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Dracunculiasis, caused by the Dracunculus medinensis or Guinea worm, has been recognised for thousands of years. The parasite has been identified in calcified Egyptian mummies and it has been suggested that it may have been “the fiery serpent” that plagued the Israelites in the Old Testament.
The parasite’s life cycle begins when the water-borne larvae are ingested by microscopic arthropods called copepods, which are themselves ingested by humans from contaminated drinking water. The worms mate in the abdominal cavity, where the male dies, leaving the female to make its way to the legs and feet of the host.
About 12 months after the initial infestation, one end of the worm, now up to 60cm long, breaks through a blister on the skin, the whole process causing intense, often debilitating pain. If the host immerses his or her leg in water, the worm can release hundreds of thousands of larvae into the water, allowing the process to repeat itself.
In 1986, former US president Jimmy Carter set up the Carter Centre, which aims to eradicate the Guinea worm from Asia and Africa. The 86-year-old recently told press that he still expected to outlive the last Guinea worm, a goal he set at the programme’s beginning. The incidence of the disease has fallen from 3.5 million cases in 1986 to 3,190 in 2009.
There is no drug treatment or vaccine for dracunculiasis, and the programme’s success has relied upon grass roots public health initiatives involving a huge volunteer network with the aim of providing public health education aimed at changing behaviour and habits.
Eradication would be an unprecedented achievement, since the only other successful disease eradication programme, involving smallpox, resulted from a worldwide vaccination programme.
Dracunculiasis is completely preventable by such simple measures as providing water filters that exclude the copepods and preventing people with emergent worms from standing in drinking water supplies. It is hoped that eradication can be achieved within five years.