Eradication of dracunculiasis

[2] The number of cases has since been reduced by more than 99.999% to 14 in 2023[3][4] with only six countries remaining: South Sudan, Chad, Mali, Ethiopia, Angola, and Central African Republic.

Previously, 1991, 2009, 2015, and 2020 were set as target years,[8] but full eradication of dracunculiasis has proven to be much more difficult than originally thought, after the discovery of non-human animal hosts.

[14] This project is supported by all major pharmaceutical companies, the Bill & Melinda Gates Foundation, the United States Agency for International Development, the United Kingdom Department for International Development, the Carter Center, and the World Bank, in cooperation with the governments of countries in which the disease is endemic.

[18] The results of this certification scheme been able to certify, by 2007, Benin, Burkina Faso, Chad, Ivory Coast, Kenya, Mauritania, Togo, and Uganda had stopped transmission, and Cameroon, Central African Republic, India, Pakistan, Senegal, and Yemen were WHO certified.

In the early 1980s, the disease was endemic in Pakistan, Yemen and 17 countries in Africa with a total of 3.5 million cases per year.

[38] At that time the disease was endemic in Pakistan, Yemen and 17 countries in Africa, which reported a total of 3.5 million cases per year.

Key to the effort was, according to Carter, the work of "village volunteers" who educated people about the need to filter drinking water.

In December 2008, The Carter Center announced new financial support totaling $55 million from the Bill & Melinda Gates Foundation and the United Kingdom Department for International Development.

[42] The funds will help address the higher cost of identifying and reporting the last cases of Guinea worm disease.

Since the worm has a one-year incubation period, there is a very high cost of maintaining a broad and sensitive monitoring system and providing a rapid response when necessary.

[42] One of the most significant challenges facing Guinea worm eradication during the 1990s was the Second Sudanese Civil War, which made Southern Sudan largely inaccessible to health workers due to violence.

[13][43] To address some of the humanitarian needs in Southern Sudan, Jimmy Carter negotiated a ceasefire—commonly called the "Guinea Worm ceasefire"—in 1995.

[47] Sporadic insecurity or widespread civil conflict could at any time ignite, thwarting eradication efforts.

[47] The remaining endemic communities in South Sudan are remote, poor and devoid of infrastructure, presenting significant hurdles for effective delivery of interventions against disease.

Moreover, residents in these communities are nomadic, moving seasonally with cattle in pursuit of water and pasture, making it very difficult to know where and when transmission occurred.

Late detection of two outbreaks, due to inadequate surveillance resulted in a meager 36% containment rate in Mali in 2007.

Multiple changes can be attributed to the improved containment and lower incidence of dracunculiasis: better supervision and accountability, active oversight of infected people daily by paid staff, and an intensified public awareness campaign.

[53] Burkina Faso and Togo were both certified free of dracunculiasis in 2011, as the last endemic cases were in November 2006 and December 2006, respectively.

Médecins du Monde reported rumours of a further 5 unconfirmed cases in northern Mali since March.

Due to civil insecurity in South Sudan, monitoring was suspended in parts of the country in December.

[62][63] A report from the WHO Collaborating Center for Research, Training and Eradication of Dracunculiasis, CDC noted two specific problems encountered while eliminating the last few cases in Chad—some dogs seemed to be infected with the parasite, and the large number, size and heavy vegetation of lagoons used by fishermen reducing the effectiveness of the Abate larvicide.

A major factor in this increase was probably the financial reward started in January for reporting an infected dog.

Dogs are now believed to be the major source of the parasite infecting humans in Chad, a country in which no indigenous cases of guinea worm were reported in the decade leading up to 2010.

The level of containment of infected dogs before they become a risk of spreading the parasite has improved to 81% compared to 67% last year.

[76] The World Health Organization revised its target date for eradication from 2020 to 2030, citing civil conflicts and new information about transmission between humans and dogs.

[3][4][83] In 2023 the WHO's Control of Neglected Tropical Diseases Team set the following criteria for WHO certification of eradication:[84] [E]limination will be considered to have been achieved when surveillance systems have not discovered any evidence of transmission in humans or animals despite rigorous annual searches, carried out during the expected transmission season, for 3 consecutive years.

For surveillance to be deemed adequate, this should include the submission of evidence of reporting active searches for human cases and animal infections, if necessary, even in the most remote and difficult-to-access areas of the country.

The objective of surveillance for dracunculiasis during the 3-year precertification period is to rapidly detect and contain any human cases or animal infections that might occur, to prevent further transmission.

Confirmation of the absence of transmission in a country is judged based on: (i) an assessment of the capability of the surveillance system to detect human cases and animal infections should they occur; and

(ii) the records compiled by the national authorities, the quality of which can be determined during a field appraisal by an ICT.