Date: Mon 18 Jun 2018
Source: The New York Times [edited]
<https://www.nytimes.com/2018/06/18/health/guinea-worms-dogs-chad.html>

In this arid central African country [Chad], the long global struggle to eliminate a horrifying human parasite has encountered a serious setback: dogs. They are being infected with Guinea worms [dracunculiasis], and no one knows how.

Scientists are desperate to solve the puzzle. If the answer isn't found soon, or if the worms begin to spread widely into other species -- a handful already have been found in cats and even baboons -- then 32 years of work to end the scourge may crumble, said Mark L Eberhard, a parasitologist at the Centers for Disease Control and Prevention.

In 1986, when the Carter Center -- the global health philanthropy in Atlanta founded by President Jimmy Carter -- launched the eradication drive, an estimated 3.5 million people in 21 countries had worms.

Last year [2017], only 30 human cases were found: half in Chad and half in Ethiopia.

But 6 years ago, here on the hot, dusty banks of the Chari River, the worms mysteriously began emerging from dogs. Last year [2017], over 800 Chadian dogs had them.

Dogs cannot infect people directly, but they may carry the worms into ponds from which people drink, which is how humans are normally infected.

"They haven't caused a big human outbreak yet, knock wood, but that's my nightmare," said Ernesto Ruiz-Tiben, who directs the Carter Center's campaign.

To prevent that, Chad is paying villagers to tether dogs until all their worms wriggle out. The reward is $20 cash, plus a stout chain with 2 locks. (Dogs chew through ropes or are freed by children who take pity on them.)

The reward is $100 to humans with worms. To generate publicity, the cash is handed out at ceremonies held in the weekly roadside markets where villagers gather to barter meager fish hauls for goods like plastic buckets or quart bottles of gasoline.

At one such ceremony in Dangabol, in southeast Chad, Dr Hubert Zirimwabagabo, who heads the Carter Center's work in the country, played a quiz game with the audience, handing out bars of soap as prizes. Asked what caused worms, one winner shouted, to general laughter: "Drinking bad water -- and speaking ill of others."

Then Dr Zirimwabagabo asked local officials to present $100 to each of 3 women who had worms, reported them, and kept them away from drinking water. The officials obliged with grand ceremony, to loud ululations. People here may not see that much cash in a year.  [Byline: Donald G McNeil Jr]
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[HealthMap/ProMED-mail map of Chad:
<http://healthmap.org/promed/p/57>

The reservoir in dogs in Chad was discussed by the WHO in the 2014: "Dracunculiasis eradication: global surveillance summary, 2014" (Weekly Epid Rec. 2015; no. 19, (May 2015, pp. 201-15. <http://apps.who.int/iris/bitstream/handle/10665/242354/WER9019_201-215.PDF>), which wrote "the unusually high number of dogs with confirmed Guinea-worm infections in Chad, which poses epidemiologic and biologic questions."

The situation was also described in a 2014 paper, Eberhard ML et al. The peculiar epidemiology of dracunculiasis in Chad. Am J Trop Med Hyg. 2014; 90(1): 61-70. doi: 10.4269/ajtmh.13-0554; available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886430/>).

The contribution by the canine reservoir to maintaining infections in humans and whether they actually transmit the infection to humans by contaminating the water reservoirs is not known. A zoonotic reservoir is a potential complication to the attempts to eradicate dracunculiasis. - ProMED Mod.EP]

[In the majority of cases, under unhygienic conditions, both people and animals are affected by dracunculiasis.

Exceptionally, Guinea worm may occur as a purely animal infection. This was demonstrated during the last century, when 11 percent of stray dogs were found infected in Kizylorda (Kazakhstan), where no human infection was known.

In Uzbekistan and Turkmenistan, _Dracunculus medinensis_ has been identified in golden jackals (_Canis aureus_), which potentially can infect water sources.

According to WHO 2017 data, 817 dogs in Chad, 11 dogs in Ethiopia, and 9 dogs in Mali were reported to be infected with Guinea-worm (see at <http://apps.who.int/iris/bitstream/handle/10665/272648/WER9321-305-320.pdf>).

_D. medinensis_ infection in dogs remains a challenge to global eradication, particularly in Chad and to a lesser extent in Ethiopia and Mali. - ProMED Mod.AS]
Date: Tue, 29 May 2018 04:39:34 +0200

N'Djamena, May 29, 2018 (AFP) - Hospitals and schools were shut in Chad Monday as civil servants went on strike over pay cuts imposed by the cash-strapped government which is under pressure to cut public funding to meet the demands of international donors.   Public sector workers are demanding payment of their "full salary" after bonuses and allowances were slashed by 50 percent in January as part of a package of austerity measures to improve state finances. They had already seen a similar 50 percent cut in 2016.   President Idriss Deby, who has been in power since 1990, had asked them to wait until the end of the year to regularise their salaries.   The unions on Saturday refused his request and called for an indefinite strike.   Primary and secondary schools in the capital and the University of N'Djamena were closed on Monday while the main ministries were functioning at a slow pace, with many offices shut.   "This strike is jeopardising thefuture of our children who are in exam class," said parent Joseph Issa.   Schools in other major cities were also closed.

At the general hospital in N'Djamena, staff nurse Ali Soumaine said they were providing "a minimal service for surgery, resuscitation and other sensitive services".   The government was "surprised" at the strike call, spokeswoman Madeleine Alinque said in a statement.   "We question the headlong rush of unions that do not honour our country or workers," she said.   "The government is inviting all workers to go about their daily business normally, and efforts are under way for a sustainable recovery of the social situation," she added.   Magistrates on Monday also began a three-day strike in protest at a police attack on lawyers in Doba last week.   According to trade union leader Michel Barka, the situation of civil servants "is more and more unacceptable, and it gives the workers no pleasure every time they have to close the schools, the hospitals, the public administration".   Barka accused the government of not "making an effort" to deal with the situation.

Chad, a poverty-stricken landlocked country of nearly 15 million people, has about 92,000 civil servants.   The austerity measures imposed in January led to a seven-week strike by civil servants. The government and trade unions in March reached an agreement to end the paralysis of the public sector.   The government proposed ending the cuts to bonuses and allowances at the end of May.   N'Djamena obtained a three-year $312 million (254 million euro) credit line from the International Monetary Fund last June. It has received two tranches of $99.8 million but has to make progress on improving state finances to access further funds.   The economy of Chad, where 40 percent of the population live in poverty, has been badly hit by a downturn in the price of oil exports since 2015.
22nd March 2018

Lake Chad Basin
 - The detection of wild poliovirus type 1 (WPV1) (Borno state, Nigeria in 2016) and circulating vaccine-derived poliovirus type 2 (cVDPV2) (Borno and Sokoto states in 2016) continue to pose a risk to the neighbouring countries of the Lake Chad basin.
 - Emergency outbreak response efforts continue across the Lake Chad basin, together with activities to fill subnational surveillance gaps across the region.
 - These activities include efforts to vaccinate children at markets, in internally displaced persons camps, and at international borders. The next set of supplementary immunization days are planned for early April, synchronized across countries in the Lake Chad basin.
Date: Tue, 20 Mar 2018 18:35:47 +0100

N'Djamena, March 20, 2018 (AFP) - Civil servants in Chad returned to work on Tuesday after a strike over austerity measures paralysed the impoverished country's public sector for seven weeks.   Trade unions had called the strike in late January after the government slashed civil servants' pay, and the whole public sector ground to a halt.   But a deal was struck last week between the government and unions, after two weeks of negotiations.    Work resumed on Tuesday at government ministries and healthcare facilities in the capital N'Djamena, an AFP journalist said.

Teachers and students also slowly headed back to schools.   The deal was made for "the suspension of the strike and the resumption of work" after payments to civil servants, some 31,000 of whom did not receive wages in February.   A union statement on Monday said "having noted the actual payment of wages in N'Djamena and the province, the unions called on all workers to return to work".   "The return to work is a bit difficult but we are responding to the union's call," Mahamat Issa, an official at the finance ministry, told AFP.   Chad, where 40 percent of the 14-million population live in poverty, introduced the austerity measures to meet the requirements of international donors.
Date: Thu, 15 Mar 2018 10:06:08 +0100

N'Djamena, March 15, 2018 (AFP) - Chad's government and unions have signed a deal to end a strike over austerity measures that has paralysed the public sector for more than six weeks.   The impoverished country, badly hit by a fall in the price of oil exports since 2015, introduced the austerity measures this year to meet the requirements of international donors.   But the public spending cuts have increased social tension and anger towards President Idriss Deby, in power since 1990.

Trade unions called an indefinite general strike in the state sector on January 29 after the government slashed civil servants' pay, and since then the whole public sector has stopped work, paralysing key sectors.   Late on Wednesday, the government and the trade union consortium announced a deal after two weeks of negotiations.    It calls for "the suspension of the strike and the resumption of work" after payments to civil servants, some 31,000 of whom did not receive wages in February.

In 2017, public-sector salaries totalled 376 billion CFA francs, roughly the equivalent of the combined revenue from income tax and customs duties, according to official figures given to AFP.   The International Monetary Fund (IMF) opened up a three-year $312 million (254 million euro) credit line last June under a stabilisation programme.    But Chad, where nearly 40 percent of the population lives below the poverty line, has to make progress in improving state finances in order to gain access to the full amount.
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