disease eradication dracunculiasis (guinea worm disease) a_addis.pdf · dracunculiasis eradication...
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Disease Eradication
Dracunculiasis
(Guinea Worm Disease)
David Addiss, MD, MPH
7th Annual CUGH Conference
San Francisco, CA
April 10, 2016
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How do we change the world?
“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.”
Margaret Mead
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What drives disease eradication efforts?Frank Richards’ ‘ACE’ Principles
• Accomplishment
• Closure
• Equity
• Compassion
Frank Richards, Jr. MD
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Drancunculiasis
(Guinea Worm Disease)
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Drancunculiasis
(Guinea Worm Disease)
A and B: The female guinea worm induces a painful blister (A); after rupture of the blister, the
worm emerges as a whitish filament (B) in the center of a painful ulcer which is often
secondarily infected. (Images contributed by Global 2000/The Carter Center, Atlanta, Georgia).
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Prevention of Guinea Worm Disease
• Surveillance (case detection) and case
containment
• Vector control using a chemical larvicide
(Abate)
• Provision of safe drinking water
• Health education and
community mobilization
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Criteria for Certification of Guinea
Worm Disease EradicationInternational Commission for the Certification of
Dracunculiasis Eradication
• Adequate active surveillance systems confirm the absence of Guinea Worm disease for ≥3 years.
• A “rumor log” of suspected cases maintained for a 3-year period: particulars, origin, and final diagnosis of each suspected case.
• All confirmed cases imported from endemic countries traced to their origins and fully contained.
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International Task Force for Disease
Eradication, 1993
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1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005*
0
100
200
300
400
500
600
700
800
900
1000
Year
Number of Reported Cases of Dracunculiasis by year
1989 - 2005N
um
ber
of
report
ed c
ases (
in T
housa
nds
) Cases ~3,500,000(1986)
10,674(2005)
Villages 23,165(1993)
2,114(2005)
Countries 20(1986)
9(2005)
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Historical Distribution of Reported
Cases of Dracunculiasis
Source: Ruiz-Tiben & Hopkins, 2006
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Human Guinea Worm Cases
2014-2015
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Soper Principle
• Near invisibility of a disease in a population is the point that the serious work of eradication actually begins
• There is no acceptable prevalence or incidence figure
*
Fred L. Soper, MD, DrPH
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Source: CDC. Guinea Worm Wrap Up #239, March 25, 2016
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Mr. Carter said around 88 million cases have been avoided in the last 30 years, meaning it's cost around $3 (£2) to prevent each case. – BBC News
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Thank you!
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Auxilary Slides
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Save the Guinea Worm FoundationD E F E N D I N G T H E W O R L D ' S M O S T E N D A N G E R E D S P E C I E S
The Endangered Guinea Worm
The rare Guinea Worm faces extinction. Yet despite growing
public support for environmentalism and preservation of
endangered species, few people will speak out on the Guinea
Worm's behalf. In fact, the United Nations and several
prominent U.S. agencies are leading a quiet campaign to
eradicate this dwindling species forever from the planet. Is the
Guinea Worm the world's most endangered species?
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The Tortoise and the Hare: Guinea Worm,
Polio and the Race to EradicationB. Sutton & D. Canyon
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Social Justice and Disease EradicationBailey et al, 2014
• Disadvantage ‘clusters’
• Justice requires dismantling ‘clusters of disadvantage’ involving multiple dimensions of well-being
• Three key dimensions of well-being (‘benefits’)
– Agency
– Association
– Respect
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Ethics of Guinea Worm Eradication
• Beneficence
• Non-maleficence
• Justice
• Autonomy
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1980
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Spectrum of Disease Control
Regional
elimination Eradication
Extinction
Global
elimination
Elimination
“as a public
health
problem”
Control