Chickenpox sweeties and the social ecology of infectious disease

This post contributed by Liza Lester, ESA communications officer   No one speaks for the endangered poliomyelitis. No one raises money to protect the last survivors, as health workers stalk the virus through its last redoubts in India, Pakistan, Nigeria and Afghanistan. On the contrary, the WHO spends billions on hunting it to extinction. But the virus has held out longer than expected. Joshua Michaud, policy analyst at the Kaiser Foundation, thinks the polio fighters are falling behind. Guinea worm will be the next scourge to fall, he said on an AAAS panel engaged to discuss Infectious Disease: Challenges to Eradication on Monday. Why have efforts with guinea worm been so successful? a precocious Georgetown student wanted to know. Biology was on our side. There is no vaccine for guinea worm, and no medicine to cure infection. To extract the worm, you must wind it slowly around a stick as it emerges through a sore in your leg (an oft-repeated story holds that the treatment has not changed since the Egyptians of the XVIII dynasty described it in 1550 BCE, though the source appears to have been exaggerated). The process is excruciating, and it takes weeks. But we know key details of the worm’s biology that the ancient Egyptians did not. Basic technology and careful hygiene can defeat the worm. Larvae harbor in the bodies of invisible copepods, “water flies” tiny enough to swallow. Once swallowed, female larvae nestle against the long limb bones of their hosts, growing up to a meter in length over the course of a year. They surface inside a burning ulceration that sends their victims running for a dip in a cool pond—and the next generation of larvae escape to start the cycle of life anew. The good news, said Michaud, is that guinea worm does not have another host. It has no environmental bolt hole to hide in while under siege, only to emerge when health forces are not looking. It needs humans. And affected people are visibly affected. Break the cycle for one year, and you can free a communal water source, and its community, from the worm. Copapods may be microscopic, but a simple nylon strainer on the end of a drinking tube saves you from swallowing them (although not bacterial and viral parasites that might also lurk there, interjected Dennis Carroll, in charge of avian flu and other emerging threats at USAID). Help the infected, persuade them to stay out of drinking water sources when their worm breaches, and you break the cycle. Success requires the help and good will of village elders. The Carter Foundation has been courting good...

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