MALI REPORTS NO GUINEA WORM CASES; DISEASE REMAINS INJUST THREE COUNTRIES, CARTER CENTER SAYS
ATLANTA … In 2016, only three countries ― Chad, Ethiopia, and South Sudan, reported a total of 25 human cases of Guinea worm disease. For the first time, Mali reported none. In 2015, four countries ― Chad, Ethiopia, Mali, and South Sudan ― had reported 22 cases.
In 2016, there were 16 human cases in Chad, three (3) in Ethiopia, and six (6) in South Sudan. The cases were in 19 isolated villages, and all were contained within their countries of origin.
These provisional numbers are reported by the respective countries’ ministries of health and tracked by The Carter Center.
“When The Carter Center joined the fight against Guinea worm disease, there were about 3.5 million cases in 21 countries,” said former U.S. President Jimmy Carter. “This remarkable progress is due to the commitment of many partners and supporters, most especially the ministries of health in endemic nations. Mali, the most recent nation to record zero cases for one year, should be commended for its success.”
Considered a neglected tropical disease, Guinea worm disease (dracunculiasis) is contracted when people consume water contaminated with tiny crustaceans that carry Guinea worm larvae. The larvae mature and mate inside the patient’s body. The male worm dies. After a year, a meter-long female worm slowly emerges through a painful blister in the skin. Contact with water stimulates the emerging worm to release its larvae into the water and start the process all over again. Guinea worm disease incapacitates people for weeks or months, reducing individuals’ ability to care for themselves, work, grow food for their families, or attend school.
No vaccine or medical treatment exists for Guinea worm infection in humans. Instead, the ancient disease is being wiped out mainly through community-based interventions to educate and change behavior, such as teaching people to filter all drinking water and preventing contamination by keeping patients from entering water sources.
“The progress we have seen in restricting Guinea worm disease to these few cases in only three countries is a testament to the dedication of people in endemic areas to caring for their health and that of their communities,” said Dr. Dean Sienko, the Carter Center’s vice president of health programs. “It’s a privilege to partner with them as we tackle this challenge together.”
While there was a slight increase in cases from 2015, the containment rate (cases that were identified before the disease could spread) increased from 36 percent in 2015 to 56 percent in 2016, an important indicator of future eradication results. The ministries of health of the four countries are to be commended for their persistence and skill in tracking down cases and rumors of cases, often in insecure areas.
Many generous foundations, corporations, governments, and individuals have made the Carter Center's work to eradicate Guinea worm disease possible, including major support from the Bill & Melinda Gates Foundation; the United Kingdom's Department for International Development (DFID); Children's Investment Fund Foundation (CIFF) - United Kingdom; the Conrad N. Hilton Foundation; and The Federal Republic of Germany. Major support from the United Arab Emirates began with Sheikh Zayed and has continued under Sheikh Khalifa and Crown Prince Mohammed bin Zayed. The DuPont Corporation and Precision Fabrics Group donated nylon filter cloth early in the campaign; Vestergaard's LifeStraw® donated pipe and household cloth filters in recent years. Abate® larvicide (temephos) has been donated for many years by BASF. Key implementing partners include the ministries of health in endemic countries, The Carter Center, WHO, CDC, and UNICEF.
“These last few cases of Guinea worm disease remain because they are the most difficult to reach, often appearing in conflict areas or among remote, disenfranchised populations,” said President Carter. “The Carter Center is bringing to bear all of our experience and every resource available to track down, isolate, and treat these last remaining cases. Every case and every person counts when eradication is the goal.”
Chad – Seven years after the reoccurrence of infections in Chad, Guinea worm transmission there remains in humans and has shown an emergence in dogs in recent years.Although the worms in Chad are genetically indistinguishable from those in other countries, this unusual epidemiology has not been seen at this level in other nations: Chad has seen an escalation of infections in dogs, while human cases are consistently sparse and random. Human cases in 2016 (16) and 2015 (9) have been found in remote villages, many spread over hundreds of miles along the Chari River. Chad reported 1,013 infected dogs (January-December). The human cases of 2016 have few obvious ties: The 16 patients reside in 12 different villages, are of 11 different ethnicities, and speak 11 different languages. The Chad Guinea Worm Eradication Program is doing extensive investigation: As of October, it had 1,497 villages under active surveillance, including 316 given high priority. The program continues to offer cash rewards, expand surveillance, refine health education messages, and implement new research, including two canine drug trials.
Ethiopia – In 2016, Ethiopia reported three cases from Gog district in the Gambella region, which remains the nation's only Guinea worm-endemic area. Ethiopia is well positioned to stop transmission in 2017. It also reported three cases in 2014 and 2015. Continued political will, security, and sensitive surveillance are critical to ending Guinea worm disease in Ethiopia once and for all.
Mali – For the first time since it began in 1992, the Mali Guinea Worm Eradication Program has not reported any human cases for more than 12 consecutive months, reducing its total number of cases from 16,024 in 1991 to zero in 2016. Currently, 698 villages or settlements in five regions remain under active surveillance. Some of these are in areas at high risk for insecurity, which poses a serious challenge to program operations. Public awareness of cash rewards leading to the discovery of a case is nearly 85 percent; the Guinea worm program investigated 515 of 516 rumored cases (January-October) within 24 hours of the worm’s emergence, thus preventing potential contamination of water sources. Mali’s minister of health, Mme. Marie Madeleine Togo , personally visited health workers and former sufferers in the field. The welcome news of Mali’s apparent success is tempered by two challenges to demonstrating that interruption of the disease has been achieved, namely: constraints to surveillance posed by continued insecurity in parts of the country, and recent detection of Guinea worm infections in dogs in an isolated area. To assure elimination in humans, Mali will need to continue interventions to wipe out infections in dogs.
South Sudan – The South Sudan Guinea Worm Eradication Program reported six cases in 2016. It reported five cases in 2015, compared to 70 cases in 2014, a reduction of 93 percent. The program also achieved nine months reporting zero Guinea worm cases in 2016. This success remains noteworthy as the program continues to function effectively despite continued political turbulence. The number of Guinea worm cases in South Sudan has been reduced by 99.98 percent since 20,582 cases were reported in 2006. Thousands of community-based health workers demonstrate daily acts of courage to improve the lives of their families and neighbors, often under dangerous circumstances. Most international program staff were evacuated as a safety precaution in July. However, under the leadership of South Sudan Guinea Worm Eradication Program Director Samuel Makoy Yibi , South Sudanese nationals already working at the village level continue to implement interventions and surveillance. In September 2016, South Sudan Minister of Health Dr. Riek Gai Kok visited the endemic areas in Wau State to personally distribute cash rewards to three individuals. South Sudan is on the verge of breaking transmission; immediate and sustained peace is needed to complete elimination and achieve WHO certification.
STEPS TO ERADICATION
"We've navigated plenty of challenges -- including wars -- over the 30 years we've been working to eradicate Guinea worm,” said Dr. Donald Hopkins, Carter Center special advisor for Guinea worm eradication. "Sporadic infections in animals constitute another puzzle to be solved, and we are working with a host of partners to confirm the best interventions to prevent this.”
The Carter Center leads the international Guinea worm eradication campaign and works in close partnership with national programs, the World Health Organization (WHO), U.S. Centers for Disease Control and Prevention (CDC), UNICEF, and many other partners. The Carter Center provides technical and financial assistance to national Guinea worm eradication programs to interrupt transmission of the disease. When transmission is interrupted, the Center provides continued assistance in developing or strengthening surveillance in Guinea worm-free areas for three years and helps prepare nations for official certification by the WHO. CDC provides technical assistance and verifies that worms from these final patients are truly Guinea worms. The presence of Guinea worm disease in an area usually indicates abject poverty, including the absence of safe drinking water; UNICEF mainly assists countries by helping governments provide safe sources of drinking water to priority areas identified by the national Guinea worm eradication programs. The WHO is responsible for certifying countries as Guinea worm-free and is the only organization that can officially certify the eradication of a disease.
For a disease to be eradicated, every country must be certified, even if transmission has never taken place there. Only eight countries remain to be certified globally.