Don Hopkins 2008 Guinea Worm Status
July 12, 2008
Dr. Hopkins discusses the statuus of the Guinea Worm Eradication Program and relates that to the lessons learned from smallpox eradication. Cases still occuring in Sudan, Nigeria, Pakistan.
He is introduced by Dr. Stanley Foster.
He is introduced by Dr. Stanley Foster.
The David J. Sencer CDC Museum at the U. S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333
“Don Hopkins 2008 Guinea Worm Status,” The Global Health Chronicles, accessed March 30, 2017, http://globalhealthchronicles.org/items/show/3547.
Interview Transcript Speech Don Hopkins Audio File Transcribed: February 5 | Duration 0:15:38 Welcome By Stanley: ...briefly of two of the programs that sort of learned from Smallpox and have gone on and are now doing tremendous things around the world. So first I'd like to introduce Don Hopkins. Don was in the original group in West Africa. His work in Sierra Leone where he had enough resources to do mass vaccination in one, and surveillance and containment in the other, showed the surveillance and containment was far more effective, and then he went on to work in India. I guess you were in Calcutta, Don? Then over the last few years he's been battling the serpent, so let's give a hand of welcome to Don Hopkins. Speech: Don Hopkins Good morning. It's great to be here and a wonderful occasion, and especially for me to be able to share a bit of the story of the Great Worm. To do so would really require another symposium to do so fully. But I've only got nine slides and I want to run through them quickly. Stan asked me whether I might need more time and I said, "No." Fortunately the story of Guinea Worm Eradication, or at least part of it, is told very simply these days. Thank God. Here you see this worm that grows up to two to three feet long, emerges directly through the skin on any part of the body. People who are infected by drinking contaminated water containing immature forms of the parasite, the parasite gets into the water when people with worms coming out of their body, go in to the water and the female worms spew these immature forms into the worm where they're taken up by water fleas and people drink water containing those infected fleas; and a year later the infection emerges. Someone has said, "This is the ultimate in an emerging and infectious disease." I have nine slides, but this is really the one that tells the full story or much of it to date. This initiative began right here at CDC or right here at what used to be CDC, in a different part of the place, with an estimated three and a half million cases. We began here at CDC in 1980. They called us in when President Carter took this up in 1986. But in 1986 we had an estimated three and a half million cases as you see, as of last year, and these are not provisional data; these are final data for 2007. We're down, for the first time, to under 10,000 cases. Two years ago when I presented this; we're still at over 25,000 cases. We've gone from almost 24,000 villages in 1993 to just over 2,000 villages now, infected, and as you see, from 20 countries infected when the program began, now to five. (Next slide) This shows on top there the less than 10,000 indigenous cases reported in 2007 and you can see here the years in which the last cases occurred; and two years ago when I made this presentation to the West Africa Group, we still had a number of other countries including these four which had their last case in 2006 which was still then considered endemic. We are now down as of the end of last year, to five countries: Sudan, Ghana, Mali, Nigeria, and Niger; and for a little bit of perspective, let me just note that when in the early 1980s, Ghana and Nigeria were each reporting on the order of 3,000 or 4,000 cases to the World Health Organization. When Ghana did its first case search in 1989, they found just under 180,000 cases, they're down last year to under 4,000 cases. When Nigeria made their count the first time that year as well, Nigeria then counted over 653,000 cases, so you can imagine how far around this room that bar would go, if these data were for 1989 for Nigeria. On the bottom here, you see the last five countries and we've listed Ethiopia here, even though Ethiopia recorded its last official case in 2006. Early this year, they became aware of 37 cases that reportedly were imported from Southern Sudan where there's a lot more Guinea Worm known, but we include Ethiopia here, again, to keep Ethiopia on its toes and not let them feel too comfortable. But here, you see through June of 2008, the number of cases reported so far this year and that in essence is where we are. Here, you see that presented in the form of a map in yellow, the countries that have already broken transmission including all three in Asia: India, Pakistan and Yemen. Then in Africa: Nigeria and Niger there in what appears pink to you; the countries that reported under 100 cases in 2007, and we think that both of them may well have broken transmission already with Niger having reported its last case in November of last year, and Nigeria having had no cases in April, May and June this year. Then you have Mali, Ghana and Sudan there in red, each having had more than 100 cases last year. Here you see cumulatively the global campaign as of the number of cases 2006, 2007, first seven months of 2008. Now the rest of the top three countries remaining, this is Sudan which has reduced its cases so far this year compared to last year by 54%. The Civil War, having ended officially at the beginning of 2005, we have a very energetic group of people there and things are proceeding very well, except for the political insecurity that still remains. Ghana, surprisingly for all of us, was an enormous headache for much longer that it should have been, but they have gotten now back on the straight and narrow and you can see here, Ghana having - this is a record - Jim Zingerser is here, they beat[inaudible 0:7:22] even Niger some years back, but Ghana has reported 85% fewer cases so far this year as compared to last year. This is not a calendar year, this is the epidemiologic year, beginning in July and someone mentioned earlier the importance - I think it was you, Stan, in Bangladesh of social will and involvement of the media and that has certainly been true in Ghana, after over a decade of stagnation in cases. Last year, 2007, Ghana had an explosion of cases in the first of the year, January and February, up in the North of the country; a very neglected part of Ghana from even Colonial times. The epidemic happened to coincide just before March 6, 2007 when Ghana was to celebrate the 50th Anniversary of its Political Independence from Britain. The month before that celebration in February, President Carter came and we used that occasion which unfortunately - fortunately for us - coincided with that terrible outbreak and they were represented on Ghanaian Television; there was just one reporter who was with us when the Chicago Tribune said, this was a scene from hell; of lots of pre-school-aged children crying. It was just awful, but all of that was on Ghanaian Television and there were reporters already, international reporters, beginning to come into the country for the 50th Anniversary of celebration and that helped to generate the requisite political will, social will in Ghana. Mali is having a political problem with Tuaregs in the North, but Mali was well on its way to getting rid of this disease when year before last, unbeknownst to anybody else. A Koranic student walked from an endemic area several hundred kilometers up to the North near the border with Algeria in the region of Kidal; and a year later we, and those people there, became aware of this outbreak. The only good thing about it was that these people in that area of the country were not used to having Guinea Worm disease and they were immediately hell-bent on getting rid of it, so we are having very good cooperation from that population. But we're still having some problems up in that area which we think we are getting on top of. The President of the country has promised to pay more attention to this now and he has been a very strong supporter of this eradication effort. In fact, now President Tour� has been proselytizing for Guinea Worm Eradication in all of the other endemic Francophone countries of Africa and now, to my great sadness, his own country Mali is going to be the last Francophone country to have Guinea Worm disease. This is my last slide showing that the countries in green that have been certified already by WHO as having eradicated - eliminated Guinea Worm disease. You see there that Cambodia in Asia is the only other country outside of Africa, remained to be certified. One of the spillovers from the Smallpox Eradication Program to the Guinea Worm Eradication Program is Joel Breman whose on the International Commission for the Certification of Dracunculiasis Eradication. There have been many other spillovers in the form of the surveillance containment, we call it "Case Containment Strategy" as supplied in the Guinea Worm Program; the use of data and indicators to motivate people and to make senior people uncomfortable. In Sierra Leone, we had a little newsletter run off by mimeograph called, The Eradicator - We Now Have Guinea Worm Wrap Up, put out through CDC. Use of hand-drawn maps with dots from Sierra Leone to West Bengal, India, in my experience; lots and lots of local heroes. Some of whom, you've heard about. One thing unfortunately, we do not share with the Smallpox Eradication Program, was a two-week incubation period. Oh! What I wouldn't give for a two-week incubation period of Guinea Worm disease. Let me just ask all of the people in the audience who are veterans of the Smallpox Eradication Program who have also now worked in the Guinea Worm Program to stand. Bill, thank you. That should have included you. Just to end with one smallpox story; we're aiming to get rid of Guinea Worm disease by the end of next year. Sudan is going to be the final battle. We're getting very close, but we're not there yet. I didn't tell a smallpox story last night, but I just want to note that I spent three months, Ernie and I, in West Bengal, India, in the fall of 1973 as part of the first Autumn Campaign. I went there very full of enthusiasm and enjoyed it much more even than I expected to, but by the time I'd left - you have to understand that as much as I loved India, I did not like Indian food and the thing that saved me was that we found a Chinese restaurant in Calcutta when we came back before I left. That, plus walking into the villages caused me to loose - and at that time when I went into India I weighed a little less than I weigh now, but I lost 17 lbs. going there, and I also came hell-bent on getting a replica of this Shitala Mata, Goddess of Smallpox. I had a copy from the program in Lagos, the last big reunion I attended in Lagos of the smallpox program, of the Smallpox Goddess of West Africa; and I wanted to get one of India, and the whole three months in West Bengal, asking, asking, asking; I never found one. Debriefed in Delhi and took a last quick trip down to Agra to see the Taj Mahal. Leaving the city in the vehicle going back to New Delhi, my last full day in India and I see - because I'm doing constant surveillance for my Smallpox Goddess - I saw in a little shop along the way this thing; and I shouted, "Stop!" to the diver, got out and bought - these were two marble, I think, small replicas of this goddess. I bought two of them and put them in my pocket because it's my last day there. Leaving the country, I was overweight, so I put them in my trench coat pocket, I didn't have any room to plant them [inaudible15:01] and I actually won a discussion with the airline people who wanted to charge me overweight baggage. But I explained that I weighed 17 lbs less than when I came here; and so, I got rid of it. That is how Dave Sencer came to acquire a copy of the smallpox goddess which he donated - you see it in the Odyssey downstairs there. They were not presented to me, I bought them. Thank you. [End of audio]