EAST WINDSOR, New Jersey — Guinea worm was once counted among the most widespread tropical diseases affecting impoverished nations, primarily concentrated in Africa and some parts of Asia. Caused by a parasitic nematode worm found in unclean drinking water, it affected 3.5 million people a year until humanitarian and former U.S. president Jimmy Carter began a targeted campaign to eradicate the disease in 1986.
The Carter Center has since waged such an effective war on the disease that complete guinea worm eradication is expected by 2030, with only 13 cases reported in 2022. It has been eliminated in 17 countries, with cases mostly remaining in Sudan. If guinea worm is successfully wiped out, it will be the second disease in human history to go extinct — the first being smallpox. The disease has strong links to poverty as it typically affects impoverished communities that lack access to clean drinking water, according to the Centers for Disease Control and Prevention.
The Effects Of Guinea Worm
This parasitic disease is not fatal, but the infected person can experience debilitating symptoms for weeks or months. From that time, the parasitic infection can take between 10 and 14 months for the transmission cycle to finish. Once complete, a mature female worm emerges from the human body, typically through a blister site in the lower limbs.
The parasite is transmitted mainly when people drink stagnant water contaminated with parasite-infected water fleas. Stomach acid kills the water fleas, and the guinea worm is left free to reproduce and move throughout the host body over several weeks. The male worms die while the female worms utilize the body’s resources to mature over about a year, during which time the host feels no symptoms.
It is only when the worm needs to emerge that the illness begins. Typically migrating to the lower half of the body and choosing to emerge around the leg or foot area, the victim starts suffering fever, nausea and rashes until the exit site becomes covered by a large blister.
The typical treatment is a painstaking process in which the worm is slowly spun around a stick and pulled out — an ordeal that can take up to 8 weeks. The burning pain is often relieved by either pouring water on it, which can worsen the skin loss caused by the physical trauma, or submerging the affected area in water, which allows the parasite to release larvae and continue the reproduction cycle. Skin lesions are the primary effect of the guinea worm, but those lesions, in turn, open up to a wide range of infections, especially tetanus, cellulitis and sepsis. Over 50% of cases involve further infections plaguing the lesions caused by the guinea worm.
In less common cases, the worm can migrate within the body to some organs, causing many other problems, such as pancreatitis and spinal compression. Continued pain, even after the parasite has fully exited the body, is common, affecting up to 28% of cases, and though permanent disabilities are rare, they do happen.
Because of its prevalence in areas lacking clean drinking water, guinea worm almost exclusively impacts the rural and impoverished people of the countries where it is present. On average, sufferers lose about 100 days of work, putting significant financial strain on the families of those who rely on them, often families who cannot afford to lose that source of income. The people of Mali have a saying about guinea worm, calling it “the disease of the empty granary.”
Efforts Toward Eradication
Although no vaccine or drug is available for the disease, the World Health Organization says it is “relatively easy to eliminate and eventually eradicate” through preventative efforts.
Guinea worm eradication has been monumentally successful since it was prioritized by the Carter Center in 1986. With no ability to engineer vaccinations against the disease and no proper treatments, the goal became prevention. Plans began with a volunteer surveillance network to track disease cases among humans and animals. Once the organization could effectively track the disease, the efforts to educate people in affected areas could begin earnestly, with materials distributed mainly focusing on the importance of water filtration and effective methods.
The Carter Center diverted funding to distribute portable filtration pipes that people could wear around the neck, allowing people to safely drink from available water sources. The organization has also made a concerted effort to bore new holes for clean wells, enabling easy access to clean water. Certain types of pesticides have proven helpful in treating infected waters as well.
However, the campaign has faced setbacks, as Angola started to report cases in 2018 after previously reporting none. The Carter Center also recently discovered that guinea worm had infected a group of baboons, presenting another population that needs monitoring as the baboons could harbor the parasites.
The goal of the guinea worm eradication campaign has been the extinction of the guinea worm — since there is no acquired immunity and no way to vaccinate a population, the only thing that guarantees that the disease would not return is the destruction of the parasite species. The campaign is on track to achieve this within ten years. The lessons learned from the great success that the initiative has achieved could be applied to other similar water-borne parasitic diseases.
The CDC states that guinea worm is both a disease and a cause of poverty due to the ensuing disability that arises. The disease has severe economic and social impacts on households. Working individuals can no longer engage in income-generating activities, pushing a family into poverty and food insecurity. Children may need to drop out of school to take care of sick parents or work to supplement the household income, which impacts the child’s potential to break cycles of poverty through education.
Considering these impacts on poverty, the work of the Carter Center is crucial in eradicating the disease and preventing already impoverished people from falling deeper into poverty.
– Cheyenne Astarita
Photo: Wikimedia Commons