After smallpox another infectious disease may be eradicated in near future. This year there are only two confirmed cases of Guinea worm infection. If things go according to plan, this horribly painful infection will be confined soon to history books.

This eradication is in many way unique. There is no treatment for Guinea worm infection. There is no vaccine.. So the tools for eradication are health education and preventive measures. Scientific knowledge of the way it spreads and common sense approach to prevent it spreading was the key for the success.

The stage 1 larvae of the worm present in water is ingested by water flea(copepod).Inside the copepod the larvae undergoes moltimg  twice to become stage 3 larvae.When the flea contaminated water is consumed by humans without filtering or boiling, the larvae enters the abdominal cavity. After maturation into adult worm the male and female mate. Male dies after mating. The fertilised female worm travel through the tissue under the skin and produce a blister on the surface near legs. The horribly painful blister breaks open to expose the worm. Due to severe burning sensation the human infested with the worm will immerse his leg in water to get momentary relief. At that moment the worm releases hundreds of larvae into the water and the cycle continues.

In 1986 there was around 3.5 million cases of Guinea worm disease in 20 countries of Africa and Asia. In 2016 there are only two.

How was this achieved?

David Agyemang, who is the now program manager for Sightsavers’ Ghana office, used to work on Ghana’s national Guinea worm eradication program.

“Guinea worm has no cure,” he says. “So everything was about getting people to change their behavior. Getting people to do the right things.”

In the short-term that means stopping people who had a worm dangling from their foot or leg from entering bodies of water for that momentary relief.

The longer-term solution is to get people access to clean drinking water.

Agyemang says education was the key in the drive against Guinea worm in Ghana, which eliminated the disease in 2010.

In Ghana, as soon as people learned how the worms spread, most would stay out of the rivers and lakes, says Agyemang. Even if their leg felt like it was on fire.

But to completely stop the cycle of transmission, you can’t just rely on people doing the “right thing.”

Communities posted guards at watering holes and new laws were put into place.

“You are not supposed to a enter a water source if you have Guinea worm,” Agyemang says. “People who did that were punished. So bylaws helped us a lot.” Public health officials stress that anti-Guinea worm measures should not be imposed by outsiders.

The Carter Center in Atlanta was deeply involved in this eradication program.

“The key thing is to engage the community,” says Donald Hopkins, who’s been working on the center’s eradication program for decades. “Because it would be a disaster for outsiders, and by that I mean people from other countries, or even people from outside the community, to come in and demand that people do one thing or another.”

He adds that it’s crucial is to explain to the community that this parasite is coming from their drinking water and convince them that they have the power to stop it.

“And then let them figure out what to do,” he says.

In his view, having a local plan is critical. “It’s true that in some communities, the village elders got together and agreed that if anyone knowingly goes into a drinking water source with a Guinea worm coming out of their body, they will fine them a goat or something else as a way of punishment, but the important thing is that it must be the community that puts those sanctions in place.”

The Guinea worm success story reaffirms the fact that health education and scientific methods of prevention, using simple common sense measures by the community itself, can help a long way in eradicating many of our infectious diseases.