DRACUNCULIASISMODERATED BY: Dr. ROHUL JABEEN SHAHS.R. INCHARGE : Dr. FEROZ AHMAD WANI

PRESENTED BY : Dr. UROOSA FAROOQ

TABLE OF CONTENTS:1.Definitions2.Introduction3.Problem statement4.Epidemiology5.Life cycle of Guinea worm6.Clinical features7.Preventive measures8.Treatment9.National Guinea worm Eradication Programme

CONTROL :The reduction of disease incidence, prevalence, morbidity or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction. e.g., diarrhoeal diseases.

ELIMINATION OF DISEASE : Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts; continued intervention measures are required. e.g., neonatal tetanus.

ELIMINATION OF INFECTIONS: Reduction to zero of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts; continued measures to prevent re-establishment of transmission are required. e.g.,

measles, poliomyelitis, guinea worm and diphtheria.

ERADICATION: Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed. e.g., smallpox.

EXTINCTION: The specific infectious agent no longer exists in nature or in the laboratory.

ERADICATED DISEASES: Small pox Rinderpest

GLOBAL ERADICATION UNDERWAY: Polio Dracunculiasis Yaws Malaria

REGIONAL ELIMINATION ESTABLISHED OR UNDER WAY: Hookworm Measles Rubella Onchocerciasis Syphilis Rabies Filariasis

INTRODUCTION

DRACUNCULIASIS : Also known as guinea worm

disease. Vector borne parasitic disease. Involves subcutaneous

tissues(leg and foot). Caused by nematode parasite,

Dracunculus medinensis. Its not lethal but disable its

victim temporarily.

Transmitted exclusively when people drink stagnant water contaminated with parasite infected water fleas.

It affects people in rural, deprived and isolated communities who depend mainly on open surface water sources such as ponds and wells.

YEAR NO. OF CASES

1980 3.5 million cases

1989 892,005 2007 10,000 2012 542 2013 148 2014 126 2015 22:9 Chad

3 Ethiopia 5 Mali 5 South Sudan

PROBLEM STATEMENT: WHOLE WORLD

(WHO 2015)

In India, the last case was reported in july 1996.

On completion of three years of zero incidence, India was declared free of guineaworm disdease.

EPIDEMIOLOGY:

AGENT :Dracunculus medinensis It is a round worm Also called

serpent/medina/Thread worm. Adult parasite inhabits

subcutaneous tissue mainly of legs but other parts are also included like head and neck.

Female worm is 55 to 120cm long as compare to male 2 to 3cm long.

HOST FACTORS: Man is the definitive host. Multiple and repeated

infections may occur in the same individual.

Habit of washing and bathing in surface water and using step-well makes them prone to infection.

ENVIRONMENTAL FACTORS: SEASON : Where the step-

wells are the source of water supply, peak transmission occurs during the dry season(March-May) when the contact between open cases of gunieaworm disease and the drinking water is the greatest.

Where ponds are used transmission occurs when ponds are full during June-September.

TEMPERATURE:Larvae develop best between 25 and 30 deg C and will not develop below 19 deg C.

Disease is limited to tropical and subtropical regions.

LIFE CYCLE OF DRACUNCULIASIS:

Gravid female goes down infected persons lower limb near skin surface.

Worm penetrates into the dermis and induces an inflammatory reaction and blister formation.

Upon contact with water the worm bursts releases up to 1 million microscopic, free swimming larva in water.

Larvae remain active in water for 3-6 days.

Fresh water crustacean called cyclops take these larvae.

Larvae require 15 days for their development in these cyclops.

Cyclops act as INTERMEDIATE HOST.

Man acquires infection by drinking water containing infected cyclops.

In human body digested by gastric juice, parasites are released.

These parasites can penetrate the duodenal wall.

Migrate through the viscera to the subcutaneous tissues of various parts of the body.

Grow into adult worms in 10-14 months.

SIGN/SYMPTOMS : Intense burning pain

localized to path of travel of worm(the fiery serpent).

Fever Nausea Vomiting Allergic reaction

Arthritis and paralysis (due to

death of adult worm in joint).

Skin blisters , which when rupture form ulcers.

Adult worms protrude from these ulcers.

MODE OF TRANSMISSION: Disease is transmitted

entirely through the consumption of water containing cyclops harboring the infective stage of the parasite.

Guinea worm disease is a totally water-based disease.

PREVENTION: Two preventive measures are: 1.Prevent people from drinking contaminated water containing the cyclops which can be seen in clear water as swimming white specks . This can be done by using: Piped water Water from borehole

Boiled water.Filter all drinking water , using a fine-mesh cloth filter to remove the guinea worm containing crustaceans.

Filter the water through ceramic or sand filters.

Treat water sources with larvicides to kill the water fleas.

2.Prevent people with emerging Guinea worms from wading into water sources used for drinking:Community-level case detection and containment is key. Staff must go door to door looking for cases, and population must be willing to help and not hide their cases.

Immerse emerging worms in buckets of water to reduce the number of larvae in those worms and discard this water on dry ground.

Guard local water sources to prevent people with emerging worms from entering.

TREATMENT: No drug cures the infection

but metronidazole and mebendazole are sometimes used to limit inflammation and facilitate worm removal.

Wet compressions relieve discomfort.

Occlusive dressings improve hygiene and limit shedding of infectious larvae.

Worms are removed by sequentially rolling them out over a small stick. ‘ROD OF ASCLEPIUS”

Simple surgical procedure can be used for removal of worms.

Topical antibiotics may limit bacterial superinfection.

NATIONAL GUINEAWORM ERADICATION PROGRAMME

India launched its National Guineaworm Eradication Programme in 1984 with technical assistance from WHO.

The country has reported zero case since August 1996.

In February 2000, the International Commission for the Certification of Dracunculiasis Eradication Team Geneva recommended that India be certified free of dracunculiasis transmission.

Following activities are continuing as per recommendations of ICCDE:Health education activities with special emphasis on school children and women in rural areas.

Rumour registration and rumour investigation.

Maintenance of guineaworm disease on list of notifiable disease and continuation of surveillance in previously infected areas.

Careful supervision of the functioning of hand pumps and other sources of safe drinking water.

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