Assessment of the Chad guinea worm surveillance information system: A pivotal foundation for eradication.

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.

Ecology of domestic dogs (Canis familiaris) as a host for Guinea worm (Dracunculus medinensis) infection in Ethiopia.

The global programme for the eradication of Guinea worm disease, caused by the parasitic nematode Dracunculus medinensis, has been successful in driving down human cases, but infections in non-human animals, particularly domestic dogs (Canis familiaris), now present a major obstacle to further progress. Dog infections have mainly been found in Chad and, to a lesser extent, in Mali and Ethiopia. While humans classically acquire infection by drinking water containing infected copepods, it has been hypothesized that dogs might additionally or alternatively acquire infection via a novel pathway, such as consumption of fish or frogs as possible transport or paratenic hosts. We characterized the ecology of free-ranging dogs living in three villages in Gog woreda, Gambella region, Ethiopia, in April-May 2018. We analysed their exposure to potential sources of Guinea worm infection and investigated risk factors associated with infection histories. The home ranges of 125 dogs and their activity around water sources were described using GPS tracking, and the diets of 119 dogs were described using stable isotope analysis. Unlike in Chad, where Guinea worm infection is most frequent, we found no ecological or behavioural correlates of infection history in dogs in Ethiopia. Unlike in Chad, there was no effect of variation among dogs in their consumption of aquatic vertebrates (fish or frogs) on their infection history, and we found no evidence to support hypotheses for this novel transmission pathway in Ethiopia. Dog owners had apparently increased the frequency of clean water provision to dogs in response to previous infections. Variations in dog ranging behaviour, owner behaviour and the characteristics of natural water bodies all influenced the exposure of dogs to potential sources of infection. This initial study suggests that the classical transmission pathway should be a focus of attention for Guinea worm control in non-human animals in Ethiopia.

Agent-Based Simulation for Seasonal Guinea Worm Disease in Chad Dogs.

The campaign to eradicate dracunculiasis (Guinea worm [GW] disease) and its causative pathogen Dracunculus medinensis (GW) in Chad is challenged by infections in domestic dogs, which far outnumber the dwindling number of human infections. We present an agent-based simulation that models transmission of GW between a shared water source and a large population of dogs. The simulation incorporates various potential factors driving the infections including external factors and two currently used interventions, namely, tethering and larvicide water treatments. By defining and estimating infectivity parameters and seasonality factors, we test the simulation model on scenarios where seasonal patterns of dog infections could be driven by the parasite's life cycle alone or with environmental factors (e.g., temperature and rainfall) that could also affect human or dog behaviors (e.g., fishing versus farming seasons). We show that the best-fitting model includes external factors in addition to the pathogen's life cycle. From the simulation, we estimate that the basic reproductive number, R 0, is approximately 2.0; our results also show that an infected dog can transmit the infection to 3.6 other dogs, on average, during the month of peak infectivity (April). The simulation results shed light on the transmission dynamics of GWs to dogs and lay the groundwork for reducing the number of infections and eventually interrupting transmission of GW.

Dogs and the classic route of Guinea Worm transmission: an evaluation of copepod ingestion.

Dracunculus medinensis, the causative agent of Guinea worm disease in humans, is being reported with increasing frequency in dogs. However, the route(s) of transmission to dogs is still poorly understood. Classical transmission to humans occurs via drinking water that contains cyclopoid copepods infected with third stage larvae of D. medinensis, but due to the method of dog drinking (lapping) compared to humans (suction and/or retrieval of water into containers), it seems unlikely that dogs would ingest copepods readily through drinking. We exposed lab raised beagles to varying densities of uninfected copepods in 2 liters of water to evaluate the number of copepods ingested during a drinking event. We confirmed dogs can ingest copepod intermediate hosts while drinking; however, low numbers were ingested at the densities that are typically observed in Chad suggesting this transmission route may be unlikely. Overall, the relative importance of the classic transmission route and alternate transmission routes, such as paratenic and transport hosts, needs investigation in order to further clarify the epidemiology of guinea worm infections in dogs.

A mathematical study to control Guinea worm disease: a case study on Chad.

Global eradication of Guinea worm disease (GWD) is in the final stage but a mysterious epidemic of the parasite in dog population makes the elimination programme challenging. There is neither a vaccine nor an effective treatment against the disease and therefore intervention strategies rely on the current epidemiological understandings to control the spread of the disease. A novel mathematical model can predict the future outbreaks and it can quantify the dissemination rates of control interventions. Due to the lack of such novel models, a realistic mathematical model of GWD dynamics with human population, dog population, copepod population and the worm larvae is proposed and analyzed. Considering case data from Chad, we calibrate the model and perform global sensitivity analysis of the basic reproduction number with respect to the control parameters and copepod consumption rates. Furthermore, we investigate the impact of three control interventions: awareness of humans, isolation of infected dogs and copepod clearance from contaminated water sources. We also address the impact of combination interventions which leads to the conclusion that the combination of isolating the infected dogs and treating the contaminated ponds is a plausible way for eliminating the burden of GWD from Chad.

Prevalence, Structure, and Distribution of Novel Parasite Cysts Containing Dracunculus Species in River Otters ( Lontra canadensis) from Arkansas.

Adult female guinea worms ( Dracunculus spp.) usually are reported to occur singly in the extremities of their hosts, from which they deliver their larvae into the water through fistulae in the host's skin. We visually examined for the presence of worms in the fascia of the limbs of skinned carcasses of 184 river otters ( Lontra canadensis) harvested in Arkansas and report observations of cysts on wrists and ankles found on 12 otters. Cysts averaged 15.6 × 24.6 mm in diameter, were round to oval, and contained masses of up to 19 adult female Dracunculus sp. (mean 6.7). We speculate that high levels of infection in consumed paratenic hosts might have caused high infection rates, leading to large cyst formation in otters, as larvigerous Dracunculus sp. females accumulated in extremities. No males were discovered during the study, so identification of a sample of worms was based on molecular techniques.

Possible Role of Fish as Transport Hosts for Dracunculus spp. Larvae.

To inform Dracunculus medinensis (Guinea worm) eradication efforts, we evaluated the role of fish as transport hosts for Dracunculus worms. Ferrets fed fish that had ingested infected copepods became infected, highlighting the importance of recommendations to cook fish, bury entrails, and prevent dogs from consuming raw fish and entrails.

Guinea worm: from Robert Leiper to eradication.

Guinea worm disease, dracunculiasis or dracontiasis, is an ancient disease with records going back over 4500 years, but until the beginning of the 20th century, little was known about its life cycle, particularly how humans became infected. In 1905, Robert Thomas Leiper was sent by the British colonial authorities to West Africa to investigate the spread of Guinea worm disease and to recommend measures to prevent it. While carrying out his investigations, he made important contributions to the aetiology, epidemiology and public health aspects of Guinea worm disease and provided definitive answers to many outstanding questions. First, he tested the validity of previous theories; second, he confirmed the role of water fleas, which he identified as Cyclops, as the intermediate hosts in the life cycle; third, he investigated the development of the parasite in its intermediate host; and fourth, he recommended measures to prevent the disease. [The crustacean Order Cyclopoida in the Family Cyclopidae contains 25 genera, including Cyclops which itself contains over 400 species and may not even be a valid taxon. It is not known how many of these species (or indeed species belonging to related genera) can act as intermediate hosts of Dracunculus medinensis nor do we know which species Fedchenko, Leiper and other workers used in their experiments. It is, therefore, best to use the terms copepod, or copopoid crustacean rather than Cyclops in scientific texts. In this paper, these crustaceans are referred to as copepods except when referring to an original text.] Leiper described the remarkable changes that took place when an infected copepod was placed in a dilute solution of hydrochloric acid; the copepod was immediately killed, but the Dracunculus larvae survived and were released into the surrounding water. From this, he concluded that if a person swallowed an infected copepod, their gastric juice would produce similar results. He next infected monkeys by feeding them copepods infected with Guinea worm larvae, and thus conclusively demonstrated that humans became infected by accidentally ingesting infected crustaceans. Based on these conclusions, he advocated a number of control policies, including avoidance of contaminated drinking water or filtering it, and these preventive measures paved the way for further research. The challenge to eradicate Guinea worm disease was not taken up until about seven decades later since when, with the support of a number of governmental and non-governmental organizations, the number of cases has been reduced from an estimated 3·5 million in 1986 to 25 in 2016 with the expectation that this will eventually lead to the eradication of the disease.

Possible Role of Fish and Frogs as Paratenic Hosts of Dracunculus medinensis, Chad.

Copepods infected with Dracunculus medinensis larvae collected from infected dogs in Chad were fed to 2 species of fish and tadpoles. Although they readily ingested copepods, neither species of fish, Nile tilapia (Oreochromis niloticus) nor fathead minnow (Pimephalis promelas), were found to harbor Dracunculus larvae when examined 2-3 weeks later. Tadpoles ingested copepods much more slowly; however, upon examination at the same time interval, tadpoles of green frogs (Lithobates [Rana] clamitans) were found to harbor small numbers of Dracunculus larvae. Two ferrets (Mustela putorius furo) were fed fish or tadpoles that had been exposed to infected copepods. Only the ferret fed tadpoles harbored developing Dracunculus larvae at necropsy 70-80 days postexposure. These observations confirm that D. medinensis, like other species in the genus Dracunculus, can readily survive and remain infective in potential paratenic hosts, especially tadpoles.

Dracunculiasis (guinea worm disease): eradication without a drug or a vaccine.

Dracunculiasis, commonly known as guinea worm disease, is a nematode infection transmitted to humans exclusively via contaminated drinking water. The disease prevails in the most deprived areas of the world. No vaccine or medicine is available against the disease: eradication is being achieved by implementing preventive measures. These include behavioural change in patients and communities--such as self-reporting suspected cases to health workers or volunteers, filtering drinking water and accessing water from improved sources and preventing infected individuals from wading or swimming in drinking-water sources--supplemented by active surveillance and case containment, vector control and provision of improved water sources. Efforts to eradicate dracunculiasis began in the early 1980s. By the end of 2012, the disease had reached its lowest levels ever. This paper reviews the progress made in eradicating dracunculiasis since the eradication campaign began, the factors influencing progress and the difficulties in controlling the pathogen that requires behavioural change, especially when the threat becomes rare. The challenges of intensifying surveillance are discussed, particularly in insecure areas containing the last foci of the disease. It also summarizes the broader benefits uniquely linked to interventions against dracunculiasis.

Guinea worm disease outcomes in Ghana: determinants of broken worms.

In 2006, Ghana ranked second in Guinea worm disease (GWD) incidence and reported a previously undocumented 20% prevalence of worm breakage. A prospective study was conducted in 2007 to validate and describe worm breakage and determinants. Among 221 patients with known outcomes, the worm breakage rate observed was 46%. After controlling for demographics, worm and wound presentation, and treatment course and provision, worm breakage was associated with narrow-diameter worms (< 2 mm) (adjusted odds ratio [AOR] 2.79; 95% confidence interval [CI] = 1.03-7.53). Protective factors against worm breakage included antibiotic ointment use (AOR 0.31; 95% CI = 0.14-0.70), bandage protocol compliance (AOR: 0.38; 95% CI = 0.16-0.89), intact bandages (AOR 0.27; 95% CI = 0.09-0.82), and bloody compared with dry wounds (AOR 0.09; 95% CI = 0.01-0.7). The high worm breakage rate observed warrants improvement in case management and patient care. Adherence to established treatment protocols should be facilitated through improved provider training and supervision to reduce the disabling consequences of broken worms.

[Non-indigenous and non-specific parasitic nematodes--the background and the consequences]. / Zawleczone i niespecyficzne nicienie pasozytnicze--przyczyny i skutki.

Introduction of the host is the main reason behind introduction of the parasite, e. g., nematodes. The introduction of the Japanese eel (Anguilla japonica) in Europe in the 1980s resulted in expansion of the swimbladder nematode Anguillicola crassus which soon invaded not only populations of the European eel (A. anguilla), but also other local fish. The raccoon (Procyon lotor) is native to North America. It is the specific host of Strongyloides procyonis and Baylisascaris procyonis. More than 90 species of wild and domestical bird and mammal species, including humans, have been infected with B. procyonis larvae. The larvae enter various organs of paratenic hosts, particularly the central nervous system and eye, causing severe diseases and death. Asthworthius sidemi--a blood-succking, abomasal nematode, a specific parasite of the Asiatic sika deer (Cervus nippon) and sambar deer (C. unicolor)--was first introduced with its hosts into countries adjacent to Poland. A. sidemi is especially dangerous to the European bison (Bison bonasus) which is its new host. The bison populations, in both Bialowieza Primaeval Forest and the Bieszczady Mts, sometimes show a 100% prevalence and mass infection intensity. Imported animals, sold in pet shops or available from private breeding firms, often carry non-native parasites. For example, the red-eared tortoise (Trachemys scripta elegans) and Afgan tortoise (Agrionemys horsfieldii) carry nematodes Angusticaecum holopterum, Tachygonetria lobata and T. robusta. Migratory birds in their wintering grounds are often infected with parasites which are usually not constant components of the native fauna, but sometimes nematodes could find a suitable conditions to complete their life cycle. E.g. Cyathosoma microspiculum, species specific to cormorants (Phalacrocorax carbo) and previously recorded only from Asia and the Asian-European boudary, was able complete the life cycle in Poland. The increasingly frequent travels to countries with different climatic conditions contribute to introduction of non-native nematodes: Dirofilaria immitis--in dogs, D. repens or Ancylostoma brasiliense--in humans.

Potential vector species of Guinea worm (Dracunculus medinensis) in Northern Ghana.

Guinea worm disease, also known as dracunculiasis (or dracunculosis), is caused by the large female of the nematode Dracunculus medinensis. It normally lives and grows in various places in the human body, before migrating to subcutaneous tissue and eventually emerging slowly from the skin, usually on the lower limbs. If the affected portion of the body comes into contact with water, first-stage juveniles (L(1)) are expelled in large numbers from the ruptured uterus. For further development, the juveniles need to be ingested by suitable predatory species of copepods. In this study, infectivity studies on the relative importance of various copepod species in the transmission of the Guinea worm disease was carried out. The infection potentials of the vectors were evaluated based on their ability to ingest the first stage juveniles (L(1)), and to remain alive for these juveniles to develop to the infective, third-stage juveniles (L(3)). The adults of the relatively larger species recorded very high mortality rates upon infection with the first stage juveniles (L(1)) of the parasite. The highest copepod mortality rate was recorded by M. kieferi (94%). However, the copepodid stages of these species were able to withstand infection for extremely longer periods. The smaller genera did not record any remarkable mortalities on ingesting parasite juveniles. The most important implicated potential vectors of Dracunculus medinensis evaluated in the area are Mesocyclops kieferi --> M. aspericornis --> Thermocyclops incisus --> T. inopinus --> T. oblongatus.

[Report of a case of dracunculosis in a dog in the Province of Formosa--Argentina]. / Reporte de un caso de dracunculosis en un canino en la provincia de Formosa--Argentina.

It is reported Dracunculus sp. in a dog from Fontana city, department of Patiño, in the Formosa Province, Argentina. This is the fourth report of Dracunculosis occurred in animals all from the same geographic area of Formosa.

Inoculation of ferrets with ten third-stage larvae of Dracunculus insignis.

Infection with Dracunculus insignis was established in 7 of 10 ferrets experimentally inoculated intraperitoneally with 10 third-stage larvae (L3's). Worm recovery and infection rate were comparable to animals inoculated with 50 L3's. This study demonstrates that once infective larvae traverse the gut and pass into the peritoneal cavity, very few larvae are required to establish infection.

Monofilament nylon filters for preventing dracunculiasis: Durability and copepod retention after long term field use in Pakistan.

Filtration of drinking water to remove the cyclopoid copepod intermediate hosts of guinea worm. Dracunculus medinensis, is one of the primary intervention strategies for preventing dracunculiasis. In early 1987, monofilament nylon filters with 200 microns pore size were distributed to households in selected guinea worm-infected villages in Pakistan. The filters proved popular with the villagers, although reports of "loss of filters" could diminish the community-wide effectiveness of this control measure. After 12 to 15 months of usage a sample of these filters was collected and examined for damage or impairment which would decrease their use or their capacity to retain potentially infective copepods. Although all naupliar stages and early copepodids (Stages CI-II) passed through these used filters, the larger copepodids including adults (Stages CIII-VI) were retained despite small tears in the fabric. This field trial showed that after 12 to 15 months of regular use, monofilament nylon filters of 200 microns pore size remained effective in removing copepodid stages capable of supporting development of D. medinensis larvae. Considering the ease of use, popularity and effective filtration of potentially infective copepods following prolonged field use, we recommend that monofilament filters be considered in any program of guinea worm elimination.