Guinea worm outbreak dashes hopes of elimination in South Sudan

A health worker removes a Guinea worm from the leg of a patient
A health worker removes a Guinea worm from the leg of a patient Credit: Louise Gubb/AFP/Getty Images

South Sudan’s hopes of officially being declared free of Guinea worm have been dashed after an outbreak of the parasitic disease was detected in the centre of the country.

Three people in the town of Rumbek have been diagnosed with the disease, the first cases in South Sudan for more than 18 months.

Guinea worm – classed as a neglected tropical disease – is not fatal but it is incredibly debilitating. Once the minuscule parasite is ingested, through drinking contaminated water, it can grow to three feet in size, causing immense pain.

It eventually emerges, usually through a leg or foot, after a year, a painful process that can keep victims bedridden for three months. Seeking relief from the pain, the victim often places his or her leg in water, causing the worm to release larvae, starting the cycle afresh.

The outbreak will be seen as a significant blow as just four months ago government officials and the Carter Center, the United States-based charity at the forefront of efforts to eradicate Guinea worm globally, were celebrating what they believed was the end of a disease that has blighted hundreds of thousands of lives in South Sudan.

Until this week, the last diagnosis of the disease had been in December 2016, leading experts to believe that the transmission cycle had been permanently broken.

“The dream has come true,” South Sudan’s health minister, Dr Riek Gai Kok, said at the time. “Future generations will just read of Guinea worm in the history books.”

Guinea worm has all been but eradicated around the world. Just 30 cases were reported in two African states – Chad and Ethiopia – last year. In May, the World Health Organization (WHO) officially declared Kenya, South Sudan’s neighbour, free of the disease.

South Sudan, blighted by a civil war that has displaced four million people since 2013, hoped to follow suit in what would have been a remarkable victory in such a hostile climate.

Despite the setback, aid workers say they are convinced that the disease can be defeated.

“I am totally convinced that the eradication of Guinea worm disease in this country is on the horizon if the right measures are put in place,” Moses Nganda, the WHO’s South Sudan representative was quoted as saying by the Sudan Tribune newspaper.

South Sudan was once one of the countries most afflicted by Guinea worm. 

When the Carter Center, founded by former US president Jimmy Carter, launched its Guinea worm global eradication programme, there were 3.5 million cases in the world and the disease affected 20 countries, mostly in Africa.

Such has been the success in countering the disease that the WHO has set 2020 as a target for its complete elimination. Smallpox is the only human disease that has successfully been eradicated before.

Dr Kok said that an emergency surveillance team has been sent to Rumbek to contain the disease. He identified two teenage girls and a 23-year-old man as the victims.

Although improved monitoring and intervention methods are likely to ensure success, health workers may struggle to discover how Guinea worm has re-emerged.

Scientists have spoken of their alarm after Guinea worm, which had previously only attacked humans, was found to have infected dogs, cats and even baboons in Chad in recent years. At least 800 dogs were diagnosed with Guinea worm disease in Chad last year.

Some health workers say that the spread of the disease beyond humans could make it harder to eliminate.

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