Guinea Worm Eradication at Its Lowest Level Since the Program Began

First published January 25, 2024 by The Carter Center.

A South Sudanese woman collects water for daily household use. The water will be filtered to prevent Guinea worm disease. (Photo: C. Marin/The Carter Center)

Eradication of Guinea worm disease remains in sight with only 13 provisional human cases reported worldwide in 2023, The Carter Center announced Thursday. The number matches the lowest annual total of human cases ever reported, following 13 cases in 2022 and 15 in 2021.

When The Carter Center assumed leadership of the global Guinea Worm Eradication Program in 1986, an estimated 3.5 million human cases occurred annually in 21 countries in Africa and Asia.

“Eradicating Guinea worm disease and the suffering it causes has long been a dream of my grandparents, and they have worked incredibly hard to make it a reality,” said Jason Carter, Carter Center board chair and eldest grandson of former U.S. President Jimmy Carter and the late First Lady Rosalynn Carter. “They witnessed firsthand how this work improves the lives of millions of people, and The Carter Center will keep working with our partners until there are zero cases.”

While at the containment center in Savelugu, Ghana, Sadia Mesuna and her friend Fatawu Yakubu look at a picture book about Guinea worm disease. (The Carter Center/L. Gubb)

Reported infections in animals rose modestly, from 685 in 2022 to 713 in 2023. Adam Weiss, the Center’s Guinea Worm Eradication Program director, attributed the increase to expanded surveillance and reporting in Angola and Cameroon.

“A single worm can cause 80 or more new cases the following year, and last year major outbreaks were prevented,” said Weiss. “These numbers underscore the grit and determination of the impacted countries to reach the finish line. The Carter Center remains focused because zero is the goal and every case is a person who deserves to live a life free of this horrific disease.”

All figures for humans and animals are provisional until officially confirmed, typically in March. Guinea worm is poised to become the second human disease in history to be eradicated, following smallpox, as well as the first parasitic disease and the first without a medicine or vaccine. Community-based and innovative behavioral change and local mobilization are the key drivers of success.

“The national programs continue to step up to tackle this debilitating disease,” said Dr. Kashef Ijaz, the Carter Center’s vice president of health. “They are implementing health education efforts, tracking down thousands of rumors to confirm or rule out Guinea worm cases, and caring for those affected, often in the most challenging environments. It’s truly heroic work.”

Case and Infection Numbers by Country  

Nine of the 13 provisional human cases reported in 2023 occurred in Chad, two in South Sudan and one each in Cameroon and Mali. Ethiopia reported zero human cases. A 2023 specimen from the Central African Republic is under investigation and requires testing, which is protocol for all specimens from a human. If testing confirms Guinea worm, the case investigation will continue to explore its origins.

A local volunteer in South Sudan uses a flip chart to educate villagers on Guinea worm disease prevention. (The Carter Center/J. Albertson)

The worms that infect animals are the same species (Dracunculus medinensis) as those that infect humans; therefore, eradication requires stopping infections in both. While Guinea worm infections in animals rose 4% globally in 2023, Chad reduced canine Guinea worm infections by 22%, its fourth consecutive year of progress. In 2023, Chad reported infections in 494 animals, Mali reported 47, Cameroon 97, Angola 73, Ethiopia one, and South Sudan one.

As in past years, people in endemic countries received cash rewards for reporting possible Guinea worms in 2023. Health workers meticulously investigated all such rumors, which are key to finding actual cases and infections.

Additional case and infection details can be found in the Guinea Worm Wrap-Up, a joint U.S. Centers for Disease Control and Prevention, World Health Organization, and Carter Center-drafted update, which is circulated nearly a dozen times a year. CDC is the WHO Collaborating Center for Dracunculiasis Eradication.

About Guinea Worm Disease  

Guinea worm disease is typically contracted when people consume water contaminated with tiny crustaceans (called copepods or water fleas) that eat Guinea worm larvae. The larvae develop into adult worms and mate within the human host. The male worm dies. After about a year, a meter-long pregnant female worm emerges slowly through a painful blister in the skin, often of the legs or feet (but it could be anywhere). A sufferer may seek relief by dipping the affected body part in water. However, contact with water stimulates the emerging worm to release its larvae and start the life cycle anew. Guinea worm disease incapacitates people for weeks or months — sometimes permanently — reducing individuals’ ability to care for themselves, work, grow food for their families, or attend school.

Interventions Implemented 

Without a vaccine or medicine, the ancient parasitic disease is being eradicated mainly through community-based interventions to educate people and change their behavior. 

Displacement by war and nomadic lifestyles in South Sudan make pipe filters — distributed to men, women, and children — an important tool against contracting Guinea worm disease. (The Carter Center/J. Albertson)

Tethering dogs to keep them out of water and not allowing them to eat potentially contaminated fish entrails are key factors in preventing Guinea worm infection in animals, particularly in Chad and Ethiopia. People who catch, sell, and consume freshwater fish and other aquatic animals are encouraged to burn or bury discarded entrails to keep dogs from eating the entrails that might contain Guinea worm-contaminated copepods.

Other interventions to stop transmission include community-based health education, the use of filters (donated by Vestergaard’s LifeStraw®) for all drinking water, barring people and animals with emerging Guinea worms from entering water sources, and targeted use of the larvicide ABATE® (temephos, donated by BASF) in stagnant, shallow water sources. To further boost surveillance, all endemic countries offer cash rewards for reporting potential cases and animal infections.

Community Involvement

Community members do the day-to-day work of maintaining community awareness and education about Guinea worm, along with monitoring for infections, filtering drinking water, and protecting water sources from contamination.

Education is an important part of surveillance and case reduction. Here, flip charts are used to show schoolchildren how Guinea worm disease is contracted, and what they must do to prevent it. (The Carter Center/E. Staub)

“Vigilant individuals are one of the main reasons this campaign has been so successful,” said Dr. Donald Hopkins, the Carter Center’s senior advisor for Guinea worm eradication and architect of the eradication campaign. “Without any vaccine or medicine, Guinea worm disease is disappearing because everyday people are careful to filter their water, tether their animals, properly dispose of fish entrails, and keep their water sources safe because they care about their communities, families, and the people they love.” 

“In the fight against Guinea worm disease, the true heroes are the local communities,” said Dr. Ibrahima Socé Fall, director, WHO Global NTD Program. “Their unwavering commitment and vigilant actions, such as water filtration and environmental care, are pivotal to eradication efforts. These community-led initiatives, embodying both prevention and vigilance, are not just steps but giant leaps towards eliminating the disease and bolstering global health. This community-centric model serves as a blueprint for tackling other neglected tropical diseases, highlighting that community involvement is crucial and indispensable for achieving lasting health triumphs. With thanks to all who are involved at all levels.”

The High Bar of Eradication

Eradication means a disease has been eliminated worldwide, with no natural possibility of return. The final cases are the most challenging, requiring persistence, ingenuity, and enormous amounts of resources to operate in difficult, remote, and often insecure areas. 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 is never known to have taken place. To date, the WHO has certified 200 countries free of Guinea worm; only six have not been certified: Angola, Chad, Ethiopia, Mali, South Sudan, and Sudan.

Guinea Worm Eradication Summit’s Impact, World NTD Day

The eradication effort continues to benefit from the momentum generated by the 2022 Guinea Worm Eradication Summit in Abu Dhabi, United Arab Emirates.

Hosted by The Carter Center and Reaching the Last Mile, an initiative representing the philanthropic commitments of His Highness Sheikh Mohamed bin Zayed Al Nayhan, president of the UAE, and in collaboration with the WHO, representatives of impacted countries and organizations renewed their commitment to eradicating the debilitating disease by 2030. They signed the Abu Dhabi Declaration on the Eradication of Guinea Worm Disease, pledging to commit resources, energy, and policy initiatives to eradicate Guinea worm disease

“Health ministers and other officials have rolled up their sleeves and done vital work since the Guinea worm summit, and we’ve seen tangible impact,” said Paige Alexander, Carter Center CEO. “The way the countries continue to invest in their programs and own their progress since the summit is impressive.”

Today’s Carter Center announcement comes in advance of the fifth annual World NTD Day, Jan. 30. NTDs are a group of 21 preventable and treatable diseases that affect more than 1.7 billion people around the world. NTDs cause disability and disfigurement, and some can be fatal. They create and continue cycles of poverty and cost developing nations billions of dollars in direct costs and lost productivity.

World NTD Day is described as a catalyst to turn awareness into action, secure increased resources for NTDs, and facilitate political leadership and ownership of NTD programs in affected countries. Hundreds of partners mark World NTD Day, promoting action to #BeatNTDs.

Key Implementing Partners’ Roles

The Carter Center leads the global campaign and works closely with national ministries of health, the WHO, the U.S. Centers for Disease Control and Prevention, UNICEF, and many other vital partners. The Carter Center provides technical and financial assistance to national Guinea worm programs to help interrupt transmission of the disease. For remaining endemic countries, when transmission is interrupted, the Center continues assisting surveillance and helps them prepare for evaluation by the independent International Commission for the Certification of Dracunculiasis Eradication, which recommends official certification by the WHO. The WHO also provides technical and financial support to improve surveillance, particularly in cross-border areas, including countries that have already been certified to help them maintain Guinea worm-free status. The CDC provides technical assistance and verifies that worm specimens truly are Guinea worms.

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; John and Kathleen Schreiber; and Alwaleed Philanthropies. Major support from the United Arab Emirates began with His Highness Sheikh Zayed bin Sultan Al Nahyan, founder of the UAE, continued under His Highness the late Sheikh Khalifa bin Zayed Al Nahyan, and has grown under His Highness Sheikh Mohamed bin Zayed Al Nahyan, president of the UAE, through his Reaching the Last Mile (RLM) initiative. BASF has donated ABATE® larvicide (temephos) since 1990, and Vestergaard’s LifeStraw® has donated personal pipe filters and household cloth filters since 1999. The DuPont Corporation and Precision Fabrics Group donated nylon filter cloth early in the campaign. The government of Japan has supported the Guinea Worm Eradication Program since 1992 and in 2022 awarded it the Hideyo Noguchi Africa Prize in appreciation of the campaign.


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