DEPARTMENT OF HEALTH & HUMAN SERVICES
Date:
Public Health Service
Centers for Disease Control
and Prevention (CDC)
Memorandum
October 30, 2006
From: WHO Collaborating Center for
Research, Training and Eradication of Dracunculiasis
Subject: GUINEA WORM WRAP-UP #167
To:
Addressees
Count Down to Glory
Consecutive months with zero indigenous cases:
Burkina Faso 9
Nigeria 5
Ethiopia 3
Detect every case. Contain each worm. Trace the source of every sporadic case.
UPDATE ON IMPLEMENTATION OF GHANA’S ACTION PLAN
Ghana’s Guinea Worm Eradication Program (GWEP) has now reported 2,968 cases of Guinea worm
disease (GWD) in January-September 2006, which is an increase of 1% from the 2,943 cases reported
during the same period of 2003 (See Table 1, and Figures 1,3 and 4). This year’s case containment rate is
stalled at 61% overall. Figure 2 compares the monthly percentage of persons with GWD in 2006 which
were prevented from transmitting their infection to others to the GWEP's monthly targets for case
containment rates. The 38 reported cases of GWD in September is a reduction of -32%, compared to 56
cases during the same month in 2005, but the case containment rate for the 38 cases reported in
September 2006 is only 44% (compared to September’s target of 76% for case containment in the Plan of
Action). The status of program indicators in 528 known endemic villages during September were: 99%
sent reports about cases, 95% had cloth filters in all households, 96% received one or more health
education/mobilization sessions, 59% were protected with ABATE® Larvicide at least once in 2006, and
47% have access to one or more safe sources of drinking water.
Other measures that have been taken in follow up to the Plan of Action developed during the Program
Review held in Atlanta in August include replacement of 2 regional and 3 district Guinea worm
coordinators, and preparations for an intensive media blitz to inform the public about the state of the
campaign and mobilize populations in the remaining endemic areas. Unfortunately, Ghana’s electrical
power crisis created by the low water level in Lake Volta is exacerbating problems with delivery of clean
drinking water to the towns of Tamale and Savelugu in the Northern Region.
On October 26, Mr Abraham Odoom, Deputy Minister of Local Government, Rural Development and
Environment announced in Tamale that the government of Ghana is committing 9.5 billion Cedis (circa
US $ 1 million) towards the eradication of Guinea worm disease. The Northern Region Poverty
Reduction Program is to receive 5.5 billion Cedis for provision of 62 borehole wells to the highest
endemic districts, i.e., Yendi, Tolon-Kumbungu, and Savelugu-Nanton. The Ministry of Finance and
Economic Planning is to receive the remaining 4 billion Cedis for a special Guinea worm eradication fund
which will be used to provide sources of safe drinking water to other lesser endemic districts.
Figure 1
Ghana Guinea Worm Eradication Program
Cases Reported, % Contained and % Change: During Jan. 2005 - Sept. 2006
800
100
Number of Cases of Dracunculiasis and Percent Contained: 2005 and 2006*
700
500
71
553
66
71
72
65
65
62
458
395 397
400
383
37
300
64
455
54
64
433
65
60
63
56
46
337
40
293
31
162
100
60
57
403
355
41
224
200
80
# Cases
66
483
% Contained
621 606
160
60
20
77
56
38
0
0
100
% Change in Cases of Dracunculiasis Compared to the Same Month in the Previous Year: Jan. 2005 - Sept. 2006*
47
28
25
% Change
12
-3
-2
-26 -23
-37
-56 -57 -60 -56
-49
2
-8
-19
-26
10
-32
-48
-100
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2005
2006
% of cases contained
Number of cases
600
74
Figure 2
Ghana Guinea Worm Eradication Program Major Indicators by month
% Cases Contained by month 2006 - 2007
100%
100%
* March 2007 is Ghana's
Target for stopping
transmission of Guinea
worm disease.
75%
Percentage
64%
60%
62%
62%
61%
60%
59%
56%
57%
50%
45%
2006
25%
0%
2006
Target
Target
2005
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
60%
64%
62%
61%
59%
62%
60%
56%
57%
45%
64%
65%
65%
65%
65%
68%
70%
73%
76%
Oct
Nov
Dec
Jan
Feb
Mar
100.0%
79%
83%
88%
94%
98%
100.0%
Table 1
Number of Cases Contained and Number Reported by Month during 2006*
(Countries arranged in descending order of cases in 2005)
NUMBER OF CASES CONTAINED / NUMBER OF CASES REPORTED
COUNTRIES
REPORTING CASES
%
JANUARY
FEBRUARY
GHANA
NIGER
10
NIGERIA
0
TOGO
BURKINA FASO
0
/
COTE D'IVOIRE
0
/
0
1
0
0
/
ETHIOPIA
1
UGANDA
0
0
333
638
0
0
2934
/
584
3264
5524
4475
/
/
/
/
/
14
86
/
/
/
3
0
/
/
/
5
100
3
100
2
100
22152
53
/
/
2
/
1
933
3525
67
/
0
0
/
15
/
/
1305
/
/
1
1
2341
/
83
/
3
0
/
71
10
1
/
0
0
2672
/
/
0
0
/
89
5
0
/
1
1
/
1
/
0
1
0
1
465
/
654
1
0
1
/
1
2
199
2
1
/
61
/
1
/
0
/
/
0
/
0
2
1
0
0
0
/
0
/
/
0
1
/
2968
12
5
/
2
/
1
0
1
396
/
0
/
0
2
/
0
0
1
403
TOTAL*
0
/
0
1
0
/
0
/
0
0
/
0
0
0
0
0
0
0
/
0
/
1
51
/
1
0
/
/
/
0
0
/
1
0
/
21
/
5
2
1
/
/
/
/
0
0
0
0
/
1
0
3
1
0
/
0
0
/
/
18872
/
59
21
/
0
2
/
/
/
/
91
/
0
/
0
1
1
0
0
/
/
0
0
14
2
1
/
/
0
/
15
12
7
/
/
/
/
0
0
0
0
/
6
2
0
0
2
0
/
178
72
/
/
/
/
/
/
/
/
38
/
17
11
7
/
79
14
14
3
/
1811
77
/
/
/
6
1
0
0
1
0
1
3
2
/
/
/
/
MALI
/
/
66
TOTAL*
1203
/
11
14
DECEMBER
17
160
293
337
3
1
0
1
403
433
606
621
3
NOVEMBER
9700
1955
/
OCTOBER
/
/
44
90
/
SEPTEMBER
819
3335
4156
/
AUGUST
1172
/
/
177
209
/
JULY
2225
5175
2857
/
/
/
JUNE
2469
/
/
237
265
376
MAY
2714
151
30
10
396
APRIL
226
/
/
1
SUDAN
MARCH
68
7
0
CONT.
0
/
2131
0
/
1357
0
/
0
11782
/
0
/
0
% CONTAINED
63
61
57
14
53
60
66
61
69
#DIV/0!
#DIV/0!
#DIV/0!
53
% CONT. OUTSIDE SUDAN
64
62
61
59
63
64
61
76
74
#DIV/0!
#DIV/0!
#DIV/0!
63
#DIV/0!
#DIV/0!
* provisional
Shaded cells denote months when zero indigenous cases were reported. Numbers indicate how many imported cases were reported and contained that month.
Figure 3
Distribution by Country of 22,140 Indigenous Cases
of Dracunculiasis Reported During 2006*
Number of cases
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
18,872
Sudan (9)
2,968
Ghana (9)
Mali (9)
20,000
195
Niger (9)
70
Nigeria (10)
15
Togo (9)
14
Cote d'Ivoire (9)
5
Ethiopia (9)
1
Burkina Faso (9)
0
Target Dates for Last Case
2006 – 2007
Burkina Faso
Cote d'Ivoire
Ethiopia
Mali
Niger
Nigeria
Togo
2007 – 2008
Ghana
2009
Sudan
* Provisional
(9) Number of months for which reports have been received, e.g. Jan. - Sept. 2006
Figure 4
Number of Indigenous Cases Reported During the Specified Period in 2005 and 2006*, and Percent
Change in Cases Reported
Country
Indigenous Cases
Reported
2005
% CHANGE 2005 - 2006
2006 -100%
Burkina Faso (9)
21
0
-100%
Ethiopia (9)
29
1
-97%
Nigeria (10)
116
15
Togo (9)
56
14
Mali (9)
415
195
8
5
2943
2968
60
70
4896
18872
Cote d'Ivoire (9)
Ghana (9)
Niger (9)
Sudan (9)
-80%
-60%
-40%
All countries, excluding
Sudan and Ghana
8544
22140
705
300
0%
20%
40%
60%
80%
100%
-87%
-75%
-53%
-38%
1%
17%
285%
Goal: 80% reduction
Total
-20%
Overall % change outside of Sudan = -10%
(9) Indicates months for which reports were received, i.e., Jan. -Sept. 2006
* Provisional
-57%
158%
Figure 5
SUDAN GUINEA WORM ERADICATION PROGRAM
NUMBER OF REPORTED CASES OF DRACUNCULIASIS: 2005 AND 2006*
6,000
2005 = 5569
2006 = 18872
5,175
Number of cases
5,000
4,156
4,000
3,335
3,000
2,857
1,955
2,000
1,606
1,442
1,203
1,000
0
30
102
10
66
Jan
542
151
169
Feb
499
146
Mar
Apr
324
410
262
1
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
* Provisional
Figure 6
SUDAN GUINEA WORM ERADICATION PROGRAM
ENDEMIC COUNTIES BY STATE REPORTING 17,789 (94%) OF 18,872 CASES OF DRACUNCULIASIS
DURING JANUARY - SEPTEMBER 2006*
Number of Cases
0
2,000
4,000
6,000
7,697
Kapoeta North, E. Equatoria
4,318
Kapoeta East, E. Equatoria
1,612
Gogrial East, Warrab
1,049
Kapoeta South, E. Equatoria
710
Ayod, Jonglei
Gogrial West, Warrab
528
Wuror, Jonglei
496
Aweil East, N. BAG
Terekeka, Cent. Equatoria
8,000
435
340
Awerial, Lakes
270
Nyirol, Jonglei
236
Duken, Jonglei
198
* Provisional
SUDAN
Provisional data from the southern Sudan GWEP during January –September indicates a total of 18,872
cases of GWD reported from 2,611 endemic villages, a 285% increase in cases compared to the 4,896
cases reported during the same period in 2005 (Table 1, Figures 3 and 4). The 2,611 endemic villages in
2006 is already a 141% increase over the 1,085 endemic villages reported during 2005. Figure 5 ranks the
most endemic counties in southern Sudan in descending order of cases reported so far.
The reporting rate from endemic villages so far during 2006 is 63%, but the goal is to improve it to 75%
or better by the end of the dry season in May 2007 or before, if possible. Full filter coverage (cloth filters
in every household) in each endemic village is 16%, and 25% of endemic villages have achieved full pipe
filter coverage (70% of total population or 53% of 333,907 eligible individuals). One or more health
education sessions have been provided to 66% of the endemic villages, and 7% of these have been
protected with the use of ABATE® Larvicide. Only 16% of endemic villages have access to one or more
safe sources of drinking water.
The increases in cases of GWD and endemic villages in 2006 are a result of improved accessibility to
areas of southern Sudan during 2006, unprecedented support since December 2005 by the Government of
Southern Sudan and The Carter Center to intensify the GWEP, ongoing assessments of the extent of
GWD in southern Sudan, and the speed and diligence with which the GWEP has been able to establish a
program infrastructure and logistical support to immediately activate surveillance and monthly reporting
of cases and to implement interventions in newly discovered endemic areas. UNICEF is assisting with the
provision of safe sources of drinking water and WHO with surveillance in non-endemic areas.
IN BRIEF:
Togo. Dr. Bakaye Awani Su Keya DOTSE has been named the new national coordinator of Togo’s
GWEP. The Togolese GWEP held regional reviews in all five regions of Togo the first week of October.
MEETINGS
14-15 November 2006 Program Review for Burkina Faso, Cote d’Ivoire, Mali, Niger, Togo,
The Carter Center, Atlanta, USA
15 November 2006
Ceremony to honor Benin, CAR, Mauritania, Uganda
The Carter Center, Atlanta, USA
5-6 December 2006
Program Review for South Sudan GWEP
Juba, Sudan
5-7 December 2006
National Review for Niger GWEP
Dosso, Niger
Sixth Meeting of the International Commission for the Certification of
Dracunculiasis Eradication
WHO, Geneva, Switzerland
5-7 March 2007
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, NCID, Centers for Disease Control and Prevention, F-22, 4770 Buford Highway, NE, Atlanta, GA 303413724, 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.