Boys in South Sudan use ‘pipe filters’ to consume water without ingesting Guinea worm larvae.Credit: L. Gubb/The Carter Center

南苏丹的男孩使用“管道过滤器”饮水而不摄入麦地那龙线虫幼虫。信贷：L.古布/卡特中心

Lire en françaisIn 2006, a contested region of southern Sudan that had been embroiled in a long civil war recorded more than 20,000 cases of Guinea worm disease, 80% of the world’s total. Last year, the now independent nation of South Sudan reported just two cases of the parasitic infection, down from five the previous year.The drastic decline has been achieved thanks to an eradication programme that relies, in large part, on community-based volunteers.

2006年，苏丹南部一个备受争议的地区，卷入了漫长的内战，记录了20000多例几内亚蠕虫病，占世界总数的80%。去年，现已独立的南苏丹仅报告了两例寄生虫感染病例，而去年只有五例。由于在很大程度上依赖社区志愿者的根除计划，人口急剧下降。

When South Sudan became independent in 2011, there was little infrastructure and the new government’s institutions did not have the capacity to send trained staff to areas affected by the parasite, says Makoy Samuel Yibi, director of the Guinea worm eradication programme at the country’s Ministry of Health.

南苏丹卫生部麦地那龙线虫根除项目主任马科伊·塞缪尔·伊比（MakoySamuelYibi）表示，当南苏丹于2011年独立时，几乎没有基础设施，新政府的机构也没有能力向受寄生虫影响的地区派遣训练有素的工作人员。

“From the outset, the design of the programme was anchored on the structures of the community,” Yibi says.Globally, Guinea worm has declined from an estimated 3.56 million cases across 20 countries in 1986 to just 14 human cases in 5 countries in 2023 — mostly through bottom-up, low-technology efforts similar to those in South Sudan.

“从一开始，项目的设计就以社区的结构为基础，”Yibi说。在全球范围内，几内亚蠕虫已从1986年20个国家估计的356万例减少到2023年5个国家的14例人类病例，主要是通过与南苏丹相似的自下而上的低技术努力。

What’s more, this has been achieved despite the lack of a vaccine or drug treatment for the parasite. The Guinea worm eradication effort shows the power of relatively simple, non-pharmaceutical interventions that emphasize improved hygiene and community empowerment. But a series of unexpected setbacks over the past decade and a half have kept total eradication just out of reach, demonstrating the unpredictability of the disease.Cycle of miseryGuinea worm disease, also known as dracunculiasis, is caused by the roundworm Dracunculus medinensis (see ‘The Guinea worm life cycle’).

更重要的是，尽管缺乏针对寄生虫的疫苗或药物治疗，但这一目标已经实现。根除麦地那龙线虫的努力显示了相对简单的非药物干预措施的力量，这些干预措施强调改善卫生和赋予社区权力。但是在过去的十五年中，一系列意想不到的挫折使得彻底根除艾滋病遥不可及，这表明该疾病的不可预测性。麦地那龙线虫病（也称为麦地那龙线虫病）的周期是由麦地那龙线虫（Dracunculus medinensis）引起的（见“麦地那龙线虫生命周期”）。

People in remote communities in Africa who lack access to safe water supplies can unwittingly ingest water contai.

非洲偏远社区缺乏安全供水的人可能会不知不觉地摄入水。

Infographic by Alisdair Macdonald

Alisdair Macdonald的信息图

The parasitic infection itself is rarely fatal, but can hamper people’s activities for weeks or months at a time. The gradual emergence of the female worm, which can be one metre long, causes debilitating pain, and secondary bacterial infections can develop at the site of emergence. Affected adults might be unable to plant or harvest crops and children might be unable to go to school, putting livelihoods and access to education at risk in already under-served areas.

寄生虫感染本身很少致命，但一次会妨碍人们数周或数月的活动。雌性蠕虫的逐渐出现（可能有一米长）会引起虚弱的疼痛，并且在出现的部位会发生继发性细菌感染。受影响的成年人可能无法种植或收获作物，儿童可能无法上学，这将危及已经服务不足的地区的生计和教育机会。

Infection does not confer immunity to the parasite, and in the past many people in affected communities contracted Guinea worm year after year after year.Guinea worm has been around for millennia. The disease is mentioned in Egyptian medical texts dating to 1,550 bc, which also describe the treatment that is still standard today: winding the emerging worm around a small stick and painstakingly pulling it out centimetre by centimetre over the course of weeks.

感染并不能赋予寄生虫免疫力，过去受感染社区的许多人年复一年地感染了麦地那龙线虫。麦地那龙线虫已经存在了数千年。早在公元前1550年的埃及医学文献中就提到了这种疾病，其中也描述了今天仍然是标准的治疗方法：将新出现的蠕虫缠绕在一根小棍子上，并在数周内一厘米一厘米地将其拔出。

This is a delicate task that can’t be rushed, because if the worm breaks and remains partly inside the body, serious secondary infections can ensue.Previously, Guinea worm was widespread across South and Southwest Asia and Africa. An estimated 48 million cases occurred annually worldwide in the 1940s; advances in sanitation brought the numbers down over the next several decades to just a few million per year.

这是一项棘手的任务，不能仓促完成，因为如果蠕虫破裂并部分留在体内，可能会导致严重的继发感染。此前，麦地那龙线虫在南亚、东南亚和非洲广泛传播。20世纪40年代，全世界每年估计发生4800万例病例；卫生设施的进步使未来几十年的数字下降到每年只有几百万。

Then, in 1986, the Carter Center, the humanitarian non-profit organization launched by former US president Jimmy Carter, took over and expanded a global eradication programme that had been started six years earlier by the US Centers for Disease Control and Prevention (CDC). Guinea worm was the first parasitic disease targeted for eradication and the only disease for which an eradication programme was launched in the absence of a drug or vaccine.Comm.

1986年，美国前总统吉米·卡特（JimmyCarter）发起的人道主义非营利组织卡特中心（Carter Center）接管并扩大了美国疾病控制与预防中心（CDC）六年前启动的全球根除计划。麦地那龙线虫是第一种旨在根除的寄生虫病，也是唯一在没有药物或疫苗的情况下启动根除计划的疾病。通信。

A Ghanaian volunteer demonstrates how to filter water.Credit: Emily Staub/The Carter Center/CDC

。图片来源：艾米丽·斯塔布/卡特中心/疾病预防控制中心

With their deep, embedded understanding of the local community, village volunteers “use the local sentiment and religious and cultural context as part of their story, as they encourage the adoption of behaviour change”, says Adam Weiss, director of the Guinea worm programme at the Carter Center.In a paper published last year1, Roberts catalogued many of the ways in which countries and communities have adapted the global Guinea worm eradication programme to suit local conditions.

卡特中心几内亚蠕虫项目负责人亚当·韦斯（AdamWeiss）表示，由于对当地社区有着深刻的理解，乡村志愿者“将当地情绪、宗教和文化背景作为他们故事的一部分，鼓励人们改变行为”。在去年发表的一篇论文1中，罗伯茨对各国和社区调整全球麦地那龙线虫根除计划以适应当地条件的许多方式进行了分类。

In Ghana, for example, workers developed simple, picture-based documents so that people who can’t read can serve as volunteers, leading to an increase in the recruitment of women. In Burkina Faso, communities established a new village authority known as bouilla naba or ‘chief of the pond’, charged with maintaining and guarding village water sources.

例如，在加纳，工作人员开发了简单的基于图片的文档，以便不识字的人可以担任志愿者，从而增加了女性的招聘。在布基纳法索，社区建立了一个新的村庄管理局，称为bouilla naba或“池塘负责人”，负责维护和保护村庄的水源。

Often, this responsibility is given to older men as a way for them to continue to contribute to community well-being despite perhaps being unable to undertake heavy physical labour, Roberts says.Building local capacity in these ways has benefited health-care infrastructure more broadly in many sub-Saharan African nations, Weiss says.

罗伯茨说，这种责任通常被赋予老年男性，作为他们继续为社区福祉做出贡献的一种方式，尽管他们可能无法承担繁重的体力劳动。Weiss说，以这些方式建设地方能力，使许多撒哈拉以南非洲国家的医疗保健基础设施受益更广。

The legacy of anti-Guinea worm efforts can be seen in “community-based surveillance systems that cover multiple diseases”, he says. “They might track maternal and infant deaths, they track malaria — they can do all types of different things.”South Sudan’s Guinea worm programme involved more than 20,000 community-based health workers at its peak, Yibi says.

他说，在“覆盖多种疾病的基于社区的监测系统”中可以看到抗几内亚蠕虫努力的成果。“他们可能追踪孕产妇和婴儿的死亡，追踪疟疾-他们可以做各种不同的事情。”伊比说，南苏丹的麦地那龙线虫计划在高峰期涉及20000多名社区卫生工作者。

Many of these individuals later underwent further medical training and still work in health care, providing a variety of services. In 2016, the country’s Ministry of Health adopted a community-based health system modelled on the Guinea worm programme. “In many of the l.

其中许多人后来接受了进一步的医疗培训，仍然从事医疗保健工作，提供各种服务。。“在许多l。

A parasite is examined under the microscope to verify the presence of Guinea worm.Credit: Jane Hahn/The Carter Center

在显微镜下检查寄生虫以验证几内亚蠕虫的存在。图片来源：简·哈恩/卡特中心

The emergence of Guinea worm infections in non-human animals has posed a huge challenge to the eradication programme. One reason the parasite had been seen as a good candidate for eradication in the first place was that it was thought to affect humans almost exclusively. Diseases are always harder to stamp out if they can circulate in multiple species.In areas where domestic-animal infections are prevalent, they are now driving the persistence of Guinea worm in humans, studies suggest3.

非人类动物中出现的麦地那龙线虫感染给根除计划带来了巨大挑战。首先，这种寄生虫被视为根除的良好候选者，原因之一是它被认为几乎只影响人类。如果疾病可以在多个物种中传播，那么它们总是很难根除。研究表明，在家畜感染普遍的地区，它们现在正在推动几内亚蠕虫在人类中的持续存在3。

Reports of animal infections increased from 685 in 2022 to 878 in 2023, which the Carter Center attributes to increased surveillance in Angola and Cameroon. Meanwhile, infections among dogs in Chad fell for the fourth year in a row. In 2019, the WHO’s target date for Guinea worm eradication was pushed back from 2020 to 2030, in part in recognition of the challenge posed by animal infections.But according to Weiss, the goal of the programme hasn’t changed: “The endgame remains getting to zero in all hosts, unless the science tells us otherwise,” he says.Animal opportunitiesIf animal hosts are driving continued circulation of Guinea worm, then wiping out the parasite — altogether, or even just in humans — requires addressing infections in animals.

有关动物感染的报告从2022年的685份增加到2023年的878份，卡特中心认为这是由于安哥拉和喀麦隆加强了监测。与此同时，乍得犬类感染率连续第四年下降。2019年，世卫组织根除麦地那龙线虫的目标日期从2020年推迟到2030年，部分原因是认识到动物感染带来的挑战。但根据维斯的说法，该节目的目标没有改变：“除非科学另有说明，否则所有主持人的结局仍然为零，”他说。动物机会如果动物宿主正在推动几内亚蠕虫的持续传播，那么彻底消灭这种寄生虫，甚至只是人类的寄生虫，就需要解决动物的感染问题。

Many of the low-tech, non-pharmaceutical strategies that drove down human guinea worm infections to near zero are now being adapted and applied to controlling these animal infections. For example, community volunteers have begun to monitor dogs for signs of Guinea worm infection. And people in areas where animal infections are prevalent are being encouraged to tether domestic dogs (and sometimes cats) to prevent them from either drinking contaminated water or entering water sources if they show signs of infection.People are also being encouraged .

许多将人类几内亚蠕虫感染率降至接近零的低技术非药物策略现在正在被调整并应用于控制这些动物感染。例如，社区志愿者已经开始监测狗是否有麦地那龙线虫感染的迹象。在动物感染流行的地区，人们被鼓励拴住家养的狗（有时还有猫），以防止它们饮用受污染的水或在有感染迹象时进入水源。人们也受到了鼓励。

Children in Ghana study a book on Guinea worm disease.Credit: L. Gubb/The Carter Center

加纳的孩子们正在研究一本关于麦地那龙线虫病的书。信贷：L.古布/卡特中心

Detecting the presence of Guinea worm in the environment would be a significant advance. This, too, could give clues about where cases are likely to emerge and help to tailor preventive interventions. It would also aid efforts to certify countries as Guinea worm-free, which is more complicated in an era of animal infections.The WHO published preliminary standards for both types of test late last year, but it will be challenging to develop approaches that are accurate, are practical in real-world conditions and offer a fast turnaround.

检测环境中是否存在麦地那龙线虫将是一项重大进步。这也可以提供可能出现病例的线索，并有助于制定预防干预措施。它还将有助于认证国家无几内亚蠕虫，这在动物感染时代更为复杂。世卫组织去年年底公布了这两种测试的初步标准，但要开发出准确、在现实世界条件下实用并能快速扭转局面的方法将具有挑战性。

The roll-out is likely to be an iterative process, says Delea, with tests that meet minimal standards moved into use as quickly as possible and then refined over time. A test to detect an immune response to a Guinea worm antigen, known as DUF148, has shown promise in laboratory studies6, but the method remains complex.

Delea说，推出可能是一个反复的过程，满足最低标准的测试会尽快投入使用，然后随着时间的推移进行改进。一项检测几内亚蠕虫抗原（称为DUF148）免疫反应的测试在实验室研究中显示出前景6，但该方法仍然很复杂。

Still, it’s a first step. “We’re really hoping that we will get something to the field by early next year,” Delea says..

不过，这是第一步。德莱亚说：“我们真的希望明年初我们能在这个领域取得一些进展。”。。