Target product profile to detect "Dracunculus medinensis" presence in environmental samples 

Overview

Dracunculiasis, also known as Guinea-worm disease, is caused by infection with the parasitic nematode (the Guinea worm). In May 1986, the Thirty-ninth World Health Assembly declared global elimination (i.e. eradication) of dracunculiasis as a goal. The global dracunculiasis eradication campaign, through community-based interventions, has reduced the burden of the disease from an estimated 3.5 million cases per year in 1986 to only 13 human cases and 688 animal infections during 2022. To date, however, there are no field-validated tests to detect the presence of D. medinensis-specific analytes in the environment.

Although the scale of the surveillance infrastructure in countries endemic for Guinea-worm disease is impressive, initiating active surveillance and implementing disease-preventive interventions in any given area is triggered only when a host with an emergent worm is detected in that area or a nearby area. Unlike polio eradication, where an environmental diagnostic tool exists, there is no such tool for dracunculiasis eradication. Diagnostic tools that can detect evidence of analytes specific to D. medinensis in environmental samples can be used to identify geographies that are at risk for transmission of D. medinensis. Results from such environmental tools can complement surveillance data generated via active, community-based case and infection searches for subcutaneous and emergent Guinea worms and proactive or passive reporting of Guinea-worm disease. As such, environmental surveillance tools could augment current surveillance activities and enhance surveillance in a manner unprecedented for the global dracunculiasis eradication campaign.

Viable environmental assays that can detect evidence of analytes (nucleic acid or other antigens) specific to D. medinensis in various environmental samples from water, aquatic animals, and perhaps aquatic animal waste, could be used to guide the targeting and implementation of disease-preventive interventions in endemic areas. For example, such tools could further inform which surface water sources should be treated with larvicide. Environmental surveillance tools could also generate additional data to inform decision-making about when and where to contract or expand active, community-based surveillance and implement other programmatic interventions. Environmental surveillance tools would be useful for generating additional surveillance data in areas with known or suspected wildlife transmission. Diagnostic tools capable of detecting D. medinensis-specific analytes in environmental samples would also generate data on the absence of Guinea worm in the environment, which could help certify countries as free of dracunculiasis transmission, ultimately facilitate the certification of dracunculiasis eradication, and support post-certification efforts.