Tropical Medicine Programs

of the

Carter Center

Guinea Worm Eradication Program

Guinea worm disease is set to become only the second disease to be wiped off the face of the earth. The "fiery serpent," as it is commonly called throughout the world, has been around for centuries. It's even been found in 3,000-year-old Egyptian mummies. The numbers afflicted by this debilitating disease have been reduced worldwide by 98 percent, from 3.2 million cases in 1986 to less than 100,000 in 2001. Guinea worm will be the second disease to be eliminated from the world (after smallpox) and the first disease to be overcome without "magic-bullet" vaccines and medications.

The Carter Center began its fight against Guinea worm in Pakistan and Ghana in 1987. Today, the Center leads the effort worldwide. Much of the Center's work is concentrated in countries with the heaviest burden of disease: Sudan, Nigeria, and Ghana, where 91 percent of the 60,000 cases remaining are located.

Guinea worm is a painful and debilitating disease whose effects reach beyond a single victim, crippling agricultural production and school attendance, for example. A child suffers and is unable to attend school. Or his parent suffers, unable to harvest crops or attend to younger children. The village suffers a food shortfall when its people are unable to work. During one year in the mid-1980s in southeastern Nigeria, rice farmers lost $20 million (U.S.) due to outbreaks of Guinea worm.

Guinea worm is contracted when stagnant water, contaminated with microscopic fleas carrying infective larvae, is consumed. Inside a human's abdomen, the larvae mature and grow, some as long as three feet. After a year, the worm slowly emerges through an agonizingly painful blister in the skin.

Some worms can take up to two months to be completely expunged. The burning sensation caused by the emerging worm leads many victims to immerse their limbs in water, seeking relief, but the cycle of infection only begins again as the worm releases more larvae into the water.

Preventing Guinea worm seems simple: don't enter the water with an
emerging Guinea worm and don't drink unfiltered water. But the challenge lays in educating villagers to always filter their water and ensuring they have the necessary filters to do so. Teaching these practices can come in conflict with traditional beliefs; for example, some villagers believe Guinea worm is the result of sorcery. Carter Center staff help train local health workers to use educational materials to explain the cause of Guinea worm and to treat those who are infected. They also treat stagnant ponds with monthly larvacide treatments.

How many supplies are needed to treat Guinea worm in 5,000 villages?

6,000 forceps
6,000 scissors
30,000 tablets of painkiller
6,000 plastic bags
6,000 gauze pads

The Carter Center helps to provide the essential ingredients for a successful eradication campaign--political will, financial support, and technical expertise. Our partners in the fight against Guinea worm help make our work possible. The government of Japan provides funding, water wells and vehicles, while the Japan Overseas Cooperation Volunteers provide hands-on support. Major assistance is also being provided by the U.S. Peace Corps volunteers. There are also numerous ongoing corporate and private donors. E.I. du Pont de Nemours & Company and Precision Fabrics Group have given filter cloth valued at more than $14 million; BASF has provided the larvicide Abate, valued at more than $2 million; Johnson & Johnson has donated enough medical supplies-like Tylenol®, forceps and gauze-to treat more than 3,000 villages; Hydro Polymers has provided 9 million pipes to provide personal water filters; and the Gates Foundation has given generous funding.

River Blindness Program

The Carter Center is one of the few organizations fighting onchocerciasis, commonly known as river blindness, in both Africa and Latin America, working in all endemic areas in the Americas, which include Colombia, Ecuador, Guatemala, Mexico, Venezuela, and Brazil. Of the 18 million people infected with river blindness worldwide, 500,000 are blinded or visually impaired. The Carter Center is part of a global effort to eliminate the disease as a public health problem by 2007.

River blindness is spread through the bite of a small, black fly that breeds in rapidly flowing rivers and streams along the most fertile banks. When a fly bites, millions of microscopic nematodes are released into the body, causing incessant, debilitating itching. The worms can cause eyesight damage and potential blindness, when they enter the eyes. The economic and health consequences of this disease are devastating as adults cannot farm or care for their children. Fertile riverbanks are abandoned for fear of contracting the disease, and people move to less fertile grounds, disrupting a stable village economy.

Ivermectin known by its trade name, Mectizan® -- is the only known drug available to treat river blindness without severe side effects. Mectizan does not affect adult worms, but a single oral dose each year kills the microscopic infants, thus stopping the onset of blindness and the skin disease. The company that produces Mectizan, Merck & Co., has generously donated the drug treatments to the world for as long as there is a need. Since The Carter Center began its River Blindness Program in 1996, the Center has enabled the delivery of more than 38.5 million treatments of Mectizan- handling more treatments than any other organization combating this disease.

In June 2001, a panel of international experts that comprise The Carter Center’s International Task Force for Disease Eradication, concluded that it is feasible to completely eradicate river blindness in the Americas if the treatment programs can treat at least 85 percent of the people living in endemic areas can be treated with Mectizan twice a year.

The Center launched the Global 2000 River Blindness Program as part of a worldwide coalition, including the World Health Organization, the Lions Clubs International Foundation, and the World Bank. It maintains field offices in Guatemala, Cameroon, Nigeria, Sudan, Ethiopia, and Uganda to help local residents and health workers distribute Mectizan. In Africa the program has worked extensively with the World Bank to secure funding for the African Program for Onchocerciasis control (APOC) to establish community-based programs and in Latin America it oversees a regional coalition known as the Onchocerciasis Elimination as the Onchocerciasis Elimination Program for the Americas (OEPA).

Lymphatic Filariasis Elimination Program

Lymphatic filariasis (elephantiasis) is a debilitating and deforming disease caused by infection from a parasitic nematode. The infection is transmitted from person to person by mosquitoes. The parasite lives in the victim's lymphatic system. In its severest form, lymphatic filariasis causes elephantiasis- or dramatic swelling of limbs (usually the leg) and genitals (usually the scrotum). These conditions have a devastating effect on the quality of life of those affected, impacting them not only physically, but also emotionally and economically. The disease affects 120 million people in 73 endemic countries worldwide of Africa, Asia, the Western Pacific and Latin America. More than 41 million of those cases are in Africa. An additional 900 million people are at risk. Lymphatic filariasis is ranked by the World Health Organization (WHO) as the second leading cause of permanent and long-term disability.

Fortunately, transmission of the infection can be halted by treating infected individuals once a year, for four to six years, with a single-dose combination of oral medicines. The drug combinations include diethylcarbamazine (DEC) and albendazole, DEC and ivermectin, or albendazole and ivermectin. The main drug for this infection is mectizan in combination with albendazole. Basic preventive measures, such as the use of bed nets and/or curtains (pre-impregnated with insecticide) also help control transmission of the infection. In patients with elephantiasis, binding affected limbs with compressive bandages and practicing proper hygiene helps reduce swelling and discomfort.

Lymphatic filariasis is one of the only six infectious diseases in the world considered eradicable. To help meet that goal, The Carter Center's Global 2000 Program is working to help eliminate lymphatic filariasis in Nigeria, the country with the greatest number of persons infected in Africa. Similar to its work to combat river blindness, Global 2000 is working with the government, health authorities, and villagers to establish and implement community-based drug treatment plans. Field staff will emphasize health education and the training and supervision of local village health workers. The hope is that within 15 years lymphatic filariasis will no longer be a public health problem in Nigeria.