Epidemiology and Etiology

Dracunculiasis is a seasonal infection, usually occurring at the precise time of year when rural villagers must plant or harvest their crops. People are infected when they drink water containing a tiny crustacean of the genus Cyclops, called a copepod, which harbors the infective larvae of the parasite. About a year later, the adult worms emerge through the skin to discharge larvae into freshwater, to be ingested by an appropriate copepod, thus continuing the cycle. In drier ecological areas, such as the Sahelian zone in Africa, the infection appears during the brief rainy season (summer), when surface water is available. In areas that receive more rainfall, such as the coastal regions along the Bight of Benin, the infection appears, and is transmitted, during the dry season (winter), when stagnant surface water sources are scarcest and most polluted.

The most commonly affected age groups are generally persons 15 to 45 years of age - that is, working adults. Younger children are affected, but not infants under 1 year, and generally not many children under 5 years. Often farmers are particularly liable to infection, apparently because they drink large volumes of contaminated water while laboring on their farms. School children also suffer high rates of infection in some areas. Male or female victims may predominate in any given area, depending on their relative exposures.

There is no drug suitable for effective mass treatment of dracunculiasis, and from time immemorial, the disease has been treated by slowly winding the emerging worm around a stick. The disease can, however, be prevented by teaching villagers to boil their drinking water or filter it through a cloth, by treating contaminated sources of water with a chemical (temephos), or by providing protected sources of drinking water, such as tube wells or draw wells (rather than ponds or open "step wells").

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