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Dracunculiasis, more commonly known as Guinea Worm Disease (GWD), is a preventable infection caused by the parasite Dracunculus medinensis. The word Dracunculus comes from the Latin "little dragon". more...

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Life cycle

Adult female Dracunculus worms emerge from the skin of infected persons annually. Persons with worms protruding through the skin may enter sources of drinking water and unwittingly allow the worm to release larvae into the water. These larvae are ingested by fresh water copepods ("water fleas") where these develop into the infective stage in 10-14 days. Persons become infected by drinking water containing the water fleas harboring the infective stage larvae of Dracunculus medinensis.

Once inside the body, the stomach acid digests the water flea, but not the Guinea Worm. These larvae find their way to the small intestine, where they penetrate the wall of the intestine and pass into the body cavity. During the next 10-14 months, the female Guinea Worm grows to a full-sized adult,and mates with the male, who soon dies afterwards.It is 60‑100 centimeters (2‑3 feet) long and as wide as a cooked spaghetti noodle, and migrates to the site where she will emerge—usually the lower limbs.

A blister develops on the skin at the site where the worm will emerge. This blister causes a very painful burning sensation and it will eventually (within 24 to 72 hours) rupture. For relief, persons will immerse the affected limb into water. When someone with a Guinea Worm ulcer enters the water, the adult female releases a milky white liquid containing millions of immature larvae into the water, thus contaminating the water supply. For several days after it has emerged from the ulcer, the female Guinea Worm is capable of releasing more larvae whenever it comes in contact with water.


Infected persons do not usually have symptoms until about 1 year after they become infected. A few days to hours before the worm emerges, the person may develop a fever, swelling and pain in the area. More than 90% of the worms appear on the legs and feet, but may occur anywhere on the body.

People, in remote, rural communities who are most commonly affected by GWD do not have access to medical care. Almost invariably the skin lesions caused by the worm develop secondary bacterial infections, which exacerbate the pain, and extend the period of incapacitation to weeks or months-causing in some cases disabling complications, such as locked joints and even permanent crippling. Each time a Guinea worm emerges, persons may be unable to work or resume daily activities for an average of 3 months. This usually occurs during planting or harvesting season, resulting in heavy crop losses.


Once the worm emerges from the wound, it can only be pulled out a few centimeters each day and wrapped around a small stick. Sometimes the worm can be pulled out completely within a few days, but this process usually takes weeks or months.


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Update: dracunculiasis eradication - Mali and Niger, 1993 - International Notes
From Morbidity and Mortality Weekly Report, 2/4/94

Mali and Niger, countries in West Africa, ranked sixth and eighth in the number of reported cases of dracunculiasis (i.e., Guinea worm disease) in 1992 (1). In March 1993, Global 2000, Inc., and the World Health Organization (WHO) Collaborating Center for Research, Training, and Eradication of Dracunculiasis at CDC began providing direct assistance for the eradication of dracunculiasis in both countries by assigning a resident public health advisor to each country. This report summarizes surveillance data for the two countries during 1991-1993 and describes their progress toward eradication of dracunculiasis.


In 1990, Mali (population: 8.5 million) reported 884 cases of dracunculiasis to WHO (1). During that year, health officials in Mali initiated a pilot project to control dracunculiasis in 68 villages with endemic disease within Douentza District of Mopti Region. This effort employed trained village-based health workers to conduct health education, undertake active surveillance, and distribute nylon cloth to families for filtering drinking water.

From December 1991 through March 1992, national village-by-village searches for cases detected 16,060 cases of dracunculiasis in 1264 villages in five of seven regions of the country (Table 1 ). Approximately 95% of cases were enumerated in two regions (Mopti and Kayes). By December 1993, Mali's Guinea Worm Eradication Program (GWEP) had trained one village-based health worker in each of 1100 (87%) villages with endemic dracunculiasis and had begun monthly reporting of cases from 433 (34%) such villages. In addition, health education had been initiated in 68% of villages with endemic disease in Mali and use of cloth filters in 34%; improved water supplies already existed or were scheduled to be available by 1994 in 60%. A provisional total of 5779 cases was reported for 1993.


In 1989 (the most recent year for which passive data were available), Niger (population: 8 million) reported 288 cases of dracunculiasis to WHO. In 1991, the Ministry of Health initiated a pilot project to control dracunculiasis in Boubon, Niger (population: approximately 4500), a village in which 2700 cases had been reported that year. Elements of this project included trained village-based health workers, health education, improved water supplies, and use of nylon filters. By 1993, the incidence of dracunculiasis in Boubon had declined to 108 cases.

From October through November 1991, national village-by-village searches detected 32,831 cases of dracunculiasis in 1690 villages. Nearly two thirds of persons with dracunculiasis (21,057) resided in Zinder, one of the country's seven departments; of these, 85% resided in one district (Mirriah).

By December 1993, Niger's GWEP had initiated at least one intervention in 928 (55%) villages with endemic dracunculiasis and had trained health workers for dracunculiasis eradication activities at national, regional, and district levels and in 298 (18%) villages with endemic disease. In addition, health education had been initiated in 49% of villages with endemic disease in Niger and use of cloth filters in 31%; improved water supplies already existed or were scheduled to be available by 1994 in 63%. Completion of training of village-based health workers for all villages in Niger with endemic disease is projected in early 1994. Niger has not yet begun monthly reporting of cases but has recorded a provisional total of 16,231 cases for 1993. Reported by: AT Toure, President, National Intersectorial Committee for Dracunculiasis Eradication; I Degoga, MD, National Program Coordinator, Guinea Worm Eradication Program, Ministry of Public Health, Mall. S Moussa, National Program Coordinator, Guinea Worm Eradication Program, Ministry of Public Health, Niger. 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: Mali and Niger are part of the core area of West Africa where dracunculiasis is endemic. Although Mall and Niger joined the campaign to eradicate dracunculiasis when fewer than 3 years remained until the target date for eradication (December 1995), both countries were successful in rapidly establishing GWEPs. However, implementation of the interventions described in this report (i.e., health education, cloth filters, and improved supplies of safe drinking water) will probably be insufficient alone to eradicate dracunculiasis before December 1995. To complete eradication of dracunculiasis, in 1994 health officials in Mali and Niger are planning to implement more stringent measures for case containment and begin selective use of temephos (Abate[R])* to kill the copepod intermediate host of the parasite in unsafe drinking water sources of selected villages (2).

TABLE 1. Numbers of cases of dracunculiasis and villages with endemic disease detected during national village-by-village searches for cases -- Mali and Niger, 1993

* Not available; these regions have not been searched yet.

t Imported dracunculiasis.


1. World Health Organization. Dracunculiasls: global surveillance summary, 1992. Wkly Epidemiol Rec 1993;68:125-31.

2. Hopkins DR, Ruiz-Tiben E. Strategies for dracunculiasis eradication. Bull World Health Organ 1991 ;69:533-40.

* 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.

COPYRIGHT 1994 U.S. Government Printing Office
COPYRIGHT 2004 Gale Group

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