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https://globalhealthchronicles.org/files/original/cbb3d56bfa206201b04f8b0956292f46.mp4
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Title
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Guinea Worm
Description
An account of the resource
<div class="landing">
<p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p>
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Media
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Transcription
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<pre><strong>Interview Transcript</strong>
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]
</pre>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
2008 Guinea Worm Status
Description
An account of the resource
Dr. Don 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.
Source
A related resource from which the described resource is derived
The David J. Sencer CDC Museum at the U. S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333
www.cdc.gov/museum
Date
A point or period of time associated with an event in the lifecycle of the resource
July 12, 2008