DRACUNCULIASIS
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Jimmy CarterJames Earl Carter Jr. (October 1, 1924 – December 29, 2024) was an American politician and humanitarian who served as the 39th president of the United States from 1977 to 1981. A member of the Democratic Party, Carter served from 1971 to 1975 as the 76th governor of Georgia and from 1963 to 1967 in the Georgia State Senate. He was the longest-lived president in U.S. history and the first to reach the age of 100. Born in Plains, Georgia, Carter graduated from the U.S. Naval Academy in 1946 and joined the submarine service before returning to his family's peanut farm. He was active in the civil rights movement, then served as state senator and governor before running for president in 1976. He secured the Democratic nomination as a dark horse little known outside his home state before narrowly defeating Republican incumbent Gerald Ford in the general election. As president, Carter pardoned all Vietnam draft evaders and negotiated major foreign policy agreements, including the Camp David Accords, the Panama Canal Treaties, and the second round of Strategic Arms Limitation Talks, and he established diplomatic relations with China. He created a national energy policy that included conservation, price control, and new technology. He signed bills that created the Departments of Energy and Education. The later years of his presidency were marked by several foreign policy crises, including the Soviet invasion of Afghanistan (leading to the end of détente and the 1980 Olympics boycott) and the fallout of the Iranian Revolution (including the Iran hostage crisis and 1979 oil crisis). Carter sought reelection in 1980, defeating a primary challenge by Senator Ted Kennedy, but lost the election to Republican nominee Ronald Reagan. Polls of historians and political scientists have ranked Carter's presidency below average. His post-presidency—the longest in U.S. history—is viewed more favorably. After Carter's presidential term ended, he established the Carter Center to promote human rights, earning him the 2002 Nobel Peace Prize. He traveled extensively to conduct peace negotiations, monitor elections, and end neglected tropical diseases, becoming a major contributor to the eradication of dracunculiasis. Carter was a key figure in the nonprofit housing organization Habitat for Humanity. He also wrote political memoirs and other books, commentary on the Israeli–Palestinian conflict, and poetry.
MetronidazoleMetronidazole, sold under the brand name Flagyl and Metrogyl among others, is an antibiotic and antiprotozoal medication. It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, and bacterial vaginosis. It is effective for dracunculiasis, giardiasis, trichomoniasis, and amebiasis. It is an option for a first episode of mild-to-moderate Clostridioides difficile colitis if vancomycin or fidaxomicin is unavailable. Metronidazole is available orally (by mouth), as a cream or gel, and by slow intravenous infusion (injection into a vein). Common side effects include nausea, a metallic taste, loss of appetite, and headaches. Occasionally seizures or allergies to the medication may occur. Some state that metronidazole should not be used in early pregnancy, while others state doses for trichomoniasis are safe. Metronidazole is generally considered compatible with breastfeeding. Metronidazole began to be commercially used in 1960 in France. It is on the World Health Organization's List of Essential Medicines. It is available in most areas of the world. In 2022, it was the 133rd most commonly prescribed medication in the United States, with more than 4 million prescriptions.
DracunculiasisDracunculiasis, also called Guinea-worm disease, is a parasitic infection by the Guinea worm (Dracunculus medinensis). A person becomes infected by drinking water contaminated with Guinea-worm larvae that reside inside copepods (a type of small crustacean). Stomach acid digests the copepod and releases the Guinea worm larva, which penetrates the digestive tract and escapes into the body. Around a year later, the adult female worm migrates to an exit site – usually the lower leg – and induces an intensely painful blister on the skin. Eventually, the blister bursts, creating a painful wound from which the worm gradually emerges over several weeks. The wound remains painful throughout the worm's emergence, disabling the affected person for the three to ten weeks it takes the worm to emerge. The female worm releases larvae when the host submerges the wound in water in attempts to relieve the pain, thus continuing the life cycle. There is no medication to treat or prevent dracunculiasis. Instead, the mainstay of treatment is the careful wrapping of the emerging worm around a small stick or gauze to encourage and speed up its exit. Each day, a few more centimeters of the worm emerge, and the stick is turned to maintain gentle tension. Too much tension can break and kill the worm in the wound, causing severe pain and swelling. Dracunculiasis is a disease of extreme poverty, occurring in places with poor access to clean drinking water. Prevention efforts center on filtering drinking water to remove copepods as well as public education campaigns to discourage people from soaking affected limbs in sources of drinking water, as this action allows the worms to spread their larvae. Accounts consistent with dracunculiasis appear in surviving documents from physicians of Greco-Roman antiquity. In the 19th and early 20th centuries, dracunculiasis was widespread across much of Africa and South Asia, affecting as many as 48 million people per year. The effort to eradicate dracunculiasis began in the 1980s following the successful eradication of smallpox in 1977. By 1995, nearly every country with endemic dracunculiasis had established a national eradication program. In the ensuing years, dracunculiasis cases have dropped precipitously, falling below 100,000 cases per year in 1997, below 10,000 cases in 2007, below 1,000 cases in 2012, below 100 cases in 2015, and reaching down to 13–15 cases per year for 2021–2024. Since 1986, 16 previously endemic countries have eradicated dracunculiasis, leaving the disease primarily endemic in two landlocked developing countries of central Africa that have experienced recent political instability – Chad and South Sudan. Four additional countries remain to be certified as free of dracunculiasis transmission that have had no reported human cases since the end of 2023: Angola, Ethiopia, Mali, and Sudan. One of these four, Sudan, is pre-certified but not yet confirmed free of transmissions. Additionally, although Cameroon has been certified free of internal transmission since 2007, it has experienced three cases since 2019 along its border with Chad. D. medinensis can also infect dogs, cats, and baboons, though non-human cases are also falling due to the eradication efforts. Other Dracunculus species cause dracunculiasis in reptiles worldwide and in mammals in the Americas. In 2020, the World Health Organization set 2027 as its target date for eradication of dracunculiasis. If the eradication program succeeds, dracunculiasis is expected to become the second human disease to be eradicated, after smallpox.
Dracunculus medinensisDracunculus medinensis (Guinea worm, dragon worm, fiery serpent) is a nematode that causes dracunculiasis, also known as Guinea worm disease. The disease is caused by the female which, at around 80 centimetres (31 inches) in length, is among the longest nematodes infecting humans. The length of specimens exhibits extreme sexual dimorphism, as the longest recorded male Guinea worm is only 4 cm (1+1⁄2 in). Guinea worm disease is on target to be the second infectious disease of humans to be eradicated, after smallpox, and the D. medinensis species would be made extinct to accomplish it. It was formerly endemic to a wide swath of Africa and Eurasia; as of 2023, it remains endemic in five countries: Chad, Mali, South Sudan, Angola and Ethiopia, with most cases in Chad. Guinea worm spread to Angola c. 2018, and it is now considered endemic there. Infection of domestic dogs is a serious complication in Chad. The common name "Guinea worm" is derived from the Guinea region of Western Africa.
Waterborne diseaseWaterborne diseases are conditions (meaning adverse effects on human health, such as death, disability, illness or disorders): 47 caused by pathogenic micro-organisms that are transmitted by water. These diseases can be spread while bathing, washing, drinking water, or by eating food exposed to contaminated water. They are a pressing issue in rural areas amongst developing countries all over the world. While diarrhea and vomiting are the most commonly reported symptoms of waterborne illness, other symptoms can include skin, ear, respiratory, or eye problems. Lack of clean water supply, sanitation and hygiene (WASH) are major causes for the spread of waterborne diseases in a community. Therefore, reliable access to clean drinking water and sanitation is the main method to prevent waterborne diseases. Microorganisms causing diseases that characteristically are waterborne prominently include protozoa and bacteria, many of which are intestinal parasites, or invade the tissues or circulatory system through walls of the digestive tract. Various other waterborne diseases are caused by viruses. Yet other important classes of waterborne diseases are caused by metazoan parasites. Typical examples include certain Nematoda, that is to say "roundworms". As an example of waterborne Nematode infections, one important waterborne nematode disease is Dracunculiasis. It is acquired by swallowing water in which certain copepoda occur that act as vectors for the Nematoda. Anyone swallowing a copepod that happens to be infected with Nematode larvae in the genus Dracunculus, becomes liable to infection. The larvae cause guinea worm disease. Another class of waterborne metazoan pathogens are certain members of the Schistosomatidae, a family of blood flukes. They usually infect people that make skin contact with the water. Blood flukes are pathogens that cause Schistosomiasis of various forms, more or less seriously affecting hundreds of millions of people worldwide.
Eradication of infectious diseasesThe eradication of infectious diseases is the reduction of the prevalence of an infectious disease in the global host population to zero. Two infectious diseases have successfully been eradicated: smallpox in humans, and rinderpest in ruminants. There are four ongoing programs, targeting the human diseases poliomyelitis (polio), yaws, dracunculiasis (Guinea worm), and malaria. Five more infectious diseases have been identified as of April 2008 as potentially eradicable with current technology by the Carter Center International Task Force for Disease Eradication – measles, mumps, rubella, lymphatic filariasis (elephantiasis), and cysticercosis (pork tapeworm). The concept of disease eradication is sometimes confused with disease elimination, which is the reduction of an infectious disease's prevalence in a regional population to zero, or the reduction of the global prevalence to a negligible amount. Further confusion arises from the use of the term 'eradication' to refer to the total removal of a given pathogen from an individual (also known as clearance of an infection), particularly in the context of HIV and certain other viruses where such cures are sought. The targeting of infectious diseases for eradication is based on narrow criteria, as both biological and technical features determine whether a pathogenic organism is (at least potentially) eradicable. The targeted pathogen must not have a significant non-human (or non-human-dependent) reservoir (or, in the case of animal diseases, the infection reservoir must be an easily identifiable species, as in the case of rinderpest). This requires sufficient understanding of the life cycle and transmission of the pathogen. An efficient and practical intervention (such as a vaccine or antibiotic) must be available to interrupt transmission. Studies of measles in the pre-vaccination era led to the concept of the critical community size, the minimal size of the population below which a pathogen ceases to circulate. The use of vaccination programs before the introduction of an eradication campaign can reduce the susceptible population. The disease to be eradicated should be clearly identifiable, and an accurate diagnostic tool should exist. Economic considerations, as well as societal and political support and commitment, are other crucial factors that determine eradication feasibility.
Eradication of dracunculiasisEradication of dracunculiasis is an ongoing program. Dracunculiasis, or Guinea worm disease, is an infection by the Guinea worm that causes severe pain and open wounds when guinea worms exit the body through the skin. In 1986, there were an estimated 3.5 million cases of Guinea worm in 20 endemic nations in Asia and Africa. The number of human cases has since been reduced by more than 99.999%, to the range of 13–15 per year in 2021–2024, with only six countries remaining: South Sudan, Chad, Mali, Ethiopia, Angola, and Central African Republic. Of these, only Chad and South Sudan have had human cases reported since the end of 2023. The campaign has been spearheaded by the Carter Center and other members of the London Declaration on Neglected Tropical Diseases, with former U.S. president Jimmy Carter as part of its deworming programs, designed to eliminate neglected tropical diseases. Discussing his diagnosis of melanoma (which had metastasized to his brain), Carter said in 2015 that his last wish was to see the last Guinea worm dead before he was. Carter died in 2024 without quite seeing that wish fulfilled. The World Health Organization (WHO) is the international body that certifies whether a disease has been eliminated from a country or eradicated from the world. The Carter Center also reports the status of the Guinea worm eradication program by country. As of 2024, the WHO goal for eradication in humans and animals is the year 2030. Previously, 1991, 2009, 2015, and 2020 were set as target years, but full eradication of dracunculiasis has proven to be much more difficult than originally thought, after the discovery of non-human animal hosts.
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