Progress Toward Global Eradication of Dracunculiasis — Worldwide, January 2021–June 2022

Abstract

Dracunculiasis (Guinea worm disease), caused by the parasite Dracunculus medinensis, is acquired by drinking water containing small crustacean copepods (water fleas) infected with D. medinensis larvae. Recent evidence suggests that the parasite also appears to be transmitted by eating fish or other aquatic animals. About 1 year after infection, the worm typically emerges through the skin on a lower limb of the host, causing pain and disability (1). No vaccine or medicine is available to prevent or treat dracunculiasis. Eradication relies on case containment* to prevent water contamination and other interventions to prevent infection, including health education, water filtration, treatment of unsafe water with temephos (an organophosphate larvicide), and provision of safe drinking water (1,2). CDC began worldwide eradication efforts in October 1980, and in 1984 was designated by the World Health Organization (WHO) as the technical monitor of the Dracunculiasis Eradication Program (1). In 1986, with an estimated 3.5 million cases occurring annually in 20 African and Asian countries (3), the World Health Assembly called for dracunculiasis elimination. The Guinea Worm Eradication Program (GWEP), led by The Carter Center and supported by partners that include WHO, UNICEF, and CDC, began assisting ministries of health in countries with endemic disease. In 2021, a total of 15 human cases were identified and three were identified during January-June 2022. As of November 2022, dracunculiasis remained endemic in five countries (Angola, Chad, Ethiopia, Mali, and South Sudan); cases reported in Cameroon were likely imported from Chad. Eradication efforts in these countries are challenged by infection in animals, the COVID-19 pandemic, civil unrest, and insecurity. Animal infections, mostly in domestic dogs, some domestic cats, and * Human cases are contained when all of the following criteria are met: 1) infected patients are identified 24 hours after worm emergence; 2) patients have not entered any water source since worm emergence; 3) a village volunteer/health care provider properly treats the lesion until all detectable worms are fully removed and educates the patient not to contaminate water sources; 4) the containment process is validated by a GWEP supervisor 7 days after worm emergence and 5) all contaminated and potentially contaminated sources of drinking water are treated with temephos. A dracunculiasis case is defined as an infection occurring in a person exhibiting a skin lesion or lesions with emergence of one or more worms that is laboratoryconfirmed as Dracunculus medinensis at CDC. Because D. medinensis has a 10-14-month incubation period, each infected person is counted as having a case only once during a calendar year. Initially 20 countries, but the former country of Sudan officially separated into two countries (Sudan and South Sudan) on July 9, 2011. https://www.who.int/activities/eradicating-dracunculiasis

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