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7 suspected cases with emerging worms and about 50 people under surveillance in Ethiopia
A seventh person is being treated for emerging worms at a detention center in Ethiopia following an outbreak of dracunula (guinea pig disease) in the Gambella region last month, and a transfer from all 7 suspected cases is included.
This last suspicious case – in addition to six others initially identified with emerging worms1 – includes individuals from several villages who share the same unsafe water source.
“Many suspicious cases have been removed and there are now about 50 people in our case detention center who have suspected signs and symptoms of guinea pigs – all brought here as a result of monitoring and investigation of exposures conducted immediately after suspicious human cases have been identified,“Said Kassahun Demissie, coordinator of the Ethiopian Dracunculiasis Eradication Program (EDEP).”Everyone uses unsafe drinking–water from the same ponds, as well as seven other people with emerging worms, and are observed. ”
On April 3, 2020, the WHO was notified of an epidemic in the village of Duli in Gog County in the Gambella region that was discovered on April 2, 2020 by EDEP community health workers. Five additional interim cases were subsequently uncovered. Measures to curb transmission from these suspicious cases began immediately. All of the infected used side ponds – water sources that may have been associated with an infected baboon in June 2019 in the same village.
In response, a team from EDEP within the Ethiopian Institute of Public Health, the Gambella Regional Health Office and the Carter Center – the World Health Organization’s main partner for the Global Eradication Program – conducted preliminary investigations and immediate intervention measures.
“Worm samples have already been removed from all suspected cases and are ready for shipment to the WHO Collaborating Center at CDC Atlanta, for laboratory confirmation.2“ said Dr. Zeyede Kebede, Acting NTD Coordinator, WHO State Office, Ethiopia. “The interruption of courier services due to COVID-19 somewhat delayed the process. “
Case search and contact search
EDEP has all the villages and hamlets already under active supervision in Abobo and Gog woredas with the support of the Carter Center. Searches are intensifying in seven villages where suspicious cases have been detected and / or where people are at higher risk of infection due to social links with the reporting villages. During the investigation, a total of 217 households were visited, and 1254 persons were surveyed and provided with health education.
With the support of the WHO, EDEP has stepped up surveillance in cross-border areas, especially in and around refugee camps in the Gambella and Benishangul Gumuz regions, to prevent any spread of the disease to South Sudan.
To kill water fleas that act as intermediate hosts for guinea pig larvae, several ponds were treated with Temephos larvicide and pipe and fabric filters distributed to villagers.3.
Further training and guidance was provided to volunteers and health workers to conduct field activities in the context of the current COVID-19 pandemic.
Dracunculias in Ethiopia
EDEP began in 1994 when the country reported more than 1,100 cases a year.
The implementation of eradication activities over the decades has drastically reduced the number of human cases. In 2017, an outbreak of a farm epidemic in the Gambella region resulted in 15 cases. After that, no case in humans has been reported for more than two consecutive years, although sporadic infections with indigenous dracunulae have been reported in animals (dogs and baboons) since 2013.
Gambella is the only region in Ethiopia with a low rate of guinea pig disease transmission. With the latest cases reported from Gog County, increased surveillance is in place in other counties and refugee camps in the region where more than 272,000 South Sudanese nationals live.
Regular cross-border population movements between Ethiopia and South Sudan (due to insecurity in South Sudan and the activities of nomadic pastoralists) pose a risk of spreading the disease in the area.
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1The worms that appeared are morphologically consistent with Dracunculus medinensis, although laboratory confirmation is ongoing.
2WHO requirements: All worm samples obtained from each case are sent for confirmation to the WHO Collaborating Center for Research, Training and Control of Dracula at the Centers for Disease Control and Prevention (CDC) of the United States.
3Temephos (Abate®) and filters are donated by BASF and Vestergaard, respectively through the Carter Center.
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