The Carter Center's Amazing Work on Guinea Worm Disease

Since 1986, The Carter Center has led the international campaign to eradicate Guinea worm disease. Guinea worm disease is a parasitic disease caused by a nematode roundworm parasite called Dracunculus. It is contracted when people consume water from stagnant sources contaminated by Guinea worm larvae. Inside a human’s abdomen, male and female worms mature and grow.  After about a year, the female Guinea worm, one meter long, creates an agonizingly painful lesion on the human’s skin as it slowly emerges.  Guinea worm sufferers often try to seek relief from burning sensations and immerse themselves in water.  The emerging worm releases its larvae into the water and so the cycle of infection goes on.  

In 1986 there were an estimated 3.5 million cases of Guinea worm disease in 21 countries in Asia and Africa.  Today that number has been reduced by 99.99% to 28 cases in 2018. It could be the second human disease, after smallpox, to be eradicated without the use of a vaccine or medicine.  The Carter Center has worked closely with ministries of health and local communities, US Centers for Disease Control and Prevention, the WHO and UNICEF.  Community based interventions have included teaching people to filter all water, done in some ingenious ways, and keeping people with an emerging worm from entering water sources.  

A challenge to eradication has been the emergence of Guinea worm disease in animals, such as domesticated dogs, who may eat infected fish and fish entrails.  Cash rewards are being paid to the reporting of infected animals, and the use of veterinary deworming drugs.  In 2018 Ethiopia reported infections in 11 dogs, 5 cats and 1 baboon. Another challenge is insecurity – conflicts make some areas unsafe for travel.  

Enormous dedication and attention to detail is critical for all field supervisors and the thousands of community-based volunteers charged with executing the campaign.  The disease has been eliminated in 17 countries. 80 million cases have been averted among the world’s poorest and most neglected people. 

WHO is responsible for certifying countries as free of Guinea worm disease.  The US Centers for Disease Control and Prevention provide technical assistance and verify whether worms from patients are truly Guinea worms. UNICEF helps to provide safe sources of drinking water. 

Dear Readers – the take home message from this column is one of hope and awe, that President Jimmy Carter has provided such important leadership in the relief of suffering. Donations to his center are always appreciated.  I am dedicating this column to the memory of my ex- husband, Dr. Robert Goldsmith, father of my 2 sons and step-daughter. Dr. Goldsmith died last week in San Francisco. His children provided a beautiful and meaningful memorial service for him yesterday.  He was a Professor of Tropical Medicine at UCSF, and would have known all about the efforts to eliminate Guinea worm disease.   I am sorry I could not discuss this matter with him.  

Sadja Greenwood, MD, MPH

Too Busy to Floss? This Could Change Your Mind!

There is new research on how bacteria involved in gum disease can travel through the body, exuding toxins connected to Alzheimer’s disease, rheumatoid arthritis and aspiration pneumonia.  Experiments in mice, using  bacteria from people with Alzheimer’s disease, showed that the bacteria can find their way from mouth to brain.  The bacterium is Porphyromonas gingivalis (P g for short).  It is involved in periodontitis – inflammation of the gums. According to Jan Potempa, PhD, DSC, a professor at the University of Louisville School of Dentistry and head of the Department of Microbiology at Jagiellonion University in Krakow, Poland, oral hygiene is important and will decrease the risk of many serious diseases. Researchers  compared brain samples of deceased people with and without Alzheimer’s disease, same age at death, and found that P g was more common in the samples from people with Alzheimer’s , as evidenced by DNA and the presence of certain key toxins.  Studies in mice showed that P g can move from mouth to brain. An experimental drug that blocks bacterial toxins is in phase 1 clinical trial for Alzheimer’s.  About 20% of people have low levels of P g in their gums by age 30.  While not necessarily harmful, if it grows to large numbers it creates inflammation. Smokers and older people are at increased risk.  

The take-home message here is clear.  Brush your teeth and floss regularly.  Visit your dentist and dental hygienist, at least yearly.  

Sadja Greenwood, MD, MPH