Flubendazole reduces emerging Dracunculus medinensis in dogs in Chad: Results from a two-year study
14 affiliations
- 1Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
- 2Institute of Parasitology, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
- 3School of Biological Sciences, Queen’s University-Belfast, Northern Ireland, United Kingdom
- 4Department of Pharmaceutical and Biomedical Sciences, University of Georgia, Athens, Georgia, United States of America
- 5Southeastern Cooperative Wildlife Diseases Study, University of Georgia College of Veterinary Medicine, Athens, Georgia, United States of America
- 6Center for Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, United States of America
- 7Warnell School of Forestry and Natural Resources, University of Georgia, Athens, Georgia, United States of America
- 8Department of Veterinary Pathology, College of Veterinary Medicine and Biological Sciences, Texas A&M University, College Station, Texas, United States of America
- 9Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
- 10Zachery Consulting LLC, Ila, Georgia, United States of America
- 11The Carter Center, Atlanta, Georgia, United States of America
- 12The Carter Center, N’Djamena, Chad
- 13Institut de Recherche en Élevage pour le Développement, Afrique One Aspire, N’Djamena, Chad
- 14Programme National d’Éradication du Ver de Guinée, Ministry of Health, N’Djamena, Chad
Abstract
Since being targeted for eradication in the 1980s, global human cases of dracunculiasis (Guinea worm disease; GWD) have been reduced by over 99.9% through interventions aimed at interrupting the life cycle of the causative parasite, Dracunculus medinensis. However, the burden of GWD in dogs is higher than in humans and other monitored mammalian host species, threatening eradication of GWD. Expanding on a previous clinical trial of flubendazole (FLBZ) in dogs in Chad, we conducted a cluster-randomized controlled trial in which half of enrolled villages (N = 29) were assigned to receive FLBZ and the other half (N = 27) to receive no treatment. An annual difference-in-differences analysis revealed that treated villages had 59.3% fewer predicted emerging D. medinensis adult females (95% CI: 53.8% fewer to 69.2% fewer) per village per year during the second year of the study compared to control villages. Analyses examining effects of FLBZ monthly, at the individual dog level, and through histopathology of D. medinensis female reproductive morphology, all support the conclusion that FLBZ inhibits embryogenesis and larval development within the uterus of gravid female worms. Together these data are consistent with a hypothesis that although D. medinensis emerged from individually treated dogs, the L1s released from dogs treated with FLBZ exhibited reduced viability, thus reducing the risk of infection in the next mammalian host. This trial builds the body of knowledge about FLBZ’s impacts on D. medinensis in the canine host and provides compelling evidence on the effectiveness of FLBZ in reducing the number of emerging D. medinensis in dogs, which can contribute to the eradication of this parasite. However, additional questions remain regarding the formulation, which need to be addressed in future studies before being deployed at scale. Author summary: Annual cases of Guinea worm disease (GWD) in humans have been greatly reduced globally through public health interventions such as improving access to clean water, expanding surveillance, treating bodies of water suspected to contain GW larvae with temephos, and educating local populations on reducing their risk of GWD. Dog GW infections remain high compared to human cases, impeding the goal of eradication. We conducted a cluster-randomized clinical trial of flubendazole (FLBZ) in Chadian dogs from October 2021 through June 2023 during which Chad had the highest number of dogs with reported GW infections compared to other endemic countries. All dogs in villages were randomly assigned to receive FLBZ or no treatment. The main annual analysis predicted 59.3% fewer emerging adult female D. medinensis (95% CI: 53.8% fewer to 69.2% fewer) per village only during the second year of the study in treated villages compared to control villages. Analyses looking at monthly village-level outcomes, individual dog outcomes, and comparing the histopathology of female worm reproductive morphology all support the hypothesis that FLBZ in this dose and formulation inhibits the viability of 1st-stage larvae that are expelled from gravid female worms such that the risk of infection is decreased in the next mammalian host. This study provides evidence for flubendazole as a potential therapeutic intervention for Guinea worm disease among dogs, though more research is needed regarding the formulation of the drug in both laboratory and field settings. Future studies would provide additional evidence necessary to inform decisions regarding when and how the drug could be deployed at scale.
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BibTeX
@article{dupper2026flubendazole,
title = {{Flubendazole reduces emerging Dracunculus medinensis in dogs in Chad: Results from a two-year study}},
author = {Amy C. Dupper and Charles D. Mackenzie and Timothy G. Geary and Deborah L. Elder and Wided Najahi-Missaoui and Christopher A. Cleveland and Ellen K. Haynes and Michael J. Yabsley and Guilherme Gomes Verocai and Macon Overcast and John A. Bryan II and Fernando Torres-Velez and Métinou Koumétio Sidouin and Bongo Nare Richard Ngandolo and Philip Tchindebet Oaukou and Adam J. Weiss and Rebecca Garabed},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = sep,
doi = {10.1371/journal.pntd.0014763},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014763},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Flubendazole reduces emerging Dracunculus medinensis in dogs in Chad: Results from a two-year study
AU - Amy C. Dupper
AU - Charles D. Mackenzie
AU - Timothy G. Geary
AU - Deborah L. Elder
AU - Wided Najahi-Missaoui
AU - Christopher A. Cleveland
AU - Ellen K. Haynes
AU - Michael J. Yabsley
AU - Guilherme Gomes Verocai
AU - Macon Overcast
AU - John A. Bryan II
AU - Fernando Torres-Velez
AU - Métinou Koumétio Sidouin
AU - Bongo Nare Richard Ngandolo
AU - Philip Tchindebet Oaukou
AU - Adam J. Weiss
AU - Rebecca Garabed
PY - 2026
DA - 2026/09/25
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014763
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014763
AB - Since being targeted for eradication in the 1980s, global human cases of dracunculiasis (Guinea worm disease; GWD) have been reduced by over 99.9% through interventions aimed at interrupting the life cycle of the causative parasite, Dracunculus medinensis. However, the burden of GWD in dogs is higher than in humans and other monitored mammalian host species, threatening eradication of GWD. Expanding on a previous clinical trial of flubendazole (FLBZ) in dogs in Chad, we conducted a cluster-randomized controlled trial in which half of enrolled villages (N = 29) were assigned to receive FLBZ and the other half (N = 27) to receive no treatment. An annual difference-in-differences analysis revealed that treated villages had 59.3% fewer predicted emerging D. medinensis adult females (95% CI: 53.8% fewer to 69.2% fewer) per village per year during the second year of the study compared to control villages. Analyses examining effects of FLBZ monthly, at the individual dog level, and through histopathology of D. medinensis female reproductive morphology, all support the conclusion that FLBZ inhibits embryogenesis and larval development within the uterus of gravid female worms. Together these data are consistent with a hypothesis that although D. medinensis emerged from individually treated dogs, the L1s released from dogs treated with FLBZ exhibited reduced viability, thus reducing the risk of infection in the next mammalian host. This trial builds the body of knowledge about FLBZ’s impacts on D. medinensis in the canine host and provides compelling evidence on the effectiveness of FLBZ in reducing the number of emerging D. medinensis in dogs, which can contribute to the eradication of this parasite. However, additional questions remain regarding the formulation, which need to be addressed in future studies before being deployed at scale. Author summary: Annual cases of Guinea worm disease (GWD) in humans have been greatly reduced globally through public health interventions such as improving access to clean water, expanding surveillance, treating bodies of water suspected to contain GW larvae with temephos, and educating local populations on reducing their risk of GWD. Dog GW infections remain high compared to human cases, impeding the goal of eradication. We conducted a cluster-randomized clinical trial of flubendazole (FLBZ) in Chadian dogs from October 2021 through June 2023 during which Chad had the highest number of dogs with reported GW infections compared to other endemic countries. All dogs in villages were randomly assigned to receive FLBZ or no treatment. The main annual analysis predicted 59.3% fewer emerging adult female D. medinensis (95% CI: 53.8% fewer to 69.2% fewer) per village only during the second year of the study in treated villages compared to control villages. Analyses looking at monthly village-level outcomes, individual dog outcomes, and comparing the histopathology of female worm reproductive morphology all support the hypothesis that FLBZ in this dose and formulation inhibits the viability of 1st-stage larvae that are expelled from gravid female worms such that the risk of infection is decreased in the next mammalian host. This study provides evidence for flubendazole as a potential therapeutic intervention for Guinea worm disease among dogs, though more research is needed regarding the formulation of the drug in both laboratory and field settings. Future studies would provide additional evidence necessary to inform decisions regarding when and how the drug could be deployed at scale.
SN - 1935-2735
ER -