Clinical Guidance for Guinea Worm

Guiding principles

The Guinea Worm Eradication Program (GWEP) is a group of national and international partners who support global activities to eradicate Guinea worm disease (GWD). Preventing GWD focuses on

• Surveillance (case detection) and case containment
• Safe drinking water
• Vector control
• Health education and community mobilization

Village volunteers (people selected by the community to work with the GWEP) provide many GWD interventions. Village volunteers identify and manage people with GWD to help prevent them from contaminating drinking water sources (i.e., case containment). They also distribute water filters and provide health education to the community.

GWEP village volunteers look for GWD cases in their community daily. Each month, they report the total number of cases in their communities to supervisors, who compile the information and send it to the national GWEP headquarters. The information is then shared with The Carter Center and the World Health Organization (WHO), where the organizations can identify where transmission is occurring and how the disease is spreading.

Preventing transmission

Case containment

Case containment centers are built in strategic locations in several countries¹ provide treatment and support to people with GWD and prevent them from contaminating water sources. A case of GWD is considered to be contained if all of the following conditions are met: ^{2 3}

1. Village volunteers identify the person with GWD before or within 24 hours of the worm emerging, AND
2. The infected person has not entered any water source since the worm has emerged; AND
3. The village volunteer or other health care provider has properly managed the case, by cleaning and bandaging the wound until the worm has been fully removed and by providing health education to discourage the patient from contaminating any water source (if two or more emerging worms are present, the case is not contained until the last worm is removed); AND
4. Within seven days of the worm emerging, a GWEP supervisor determines that the above criteria have been met and the case is truly GWD; AND
5. The approved chemical temephos (ABATE^®*) is used to treat potentially contaminated surface water if there is any uncertainty about contamination of sources of drinking water or if a source of drinking water is known to have been contaminated and if the water body in question meets certain other logistical criteria.

Centers should also apply the criteria for defining a contained case of Guinea worm disease in a human.

Safe water

Safe drinking water sources include bore-hole wells and deep hand-dug wells with protective walls around them that prevent contaminated water from flowing back into the well (e.g., after rains or floods or if someone pours/spills water nearby the well).

Flowing water (e.g., water found in a stream or river), is also safe from Guinea worm. The GWEP advocates for the development and maintenance of safe drinking water sources and encourages treatment of potentially contaminated drinking water.

Households receive fine-mesh cloth filters to strain out copepods (tiny "water fleas" too small to be clearly seen without a magnifying glass) from contaminated drinking water where there are no safe water supplies.

People who travel or work away from the household and might not have access to filtered water receive individual pipe filters. These devices are used like straws to drink water from unsafe water sources.

Vector control

A vector is an organism that carries or transmits a disease. The vector for GWD is the copepod. GWEP puts a measured amount of the approved chemical temephos (ABATE®*) into water sources that are suspected or known to be contaminated with Guinea worm-infected copepods. This chemical kills the infected copepods and prevents people from becoming infected with GWD when they drink the water.

Health education and community mobilization

1. GWEP works to educate and mobilize the community to learn about spread through household education and organized events (e.g., Worm Weeks)
2. Learn about GWD and spread through educating people during household visits by GWEP volunteers and staff through organized events, (e.g., Worm Weeks)
3. Help villagers act against the disease by not entering water sources (e.g., lakes and ponds) with emerging worms to prevent contaminating drinking water supplies
   1. Use water filters to protect against GWD
   2. Bury or burn fish guts left over from fish processing to prevent dogs from eating them
   3. Avoid feeding fish guts to dogs
   4. Thoroughly cook any fish and other aquatic animals before eating them to prevent themselves from becoming infected
   5. Work in partnership with GWEP to tether dogs known or suspected to be infected until their worms are fully emerged or infection is ruled out
4. Help villagers understand the need for safe chemical treatment (temephos) in their water supply.

*Use of trade names is for identification only and does not imply endorsement by the Public Health Service or by the U.S. Department of Health and Human Services.

References

1. Hochberg N, Ruiz-Tiben E, Downs P, Fagan J, Maguire JH. The Role of Case Containment Centers in the Eradication of Dracunculiasis in Togo and Ghana. Am J Trop Med Hyg, 2008. 79(5): p. 722–8.
2. WHO Collaborating Center for Dracunculiasis Eradication, Guinea Worm Wrap Up #194, 2010. Centers for Disease Control and Prevention (CGH): Atlanta. https://www.cartercenter.org/resources/pdfs/news/health_publications/guinea_worm/wrap-up/194.pdf
3. Hopkins DR, et al., Progress Toward Global Eradication of Dracunculiasis, January 2016–June 2017. MMWR, 2017 Dec 8. 66(48): p. 1327–31. https://www.cdc.gov/mmwr/volumes/66/wr/mm6648a3.htm?s_cid=mm6648a3_w