DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
Centers for Disease Control
and Prevention (CDC)
Memorandum
Date: July 31, 2005
From: WHO Collaborating Center for
Research, Training and Eradication of Dracunculiasis
Subject: GUINEA WORM WRAP-UP #154
To:
Addressees
GUINEA WORM BOX SCORE
Number of consecutive months reporting zero indigenous cases
Uganda
18 (8/03 – 6/05)
Benin
15 (4/04 – 6/05)
Mauritania
12 (7/04 – 6/05)
BENIN, MAURITANIA REPORT ZERO CASES FOR 12+ MONTHS
As of the end of June 2005, Benin has reported zero indigenous cases for fifteen consecutive
months, while Mauritania has reported zero indigenous cases for twelve consecutive months (see
Box Score). These are welcome benchmarks for both programs. With Uganda having reported
zero indigenous cases for an entire calendar year for the first time in 2004, it now appears that
Benin and Mauritania are set to follow in 2005.
UPDATE: STATUS OF UNICEF/GATES WATER SUPPLY FOR MALI, NIGER, AND
TOGO
Mali. As of July 20, 4 of the 14 endemic villages targeted have pumps with flowing water. The pumps
were installed in July. These 4 villages are in Ansongo District and had already reported 21 cases, or 36%
of Mali's cases during January-June 2005. These same 4 villages reported a total of 46 cases in 2004. The
program reports that drilling for the remaining wells has been halted, apparently due to unresolved issues
between Hydraulique-Mali and UNICEF/Mali concerning accounting of funds for past projects.
Niger. Drilling has not yet started. Geologic survey is underway. The 12 endemic villages that are
targeted in Niger have reported 4 cases in January-June, or 17% of Niger’s cases so far this year.
Togo. Drilling has not yet started, delayed because of the recent political crisis. Bidding for contractors
is underway. The fourteen endemic villages that are targeted to receive new borehole wells reported 23,
or 49% of Togo's cases in January-June 2005.
GUINEA WORM WRAP-UP GOING ELECTRONIC
Beginning with issue #155 we will distribute a link to the internet allowing access to the current
issue of the Guinea Worm Wrap-Up. We will not send printed copies via mail. Please send your
name and current e -mail address to gwwrapup@cdc.gov, so we can begin to implement this very
important change.
Table 1
Number of cases contained and number reported by month during 2005*
(Countries arranged in descending order of cases in 2004)
NUMBER OF CASES CONTAINED / NUMBER OF CASES REPORTED
COUNTRIES
REPORTING
%
CASES
JANUARY
374
343
/
GHANA
/
/
NIGERIA
2
/
BURKINA FASO
/
/
BENIN
0
2
TOTAL*
% CONTAINED
0
363
/
61
687
/
0
297
/
57
641
/
38
776
33
809
1278
0
/
/
/
/
/
115
63
/
/
/
/
/
/
58
84
23
74
53
87
3
100
7
14
1
100
32
88
0
0
4
0
4233
48
17
/
3
/
6
/
/
/
/
/
46
/
8
/
6
/
/
/
/
/
/
2
/
/
/
/
/
/
1
/
3
/
3
/
/
/
/
/
/
0
/
/
/
/
/
/
/
20
/
/
/
/
/
/
0
/
0
/
0
/
/
/
/
/
/
4
/
0
388
/
/
5
4
/
0
269
/
28
/
7
0
/
/
0
/
0
0
68
1
/
0
0
/
0
0
/
0
416
/
0
0
/
UGANDA
/
0
0
/
16
/
3
0
/
0
/
0
7
/
0
0
/
0
/
0
3
/
0
0
/
MAURITANIA
/
2
0
1
0
2659
3
/
0
0
/
/
/
25
0
/
0
0
/
0
0
/
ETHIOPIA
/
/
6
/
19
0
/
1
1
/
2
/
1
0
/
0
0
/
4
/
3
0
/
0
1
/
0
0
/
0
0
CONT.
73
/
6
7
/
3
1
TOTAL*
49
/
26
16
/
2
0
/
0
0
COTE D'IVOIRE
4
0
/
/
3
/
4
3
/
/
4
/
9
2
/
1
2
/
11
0
/
4
1
/
TOGO
/
2
11
/
NOVEMBER DECEMBER
23
/
1
1
/
322
22
/
1
1
OCTOBER
/
385
4
/
29
0
/
1
4
/
NIGER
/
4
2
1
SEPTEMBER
1821
/
458
7
/
13
AUGUST
4
/
373
11
/
17
1
/
MALI
/
36
JULY
2
/
364
9
JUNE
241
/
395
1
/
131
13
MAY
332
/
393
0
/
88
APRIL
249
/
484
1
25
MARCH
282
/
544
0
SUDAN
FEBRUARY
4
300
/
46
844
/
/
14
/
66
456
/
0
/
20
70
/
0
/
0
#DIV/0!
/
0
/
0
#DIV/0!
/
0
/
0
#DIV/0!
/
0
/
0
#DIV/0!
2047
/
0
#DIV/0!
/
48
#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 1
Distribution by Country of 4,189 Indigenous Cases of Dracunculiasis
Reported during 2005* and Percent Change in Cases Compared to the Same Reporting Period in 2004
Number of cases
0
1,000
2,000
3,000
2,655
Ghana (6)
1,278
Sudan (5)
115
Nigeria (7)
%
Change
-56%
-52%
-69%
Mali (6)
58
+205%
Togo (7)
51
-67%
Ethiopia (6)
24
+700%
Niger (7)
19
-67%
Cote d'Ivoire (7) 7
-59%
Burkina Faso (6) 2
-71%
Benin (6) 0
-100%
Mauritania (6) 0
-100%
All 2005 data is provisional
Numbers in parentheses indicate how many months the country has provided monthly reports in 2005. For example: Benin (6) =
Jan-Jun 2005
Figure 2A
Number of Cases Reported by Year: 2004 - 2005*
Ghana
Sudan
1500
1500
2004
1245
907 905
544
500
484
393 395
458
520
439
385
257
496
Number of cases
Number of cases
990
1000
1217
2005
1133
2004
1316
1188
2005
1000
772
652
593
500
385
364 373
322
243 278 255
131
88
230
115
38
0
180
98
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Nigeria
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
120
112
2004
2004
102
2005
73
69
60
48
36
37
31
29
17
20
45
13
Feb
Mar
9
Apr
2005
80
72
66
60
54
40
26
23
May
15
12
6
5
Jun
Jul
20
0
0
Jan
40
100
Number of cases
Number of cases
100
80
Dec
Mali
120
40
38
0
Aug
Sep
0
Oct
Nov
Dec
25
26
12
1
1
1
01
Jan
Feb
Mar
Apr
6
5
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Figure 2B
Number of Cases Reported by Year: 2004 - 2005*
Togo
Niger
60
60
2004
2004
51
47
46
40
29
30
28
21
20
20
19
19
8
2
28
22
11
10
4
50
2005
9
6
3
Number of cases
Number of cases
50
40
34
28
30
20
28
17
16
9
10
3
4
2
21
0
49
2005
4
1
6
3
3
May
Jun
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Burkina Faso
Jan
Feb
Mar
Apr
Jul
Aug
Sep
Oct
Nov
Dec
Ethiopia
25
25
2004
2005
15
15
10
8
5
5
1
0
Jan
2
0
0
Feb
Mar
2
1
Apr
9
8
5
5
May
10
8
7
5
0
Jun
Jul
Aug
Sep
Oct
Nov
2005
15
2
0
20
20
Number of cases
Number of cases
20
0
2004
Dec
2
1
0
Jan
3
0
0
Feb
Mar
Apr
3
May
Jun
2
Jul
0
0
0
0
0
Aug
Sep
Oct
Nov
Dec
Figure 3
Distribution by Country of Origin of the Combined Cases of
Dracunculasis Exported to Other Countries During 2004 and 2005*
Number of Cases
0
10
60
12
4
2
2
0
2004=69 Cases
2005*=24 Cases
3
Mali
Cote d'Ivoire
50
15
Togo
Burkina Faso
40
5
Sudan
Niger
30
43
Ghana
Nigeria
20
3
1
1
0
1
1
0
*provisional
GHANA EVALUATIONS
From June 6-20, a team jointly sponsored by The Carter Center, WHO, UNICEF, and the Ghana Health
Service and led by Prof. Sandy Cairncross of the London School of Tropical Medicine and Hygiene
conducted an independent external evaluation to examine aspects of Ghana's Guinea Worm Eradication
Program in four districts. The four districts (Tolon-Kumbungu, Savelugu-Nanton, Kete-Krachi, and Wa)
all had significant increases in cases of dracunculiasis in 2004 compared to 2003. Key findings were that
at least 93% of persons sampled knew about filtering their drinking water, and everyone had a filter, but
only 68 of 122 cases (56%) seen by members of the evaluation team had been reported, more than half of
the cases seen were not contained, and "hundreds of boreholes in endemic villages lack a hand pump".
Perhaps the most important recommendation is that supervision should be more frequent, structured, and
better documented.
Assisted by GWEP staff, an Epidemic Intelligence Service officer of CDC, Ms. Sara Russell, also
recently conducted a separate study to help the Ghana Health Service evaluate the distribution of pipe
filters in northern Ghana in 2003-2004. She interviewed villagers in a sample of villages in six districts
(Tamale, West Gonja, East Gonja, Nanumba, Yendi and Gushiegu-Karaga). Key findings were that 80%
of pipe filters were distributed at househo1d level, as intended, that 84% of those interviewed knew how
to use the pipe filter but health education about filter usage and care was inconsistent (only 32% could
describe how to clean their pipe filter properly), that there were not enough filters to cover the populations
targeted, and that women were especially under-represented among those who did receive pipe filters,
because the protocol for distribution excluded female heads of households, as these were believed to be
protected most of the time by the household cloth filter. The protocol for distribution was not adhered to
at the district level. GWEP district staff did not distribute the filters as intended, were not informed about
the durability (2-4 years) of these pipe filters, and as a result too many pipe filters were kept in storage as
replacements and were slowly distributed over many months. Overall, only 36% of the eligible population
received a pipe filter. Coverage was highest in East Gonja and Yendi Districts, and lowest in Tamale and
Nanumba Districts.
IN BRIEF:
Cote d’Ivoire . Following up on a report sent in by a UNICEF contractor on June 14, a team from the
district of M'Bahiakro confirmed 3 cases of dracunculiasis in the village of Lendoukro, in a
rebel-controlled area, on June 17-19. The worms in the cases emerged on June 6, and the
medical response was thus too late to conta in them. A team from the national program also
confirmed the 3 cases, plus a fourth case that will be officia1ly notified in July , during a
visit on June 29. The medical teams conducted health education, distributed cloth filters,
and applied ABATE@ larvic ide to appropriate ponds. UNICEF/Cote d’Ivoire supported a
technician to repair the two pumps in the village on July 12. The investigating teams found that there had
been no cases in Lendoukro in 2004, but that there had been at least one case then in the village of
Moroko, located about 3 kilometers away, and sharing a water source with Lendoukro. Moroko has so far
had no cases in 2005.
Nigeria. Dr. Cephas Ityonzughul has been appointed by WHO as the national professional
officer responsible for assisting in development of surveillance for dracunculiasis in
formerly endemic areas of the country. The appointment is for one year, effective July 1,
2005. Dr. Ityonzughul was formerly The Carter Center's zonal consultant for the north
central zone of Nigeria. Congratulations, Cephas!!
Sudan.
The Nairobi office of The Carter Center for assisting the GWEP in South Sudan was closed on July 5,
2005 and is being transferred into southern Sudan.
Table 2
Dracunculiasis Eradication Campaign: Status of Interventions during
January - June 2005*
Percentage of Endemic Villages
100%
with 1+
protected by
households
sources of
ABATE ®
with filters
safe water
% Change in
cases 2004 2005*
Number of villages
reporting 1 or more
cases 2004 - 2005
% of cases
contained in
2005
Ghana
-56%
1017
55%
Sudan **
-52%
2322
1%
65%
53%
1%
28%
Nigeria
Mali
-69%
205%
92
125
63%
84%
100%
100%
100%
93%
62%
18%
66%
34%
Togo
-65%
47
85%
100%
100%
47%
57%
Ethiopia
Niger
700%
-57%
9
45
88%
76%
100%
100%
44%
100%
67%
22%
44%
11%
Cote d'Ivoire
-76%
9
25%
100%
22%
11%
67%
Burkina Faso
Benin
-71%
-100%
10
1
100%
Mauritania
-100%
1
Country
provided
Health
Education
100%
0%
0%
100%
100%
100%
100%
100%
* provisional data
** Sudan reporting at 40%
MEETINGS
Ghana will hold its annual review of the GWEP during August 15-16 in Accra. The French- speaking
endemic countries will meet in Cotonou, Benin during August 18-19 for their annual program review.
The annual review of Nigeria’s GWEP will be on September 7, 2005 in Abuja.
RECENT PUBLICATIONS
Bimi L, Freeman AR, Eberhard ML, Ruiz- Tiben E, Pieniazek NJ, 2005. Differentiation of Dracunculus
medinensis and Dracunculus insignis by sequence analysis of the 18S RNA. Ann Trop Med Parasitol
99; 1-7.
WHO, 2005. Report and Recommendations of the International Commission for the Certification of
Dracunculiasis Eradication. Fifth Meeting, 9-11 March. 2004. WHO/CDS/CPE/CEE/2005.51. Geneva:
World Health Organization.
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 Dr. Sharon Roy, 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
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.