ATLANTA — A provisional total of 53 cases of Guinea worm disease were reported in 2019, The Carter Center announced Wednesday. Intensified surveillance and reporting incentives in endemic areas in recent years have produced expected fluctuations in the small number of Guinea worm cases. When The Carter Center assumed leadership of the program in 1986, about 3.5 million human cases occurred annually in 21 countries in Africa and Asia.
The campaign against the disease, also called dracunculiasis, has taken on additional complexity in recent years with the rise of infections in animals, primarily dogs in Chad. The world’s foremost experts and partner governments are responding vigorously.
“The time to eradicate Guinea worm is now,” said Adam Weiss, director of the Carter Center Guinea Worm Eradication Program. “To prevent unnecessary suffering, the remaining endemic countries are going all out with every intervention available.”
For example, in Chad, the national program intensified surveillance and broadly promoted cash incentives for reporting suspected infections. As a result, in 2019, rumors of human cases rose 137% and rumors of animal infections rose 268% compared to 2018. The program investigated 95% of those rumors within 24 hours. Additionally, the larvicide Abate was applied to water sources in 408 villages in 2019, compared to 72 villages the previous year.
Case and Infection Numbers by Country
During 2019, 47 human cases of the disease were reported in Chad, four in South Sudan, one in Angola, and one in Cameroon that is believed to have been imported from Chad. No human cases have been reported for two years in Ethiopia or four years in Mali, but the two countries are still considered endemic. As for Guinea worm infections in animals (mainly dogs but also a handful of cats and baboons), 1,973 were detected in Chad, nine in Mali, eight in Ethiopia, and one in Angola; none in South Sudan or Cameroon. (All 2019 figures are provisional until officially confirmed in March 2020. Further details can be found in the latest issue of Guinea Worm Wrap-Up.)
Interventions to stop transmission include community-based health education, filtering all drinking water, keeping people and animals with emerging Guinea worms from entering water sources, and targeted use of Abate in stagnant water sources.
Only one human disease has ever been eradicated; that was smallpox, 40 years ago. For a disease to be declared eradicated, every country in the world must be certified free of human and animal infection, even those where transmission has never taken place. To date, 199 countries have been certified free of Guinea worm; only seven have not.
Neglected Tropical Diseases
Wednesday’s announcement comes on the eve of the inaugural World Neglected Tropical Disease (NTD) Day, created to draw attention to a group of little-known conditions, including Guinea worm, that disproportionately affect the world’s poorest and most marginalized people.
In late 2019, the World Health Organization and the NTD community agreed to adjust and accelerate elimination targets for NTDs to align with the United Nations’ 2030 Sustainable Development Goals. The Carter Center, the WHO, and the independent International Commission for the Certification of Dracunculiasis Eradication all agreed that GW’s goal could fit into the adjusted plan. As a result, the target date for eradication of Guinea worm disease – including for the first time the certification process, which takes at least three years – now is by 2030. The WHO is the only body that can certify disease eradication.
“The Carter Center’s goal is to end the human suffering caused by the disease as soon as possible, and the revised target of 2030 would include that goal,” 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.
“The fight against Neglected Tropical Diseases is long and difficult, but so is every battle worth fighting,” added Dr. Mwelecele Ntuli Malecela, director of the WHO Department of Neglected Tropical Diseases. “Victory cannot be achieved merely by dreaming. The way to victory is marked by honest goals, good science, and focused work. We are bringing all of these to bear against Guinea worm disease.”
Carter Center Challenge Fund
The Carter Center Board of Trustees announced in September 2019 a $40 million fundraising campaign, including a $20 million Carter Center Challenge Fund, toward the eradication of Guinea worm disease. The Challenge Fund will match donations up to $10 million per year in 2019 and 2020, for a total of $20 million in matching funds.
“Our successes are a testament to the fierce persistence of people on the front lines and our committed partners,” Jason Carter, chair of the Carter Center Board of Trustees, said. “We are grateful for every ally standing with us as we seek to eradicate the first parasitic disease in human history, and we are so committed that we are investing our own endowment funds into the effort.”
About Guinea Worm Disease
Considered a neglected tropical disease, Guinea worm disease (dracunculiasis) is usually contracted when people consume water contaminated with tiny crustaceans (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 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.
Without a vaccine or medicine, the ancient parasitic disease is being wiped out 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 entering water sources.
The Carter Center has led the international Guinea Worm Eradication Program since 1986 and works closely 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 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 (ICCDE) 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.
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 Department for International Development (DFID); Children's Investment Fund Foundation (CIFF) - United Kingdom; Alwaleed Philanthropies; the Kuwait Fund for Arab Economic Development; and the Federal Republic of Germany. Major support from the United Arab Emirates began with Sheikh Zayed bin Sultan Al Nahyan 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.