Skip to main content
Part of complete coverage on

Hunting the 'fiery serpent': The quest to wipe out Guinea worm

By Meera Senthilingam, for CNN
updated 6:27 AM EDT, Fri May 9, 2014
Guinea worm disease infected millions of people just 30 years ago. Now it is close to eradication.<!-- -->
</br>The Carter Center has led efforts to fight the disease, helping educate people on how to avoid spreading the worm. Guinea worm disease infected millions of people just 30 years ago. Now it is close to eradication.
The Carter Center has led efforts to fight the disease, helping educate people on how to avoid spreading the worm.
HIDE CAPTION
Eradicating Guinea worm
Eradicating Guinea worm
Eradicating Guinea worm
Eradicating Guinea worm
Eradicating Guinea worm
Eradicating Guinea worm
Eradicating Guinea worm
<<
<
1
2
3
4
5
6
7
>
>>
STORY HIGHLIGHTS
  • Guinea worm disease once infected millions -- now it's almost eradicated
  • But finding the remaining cases will be a challenge
  • There is no vaccine -- beating the disease involves education and improved sanitation

Vital Signs is a monthly program bringing viewers health stories from around the world.

(CNN) -- "It's such a loser of a disease that some countries eradicated it without even knowing they'd had it. It can naturally disappear."

The disease Sandy Cairncross of the London School of Hygiene and Tropical Medicine is referring to is Guinea worm, a condition that culminates in a worm up to 3 feet long bursting out of your skin, often unbeknownst to the person it's bursting out of until it's about to happen.

It's something a picture could never prepare you for, and loser or not, this agonizing illness was infecting millions of people just 30 years ago. But thankfully it's a disease that's next on the cards for global eradication.

There is no treatment or vaccine.
Sandy Cairncross, London School of Hygiene and Tropical Medicine

"There is no treatment or vaccine. Its eradication involves simple interventions such as clean water and sanitation and the use of community health teams," explains Cairncross, a water engineer by background and now professor of environmental health.

Burning pain

People become infected with Guinea worm after drinking water contaminated with the larvae of the parasitic worm Dracunculus medinensis, typically in remote rural areas. The larvae then grow in the host into adult worms over the course of one year, at which point females burst out of their host's foot or leg to lay eggs. The eggs need to be laid in water and as people stand in their shallow dug-out wells to collect their daily water supply, or to relieve the terrible burning of the residing worm, the worm seizes the opportunity and contaminates the village water supply in the process.

It's rarely fatal but patients often remain sick for several months, meaning they can't work, which impacts their income and the local economy. The only "treatment" is the extraction of the worm from a patient's leg, which is then bandaged to enable recovery.

Guinea worm life cycle. Click to expand  Guinea worm life cycle. Click to expand
Guinea worm life cycle. Click to expandGuinea worm life cycle. Click to expand

Cairncross has been involved with the global Guinea Worm Eradication Program (GWEP) since the early 1990s when he joined UNICEF to target the disease in West Africa. "Guinea worm is extremely rural and is found in the poorest parts of Africa, where health services simply don't reach," he says. It's a disease of poverty.

Read: This machine makes drinking water from thin air

The U.S. Centers for Disease Control (CDC) initiated GWEP in 1980 off the back of the success of the smallpox eradication campaign. Since the disease is solely spread by contaminated water, the program was used as an indicator for the United Nations 1981-1990 International Drinking Water Supply and Sanitation Decade (IDWSSD), and large-scale advocacy for the campaign began in 1986 when the Carter Center got involved.

The Carter Center is led by former U.S. president Jimmy Carter, who wanted to use his status to broker peace and fight disease worldwide. Since 1982 the center has operated with a mandate to resolve political conflict and combat disease. Guinea worm factors in both.

The final cases

Since 1986, numbers have plummeted from 3.5 million cases across 21 countries in Asia and Africa to just 148 cases in 2013 in four remaining countries -- Chad, Ethiopia, Mali and South Sudan, where the majority of cases lie. The challenge now is finding those last cases because with eradication, "the nearer you get, the harder it gets," says Cairncross. "The cases left are either unreachable, or forgotten," he adds.

Guinea worm, sometimes known as the "fiery serpent," is not on the radar of most Western governments, especially with so few cases remaining worldwide causing the "cost per case" to increase dramatically.

The cases left are either unreachable, or forgotten.
Sandy Cairncross, London School of Hygiene and Tropical Medicine

"A million-dollar case search in Guinea once found only one case of the disease, which had been imported," says Cairncross. But aside from these costs for surveillance, the control of the disease itself is simple: clean water and education.

"It is a matter of education," explains Dr. Ernesto Ruiz-Tiben, who directs the Carter Center's program.

A crucial aspect of disease control is teaching locals to filter their water with basic nylon filters and to avoid standing in water when infected. People are encouraged to strain water through nylon filters, or even clothing material, to remove the worm's larvae before they drink it. The shallow nature of the muddy watering holes people use means they frequently stand in them when collecting water.

In the fight to educate, the real progress has been made using local villagers. The program pioneered the role of the "community health worker," who are now commonplace for a variety of global health programs.

The Carters on eradicating Guinea worm

The extreme rural nature of Guinea worm means those leading the programs cannot be in the field enough to monitor the disease closely. A large proportion of the control efforts are therefore run by local volunteers and community teams who act as surveillance units, keep an ear out in their local village to see who may be infected and supply people with filters at water collection points.

"As communities learn about the worm and its life cycle, they discover that they can get rid of it by themselves. We give them the lessons, but they do the work," says Ruiz-Tiben. "That's why it can be eradicated worldwide."

The intended date to reach eradication was 2015. "Previous targets were 1995, then 2000, now who knows?" explains Cairncross. "We need local government backing, funding and commitment."

The disease can also re-emerge due to negligence and insecurity during conflict, which is why the majority of cases now occur in South Sudan. In 2007 an outbreak occurred in Ghana due to government officials allowing a water supply to degrade and become infected. Although cases are now few, if left the disease can return and spread making the hunt for the last cases all the more important.

Ruiz-Tiben is determined to find these cases and remove the disease from our planet once and for all. "We'll be standing until the last worm goes," he concludes.

Read: From toilet to tap -- drinking recycled waste water

Read: Carpenter cuts off his fingers, makes new ones

Read: 3-D printed arm for boy maimed by bomb

ADVERTISEMENT
Part of complete coverage on
updated 6:02 AM EDT, Thu April 24, 2014
A device for extracting water from air is being used by the military -- could it help developing countries too?
updated 5:31 AM EDT, Fri May 23, 2014
Air-cleaning pavillion to be launched at the 2015 Milan Expo
Air pollution is now the biggest global environmental killer, but these high-tech solutions could save lives.
updated 3:54 PM EDT, Mon April 14, 2014
robohand metal hand
A South African carpenter lost his fingers in an accident -- now he's making mechanical fingers and hands for others.
updated 8:16 AM EDT, Thu August 7, 2014
Connie Culp was injured when her husband shot her in 2004. She underwent a near-total face transplant at the Cleveland Clinic in 2008 -- the first operation of its kind in the United States
As face transplants become more common, hospitals may soon be asking: Will you donate your face?
updated 1:18 PM EDT, Wed May 28, 2014
TB is growing increasingly drug resistant -- and it's becoming a global problem.
updated 8:49 AM EDT, Thu August 14, 2014
A 10-year-old inventor and a 20-year-old MD? Meet the whiz kids changing the face of medicine.
updated 6:27 AM EDT, Fri May 9, 2014
A Southern Sudanese man uses a pipe filter to protect himself from Guinea worm disease while drinking water from a potentially infected source. The pipe filter strains out the water fleas that can contain Guinea worm larvae.
Guinea worm disease once infected millions -- now it's almost eradicated. But can we catch the final cases?
updated 6:46 AM EDT, Thu September 4, 2014
A staff member from the Environment & Animal Society of Taiwan, a non-profit organisation based in Taipei, points at the part of a horseshoe crab where blood is drawn for use in laboratory tests against animals, during a press conference in Taipei on December 4, 2012.
Hundreds of thousands of horseshoe crabs are captured each year for their incredible blue blood. Here's why.
updated 7:27 AM EDT, Fri September 12, 2014
Lika Rose Caticon, 7, who is suffering from Typhoid fever, holds a doll as she lies in a makeshift cot at the overcrowded JP Rizal Memorial District Hospital in Calamba City south of the Philippine capital Manila on March 5, 2008.
As we travel ever further afield, which infectious diseases do you need to know about?
vital signs logo
Vital Signs is a monthly program bringing viewers health stories from around the world.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT