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2.
Lancet Microbe ; 3(2): e105-e112, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35544041

RESUMEN

BACKGROUND: Dracunculiasis (also known as Guinea worm disease), caused by the Dracunculus medinensis nematode, is progressing towards eradication, with a reduction in cases from 3·5 million cases in the mid-1980s to only 54 human cases at the end of 2019. Most cases now occur in Chad. On April 19, 2019, a 19-year-old woman presented with D medinensis in an area within the Salamat region of Chad, where the disease had not been previously reported. We aimed to investigate the connection between this case and others detected locally and elsewhere in Chad using a combination of epidemiological and genetic approaches. METHODS: In this cross-sectional field study, we conducted household case searches and informal group interviews in the Bogam, Liwi, and Tarh villages in Chad. All community members including children were eligible for participation in the outbreak investigation. Adult female D medinensis associated with this outbreak were collected for genetic analysis (18 from humans and two from dogs). Four mitochondrial genes and 22 nuclear microsatellite markers were used to assess relatedness of worms associated with the outbreak in comparison with other worms from elsewhere in Chad. FINDINGS: Between April 12 and Sept 6, 2019, we identified 22 human cases and two canine cases of dracunculiasis associated with 15 households. Six (40%) of the 15 affected households had multiple human or canine cases within the household. Most cases of dracunculiasis in people were from three villages in Salamat (21 [95%] of 22 cases), but one case was detected nearly 400 km away in Sarh city (outside the Salamat region). All people with dracunculiasis reported a history of consuming fish and unfiltered water. Worms associated with this outbreak were genetically similar and shared the same maternal lineage. INTERPRETATION: Molecular epidemiological results suggest a point-source outbreak that originated from a single female D medinensis, rather than newly identified sustained local transmission. The failure of the surveillance system to detect the suspected canine infection in 2018 highlights the challenge of canine D medinensis detection, particularly in areas under passive surveillance. Human movement can also contribute to dracunculiasis spread over long distances. FUNDING: The Carter Center.


Asunto(s)
Dracunculiasis , Dracunculus , Animales , Chad/epidemiología , Estudios Transversales , Brotes de Enfermedades/veterinaria , Perros , Dracunculiasis/epidemiología , Dracunculus/genética , Femenino , Humanos
5.
Curr Biol ; 32(4): R170-R173, 2022 02 28.
Artículo en Inglés | MEDLINE | ID: mdl-35231412

RESUMEN

Domestic dogs have an important role in the ecology of transmission of the Guinea worm, a debilitating human parasite. A new study documents how fish content in dogs' diets can predict Guinea worm infection status, suggesting additional avenues for control.


Asunto(s)
Enfermedades Transmisibles , Enfermedades de los Perros , Dracunculiasis , Animales , Dieta/veterinaria , Enfermedades de los Perros/parasitología , Enfermedades de los Perros/transmisión , Perros , Dracunculiasis/parasitología , Dracunculiasis/prevención & control , Dracunculiasis/transmisión , Dracunculus , Humanos
8.
Am J Trop Med Hyg ; 106(3): 818-822, 2022 01 24.
Artículo en Inglés | MEDLINE | ID: mdl-35073509

RESUMEN

Dracunculus medinensis, also known as the African Guinea worm, is the causative agent of dracunculiasis and the focus of the global Guinea Worm Eradication Program (GWEP). Transmission of D. medinensis to humans occurs primarily by drinking water containing cyclopoid copepods infected with third-stage D. medinensis larvae. A common intervention to interrupt transmission and decrease the number of copepods in infected water bodies is the application of the organophosphate larvicide Abate® (temephos). However, the use of alternative compounds to help decrease copepod populations would be beneficial to the GWEP. We compared the immobilization of copepods by three compounds: Abate, Natular® (spinosad), and diflubenzuron. Our results confirm that neither diflubenzuron nor Natular immobilized copepods as quickly or as effectively as Abate. However, doubling or tripling the suggested concentration of Natular resulted in immobilization rates similar to Abate over 72 hours of continuous exposure. Further research on the possible effects of higher concentrations of Natular on the environment and nontarget organisms is necessary to determine whether this compound can be used safely to control the copepod population.


Asunto(s)
Copépodos , Diflubenzurón , Dracunculiasis , Animales , Dracunculiasis/epidemiología , Dracunculus , Combinación de Medicamentos , Humanos , Macrólidos , Temefós
9.
Curr Biol ; 32(4): 775-782.e4, 2022 02 28.
Artículo en Inglés | MEDLINE | ID: mdl-34910949

RESUMEN

Exploitation of natural resources is a driver of human infectious disease emergence. The emergence of animal reservoirs of Guinea worm Dracunculus medinensis, particularly in domestic dogs Canis familiaris, has become the major impediment to global eradication of this human disease. 93% of all Guinea worms detected worldwide in 2020 were in dogs in Chad. Novel, non-classical pathways for transmission of Guinea worm in dogs, involving consumption of fish, have been hypothesized to support the maintenance of this animal reservoir. We quantified and analyzed variation in Guinea worm emergence in dogs in Chad, across three climatic seasons, in multiple villages and districts. We applied forensic stable isotope analyses to quantify dietary variation within and among dogs and GPS tracking to characterize their spatial ecology. At the end of the hot-dry season and beginning of the wet season, when fishing by people is most intensive, Guinea worm emergence rates in dogs were highest, dogs ate most fish, and fish consumption was most closely associated with disease. Consumption of fish by dogs enables a non-classical transmission pathway for Guinea worm in Chad. Seasonal fisheries and the facilitation of dogs eating fish are likely contributing to disease persistence and to this key impediment to human disease eradication. Interrelated natural resource use, climatic variation, companion animal ecology, and human health highlight the indispensability of One Health approaches to the challenges of eradicating Guinea worm and other zoonotic diseases.


Asunto(s)
Dracunculiasis , Dracunculus , Animales , Perros , Dracunculiasis/epidemiología , Dracunculiasis/prevención & control , Dracunculiasis/veterinaria , Explotaciones Pesqueras , Humanos , Estaciones del Año , Zoonosis
10.
MMWR Morb Mortal Wkly Rep ; 70(44): 1527-1533, 2021 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-34735420

RESUMEN

Dracunculiasis (Guinea worm disease), caused by the parasite Dracunculus medinensis, is traditionally acquired by drinking water containing copepods (water fleas) infected with D. medinensis larvae, but in recent years also appears increasingly to be transmitted by eating fish or other aquatic animals. The worm typically emerges through the skin on a lower limb of the host 1 year after infection, causing pain and disability (1). There is no vaccine or medicine to prevent or medicine to treat dracunculiasis; eradication relies on case containment* to prevent water contamination and other interventions to prevent infection: health education, water filtration, treatment of unsafe water with temephos (an organophosphate larvicide), and provision of safe drinking water (1,2). The eradication campaign began in 1980 at CDC (1). In 1986, with an estimated 3.5 million cases† occurring annually in 20 African and Asian countries§ (3), the World Health Assembly called for dracunculiasis elimination (4). The Guinea Worm Eradication Program (GWEP), led by The Carter Center and supported by the World Health Organization (WHO), UNICEF, CDC, and other partners, began assisting ministries of health in countries with endemic disease. With 27 cases in humans reported in 2020, five during January-June 2021, and only six countries currently affected by dracunculiasis (Angola, Chad, Ethiopia, Mali, South Sudan, and importations into Cameroon), achievement of eradication appears to be close. However, dracunculiasis eradication is challenged by civil unrest, insecurity, and epidemiologic and zoologic concerns. Guinea worm infections in dogs were first reported in Chad in 2012. Animal infections have now overtaken human cases, with 1,601 reported animal infections in 2020 and 443 during January-June 2021. Currently, all national GWEPs remain fully operational, with precautions taken to ensure safety of program staff and community members in response to the COVID-19 pandemic. Because of COVID-19, The Carter Center convened the 2020 and 2021 annual GWEP Program Managers meetings virtually, and WHO's International Commission for the Certification of Dracunculiasis Eradication met virtually in October 2020. Since 1986, WHO has certified 199 countries, areas, and territories dracunculiasis-free. Six countries are still affected: five with endemic disease and importations into Cameroon. Seven countries (five with endemic dracunculiasis, Democratic Republic of the Congo, and Sudan) still lack certification (4). The existence of infected dogs, especially in Chad, and impeded access because of civil unrest and insecurity in Mali and South Sudan are now the greatest challenges to interrupting transmission. This report describes progress during January 2020-June 2021 and updates previous reports (2,4,5).


Asunto(s)
Erradicación de la Enfermedad , Dracunculiasis/prevención & control , Salud Global/estadística & datos numéricos , Dracunculiasis/epidemiología , Humanos
13.
PLoS Negl Trop Dis ; 15(8): e0009675, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34370746

RESUMEN

BACKGROUND: In the absence of a vaccine or pharmacological treatment, prevention and control of Guinea worm disease is dependent on timely identification and containment of cases to interrupt transmission. The Chad Guinea Worm Eradication Program (CGWEP) surveillance system detects and monitors Guinea worm disease in both humans and animals. Although Guinea worm cases in humans has declined, the discovery of canine infections in dogs in Chad has posed a significant challenge to eradication efforts. A foundational information system that supports the surveillance activities with modern data management practices is needed to support continued program efficacy. METHODS: We sought to assess the current CGWEP surveillance and information system to identify gaps and redundancies and propose system improvements. We reviewed documentation, consulted with subject matter experts and stakeholders, inventoried datasets to map data elements and information flow, and mapped data management processes. We used the Information Value Cycle (IVC) and Data-Information System-Context (DISC) frameworks to help understand the information generated and identify gaps. RESULTS: Findings from this study identified areas for improvement, including the need for consolidation of forms that capture the same demographic variables, which could be accomplished with an electronic data capture system. Further, the mental models (conceptual frameworks) IVC and DISC highlighted the need for more detailed, standardized workflows specifically related to information management. CONCLUSIONS: Based on these findings, we proposed a four-phased roadmap for centralizing data systems and transitioning to an electronic data capture system. These included: development of a data governance plan, transition to electronic data entry and centralized data storage, transition to a relational database, and cloud-based integration. The method and outcome of this assessment could be used by other neglected tropical disease programs looking to transition to modern electronic data capture systems.


Asunto(s)
Enfermedades de los Perros/prevención & control , Dracunculiasis/veterinaria , Dracunculus/fisiología , Animales , Chad/epidemiología , Erradicación de la Enfermedad , Enfermedades de los Perros/epidemiología , Enfermedades de los Perros/parasitología , Perros , Dracunculiasis/epidemiología , Dracunculiasis/parasitología , Dracunculiasis/prevención & control , Dracunculus/genética
14.
BMJ Open ; 11(8): e049732, 2021 08 05.
Artículo en Inglés | MEDLINE | ID: mdl-34353803

RESUMEN

OBJECTIVES: To quantify conflict events and access across countries that remain to be certified free of transmission of Dracunculus medinensis (Guinea worm disease) or require postcertification surveillance as part of the Guinea Worm Eradication Programme (GWEP). SETTING AND PARTICIPANTS: Populations living in Guinea worm affected areas across seven precertification countries and 13 postcertification sub-Saharan African countries. OUTCOME MEASURES: The number of conflict events and rates per 100 000 population, the main types of conflict and actors reported to be responsible for events were summarised and mapped across all countries. Chad and Mali were presented as case studies. Guinea worm information was based on GWEP reports. Conflict data were obtained from the Armed Conflict Location and Event Data Project. Maps were created using ArcGIS V.10.7 and access was measured as regional distance and time to cities. RESULTS: More than 980 000 conflict events were reported between 2000 and 2020, with a significant increase since 2018. The highest number and rates were reported in precertification Mali (n=2556; 13.0 per 100 000), South Sudan (n=2143; 19.4), Democratic Republic of Congo (n=7016; 8.1) and postcertification Nigeria (n=6903; 3.4), Central Africa Republic (n=1251; 26.4), Burkina Faso (n=2004; 9.7). Violence against civilians, protests and battles were most frequently reported with several different actors involved including Unidentified Armed Groups and Boko Haram. Chad and Mali had contracting epidemiological and conflict situations with affected regions up to 700 km from the capital or 10 hours to the nearest city. CONCLUSIONS: Understanding the spatial-temporal patterns of conflict events, identifying hotspots, the actors responsible and their sphere of influence is critical for the GWEP and other public health programmes to develop practical risk assessments, deliver essential health interventions, implement innovative surveillance, determine certification and meet the goals of eradication.


Asunto(s)
Dracunculiasis , Dracunculus , Animales , Burkina Faso , Certificación , Dracunculiasis/epidemiología , Dracunculiasis/prevención & control , Humanos , Malí/epidemiología
15.
Int J Parasitol ; 51(12): 1027-1034, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34246634

RESUMEN

Guinea worm (Dracunculus medinensis) has exerted a high human health burden in parts of Africa. Complete eradication of Guinea worm disease (dracunculiasis) may be delayed by the circulation of the parasite in domestic dogs. As with humans, dogs acquire the parasite by directly ingesting infected copepods, and recent evidence suggests that consuming frogs that ingested infected copepods as tadpoles may be a viable transmission route (paratenic route). To understand the relative contributions of direct and paratenic transmission routes, we developed a mathematical model that describes transmission of Guinea worm between dogs, copepods and frogs. We explored how the parasite basic reproductive number (R0) depends on parameters amenable to actionable interventions under three scenarios: frogs/tadpoles do not consume copepods; tadpoles consume copepods but frogs do not contribute to transmission; and frogs are paratenic hosts. We found a non-monotonic relationship between the number of dogs and R0. Generally, frogs can contribute to disease control by removing infected copepods from the waterbody even when paratenic transmission can occur. However, paratenic transmission could play an important role in maintaining the parasite when direct transmission is reduced by interventions focused on reducing copepod ingestion by dogs. Together, these suggest that the most effective intervention strategies may be those which focus on the reduction of copepods, as this reduces outbreak potential irrespective of the importance of the paratenic route.


Asunto(s)
Copépodos , Dracunculiasis , Animales , Anuros , Brotes de Enfermedades , Perros , Dracunculiasis/epidemiología , Dracunculiasis/prevención & control , Dracunculiasis/veterinaria , Dracunculus
16.
PLoS Negl Trop Dis ; 15(7): e0009609, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34310598

RESUMEN

BACKGROUND: Guinea worm (Dracunculus medinensis) was detected in Chad in 2010 after a supposed ten-year absence, posing a challenge to the global eradication effort. Initiation of a village-based surveillance system in 2012 revealed a substantial number of dogs infected with Guinea worm, raising questions about paratenic hosts and cross-species transmission. METHODOLOGY/PRINCIPAL FINDINGS: We coupled genomic and surveillance case data from 2012-2018 to investigate the modes of transmission between dog and human hosts and the geographic connectivity of worms. Eighty-six variants across four genes in the mitochondrial genome identified 41 genetically distinct worm genotypes. Spatiotemporal modeling revealed worms with the same genotype ('genetically identical') were within a median range of 18.6 kilometers of each other, but largely within approximately 50 kilometers. Genetically identical worms varied in their degree of spatial clustering, suggesting there may be different factors that favor or constrain transmission. Each worm was surrounded by five to ten genetically distinct worms within a 50 kilometer radius. As expected, we observed a change in the genetic similarity distribution between pairs of worms using variants across the complete mitochondrial genome in an independent population. CONCLUSIONS/SIGNIFICANCE: In the largest study linking genetic and surveillance data to date of Guinea worm cases in Chad, we show genetic identity and modeling can facilitate the understanding of local transmission. The co-occurrence of genetically non-identical worms in quantitatively identified transmission ranges highlights the necessity for genomic tools to link cases. The improved discrimination between pairs of worms from variants identified across the complete mitochondrial genome suggests that expanding the number of genomic markers could link cases at a finer scale. These results suggest that scaling up genomic surveillance for Guinea worm may provide additional value for programmatic decision-making critical for monitoring cases and intervention efficacy to achieve elimination.


Asunto(s)
Dracunculiasis/epidemiología , Dracunculus/genética , Vigilancia de la Población/métodos , Animales , Chad/epidemiología , ADN de Helmintos/genética , Marcadores Genéticos , Genoma de los Helmintos , Genoma Mitocondrial , Humanos
18.
Sci Rep ; 11(1): 11802, 2021 06 03.
Artículo en Inglés | MEDLINE | ID: mdl-34083638

RESUMEN

Dracunculus spp. are parasitic nematodes that infect numerous species of mammals and reptiles. The life cycles of Dracunculus species are complex, and unknowns remain regarding the role of paratenic and transport hosts in transmission to definitive hosts. We had two primary objectives: to assess the susceptibility of several species of anurans, lizards, and fish as paratenic hosts for Dracunculus species, and to determine the long-term persistence of Dracunculus infections in African clawed frogs (Xenopus laevis). Animals were orally exposed to copepods infected with infectious third-stage larvae (L3s) of either Dracunculus insignis or D. medinensis. Dracunculus L3s were recovered from four anuran species, two lizard species, and one fish species, demonstrating that Dracunculus can infect tissues of a diversity of species. In long-term persistence trials, D. medinensis L3s were recovered from African clawed frogs tissues up to 58 days post-infection, and D. insignis L3s were recovered up to 244 days post-infection. Our findings regarding the susceptibility of novel species of frogs, lizards, and fish to infection with Dracunculus nematodes, and long-term persistence of L3s in paratenic hosts, address pressing knowledge gaps regarding Dracunculus infection in paratenic hosts and may guide future research regarding the transmission of Dracunculus to definitive mammalian hosts.


Asunto(s)
Enfermedades de los Animales/parasitología , Anuros , Dracunculiasis/veterinaria , Dracunculus , Peces , Interacciones Huésped-Parásitos , Lagartos , Animales , Larva
19.
Am J Trop Med Hyg ; 105(1): 188-195, 2021 05 24.
Artículo en Inglés | MEDLINE | ID: mdl-34029207

RESUMEN

The total number of Guinea worm cases has been reduced by 99.9% since the mid-1980s when the eradication campaign began. Today, the greatest number of cases is reported from Chad. In this report, we use surveillance data collected by the Chad Guinea Worm Eradication Program to describe trends in human epidemiology. In total, 114 human cases were reported during the years 2010-2018, with highest rates of containment (i.e., water contamination prevented) in the years 2013, 2014, 2016, and 2017 (P < 0.0001). Approximately half of case-patients were female, and 65.8% of case-patients were aged 30 years or younger (mean: 26.4 years). About 34.2% of case-patients were farmers. Cases were distributed across many ethnicities, with a plurality of individuals being of the Sara Kaba ethnicity (21.3%). Most cases occurred between the end of June and the end of August and were clustered in the Chari Baguirmi (35.9%) and Moyen Chari regions (30.1%). Cases in the northern Chari River area peaked in April and in August, with no clear temporal pattern in the southern Chari River area. History of travel within Chad was reported in 7.0% of cases, and male case-patients (12.5%) were more likely than female case-patients (1.7%) to have reported a history of travel (P = 0.03). Our findings confirm that human Guinea worm is geographically disperse and rare. Although the proportion of case-patients with travel history is relatively small, this finding highlights the challenge of surveillance in mobile populations in the final stages of the global eradication campaign.


Asunto(s)
Erradicación de la Enfermedad/estadística & datos numéricos , Erradicación de la Enfermedad/tendencias , Dracunculiasis/epidemiología , Dracunculiasis/fisiopatología , Dracunculus/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Chad/epidemiología , Métodos Epidemiológicos , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Adulto Joven
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