmation is pending. 2WHO requirement: All worm specimens obtained from each case are sent for confirmation to the WHO Collaborating Center for Research, Training, and Control of Dracunculiasis at the United States Centers for Disease Control and Prevention (CDC). 3Temephos (Abate®) and filters are donated by BASF and Vestergaard respectively through The Carter Center. <div> </div>