1
Public Health Service
Centers for Disease Control
and Prevention (CDC)
Memorandum
DEPARTMENT OF HEALTH & HUMAN SERVICES
Date: August 14, 2009
From: WHO Collaborating Center for
Research, Training and Eradication of Dracunculiasis
Subject: GUINEA WORM WRAP-UP #191
To: Addressees
“For what is the present, after all, but a growth out of the past?” Walt Whitman
Months since last indigenous case of dracunculiasis:
Niger: 9 months, Nigeria: 8 months
Number of uncontained cases so far in 2009:
Sudan: 437, Ghana: 14, Mali: 10, Niger: 1, Ethiopia: 1, Nigeria: 0
Figure 1
Distribution by Country of 1,947 Indigenous Cases of Dracunculiasis
Reported and (Cases Contained) During 2009*
Number of cases
0
200
400
NB:

1,000
1,200
1,400
1,600
1,800
2,000
237 (94%)
Ghana (7)
Mali (7)
34 (71%)
Ethiopia (7)
23 (96%)
Nigeria (7)
800
1,654 (74%)
Sudan (7)
Niger (7)
600
0
0
* Provisional:76% of 1,948 cases reported were contained. Excludes one
case imported into Niger from Ghana. Numbers in parenthess indicate
months for which reports have been received, i.e. (7) = January - July.

About 75% of Ghana’s cases in 2009 are associated with an outbreak in one village in
the Northern Region.
All of Ethiopia’s cases in 2009 were detected in Gambella Region.

Nigeria’s latest reported indigenous case, in November 2008, was contained.

Niger’s last reported indigenous case, in October 2008, was not contained.
The number of reported cases by month in Sudan, Ghana, Mali, and Ethiopia during 2008 and
during January through July 2009 is shown in figure 2.
Figure 2
SUDAN GUINEA WORM ERADICATION PROGRAM
NUMBER OF REPORTED CASES OF DRACUNCULAISIS: 2008 - 2009*
GHANA GUINEA WORM ERADICATION PROGRAM
NUMBER OF REPORTED CASES OF DRACUNCULAISIS: 2008 - 2009*
140
1, 000
2008 = 3,618 Cases
Jan-July 2009 = 1,654 Cases;
% Change= -35%
74% Containment
800
2008 = 501 Cases
Jan-July 2009 = 227 Cases;
% Change= -47%
94% Containment
120
783
759
100
87% Reporting
NUMBER OF CASES
Number of cases reported
618
600
536
466
456
432
400
86% Reporting
258
254
223
200
0
47
Jan
Feb
Mar
73
60
50
48
52
45
30
34
28
20
20
21
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
13
5
8
14
15
Nov
Dec
8
0
Dec
J an
MALI GUINEA WORM ERADICATION PROGRAM
NUMBER OF REPORTED CASES OF DRACUNCULAISIS: 2008 - 2009*
Feb
M ar
Apr
M ay
J un
J ul
Aug
Sept
Oc t
ETHIOPIA DRACUNCULAISIS ERADICATION PROGRAM
NUMBER OF REPORTED CASES OF DRACUNCULAISIS: 2008 - 2009*
140
140
2008 = 417 Cases
Jan-July 2009 = 8 Cases;
% Change= -83%
100% Containment
120
2008 = 38 Cases
Jan-July 2009 = 23 Cases;
% Change= -39%
96% Containment
120
120
100
100
80
Number of cases
Number of cases
74
68
40
75
34
18
80
73
160
88
32
12
80
72
60
60
60
56
40
80
60
40
27
20
0
01
0
0
01
1
22
26
16
20
10
4
7
0
Jan
Feb
Mar
Apr
May
J un
Jul
Aug Sept
Oc t
Nov
Dec
01
0
1
J an
Feb
Mar
7
Apr
5
2
8
3
May
J un
2
0
1
0
1
Jul
Aug
Sept
Oc t
Nov
* Provisional
Dec
GHANA CONTAINS 94% OF CASES IN JANUARY-JUNE 2009
Ghana’s Guinea Worm Eradication Program has reported 229 cases of dracunculiasis in JanuaryJune 2009, of which 216 (94%) met the standards for case containment, including 177 (77%)
cases that were contained in a case containment center or other medical facility. Transmission of
disease from the 13 uncontained cases is believed to have been prevented, except for one case in
Galumpe Village, Kintampo North District of Brong Ahafo Region, either because the case did
not contaminate a water source, or because of application of ABATE® Larvicide within 14 days
of contamination of water. The 229 cases were reported from 51 villages, only 17 of which
reported indigenous cases. Almost all cases (223, or 97%) were reported from the Northern
Region. Currently, 157 of Ghana’s 170 districts are free of Guinea worm disease. This is a
reduction of -45% from the 416 cases reported during January-June 2008. These data were
reported by national program coordinator Dr. Andrew Seidu-Korkor and discussed at the midyear Guinea Worm Review Meeting, which was held in Tamale, Ghana on July 28-29. External
participants included Dr. Ernesto Ruiz-Tiben and Mr. Craig Withers of The Carter Center and
Dr. Gautam Biswas of WHO headquarters. During July Ghana reported 7 additional cases (6
contained) for a total of 236 cases so far during 2009 (Figures 1 and 2; and Table1).
CASES DECLINE, SPORADIC INSECURITY IN SOUTHERN SUDAN
In January-July 2009, the number of dracunculiasis cases reported by Southern Sudan’s Guinea
Worm Eradication Program (SSGWEP) decreased by 36%, to 1,654 from the 2,572 cases
reported during the same period of 2008 (Figures 1, 2 and 3; and Table 1), while the rate of
reporting was 86% and the proportion of cases that were contained increased to 74% (from
47%). During the same seven months of 2009, increasing insecurity and banditry in various
endemic areas of Southern Sudan disrupted program operations for days or weeks in 23 separate
incidents, because staff of the program had to be temporarily confined to their quarters or
evacuated. The numbers of cases reported by month in 2008 and so far in 2009 in each of the
four epidemiologic focal areas are shown in Figure 5. The status of interventions in January-May
2009 and January-May 2008 are illustrated in Figure 6.
IN BRIEF:
Nigeria. General (Dr) Yakubu Gowon, former Nigerian Head of State, led an advocacy visit to
Katsina, Kebbi, Sokoto and Zamfara states between June 29 and July 2, 2009. General Gowon
thanked the state governments for their support of Guinea worm eradication, urged them to
maintain publicity about Guinea worm disease and the cash reward announcements, and
requested them to ensure that the state ministries of health maintain adequate and properly
documented surveillance for the disease in all health facilities. NIGEP National Coordinator Dr.
Ofeoma Anagbogu, Carter Center County Representative Dr. Emmanuel Miri, representatives
from WHO, UNICEF, and state ministries of health accompanied General Gowon. Nigeria
doubled its cash reward for reporting a case of GWD, to 10,000 naira (~$76) in April 2009.
Niger. At the request of the ministry of Health of Niger, Dr. Gautam Biswas of WHO
headquarters and Dr. Alhousseimi Maiga of WHO’s Regional office for Africa visited Niger on
July 20-26 to support surveillance of GWD in Guinea worm-free areas of the country.
Table 1
Number of Cases Contained and Number Reported by Month during 2009*
(Countries arranged in descending order of cases in 2008)
NUMBER OF CASES CONTAINED / NUMBER OF CASES REPORTED
COUNTRIES
REPORTING CASES
%
JANUARY
SUDAN
GHANA
MALI
ETHIOPIA
NIGERIA
NIGER
TOTAL*
4
40
0
0
0
0
44
/
/
/
/
/
/
/
FEBRUARY
10
12
49
45
0
0
0
0
0
0
0
0
59
57
/
/
/
/
/
/
/
MARCH
33
18
50
50
0
0
1
0
0
0
0
0
84
68
/
/
/
/
/
/
/
APRIL
164
47
27
52
0
0
7
1
0
0
0
1
198
101
/
/
/
/
/
/
/
MAY
288
223
31
28
1
0
5
7
0
0
0
0
325
258
/
/
/
/
/
/
/
JUNE
407
432
19
34
7
1
7
5
0
0
0
0
440
472
/
/
/
/
/
/
/
JULY
311
456
6
20
16
7
2
8
0
0
0
0
335
491
/
/
/
/
/
/
/
AUGUST
/
466
7
26
2
0
0
0
501
SEPTEMBER
OCTOBER
/
NOVEMBER DECEMBER
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
0
0
/
0
0
/
0
0
/
0
0
/
TOTAL*
1217
222
24
22
0
0
1485
0
/
/
/
/
/
/
/
1654
74
236
94
34
100
23
96
0
100
1
0
1948
76
% CONTAINED
77
87
83
77
69
90
67
76
% CONT OUTSIDE
SUDAN
89
98
94
97
93
94
69
91
* provisional
Shaded cells denote months when zero indigenous cases were reported Numbers indicate how many imported cases were reported and contained that month
CONT
Figure 3
Number of Indigenous Cases Reported During the Specified Period in 2008 and 2009*, and Percent
Change in Cases Reported
Country
Indigenous Cases
Reported
% CHANGE 2008 - 2009*
2008
2009*
37
0
Mali (7)
198
34
Ghana (7)
446
237
38
23
2572
1654
0
0
3291
1948
719
294
Nigeria (7)
Ethiopia (7)
Sudan (7)
Niger (7)
Total
All countries, excluding
Sudan
-100%
-50%
0%
-100%
-83%
* Provisional: excludes cases exported from one country to another
(7) Indicates months for which reports were received, i.e., Jan. - July 2009
-47%
-39%
-36%
0%
-41%
-59%
50%
100%
Figure 4
SOUTH SUDAN GUINEA WORM ERADICATION PROGRAM
PAYAMS REPORTING REPORTING 10+ CASES OF DRACUNCULIASIS DURING JANUARY-JULY 2009*
0
Paringa, Kapoeta N.
Dor, Awerial
Kauto, Kapoeta E.
Reggo, Terekeka
Kirik, Tonj N.
Awul, Tonj N.
Chumakori, Kapoeta N.
Abuyong, Awerial
Thiet, Tonj S.
Tindilo, Terekeka
Aliek, Tonj N.
Paweng, Tonj E.
Rualbet, Tonj N.
Machi II, Kapoeta S.
Mogos, Kapoeta E.
Makuac, Tonj E.
Narus, Kapoeta E.
Karakomuge, Kapoeta
Ananatak, Tonj E.
Wunlit, Tonj E.
Alabek, Tonj N.
Lokwamor, Kapoeta N.
Marial Lou, Tonj N.
Pathuon E, Gogrial E.
Paliang, Tonj E.
Pagol, Tonj N.
Palal, Tonj E.
Akop, Tonj N.
Puluk, Awerial
Najie, Kapoeta N.
Bunagok, Awerial
Katadori, Kapoeta E.
20
40
NUMBER OF CASES
60
80
100
120
140
160
153
144
122
102
89
78
72
66
50
46
44
42
41
40
31
26
24
24
22
21
20
20
19
19
18
17
16
14
14
13
13
11
*Provisional.
These 33 payams represent 1,448 (88%)
of 1,654 cases reported in 2009
Figure 5
SOUTHERN SUDAN GUINEA WORM ERADICATION PROGRAM
NUMBER OF REPORTED CASES OF DRACUNCULIASIS: 2008 AND JAN-JULY 2009*
WARRAB / WESTERN BAHAR AL GHAZAL FOCAL AREA
LAKES / CENTRAL EQUATORIA FOCAL AREA
400
400
2008 = 1,317 CASES
2009* = 555 CASES
2008 = 843 CASES
356
2009* = 457 CASES
350
300
282
250
222
216
198
200
300
Number of cases reported
Number of cases reported
350
166
150
250
204
200
150
103
100
105
100
87
56
50
73
19
6
13
9
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
69
59
27
17
6
2
9
1
Jan
Feb
12
Mar
Apr
EASTERN EQUATORIA FOCAL AREA
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
NORTHERN JONGLEI FOCAL AREA
500
50
2008 = 1,350 CASES
2009* = 551 CASES
2008 = 88 CASES
2009* = 3 CASE
439
450
400
40
374
Number of cases reported
Number of cases reported
70
46
7
0
101
88
71
68
51
50
20
5
350
300
256
250
214
200
150
125
115
30
21
13
77
10
10
87
50
8
5
36
8
0
9
3
15
1
Jan
Feb
Mar
10
Apr
21
20
121
100
0
147
135
129
May
Jun
Jul
Aug
Sept
Oct
1
0
Nov
Dec
1
0
Jan
5
2
0
0
1
0
0
0
Feb
Mar
Apr
May
Jun
Jul
1
Aug
Sept
Oct
Nov
2
Dec
* Provisional
Figure 6
Status of Interventions, Jan. - May 2008 - 2009*
Percent
0%
20%
40%
60%
60%
57%
Case Containment Rate
Indicators
100% PF Coverage
42%
26%
10%
49%
22%
84%
82%
100% CF Coverage
Monthly HE
Reporting Monthly
100%
81%
Adjusted Case Containment Rate
Protected with Vector Control
80%
97%
33%
90%
77%
2009* (1005 Endemic VIllages)
2008 (1818 Endemic VIllages)
Mali-Burkina Faso. Mali detected a 10 year-old Malian boy with dracunculiasis in the village
of Tadialat (Ansongo District) when his worm emerged on July 8, 2009 and evacuated him to a
hospital the same day. This child, who had been infected in Mali in 2008, and his father reported
that they had visited the locality of Tintagaroubane in Burkina Faso in 2008 for a short stay,
when the boy also had a worm to emerge. The program in Burkina Faso is investigating.
TRANSITION
Mr. Steven Becknell, former Carter Center Resident Advisor to the Guinea Worm Eradication
Program of Southern Sudan, who returned to the Guinea Worm Eradication Program at Carter
Center headquarters earlier this year, has accepted a position at the Centers for Disease Control
and Prevention. Steve has had over 5 years of very distinguished and effective service to the
Guinea Worm Eradication Programs of Ghana and Southern Sudan especially while working for
The Carter Center. We wish him and his family much continued success at CDC. Thank you
Steven!
RECENT PUBLICATIONS
Hopkins DR, 2009. The allure of eradication. Global Health Issue 03(Summer): 14-17. This
article may be viewed at: www.globalhealthmagazine.com
Anonymous, 2009. Ghana fights Guinea worm. Editorial by the Voice of America. See:
www.voanews.com/uspolicy/2009-07-13-voa1.cfm
Inclusion of information in the Guinea Worm Wrap-Up
does not constitute “publication” of that information.
In memory of BOB KAISER
For information about the GW Wrap-Up, contact the WHO Collaborating Center for Research, Training, and Eradication of
Dracunculiasis, NCZVED, Centers for Disease Control and Prevention, F-22, 4770 Buford Highway, NE, Atlanta, GA 30341-3724,
U.S.A. FAX: 770-488-7761. The GW Wrap-Up web location is http://www.cdc.gov/ncidod/dpd/parasites/guineaworm/default.htm
_______________________________________________________________________________________
CDC is the WHO Collaborating Center for Research, Training, and Eradication of Dracunculiasis.