India roots out another dreaded disease

The formal announcement of this achievement will be made on January 8 at a function to be attended by Prime Minister Atal Behari Vajpayee and World Health Organization director-general Gro Harlem Brundtland.

Since July 26, 1996, not a single new case of Guinea Worm has been reported in the country. What is most surprising is that the eradication comes despite the fact that till date, there are no known drugs to cure the disease.And the only way to control it is via effective public health intervention.

As safe drinking water was the only solution, this was provided to the 12,840 affected villages of 89 districts. Stepped wells were converted to draw wells and hand pumps were installed all over the endemic areas. The rural population was educated in their local language about the disease, which also helped in its eradication.

Coordinated by the Delhi-based National Institute of Communicable Diseases, the eradication program focused on integrated community-based surveillance systems, intensified case-containment measures, targeting of appropriate water supply systems (including filtration and chemical treatment of water) and health education.

Until now, seven independent national commissions have investigated the Guinea Worm Eradication Program and the last one conducted as recently as April 1999 was headed by Lt Gen D Rahgunath who reported: “We will enter into the next millennium with Guinea Worm infestation as a disease ofthe past.”

In fact, a three-member independent WHO commission, including doctors from Jordan, Yemen and Iran, visited the affected areas for two weeks last month and Health Ministry officials say they were satisfied with the Guinea Worm Eradication Program. Their report has been presented to the WHO, which is likely to issue the formal certificate of eradication very soon.

A country has to be free of this disease for three consecutive years before a certificate of eradication is issued and now India has not reported even a single case for nearly three and a half years. Another 17 countries, mostly from Africa, are still endemic to the disease.

This water-borne disease was common in the villages of seven states of Rajasthan, Gujarat, Maharashtra, Madhya Pradesh, Andhra Pradesh, Karnataka and Tamil Nadu and about 40,000 cases were reported in 1984 when the eradication program was launched.

The disease is caused by the parasitic worm dracunculus medinensis or `Guinea Worm’. This giant roundworm is thelargest of the tissue parasites affecting humans. The adult female, which carries from one to three million embryos, can measure up to a metre in length and 2 mm across. The parasite migrates through the body causing severe pain, especially in the areas around the joints. The worm eventually emerges (from the feet in 90 per cent of cases), causing an intensely painful sore, a blister and then an ulcer.

When the worm perforates the skin, intolerable pain is accompanied by fever, nausea and vomiting. Partial or total disability can last from several weeks in isolated cases up to, in most cases, several months.

The disease is transmitted through contaminated water and hence was most prevalent in areas that experienced severe water shortages. Water being rare in these endemic areas, a single stagnant source was often used to supply the domestic requirements of an entire community.

When an infected person stepped into the local water hole, the terrible burning sensation caused by the emerging worm wasrelieved. The cool water also caused the female worm to contract at the base of the ulcer causing the sudden expulsion of hundreds of thousands of embryos which are then ingested by a tiny crustacean the cyclop or water flea which in turn became infected. Acting as an intermediate host, the cyclop was absorbed by human beings as they drank the contaminated water, causing the disease.