Dracunculiasis (Guinea worm disease) -- a disabling infection
that affects persons in 16 African and three Asian countries -- has
been targeted by the World Health Organization (WHO) for global
eradication by the end of 1995. A total of 221,055 cases were
reported to WHO for 1993 (1). Efforts to eradicate dracunculiasis
in each of the 19 affected countries are focused on interrupting
all transmission. This report summarizes the impact of Pakistan's
Guinea Worm Eradication Program (GWEP).
The eradication program in Pakistan began in 1986 as a
collaborative effort involving Pakistan's National Institute of
Health, the Global 2000 project of the Carter Center, and CDC. A
nationwide village-by-village survey estimated a total of 2400
incident cases for 1987; cases were detected in three areas
including North West Frontier, Punjab, and Sindh provinces (2).
Active surveillance and control measures were implemented in
February 1988 in all 408 villages at risk for or characterized by
endemic dracunculiasis. Village-based "implementors" were
identified and trained in each village to report cases monthly,
promote filtration of unsafe drinking water through use of cloth
filters, and distribute cloth filters. Other health workers applied
temephos (Abate{Registered} * ) to unsafe sources of drinking water
monthly in each affected village to reduce populations of the
intermediate copepod hosts. Because in areas with endemic
dracunculiasis most underground sources of water are brackish,
development of such sources was not a substantial component of the
program in Pakistan.
Measures introduced in 1990 to help ensure rapid detection,
thorough investigation, and complete control of each case included
more intensive surveillance and case-containment measures (e.g.,
close supervision of the village implementors) (3). A cash reward
of 1000 rupees (approximately $40 U.S.) for reporting the first
case in a village was first offered in 1991. In 1993, other
incentives (i.e., 3000 rupees for each patient who complied with
case-containment measures and 500 rupees for the person reporting
the case) were added and publicized. A registry of reports of
potential cases was established, and all claims of cases were
promptly investigated by staff of the national eradication program.
For each calendar year during 1988-1994, the numbers of
villages in Pakistan with endemic dracunculiasis were 156, 146, 56,
35, seven, one, and zero, respectively, and the number of cases
detected through village-based surveillance were 1110, 534, 160,
106, 23, two, and zero, respectively Figure_1.
Reported by: M Azam, National Institute of Health, Pakistan. Global
2000, Inc, The Carter Center, Atlanta. World Health Organization
Collaborating Center for Research, Training, and Eradication of
Dracunculiasis, Div of Parasitic Diseases, National Center for
Infectious Diseases, CDC.
Editorial Note
Editorial Note: Because no cases were reported in 1994, Pakistan is
the first of the countries with known endemic dracunculiasis during
the 1980s to have eliminated indigenous transmission of the disease
for 1 year. In addition, dracunculiasis-eradication methods
pioneered by the Pakistan GWEP (e.g., use of village-based health
workers and case containment) have been effectively incorporated
into all GWEPs in Africa (1).
In 1992, the United Nations Childrens' Fund (UNICEF) began
providing support to the Pakistan GWEP. In 1993, WHO began
assisting Pakistan in maintaining appropriate surveillance
activities for the WHO-required 3-year period without indigenous
cases for certification of eradication. The WHO Collaborating
Center for Research, Training, and Eradication of Dracunculiasis at
CDC continues to provide technical assistance to Pakistan regarding
surveillance and containment of cases.
References
WHO. Dracunculiasis: global surveillance summary. Wkly Epidemiol
Rec 1994;69:121-8.
Use of trade names and commercial sources is for identification
only and does not imply endorsement by the Public Health Service or
the U.S. Department of Health and Human Services. Figure_1
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