Guinea Worm Cases Fell 50% in 2020, Carter Center Reports

By The Carter Center
Village volunteer Cezerina Puru Ladu treats her husband, Garbino Kenyi, a farmer from Terekeka County, South Sudan, who suffered from Guinea worm disease. In 2020, South Sudan reported a single human case*. (Photo: The Carter Center/ L. Gubb)
Village volunteer Cezerina Puru Ladu treats her husband, Garbino Kenyi, a farmer from Terekeka County, South Sudan, who suffered from Guinea worm disease. In 2020, South Sudan reported a single human case*. (Photo: The Carter Center/ L. Gubb)
Listen to article

ATLANTA (Tuesday, Jan. 26, 2021) — Despite the challenges of the COVID-19 pandemic, the number of human Guinea worm cases was cut in half to just 27* in 2020, The Carter Center announced Tuesday.

The 27 human cases of Guinea worm disease across six African countries mark a 50% decline from the number of cases reported in 2019. Guinea worm infections in animals fell 20% in the same period, the Center reported. When The Carter Center established itself as a pioneer in neglected tropical disease elimination by assuming leadership of the global Guinea Worm Eradication Program in 1986, about 3.5 million human cases occurred annually in 21 countries in Africa and Asia.

“The numbers we are seeing are very encouraging,” said Jason Carter, chair of the Center Board of Trustees. “However, the target number is zero — a complete, sustained absence of human cases and infections in animals — and we will not stop pushing until we get there.”

Case and Infection Numbers by Country
During 2020, only 12* human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one* each in South Sudan, Angola, Mali, and Cameroon.As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. (*All 2020 figures are provisional until officially confirmed, typically in March or April. Details can be found in the latest issue of Guinea Worm Wrap-Up.)

“The Chad Ministry of Health Guinea Worm Eradication Program saw a significant reduction in both human cases and animal infections in 2020,” said Dr. Kashef Ijaz, Carter Center vice president of health programs. “This was achieved through recommitted country and community efforts, innovation, and aggressive, science-based interventions. The dramatic reductions may be an early indication that we’re turning a corner in the most Guinea worm-endemic country.”

Reductions despite Covid-19
The improvement is especially notable in the context of the COVID-19 pandemic, which in 2020 forced many public health programs throughout the world to curtail or even suspend their activities because of supply-chain interruptions and the need to avoid close personal contact as occurs with mass drug administration. In contrast, the Guinea Worm Eradication Program is not dependent on the delivery of pharmaceuticals because there is no vaccine or medicine to treat the disease. The day-to-day work of community awareness and education about Guinea worm infections, along with monitoring for infections, filtering drinking water, and protecting water sources from contamination is performed by community and family members. These differences contributed to the program’s remaining up to 95% operational throughout 2020.

“I have been so impressed with the way entire communities in every country where we work embrace the responsibility for safeguarding their own health,” said Adam Weiss, director of the Guinea Worm Eradication Program. “The people who live in the villages are the heart of the program. Foreigners like me are a very small part of the operation. As an example, we have 1,026 people on the payroll in Chad, and almost 1,000 of them are Chadians. Beyond that, there are thousands of village volunteers safely working together with their neighbors.”

The role of foreign staff in Guinea worm-endemic countries is to help coordinate with national and local health ministries, train supervisors and volunteers in prevention and treatment techniques, and conduct rigorous scientific research into disease transmission mechanisms and interventions.

Guinea Worm Rumors: 99% investigated within 24 hours

Interventions to stop transmission include community-based health education, using filters (donated by Vestergaard's LifeStraw®) for all drinking water, keeping people and animals with emerging Guinea worms from entering water sources, and targeted use of the mild larvicide ABATE® (donated by BASF) in stagnant water sources. (See “About Guinea Worm” life cycle description below.) To boost surveillance at this critical point in the global campaign, all national programs offer cash rewards for reporting potential cases. From January through December 2020, the South Sudan Guinea Worm Eradication Program received 58,419 rumors of possible Guinea worm disease cases. In a country the size of France with only about 50 miles of paved road, the program investigated 99% of those rumors (57,732) within 24 hours.

“Swift investigation of rumored cases is essential to stopping transmission of the disease,” said Weiss. “The South Sudan Guinea Worm team pursues those rumors aggressively, and even though almost all turn out to be something else, in an eradication campaign it’s that remarkable level of effort that’s required to catch every single case and reach zero.”

Only one human disease has ever been eradicated; that was smallpox, in 1980. For a disease to be declared eradicated, every country in the world must be certified free of human and animal infection, even countries where transmission has never taken place. To date, 199 countries have been certified free of Guinea worm; only seven have not, including the Democratic Republic of the Congo, where no case has been reported since 1958. After three consecutive years of indigenous transmission, Angola has been added, as the 22nd country, to the list of endemic countries for the first time. Cameroon was certified by the World Health Organization as Guinea worm-free in 2007; that country has reported one case in each of the last two years but is not endemic because it has not had three years of indigenous transmission.

"The final Guinea worm-endemic areas are not random," said Dr. Donald R. Hopkins, a veteran of the campaign to eradicate smallpox who is the Carter Center’s special advisor for Guinea worm eradication. "These last countries continue to have Guinea worm cases because of undetected cases, insecurity, or inadequate political will."

The final cases of any eradication campaign are the most challenging and the most expensive to eliminate. Guinea worm eradication is no different, and The Carter Center and its partners remain committed to reaching zero.

“There should be no such thing as a neglected disease, tropical or otherwise,” said former U.S. President Jimmy Carter, who, with former First Lady Rosalynn Carter, founded The Carter Center in 1982. “With the resources, knowledge, and technology available to us today, there is little excuse for millions of people to continue to suffer from these preventable illnesses. We are grateful for our partners who are committed to righting this wrong.”

Guinea Worm Eradication Challenge Fund

Since its announcement in September 2019, the $20 million Carter Center Board of Trustees Challenge Fund for Guinea worm eradication has motivated new contributions to the program by matching, dollar for dollar, donations of $100,000 or more. The Challenge Fund marks a historic and unique opportunity for supporters to multiply the impact of their contributions through August 2021.

A major announcement regarding funding for the Guinea Worm Eradication Program is scheduled during a virtual event at 9 a.m. EST on Wednesday, Jan. 27.

Kicking off a Momentous Week for Neglected Tropical Diseases

Tuesday’s announcement arrives ahead of the public launch of the new WHO Neglected Tropical Diseases (NTD) Roadmap on Jan. 28; the roadmap establishes timelines and targets for the elimination or improved control of 20 diseases, including two eradication programs, Guinea worm disease and yaws, by 2030.

Carter Center experts across all its health programs have provided extensive guidance, beginning with the first roadmap in 2012 through development of the revised plan, which was endorsed by member states during the World Health Assembly in November 2020.

“The new roadmap addresses critical gaps across multiple diseases, integrates and mainstreams approaches within national health systems and coordinates action across sectors,” said Dr. Mwelecele Ntuli Malecela, director, WHO Department of Control of Neglected Tropical Diseases. “It also provides us with opportunities to evaluate, assess and adjust programmatic actions as needed over the next decade.”

On the roadmap’s heels, the second annual World Neglected Tropical Diseases Day is Saturday, Jan. 30. The United Arab Emirates is playing the lead role in supporting the observance, which is also supported by more than 230 partners representing diverse countries, sectors, and diseases. From Tokyo to London, Abu Dhabi to Atlanta, some of the world’s most iconic landmarks will be illuminated to raise awareness for this international cause. The Center is helping to light up at least eight landmarks in Atlanta and southwest Georgia. World NTD Day draws attention to a group of conditions, including Guinea worm disease, that are little known in highly developed countries but disproportionately affect a billion of the world’s most vulnerable and marginalized people.

About Guinea Worm Disease
Guinea worm disease (dracunculiasis, officially) is usually contracted when people consume water contaminated with tiny crustaceans (called copepods) that carry Guinea worm larvae. The larvae mature and mate inside the patient’s body. The male worm dies. After about a year, a meter-long female worm emerges slowly through an excruciatingly painful blister in the skin, often of the legs or feet. A sufferer may seek relief by dipping the affected limb in water. However, 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.

Without a vaccine or medicine, the ancient parasitic disease is being eradicated mainly through community-based interventions to educate people and change their behavior, such as teaching them to filter all drinking water and preventing contamination by keeping patients from re-entering water sources.

Key Implementing Partners’ Roles
The Carter Center has led the international Guinea Worm Eradication Program since 1986 and works closely with national programs, the World Health Organization, U.S. Centers for Disease Control and Prevention, UNICEF, and many other partners. The Carter Center provides technical and financial assistance to national Guinea worm eradication programs to help interrupt transmission of the disease. When transmission is interrupted, the Center provides continued assistance in surveillance and helps endemic countries prepare for official evaluation by the International Commission for the Certification of Dracunculiasis Eradication and certification by the WHO. The CDC provides technical assistance and verifies that worm specimens truly are Guinea worms.

The presence of Guinea worm disease in an area usually indicates abject poverty, including lack 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.

Partnerships
Many generous foundations, corporations, governments, and individuals have made the work to eradicate Guinea worm disease possible, including major support from the Bill & Melinda Gates Foundation; the United Kingdom's Foreign, Commonwealth & Development Office; the Children's Investment Fund Foundation; Alwaleed Philanthropies; and the Kuwait Fund for Arab Economic Development. Major support from the Crown Prince Court of Abu Dhabi, United Arab Emirates, began with His Highness Sheikh Zayed bin Sultan Al Nahyan and has continued under HH Sheikh Khalifa bin Zayed Al Nahyan and HH Crown Prince Mohamed bin Zayed Al Nahyan. The DuPont Corporation and Precision Fabrics Group donated nylon filter cloth early in the campaign; since 1999, Vestergaard's LifeStraw® has donated pipe and household cloth filters. ABATE® larvicide (temephos) has been donated by BASF since 1990. Key implementing partners include the ministries of health in endemic countries, The Carter Center, WHO, CDC, and UNICEF.