Department of Parasitic Diseases

Details of National Programmes

1. National Programmes implemented through division are as under National Programme Name: Guinea Worm Eradication Programme(GWEP) Email ID of Programme: dpdncdc@gmail.com Officer In-charge: Dr. Ankur Garg Programme details-

GUINEA WORM ERADICATION PROGRAMME (GWEP)

INTRODUCTION

Certification of India as a Guinea Worm disease free country by the World Health Organisation in February 2000 is a major milestone in the Public Health in India. Guinea Worm disease (Dracunculiasis) was an important public health problem in many states of India before eradication. Guinea Worm emerging from foot of an infected patient TRANSMISSION DYNAMICS AND CLINICAL PRESENTATION OF GUINEA WORM DISEASE (DRACUNCULIASIS) Dracunculiasis is caused by a large nematode, Dracunculus medinensis. The parasite is transmitted mostly when people drink stagnant water contaminated with parasite-infected water fleas. The Guinea worm passes its life cycle in two hosts – Man and Cyclops. Man (Definitive host) harbours the adult parasites in the subcutaneous tissues, especially of legs, arms and back, parts of body which are likely to come in contact with water. Clinical manifestations of Guinea worm disease appear 10-14 months after infection and include constitutional symptoms (such as low-grade fever, itchy rash, nausea, vomiting, diarrhea, dizziness) followed by a localized swelling developing into a painful blister, most often on a lower limb. The blister appears when the gravid adult female (about 60-100 cm long worm) is ready to discharge its larvae. To soothe the associated burning pain, patients often immerse the affected part of the body in water. The worm(s) then releases thousands of larvae (baby worms) into the water. These larvae are ingested by tiny crustaceans or copepods, also called water fleas (Intermediate host) and develop into infective stage in about 2 weeks. People swallow the infected Cyclops in drinking water from step wells or ponds. The larvae are liberated in the stomach, cross the duodenal wall, and enter the retro-peritoneal connective tissues where they grow and mature. The males die after mating. The females migrate in about 6 months to parts which come in contact with water. Multiple and repeated infection may occur in the same person. The worm takes about 10–14 months to emerge after infection.

GW Endemic States	Districts	PHC	Villages	Population	Cases
A. P.	6	54	1160	1566218	4461
Gujarat	13	56	444	1058012	426
Karnataka	8	73	991	1666123	5239
M. P.	21	131	3647	2723934	11341
Maharashtra	15	99	1213	1058452	3115
Rajasthan	23	146	5376	4849340	15210
Tamil Nadu	3	5	9	10048	Nil
TOTAL	89	564	12840	12932127	39792

Almost two-thirds of the total cases occurred in Rajasthan (38%) and Madhya Pradesh (29%) Figure 2: Erstwhile Guinea worm Affected States in India Table 2: List of Erstwhile Guinea Worm Disease Endemic Districts in India State

S. No	Andhra Pradesh	Gujarat	Karnataka	Madhya Pradesh	Maharashtra	Rajasthan	Tamil Nadu
1	Ananthpur	Ahmedabad	Bijapur	Barwani	Ahmednagar	Ajmer	South Arcot
2	Cuddapah	Banaskantha	Bellary	Bhopal	Beed	Banswara	Dharmapuri
3	Kurnool	Bhavnagar	Belgaum	Damoh	Latur	Barmer	Tiruchirapalli
4	Mahbubnagar	Broach	Dharwad	Dewas	Nanded	Bhilwara
5	West Godvari	Kheda	Karwar	Dhar	Nasik	Bikaner
6	Prakasam	Kutch	Bidar	Guna	Osmanabad	Bundi
7		Mehsana	Gulbarga	Hoshangabad	Pune	Churu
8		Panchmahal	Raichur	Indore	Raigad	Chittorgarh
9		Sabarkantha		Jhabua	Ratnagiri	Dungarpur
10		Surat		Khandwa	Sangli	Ganganagar
11		Surendranagar		Mandsaru	Satara	Jaipur
12		Vadodara		Rajgarh	Thane	Jaisalmer
13		Valsad		Ratlam	Sindhudurg	Jalore
14				Sagar	Chandrapur	Jhalawar
15				Sehore	Parbhani	Jodhpur
16				Shajapur		Kota
17				Shivpuri		Nagaur
18				Tikamgarh		Pali
19				Ujjain		Sawai Madhopur
20				Vidisha		Sikar
21				Panna		Sirohi
22						Tonk
23						Udaipur

GUINEA WORM ERADICATION PROGRAMME IN INDIA Ministry of Health & Family Welfare, Government of India launched the National Guinea Worm Eradication Programme (GWEP) in 1983-84 as a centrally sponsored scheme on a 50:50 sharing basis between Centre and States with the objective of eradicating guinea worm disease from the country. National Centre for Disease Control (erstwhile National Institute of Communicable Diseases, Delhi) was designated as the nodal agency for planning, co-ordination, guidance and evaluation of GWEP in the country. The Programme was implemented by the endemic State Health Directorates through the Primary Health Care system. The Ministry of Rural Development, Govt. of India, State Public Health Engineering Departments, and the Rajiv Gandhi National Drinking Water Mission (Rural Water Supply) assisted the Programme in provision and maintenance of safe drinking water supplies and conversion of unsafe drinking water sources, on priority, in the Guinea worm affected areas. Strategy of GWEP Based on the life cycle of the worm, Guinea Worm Eradication Programme envisaged the efficient implementation following strategies:

• Guinea worm case detection and continuous surveillance through three active case search operations and regular monthly reporting
• GW case management
• Vector control by the application of Temephos (50% EC) in unsafe water sources eight times a year and use of fine nylon mesh/double layered cloth strainers by the community to filter cyclops in all the affected villages
• Provision and maintenance of safe drinking water supply on priority in GW endemic villages
• Trained manpower development and
  • Intensive health education
  • Concurrent evaluation and operational research.

NCDC with financial support from the World Health Organization deployed epidemiological surveillance teams in endemic states which closely monitored the Programme and helped the district/local authorities in effective implementation of various GWEP operational components; especially surveillance and GW case containment measures. The cases and the number of affected villages declined over a period of time. State-wise trends are shown in Table 3 & 4 respectively. Table 3: Trend of decline in Guinea worm Cases in India, 1984-1997

Year	Rajasthan	Madhya Pradesh	Karnataka	Andhra Pradesh	Maharashtra	Tamil Nadu	Gujarat	Total
1984	15210	11341	5239	4461	3115	0	426	39792
1985	11644	8349	4036	2389	4211	0	322	30950
1986	10500	4217	2754	1772	3646	0	181	23070
1987	7896	3282	2405	1122	2156	0	164	17031
1988	5619	2565	1909	407	1496	0	27	12023
1989	4872	1408	896	224	475	0	6	7881
1990	3376	333	634	224	209	0	22	4798
1991	1712	120	226	126	0	1	0	2185
1992	792	91	167	30	1	0		1081
1993	547	179	29	0	0			755
1994	348	13	10					371
1995	60	0	0					60
1996	9							9
1997	0								0

Note: Last cases in the country occurred in Rajasthan in 1996. Table 4: Decline in Guinea worm af fected villages in India, 1984-1992

Year	Rajasthan	Madhya Pradesh	Karnataka	Andhra Pradesh	Gujarat	Maharashtra	Tamil Nadu	Total
1984	5376	3647	991	1160	444	1213	9	12840
1985	3394	2855	715	741	204	902	0	8811
1986	3276	1575	662	599	140	853		7105
1987	2755	1170	398	414	130	767		5634
1988	2258	867	356	241	81	475		4278
1989	2009	825	271	150	52	289		3596
1990	1565	485	249	88	15	190		2592
1991	1310	292	159	69	5	71		1906
1992	957	98	104	55	4		26	1244

Once the state remained disease free for 3 years consecutively, it was deleted from the list of endemic states. Gujarat was deleted from the list of endemic states on 31 December 1993. Andhra Pradesh and Maharashtra were deleted on 31 December 1995, while Karnataka and MP were deleted from the list on 31 December 1997. The last Guinea worm cases occurred in July 1996 when 9 guinea worm cases were reported in three villages from district Jodhpur (Rajasthan). Eventually, Rajasthan was deleted from the list of endemic states on 31 December 1999. TOWARDS CERTIFICATION OF GUINEA WORM ERADICATION IN INDIA Last case of Guinea worm in India

• 6 July 1996
• Village: Aau, PHC: Peelwa
• District: Jodhpur, Rajasthan
• Family members had history of Guinea worm infection in last one year

During April 1999, Seventh Independent Evaluation of GWEP was conducted by independent experts; twenty teams were sent to seven erstwhile endemic states and fourteen non-endemic states/UTs. The results validated the zero Guinea worm status in India.

• A National Commission for Certification of Guinea Worm Eradication was set up by the Ministry of Health and Family Welfare. The Commission comprised of eight highly experienced independent experts in the field of Public Health drawn from across the country and the Director and Joint Director and Head of Parasitology Division of the erstwhile National Institute of Communicable Diseases. The Seventh Independent Evaluation was carried out under the guidance of the Commission in April 1999.
• The country completed three years of Guinea worm disease free period in July 1999. Subsequently, International Certification Team (ICT) from International Commission for Certification of Dracunculiasis Eradication (ICCDE), WHO visited India from 9th -25th November, 1999 to assess the status of guinea worm disease in the country and to prepare a report for presentation to International Commission at Geneva.
• A meeting was organised in January, 2000 in Vigyan Bhawan to mark the eradication of Guinea worm disease from India which was presided by Hon’ble Union Minister of State, MoHFW, GoI Sh. N. T.Shanmugam and Dr. Gro Harlem Brundtland, Director General, WHO was the Chief Guest.

Preserved Worm Specimen from last case of Guinea worm Disease in India

• The International Certification Team, presented its report on Guinea worm disease status in India to the ICCDE in the meeting held in February 2000 in Geneva. On the basis of ICT report, India was declared as Guinea Worm disease free country in the year 2000.

The International Certification Team has recommended that, until the global goal of eradication is achieved, the following measures should be assiduously implemented:

• Health education regarding Guinea worm, with special emphasis on children and women in rural areas
• Guinea worm rumour registration and investigation
• Maintaining guinea worm disease on the list of notifiable disease and continuing surveillance in all previously infected areas
• Careful supervision of the functioning of hand pumps and other sources of safe drinking water, and provision of additional units wherever necessary.

CURRENT ACTIVITIES UNDER THE PROGRAMME

• Health education regarding Guinea worm disease.
• Maintaining continuing surveillance in all erstwhile 7 endemic States (now 8 including Telangana) /Districts through State/District Health Departments.
• Guinea worm rumour surveillance and investigation: rumours have been received from the many Indian States viz Gujarat, Karnataka, Madhya Pradesh, Maharashtra, Kerala, Uttar Pradesh, Goa and Rajasthan, Uttarakhand since certification of Guinea worm Disease free status. All such rumours/publications reported to NCDC after 2000, have been thoroughly investigated and have been found to be not due to Guinea worm Disease.

3. Please upload any relevant photograph of Division Department of Parasitic Diseases, NCDC Department of Parasitic Diseases Laboratory

Soil Transmitted Helminthiasis Prevalence Surveys

Demonstration to students about procedure of stool sample collection Collection of Health parameters of students Processing Stool samples using Kato-Katz Method Microscopic examination of stool slides during STH field survey

Lymphatic Filariasis

Lymphatic Filariasis- Patients with Elephantiasis Lymphedema Management services provided at NCDC branch Clinic

Guinea worm (Dracunculiasis)

Referral Proforma

• Malaria Referral Proforma
• Filaria Referral Proforma
• ELISA Referral Proforma

Other Officer in the Division

Other Staff in the Division