Dracunculus medinensis. The “fiery serpent”. Guinea worm. The next human infectious disease to be eradicated? According to the latest numbers and the trend over recent years, that will most likely be yes.

According to the Carter Center, considered a neglected tropical disease, Guinea worm disease (dracunculiasis) is a parasitic infection caused by the nematode roundworm parasite Dracunculus medenisis. It is contracted when people consume water from stagnant sources contaminated with copepods (tiny “water fleas”) that carry Guinea worm larvae (immature forms of the worm). These larvae are eaten by the copepods that live in these stagnant water sources.Guinea worm larvae.

About a year after infection, a painful blister forms – 90% of the time on the lower leg – and one or more worms emerge accompanied by a burning sensation. To soothe the burning pain, patients often immerse the infected part of the body in water. The worm(s) then releases thousands of larvae (baby worms) into the water. These larvae reach the infective stage after being ingested by tiny crustaceans or copepods, also called water fleas.

Treating Guinea worm disease involves pulling the worm gently from the wound, centimeter by centimeter, and wound around a twig or piece of gauze. The process is agonizingly slow, requiring anywhere from a few days to a month or more to tug the worm free.

How widespread was Dracunculiasis and what is the situation today?

During the mid-1980s an estimated 3.5 million cases of dracunculiasis occurred in 21 countries worldwide, primarily in Africa. The number of reported cases fell to fewer than 10,000 cases in 2007, dropping further to 542 cases (2012), 148 (2013) and 126 (2014). In 2015, only 22 cases were reported globally – the lowest in history.

In fact, according to the Carter Center’s special advisor for Guinea worm eradication and former director of all health programs, Dr Donald Hopkins, to date in 2016, only two Guinea worm disease cases have been reported to date. Both were in children and both were contained.

“We’ve got a real chance of eradication as far as human cases go,” Hopkins says.

LISTEN: 2013 interview with Dr Hopkins (sorry about the sound)

There are some obstacles to eradication. First, finding the last remaining cases are the most difficult and expensive stages of the eradication process as these usually occur in remote, often inaccessible, rural areas.

In countries where cases have been recently reported, lack of access to disease-endemic areas due to insecurity is a problem.

Lastly, infections in dogs have been reported previously in Chad and Ethiopia. Hopkins says the dogs get infected by eating discarded guts of fish with water fleas carrying the Guinea worm larvae.

The goal for eradication is 2020, which means that by the end of 2017, zero cases can be reported. After that, the World Health Organization will certify eradication after three Guinea worm free years.

If and when eradicated, Guinea worm disease would be the second disease, after smallpox, to be wiped off the face of the earth. And more remarkably, it will have been accomplished with no treatment, no vaccine, no acquired immunity, and no cure. The only method was to get people in remote regions of the world to change the way they have collected and consumed water for generations.

Last August, former President Jimmy Carter said, “I would like to see guinea worm completely eradicated before — before I die. I’d like for the last guinea worm to die before I do.”

It very well could happen, thanks to all the hard work spearheaded by the Carter Center and other international agencies.

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