In 1986, an estimated 3 million persons were infected with dracunculiasis
(Guinea worm disease) and another 120 million were at risk for infection
(1). That year and in 1991, the World Health Assembly called for the eradication of dracunculiasis
(2,3), and as a result of the implementation of the Dracunculiasis Eradication Program (DEP)*,
the annual incidence was reduced by approximately 95% by 1995
(4). This report updates the status of the eradication program as of June 2000, which indicates that
dracunculiasis has been eliminated from seven of 20 countries where it was endemic in 1995;
however, in parts of Africa, particularly Sudan, dracunculiasis remains a serious public
For surveillance purposes, village-based health workers search for infected
persons in each village with endemic disease and complete a register that provides the basis
for monthly zonal, district, and national surveillance reports
(5). During 1999, dracunculiasis was endemic in 13 countries in
Africa. These countries reported 96,293 cases in
10,914 villages. Of the total number of cases, Sudan reported 66,097 (69%) cases in 7271
villages; 2606 of the known villages with endemic disease in Sudan were not accessible
to program surveillance. Outside Sudan, 93% of 3068 villages reported monthly; in
Sudan, 44% of 4892 accessible villages reported monthly. Outside Sudan, 20% of all
villages with endemic disease reported 1 case each. Seven of the 13 countries with
endemic disease reported <500 cases each in 1999 (Figure 1).
During January--June 2000, the number of cases reported by all countries
except Sudan was 12,097, 18% less than the 14,828 cases reported during the same period
in 1999. The rate of reduction in all countries outside of Sudan was 35% except in
Ghana, which reported a slight increase in cases during the first half of 2000. Niger reported
59% fewer cases during January--June 2000. Benin, Cote d'Ivoire, Ethiopia, Mali,
Mauritania, and Uganda have reduced the number of cases by an average of 55% during
January--June 2000. Nigeria reported 35% fewer cases during January--June 2000 than during
the same period in 1999.
All programs attempt to control the spread of disease using case containment
(i.e., patients were not allowed to contaminate water and transmit infection) aimed at
detecting cases within 24 hours of emergence of the worm and instituting prevention
measures immediately. Approximately 62% of the case-patients reported outside of Sudan
during 1999 were contained; 68% were contained during January--June 2000. The
long-standing civil war in Sudan is the primary reason for the high rate of dracunculiasis in the
southern part of that country; however, the 10 northern states of Sudan have reported
66% fewer cases during the first 6 months of 2000 compared with the same period last
year (21 versus 61 cases); 16 (76%) of the 21 cases were contained.
Reported by: Global 2000, The Carter Center, Atlanta, Georgia. World Health
Organization Collaborating Center for Research, Training, and Eradication of Dracunculiasis. Div of
Parasitic Diseases, National Center for Infectious Diseases, CDC.
Dracunculiasis is a parasitic infection acquired by drinking water
from ponds contaminated by copepods (water fleas) that contain immature forms of
the parasite. A year after entering the infected person, the 40-inch (1 meter) worm(s)
emerge, usually on the lower limbs through skin wounds that frequently become
contaminated secondarily. Reinfection can occur if the person again drinks contaminated water.
No effective treatment exists; however, two countries in which dracunculiasis was
endemic at the beginning of the program (Pakistan and India) have been certified by the
World Health Organization (WHO) to have interrupted transmission. WHO also has
certified the absence of transmission from almost all countries outside Africa (Figure 2)
(6). All countries with endemic disease are required to submit a report to the
International Commission for the Certification of Dracunculiasis Eradication, documenting the
absence of indigenous cases of the disease for at least 3 consecutive years to be
recommended for certification.
Most eradication programs have begun listing villages with endemic disease in
descending order of number of cases reported to help monitor the status of
interventions. Nylon filters have been distributed to all households in 47% of villages with
known endemic disease, including 67% outside Sudan. The larvicide
Abate®§ (temephos) (American Home Products, Princeton, New Jersey) is being used in approximately 35%
of villages with endemic disease outside Sudan, and 43% of villages with endemic
disease outside Sudan have access to at least one source of safe drinking water (Table 1).
Health education and community mobilization activities (e.g., radio announcements;
posters; town criers; and talks by religious, political, and traditional leaders) aimed at persons
in villages endemic with disease or at high risk for disease have been intensified.
The current goal of DEP is to eliminate transmission in all remaining countries
with endemic disease outside Sudan by 2001. An estimated 3 to 4 years of intense
activities will be required to halt dracunculiasis transmission after a peace agreement is signed
in Sudan. To attain these targets, ministries of health in the remaining countries with
endemic disease must make dracunculiasis eradication a top national, regional, and
local public health priority. The infection can be prevented by teaching at-risk persons to
filter their drinking water through a finely woven cloth, to avoid entering sources of
water when worms are emerging, by treating water sources with Abate to kill copepods, or
by providing clean drinking water from sources such as borehole wells. Each national
program needs to intensify supervision and motivation of village-based health workers,
tend and diversify efforts to educate and mobilize villagers in communities with
endemic disease, advocate for provision of safe water sources to villages with endemic
disease, monitor the status of all interventions, and ensure that active surveillance is
maintained in all communities with endemic disease and in areas at risk for dracunculiasis.
- Watts SJ. Dracunculiasis in Africa: its geographical extent, incidence, and at-risk
population. Am J Trop Med Hyg 1987;37:121--7.
- World Health Assembly. Elimination of dracunculiasis: resolution of the 39th World
Health Assembly. Geneva, Switzerland: World Health Organization, 1986 (resolution no.
- World Health Assembly. Eradication of dracunculiasis: resolution of the 44th World
Health Assembly. Geneva, Switzerland: World Health Organization, 1991 (resolution no.
- CDC. Progress toward global eradication of dracunculiasis. MMWR 1995;44:875,881--2.
- Hopkins DR, Ruiz-Tiben E. Strategies for eradication of dracunculiasis. Bull World
Health Organ 1991;69:533--40.
- World Health Organization. International Commission for the Certification of
Dracunculiasis Eradication, fourth meeting: report and recommendations. Geneva, Switzerland,
February 15--17, 2000. (WHO/CDS/CPE/CEE/2000.6).
* Program partners include The Carter Center, CDC, United Nations Children's Fund
(UNICEF), the World Health Organization (WHO), ministries of health in countries where
dracunculiasis is endemic, private industry, and many other donors, including the Bill and Melinda
Benin, Burkina Faso, Central African Republic, Cote d'Ivoire, Ethiopia, Ghana, Niger,
Nigeria, Mali, Mauritania, Sudan, Togo, and Uganda.
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