Public Health Service
Centers for Disease Control
and Prevention (CDC)
Memorandum
DEPARTMENT OF HEALTH & HUMAN SERVICES
Date: November 12, 2007
From: WHO Collaborating Center for
Research, Training and Eradication of Dracunculiasis
Subject: GUINEA WORM WRAP-UP #177
To: Addressees
“GUINEA WORM ANYWHERE IS GUINEA WORM EVERYWHERE”
Alhaji Dr. Mohammed Bin Ibrahim, Regional Director of Health Services, Brong Ahafo Region, Ghana
ETHIOPIA & COTE D’IVOIRE STOP GWD, BEGIN PRE-CERTIFICATION!!
After months of suspense, there is increasing evidence and confidence that both Ethiopia and Cote
d’Ivoire have interrupted indigenous transmission of dracunculiasis (Guinea worm disease). As of end
October 2007, Ethiopia had reported no indigenous cases for 16 consecutive months and Cote d’Ivoire for
13 consecutive months (Figure 1). Thus thirteen of the original twenty endemic countries are now free of
indigenous dracunculiasis, (Figure 2) and it is possible that Burkina Faso and Togo, with 11 and 10
consecutive zero case months respectively, may also have already recorded their last cases of Guinea
worm disease. The 348 cases reported from all endemic countries during September 2007 (Table 1,
Figure 4) represents the lowest number of cases of dracunculiasis reported during any month since the
global program began.
Figure 1
Number of Consecutive Months with Zero Indigenous Cases of Dracunculiasis: Jan. - Oct. 2007*
Number of Months
0
5
10
15
Ethiopia
16
13
Cote d'Ivoire
Burkina Faso
Togo
20
11
10
* Provisional
The national Guinea Worm Eradication Programs of Cote d’Ivoire and Ethiopia both had to work hard to
stop transmission of dracunculiasis despite significant insecurity in their most recent endemic areas:
ethnic clashes in parts of Gambella Region, Ethiopia, and civil war in Cote d’Ivoire. Fortunately, in Cote
d’Ivoire, a strong push by MAP International, UNICEF, Health and Development International and The
Carter Center to intensify interventions in the remaining endemic area just months before the civil war
erupted in September 2002 helped prevent a potentially disastrous setback. By focusing its efforts to
repair existing hand pumps, drill and equip new borehole wells, and help villagers construct bio-sand
filters using local materials in the endemic districts of M’bahiakro, Tanda, Bondoukou and Bouna, MAP
International helped improve access to safe water and reduce the rate of broken hand pumps in endemic
and at-risk villages from 72% to 15%. Both bio-sand filters and hand pump sources were used in
Dodoassue’ village (Tanda District), which reported 80% of all cases in the country in 2001, because the
local population continued to use water from the river due to their strong relationship with the spirit of the
river. Lendoukro village in M’bahiakro District recorded all 5 of Cote d’Ivoire’s final indigenous cases in
2006. Earlier uncertainty about whether Ethiopia had eliminated indigenous transmission derived from
questions about the provenance of 3 cases recorded along Ethiopia’s border with southern Sudan, which is
still highly endemic (see Guinea Worm Wrap-Up #175). Cote d’Ivoire hosted a WHO-sponsored meeting
of Francophone countries (Benin, Chad, Cote d’Ivoire, Mauritania, Guinea) in the pre-certification phase
of dracunculiasis eradication at Abidjan on September 4-5, 2007. Ethiopia hosted a WHO-sponsored
meeting for Anglophone countries and areas (Ethiopia, Kenya, northern Sudan, Uganda) in the precertification phase at Addis Ababa on October 30-31, 2007.
Figure 2
Distribution by Country of 9,589 Indigenous Cases of Dracunculiasis Reported during 2007*
Number of cases
0
1,000
2,000
3,000
4,000
Niger (10)
7,000
3,218
223
Mali (10)
Burkina Faso (10)
6,000
6,094
Sudan (9)
Ghana (10)
Nigeria (10)
5,000
43
11
0
Togo (10)
0
Cote d'Ivoire (10)
0
2006^
0
2006^
Ethiopia (10)
Benin
0
2004^
Mauritania
0
2004^
Uganda
0
2003^
Cent. African Rep.
0
2001^
Chad
0
1998^
Cameroon
0
1997^
* Provisional. Numbers in parentheses indicate months for which reports have been received,
e.g., (10) = January - October. excludes 14 cases exported from one country to another.
^ Year last indigenous case reported.
Yemen
0
1997^
Senegal
0
1997^
India
0
1996^
Kenya
0
1994^
Pakistan
0
1993^
Pakistan and India were certified free of the disease in 1996 and 2000, respectively.
Senegal and Yemen were certified free of the disease in 2004, and Cameroon and Central
African Republic in 2007.
NIGER REDUCES CASES BY -87%, ESTABLISHES NATIONAL CERTIFICATION
COMMITTEE
On October 5, Niger’s Minister of Public Health, Mr. Issa LAMINE, issued a decree establishing the
National Commission for Certification of Dracunculiasis Eradication in Niger (Commission Nationale de
la Certification de l’Eradication de la Dracunculose au Niger-CNCED). The commission will help
mobilize resources, strengthen activities of the national Guinea Worm Eradication Program (GWEP), and
submit reports to the International Commission for the Certification of Dracunculiasis Eradication
(ICCDE). Commission members include the head of the department of public health in the Faculty of
Health Sciences at Abdou Moumouni Dioffo University of Niamey (president), the director general in the
ministry of public health (vice-president), the national coordinator of the GWEP, as well as five other
members of the government, plus local representatives of WHO, UNICEF, and The Carter Center. This
welcome step comes as Niger has recorded only 12 cases of Dracunculiasis in January-October 2007 (11
contained)(Table 1), including one imported case, compared to 91 cases during the same period of 2006, a
reduction of –87% (Figures 3 and 5). The Niger GWEP also held a Worm Week in Niger’s last
remaining endemic region (Tillaberi) on October 24-30.
Table 1
Number of Cases Contained and Number Reported by Month during 2007*
(Countries arranged in descending order of cases in 2006)
COUNTRIES
REPORTING
CASES
NUMBER OF CASES CONTAINED / NUMBER OF CASES REPORTED
%
JANUARY
38
SUDAN
812
GHANA
0
MALI
3
NIGER
7
NIGERIA
0
TOGO
2
BURKINA FASO
0
COTE D'IVOIRE
0
ETHIOPIA
0
UGANDA
862
TOTAL*
/
/
/
/
/
/
/
/
/
/
/
FEBRUARY
49
161
631
1005
0
0
0
3
9
32
1
0
0
2
0
0
0
0
0
0
690
1203
/
/
/
/
/
/
/
/
/
/
/
MARCH
102
190
442
732
1
0
0
0
1
9
0
1
0
0
0
0
0
0
1
0
547
932
/
/
/
/
/
/
/
/
/
/
/
APRIL
304
271
248
478
0
1
0
0
0
1
0
0
0
0
0
0
0
0
0
1
552
752
/
/
/
586
233
293
0
0
1
/
/
/
/
/
/
/
/
MAY
673
0
0
0
0
1
0
0
0
0
0
0
1
0
908
880
/
/
/
1339
185
272
1
0
0
/
/
/
/
/
/
/
/
JUNE
661
1
0
0
0
0
0
0
0
0
3
0
0
1
850
1613
/
/
/
/
/
/
/
/
1473
91
241
5
1
1
0
0
0
0
0
0
0
0
0
0
/
/
/
JULY
497
3
0
0
594
1718
/
/
/
/
/
/
/
/
/
/
/
AUGUST
348
1206
38
111
29
7
0
1
0
0
0
0
0
0
0
0
0
0
1
0
416
1325
/
/
/
/
/
158
612
15
41
35
120
2
0
0
0
0
/
/
/
0
0
0
0
0
0
/
/
/
SEPTEMBER
0
0
1
210
774
/
/
/
/
/
/
/
/
/
/
/
OCTOBER
/
258
/
19
15
68
4
3
0
0
0
0
0
0
0
0
0
0
0
0
19
348
NOVEMBER
/
27
/
/
/
/
/
/
/
/
/
DECEMBER
26
4
1
0
0
0
0
0
0
58
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
0
0
/
TOTAL*
2830
2695
86
11
17
1
2
0
3
3
5648
0
/
/
/
/
/
/
/
/
/
/
/
6096
46
3219
84
223
39
12
92
43
40
2
50
2
100
0
0
3
0
3
100
9603
59
% CONTAINED
72
74
73
63
56
49
45
54
60
33
#DIV/0!
#DIV/0!
59
% CONT.
OUTSIDE SUDAN
79
86
93
84
86
77
82
42
58
33
#DIV/0!
#DIV/0!
80
* provisional
Shaded cells denote months when zero indigenous cases were reported. Numbers indicate how many imported cases were reported and contained that month. CONT.
#DIV/0!
#DIV/0!
Figure 3
Number of Indigenous Cases Reported During the Specified Period in 2006 and 2007*, and Percent
Change in Cases Reported
Country
Indigenous Cases
Reported
2006
Togo (10)
% CHANGE 2006 - 2007
2007 -100%
15
0
-100%
Cote d'Ivoire (10)
5
0
-100%
Ethiopia (10)
1
0
-100%
Burkina Faso (10)
1
0
-100%
Niger (10)
90
11
Sudan (9)
18508
6094
275
223
Ghana (10)
3115
3218
Nigeria (10)
15
43
22025
9589
402
277
Mali (10)
-50%
0%
50%
100%
-88%
-67%
-19%
3%
180%
Total
All countries, excluding
Sudan and Ghana
Overall % change outside of Sudan = 1%
(10) Indicates months for which reports were received, i.e., Jan. -Oct.
* Provisional
-56%
-31%
129
Figure 4
Total Number of Dracunculiasis Cases Reported by Month,
January 2000 - September 2007*
12000
Number of Cases
10000
8000
6000
4000
2000
0
Jan
00
Jul
00
Jan
01
Jul
01
Jan
02
Jul
02
Jan
03
Jul
03
Jan
04
Jul
04
Jan
05
Jul
05
Jan
06
Jul
06
Jan
07
Jul
07
Months
* September 2007 recorded the few est monthly total of cases since the global GWEP began.
Jan
08
Figure 5
NUMBER OF REPORTED CASES OF DRACUNCULIASIS: 2006 AND 2007*
GHANA
SUDAN
2006 = 20,582 cases
1,200
2006 -= 4,132 cases
2007* = 6,096 cases
5,000
2007* = 3,219
4,367
1,000
1,003
4,000
3,734
3,349
732
621
600
609
606
433
478
400
412
403
Number of cases
Number of cases
800
63% Reporting rate:
3,137endemic villages
3,000
2,613
2,214
337
1,339
293
293
272
200
241
162
0
Feb
Mar
Apr
May
Jun
1,473
1,252
1,206
1,000
111
Jan
2,141
2,000
Jul
144
41
39
19
25
Aug
Sept
Oct
612
586
77
0
Nov
Dec
161
1
190
12
271
77
Jan
Feb
Mar
64% Reporting rate:
3,776 endemic villages
Apr
May
Jun
608
258
Jul
Aug
Sept
214
Oct
Nov
* Provisional
Dec
*provisional
MALI
NIGER
140
25
2006 = 329 cases 2007* = 223 cases
120
120
2006 = 110 cases
2007* = 12 cases
21
21
20
20
100
17
91
15
Number of cases
Number of cases
81
80
72
68
60
12
10
41
7
40
6
26
5
20
14
8
7
0
3
0
1
0
01
1
0
3
0
1
Jan
Feb
Mar
Apr
May
Jun
4
3
2
14
Aug
Sept
Oct
Nov
Dec
* Provisional
2
2
1
0
Jul
3
Jan
0
0
0
Feb
Mar
Apr
1
0
May
Jun
0
Jul
Aug
Sept
Oct
Nov
Dec
* Provisional
GHANA REPORTS SIXTH CONSECUTIVE MONTH OF FEWER CASES
Ghana has reported a total of 27 cases in October, for a cumulative total of 3,219 cases(Table 1, Figures 2
and 5), of which 84% were reportedly contained, so far in 2007. This is an increase of 3% in cases from
the same period of 2006 (Figure 3). The monthly rate of reduction in cases has increased from –27% in
April to –81% in October. The number of cases reported in September and October 2007 are the lowest
ever reported for those months since the program began. Outside of Savelugu-Nanton District, Ghana’s
other remaining endemic districts have reduced cases by –52% in January-September 2007. Intervention
indices as of September 2007 were: 98% of endemic villages with health education, 84% with cloth filters
in all households, 55% of endemic villages received pipe filters since January 2006, 47% had at least one
safe source of drinking water, and 6% of endemic villages treated with ABATE® Larvicide in September.
Five regions of Ghana are free of endemic transmission of dracunculiasis, three reported less than 100
cases, and two more than 100 cases in 2006 (Table 2). National coordinator Dr. Andrew Seidu-Korkor
briefed key majority and minority parliamentary committee members on the status of Ghana’s GWEP on
October 27.
Table 2
Ghana Guinea Worm Eradication Program
Years with no indigenous cases and remaining indigenous cases in 2006, by region
Year
Greater
Accra
Upper
East
Western
X
X
1995
1996
X
X
1997
X
X
1998
X
X
X
1999
X
2000
X
X
X
2001
X
X
X
2002
X
X
X
X
X
2003
2004
X
X
X
2005
X
X
X
2006
X
X
X
X = zero indegenous cases reported
Central
Eastern
Ashanti
Upper
West
Volta
Brong
Ahafo
Northern
66
84
204
3679
X
X
X
X
X
X
X
X
X
X
31
MALI: INSECURITY IMPEDES OUTBREAK CONTROL IN KIDAL
Mali has reported 223 cases of dracunculiasis, 86 (39%) of them contained, in 47 villages in JanuaryOctober 2007 (Figure 5). This is a decrease of -19% from the 275 cases reported during the same period
of 2006. 86 of this year’s cases are from two villages experiencing the recent outbreak imported in Kidal
Region from Gao Region (Figure 6). None of the cases of GWD confirmed in Kidal were contained.
After the initial visit to this remote area by GWEP staff, insecurity ensued in Kidal and it has precluded
the GWEP from implementing additional interventions. Four of Mali’s eight regions (Kayes, Koulikoro,
Segou, Sikasso) have eliminated dracunculiasis. Case containment rates so far this year for the other
three endemic regions outside Kidal range from 60% (67/112) in Gao; 67% (8/12) in Timbuktu; to 85%
(11/13) in Mopti.
Mali Guinea Worm Eradication Program
Area of Interest
Algeria
Tessalit Town
Mali
ABEIBARA
TESSALIT
KIDAL
Outbreak
5
TOMBOUCTOU
TIN-ESSAKO
KIDAL
REGION
Cercle / District
Kidal Town
Cases 2007
BOUREM
1-2
3-5
GOUNDAM
6-9
10 - 40
40+
MENAKA
GAO
DIRE
GOURMA-RHAROUS
TOMBOUCTOU
NIAFUNKE
GAO
Gao Town
ANSONGO
YOUVAROU
MOPTI
!
(
TENENKOU
DOUENTZA
MOPTI BANDIAGARA
Burkina Faso
KORO
0 25 50
Niger
100
150
Kilometers
200
This map is provisional and is not an authority on boundaries
or roads or exact locations. This map was created for the
purpose of the Guinea Worm Eradication Program.
WHO & CARTER CENTER REVIEW NIGERIAN ACTIVITIES From September 17-28, 2007, a team from the World Health Organization visited 16
states, 32 Local Government Areas (LGAs), 48 villages, and 353 households as part
of a review of Guinea worm surveillance, management and supervision in Nigeria.
As reported by Dr. Cephas Ityonzughul of WHO’s Nigeria office, the team concluded
that although field activities have improved since the previous external evaluation in
June 2004, there was still insufficient training, motivation, and transportation for field staff and village
volunteers, lack of written guidelines for pre-certification, inadequate integration of surveillance for
dracunculiasis into the Integrated Disease Surveillance and Reporting (IDSR) system, and inadequate
funding for program activities by government at all levels. The overall monthly reporting rates for 696
recently endemic villages in 88 LGAs and 17 states (including 12 still officially endemic villages which
have reporting rates of 100%), were 30%, 37%, 34%, 34%, 52%, 56%, 49%, and 39% for the first eight
months of 2007.
On October 22-24, The Carter Center held a Program Review for all Carter Centerassisted health programs in Nigeria, at the Sheraton Hotel in Abuja. The Opening
Ceremony, which was chaired by former Nigerian Head of State General (Dr) Yakubu
Gowon, included a passionate “farewell” address by the outgoing ambassador of Japan
to Nigeria.
Participants at the Review, which covered activities related to
dracunculiasis eradication, lymphatic filariasis elimination, and control of schistosomiasis, onchocerciasis
and trachoma, included representatives of WHO, UNICEF, CDC, the Bill & Melinda Gates Foundation,
the Yakubu Gowon Center, the Nigerian Federal Ministry of Health and several state ministries of health,
as well as The Carter Center. The new national coordinator of Nigeria’s GWEP, Mrs. Ifeoma Anagbogu,
summarized the current state of the national program.
ASSESSMENT OF POSSIBLE LOCAL TRANSMISSION IN TURKANA NORTH DISTRICT,
KENYA, ON THE BORDER WITH SUDAN AND ETHIOPIA
A team comprised of 8 officials, 3 from WHO and 5 from the Kenyan Ministry of
Health visited Turkana North District from 11 to 15 October, in particular Kibbish area,
5km from the Ethiopian border in the northwest and 60km from the Sudanese border in
the northeast. The mission was led by Michelle Gayer, Medical Officer, Disease
Control in Humanitarian Emergency in Geneva and Dr. Eric Muchiri, Programme
manager, Division of Vector Borne Diseases, Ministry of Health in Kenya.
There is frequent cross-border movement between the three countries, thereby maintaining a risk of cross
border transmission of Guinea Worm. The team surveyed the area to investigate rumors of active guinea
worm cases. The team concluded that it is unlikely the indigenous transmission of Guinea Worm is
occurring or has occurred in that part of Kenya for the last 12 years. Given the nomadic populations and
cross border movements, the water situation, the poor surveillance system and lack of knowledge on GW
disease prevention among the community, there is a risk of reintroduction of this disease into Kenya from
Sudan. Kenya could thus be certified as a GW free country; however, adequate measures must be put into
place by June 2008 to achieve certification after which it can apply to the International Certification
Committee for Guinea Worm Eradication.
IN BRIEF:
Burkina Faso has appointed another new coordinator for the national Guinea Worm Eradication
Program, following the departure of his recent predecessor for study abroad. He is Dr. Laurent
NIKIEMA, previously of the Dedougou Sanitary District. Welcome, Dr. Nikiema, and may you have no
cases to report during your service!
Table 3
Reported Importations and Exportations of Cases of Dracunculiasis: 2007*
From
To
Ghana
Burkina Faso
Jan.
2
Togo
Sudan
Feb.
Mar.
1
Apr.
Month and number of cases imported
May
June
July
Aug.
Sept
Dec.
1
3
1
1
Mali Niger
2
1
4
2
1
1
Number of caes
exported
4
1
3
0
1
6
3
1
Togo Ghana
Total
2
2
3
Uganda
Total
Nov.
1
Ethiopia
Ethiopia Sudan
Oct.
1
0
0
0
1
1
2
2
1
1
14
* Provisional
MEETINGS
Executive Board of the World Health Organization, week of January 21, 2008; Geneva (Guinea worm eradication to be discussed). Program Review for Southern Sudan GWEP January 30-31, 2008, Juba. African Regional Conference on Dracunculiasis Eradication, April 2-4, 2008. World Health Assembly, week of May 19, 2008; Geneva. (to receive report on Guinea worm eradication). SCHEDULE FOR LAST GUINEA WORM CASES*
• 2006 - 2007
Burkina Faso, Cote d’Ivoire, Ethiopia, Mali, Niger, Nigeria, Togo
• 2007 – 2008
Ghana
• 2009
Sudan
*as indicated at May 2004 World Health Assembly
RECENT PUBLICATIONS
Voelker, R, 2007, Persistence pays off in Guinea worm fight. JAMA vol:298 iss:16 pg:1856 -7 .
IN MEMORIUM Dr. Ralph Muller died in England on October 11 after being ill for several months. Most recently an
Honorary Senior Lecturer at the London School of Hygiene and Tropical Medicine (LSTMH), he
began his long and distinguished career in helminthology at Nigeria’s University of Ibadan, and served
for many years as the director of the Commonwealth Institute of Parasitology in England as well as a
Lecturer and Senior Lecturer at the LSTMH. He was the world’s foremost authority on the biology of
Dracunculus species. One of the earliest advocates of dracunculiasis eradication, he was a prominent
participant in the first international meeting on dracunculiasis, the Workshop on Opportunities for
Control of Dracunculiasis, which was held in Washington, D.C. in June 1982. He compiled an
exhaustive, invaluable 177-page long Bibliography of Dracunculiasis (with nearly two thousand
citations) as part of the published report of that historic meeting. We extend our profound
condolences to his family.
Dr. K. A. Ojodu passed away in Nigeria on September 10, less than two weeks before his 60th
birthday, and less than three months after his retirement from public service, following a motor
accident while en route from Lagos to Abuja ten days earlier. He received his PhD and MPH degrees
from Johns Hopkins University, and was a Lecturer at the University of Lagos from 1981 until 1984,
when he was posted to the Federal Ministry of Health as assistant chief scientific officer. He served as
national coordinator for Nigeria’s Onchocerciasis Control Program from 1989 to 1992, and as national
coordinator of the Guinea Worm Eradication Program from 1995 to June 2007. We extend our
profound condolences to his family.
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.