A village resident in South Sudan’s Eastern Equatoria State uses a pipe filter to drink water safely. The device filters out tiny crustaceans that harbor Guinea worm larvae. (All photos: The Carter Center)
Editor’s note: About one month after this press release was published, a parasite that emerged from a patient in Chad in November 2021 was determined to be a Guinea worm, thus revising the annual total of cases to eight in Chad and 15 overall. It remains the lowest total ever recorded.
-14 cases in 2021 mark 48% drop from previous year
-Animal infections also decline sharply
-‘Eradication is an approaching reality,’ Carter Center CEO says
ATLANTA — Just 14* human cases of Guinea worm disease occurred worldwide in 2021, drawing nearer to the goal of global eradication, The Carter Center announced Wednesday. It is the lowest annual case total ever recorded, and the cases occurred in just four countries. When The Carter Center assumed 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 14 cases mark a 48% decline from the 27 cases reported in 2020. Guinea worm infections in animals fell 45% in 2021, the Center reported.
Former U.S. President Jimmy Carter, who co-founded The Carter Center in 1982 with his wife, former First Lady Rosalynn Carter, was pleased with the news.
“Rosalynn and I are encouraged by the continued commitment and persistence of our partners and the citizens in the villages to eradicate Guinea worm,” he said. “Because of their persistence, this dreadful disease will be eradicated. Today we are closer than ever, and I am excited at the prospect of seeing the job finished.”
Carter Center CEO Paige Alexander said: “Eradication is an approaching reality. The national ministries of health, with our support, have implemented interventions that are working, and the result is a measurable reduction in human suffering and animal infections. That’s what this work is all about. We need to keep pressing to the finish line.”
The announcement came during a World Health Organization-hosted webinar to celebrate the first anniversary of the launch of the . The webinar comes in advance of the third annual World Neglected Tropical Diseases Day, conceived by the United Arab Emirates, this Sunday, Jan. 30.
A Guinea worm is slowly and carefully extracted from the foot of a person at a case containment center where patients receive care in Wau, South Sudan.
Case and Infection Numbers by Country
During 2021, seven* human cases of Guinea worm disease were reported in Chad, a dramatic 42% reduction from 12 the previous year. Four* cases were reported in South Sudan, two* in Mali, and one* in Ethiopia. Angola and Cameroon, which each had one human case in 2020, had none in 2021.
“Chad’s Ministry of Health made significant strides against both human and animal cases in 2021,” said Adam Weiss, director of the Carter Center Guinea Worm Eradication Program. “Everyone in Chad, from the national leadership to the village volunteer, has shown a strong commitment to carrying out the interventions and protecting everyone against this disease.”
As for Guinea worm infections in animals, Chad reported infections in 790 domestic dogs and 65 domestic cats, Cameroon reported 10 infected dogs along its border with an area endemic in Chad, and Mali reported 16 infected dogs and one cat. Ethiopia reported two infected dogs and one cat. Significantly, Ethiopia found no infections in baboons in 2021, compared to four infected baboons in 2020. The worms that infect animals are the same species (D. medinensis) as those that infect humans; therefore, eradication requires stopping infections in both. Case and infection details can be found in the latest issue of the joint CDC-WHO-Carter Center publication Guinea Worm Wrap-Up. (*All annual figures are considered provisional until officially confirmed, typically in March.)
Reductions Come Despite Coronavirus and Insecurity
The sharp reductions are especially notable in light of the ongoing COVID-19 pandemic and significant security challenges — military coups, civil conflict, insurgencies — in some endemic countries. While international health workers and researchers are vital to the success of the program, the day-to-day leadership and work of maintaining community awareness and education about Guinea worm, along with monitoring for infections, filtering drinking water, and protecting water sources from contamination, are largely the domain of community and family members. So, while travel restrictions have had an impact, the campaign has not been interrupted.
“Much of the great progress we are seeing is directly attributable to these committed communities that embrace the idea of looking after their own health and then act on that idea,” said Dr. Donald R. Hopkins, Carter Center special advisor for Guinea worm eradication. “Combine that commitment with frontline health workers’ daily acts of courage and devotion, and these are the results.”
People in endemic countries helpfully reported thousands of possible Guinea worms. Health workers promptly investigated all such rumors, which are key to finding actual cases and infections.
“Rumor reporting remains strong and at par with previous years,” said Dr. Kashef Ijaz, the Carter Center’s vice president for health programs. “This is really important because it demonstrates the strength of surveillance and that the decline in numbers is not an aberration.”
Left photo: A health worker extracts a Guinea worm from the knee of a South Sudanese woman. Right photo: In Chad, Dollar Taissou (bottom right) pulls a Guinea worm from the leg of 2-year-old dog Martoussia. Controlling infections in animals is necessary to eradicate the disease.
Center Focuses on Neglected Tropical Diseases
The WHO has raised to the level of an official observance under the leadership of Director General Dr. Tedros Adhanom Ghebreyesus.
“Despite the pandemic, this historically low number of cases illustrates what can be achieved with the unwavering commitment of countries and the thousands of volunteers, as well as partners who work tirelessly often in difficult terrain,” said Dr. Ren Minghui, WHO assistant director-general for universal health coverage/communicable and non-communicable diseases. “We need to maintain this momentum to rid the world of this disease of poverty that disproportionately affects women and children.”
For over 35 years, The Carter Center has been a pioneer in 0; eradicating, eliminating, and improving control of five NTDs: Guinea worm, lymphatic filariasis, river blindness, trachoma, and schistosomiasis, as well as uniquely addressing and integrating mental health and malaria.
About Guinea Worm Disease
Guinea worm disease is usually contracted when people consume water contaminated with tiny crustaceans (called copepods) that eat Guinea worm (Dracunculus medinensis) larvae. After about a year, a meter-long pregnant 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 and start the cycle 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.
Guinea Worm Interventions and Robust Research Agenda
Without a vaccine or medicine, the ancient parasitic disease is being eradicated mainly through community-based interventions to educate people and change their behavior.
Tethering dogs to keep them out of water and not allowing them to eat potentially contaminated fish entrails are key factors in improving Guinea worm infection figures in animals, particularly in Chad and Ethiopia. Fishermen, market women, and consumers burn or bury discarded entrails to keep dogs from consuming Guinea worm-contaminated copepods (water fleas) the entrails might contain.
Other 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 larvicide ABATE® (donated by BASF) in stagnant water sources. (See “About Guinea Worm”section below.) To boost surveillance at this critical point in the global campaign, all national programs offer cash rewards for reporting potential cases and animal infections.
Scientists from The Carter Center and other agencies continue to conduct intensive research and testing of new interventions in the quest to eradicate the disease. Genetic profiling of worms to help trace infections, and serological tests developed by the U.S. Centers for Disease Control and Prevention are two other important new tools being used.
Carter Center ambassador Regina Natube leads a lively song and dance to spread the word about cash rewards for reporting possible Guinea worm cases in South Sudan.
Eradication a Monumental Challenge
Eradication means a disease has been eliminated worldwide, with no possibility of return. The final cases are extremely difficult to track down, requiring persistence, ingenuity, and enormous amounts of money. 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, WHO has certified 199 countries free of Guinea worm; only seven have not been certified, including the Democratic Republic of the Congo, where no case has been reported since 1958. Sudan and DRC intend to submit its dossier for certification in 2022. After three consecutive years of indigenous transmission, Angola was added, as the 22nd country, to the list of endemic countries in 2020; however, the country reported zero human and zero animal infections in 2021. Cameroon was certified by the World Health Organization as Guinea worm-free in 2007; that country reported one case in 2019 and one in 2020 (both likely imported from Chad) but is not endemic because it has not had three years of indigenous transmission.
Key Implementing Partners’ Roles
The Carter Center works closely with national programs, the World Health Organization, 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 official evaluation by the International Commission for the Certification of Dracunculiasis Eradication and certification by the WHO. 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.
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 which provides significant other benefits 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; and Alwaleed Philanthropies. 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. BASF has donated ABATE® larvicide (temephos) since 1990, and Vestergaard's LifeStraw® has donated pipe and household cloth filters since 1999. The DuPont Corporation and Precision Fabrics Group donated nylon filter cloth early in the campaign.
Guinea Worm Eradication Challenge Fund Matches Generous Gift
John and Kathleen Schreiber, who partner with The Carter Center personally and through their family foundation, recently donated $2 million toward Guinea worm eradication. That donation was matched by the Carter Center Board of Trustees Challenge Fund, which matches donations of $100,000 or more. The Challenge Fund seeks to raise and match $20 million in donations, for a total of $40 million, by August 2022.
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Contact: Emily Staub, Emily.Staub@CarterCenter.org, (404) 420-5126
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A not-for-profit, nongovernmental organization, The Carter Center has helped to improve life for people in over 80 countries by resolving conflicts; advancing democracy, human rights, and economic opportunity; preventing diseases; and improving mental health care. The Carter Center was founded in 1982 by former U.S. President Jimmy Carter and former First Lady Rosalynn Carter, in partnership with Emory University, to advance peace and health worldwide.
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Eradication: Reduction of the worldwide incidence of a disease to zero so no further control measures are needed.
Elimination: Transmission of a disease is halted in a single country, continent, or other limited geographic area, rather than global eradication.
Control: Reduced incidence or prevalence of a disease or condition; control measures are still required.
