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Update: Dracunculiasis Eradication -- Pakistan, 1994

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

  1. WHO. Dracunculiasis: global surveillance summary. Wkly Epidemiol Rec 1994;69:121-8.

  2. WHO. Dracunculiasis: Pakistan. Wkly Epidemiol Rec 1988;63:177-

  3. CDC. Update: dracunculiasis eradication -- Pakistan, 1990. MMWR 1991;40:5-7.

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