Public Health Service

DEPARTMENT OF HEALTH & HUMAN SERVICES

Centers for Disease Control
And Prevention (CDC)
Memorandum
Date: January 26, 2022
From: WHO Collaborating Center for Dracunculiasis Eradication, CDC
Subject: GUINEA WORM WRAP-UP #284
To: Addressees

You’ve got to go there to know there.

Zora Neale Hurston

Figure 1

*Provisional

FEWEST HUMAN CASES EVER!

After reducing Guinea worm infections by 51% and 20% in humans and animals respectively in
2020, endemic countries reduced human cases and animal infections by another 48% and 45% in
2021 (Figure 1). This sustained progress brought Guinea worm in humans (14) to the lowest level
since the eradication program began and reduced the number of known animal infections (885) to

1
the second-lowest level reported since Chad, the most endemic country, extended active
surveillance to all endemic areas in 2016.
• Chad’s Guinea Worm Eradication Program led 2021 reductions with 42% less human (7)
and 48% less dog (790) infections reported; the first year it reduced human and animal
infections by so much.
• Ethiopia reported 1 human, 2 dogs, 1 cat, and 0 infected baboons in 2021 (vs. 11 humans,
3 dogs, 8 cats, 4 baboons in 2020).
• South Sudan reported 4 human cases and no animal infections.
• Mali reported 2 human cases, 16 dogs, and 1 infected cat.
• Angola reported no infected human or animal.
• Cameroon reported 10 infected dogs in border villages that were probably infected in
Chad.
In 2021 the number of months with zero human cases reported globally increased to five (January,
May, June, November, December), from three months in 2020 (June, November, December), two
months in 2019 (October December), and one month in 2018 (November). Table 1 summarizes
the status of containment and presumed sources of human infections in 2021.

Table 1

Looking forward & backward: human Guinea worm cases in 2021

Date/place detected Contained?* Probable source*

MALI
03 Aug/Markala-Segou No Unknown
15 Sep/Markala-Segou Yes Unknown

SOUTH SUDAN
23 Jul/Uror-Jonglei No Unknown
23 Jul/Rumbek N-Lakes Yes Unknown
28 Aug/Tonj E-Warrap Yes Unknown
06 Oct/Awerial-Lakes No Unknown

ETHIOPIA
23 Feb/Gog-Gambella Yes Duli Farm/Gog

CHAD
01 Feb/Amtiman-Salamat Yes Unknown
30 Mar/Kyabe-Moyen Chari Yes Marakouva 2/Kyabe
14 Apr/Aboudeja-Salamat Yes Bogam/Salamat
19 Apr/Moissala-Mandoul No Unknown
22 Jul/Guelendeng-Mayo Kebbi E Yes Unknown
29 Jul/Amtiman-Salamat No Unknown
09 Oct/Mourgui-Chari Baguirmi Yes Unknown
*See definitions in previous issue

2
 ETHIOPIA: 4 GW INFECTIONS; 4 KNOWN SOURCES, 3 CONTAINED

The Ethiopia Dracunculiasis Eradication Program (EDEP) has reported four

confirmed Guinea worm infections in 2021, compared to 26 Guinea worm
infections in 2020, a reduction of 85%. It identified the presumed sources of all
four infections and contained three of them (Tables 2 and 3):

One human case whose worm emerged in Wadmaro village/Gog district on

February 23, 2021 was contained, and the presumed source determined to be Duli Farm, which
reported 7 cases in April 2020.

An infected cat whose worm emerged in Pugnido Refugee Camp Agnuak Akobo C on August 20
was contained; the presumed source of its infection was the same Akobo C section, PRC, which
reported an infected cat in July 2020. Abate was applied to potentially contaminated sites.

An infected dog whose worm emerged in Chieng village/Gog district on October 3 was contained,
and the presumed source determined to be Awowi stream cuts, shared by the Agonna baboon troop,
which is being tracked and a member of which had Guinea worm infection in August 2020.

An infected dog which had its worm emerge in Atheti village/Gog district on November 12 was
not contained; the presumed source of infection was nearby Awowi stream, shared by the Agonna
baboon troop, a member of which had Guinea worm infection in August 2020. Abate was applied
to potentially contaminated sites.

The EDEP will hold its annual national program review virtually on January 25-26, 2022. Before
an outbreak of COVID-19 among researchers forced the suspension of operations in late October,
the baboon study project trapped, sedated, bled, and inspected six baboons from three of the six
troops being tracked. All six baboons were negative for physical signs of Guinea worm infection.
The serologic test results are pending.

Table 2. Ethiopian Dracunculiasis Eradication Program: Line List of confirmed case, 2021

Total
Age Village of Date Date Contained Entered
Sex Ethnicity Occupation District Zone Lab. Result # of
(yrs) Detection Detected Emerged (Yes / No) Water
worms

13 M Agnua Student Wadmaro Gog Agnua 22-Feb 25-Feb Yes No Confirmed 1

3
Table 3. Ethiopian Dracunculiasis Eradication Program: Line list of confirmed animal
infections, 2021

Total #
Animal Village of Date Date Contained Entered of
Age (yrs) Zone District Lab. Result
Type* Detection Detected Emerged (Yes / No) Water worms

Young
Akobo
(1 year Cat Agnua Gog 20-Aug 21-Aug Yes No Confirmed 1
C: PRC
old)
Adult
(1.5
Dog Cheing Agnua Gog 30-Sep 3-Oct Yes Yes Confirmed 1
years
old)
Adult (5
years Dog Atheti Agnua Gog 12-Nov 12-Nov Yes No Confirmed 1
old)
*All animals were males located in the Gambella region.

SOUTH SUDAN: 4 GW CASES; 0 KNOWN SOURCES, 2 CONTAINED

The South Sudan Guinea Worm Eradication Program (SSGWEP) reported 4

human Guinea worm cases and no infected animals in 2021, compared to 1 human
case in 2020 (Table 1). Two of the four cases, all of which were listed in Guinea
Worm Wrap-Up #283, were contained; none of the presumed sources of infection
was identified. Abate was applied to potentially contaminated sites. Figure 2
shows the locations of the four cases. Comparisons of the genetic profiles of these
infections are pending.

Figure 2

4
The National Minister of Health, Honorable Elizabeth Acuei Yol, opened the SSGWEP’s annual
national program review which was held at the Palm Africa Hotel in Juba on December 9-10 under
the leadership of SSGWEP Director Mr. MAKOY Samuel Yibi. Minister Yol challenged the
program to consider whether the four cases in 2021 were “the result of a failure in surveillance or
a failure in strategy”. The Minister of Health was joined by Minister of Water Resources and
Irrigation, the Honorable Manawa Peter Gatkuoth and Carter Center Vice President Mr. P. Craig
Withers Jr. to sign a declaration to pursue water, sanitation, health, and hygiene as part of Guinea
worm eradication and trachoma control in endemic areas of the country. Other key participants at
the review included the State Ministers and Director Generals from all ten states, WHO Country
Representative Dr. Fabian Ndenzako, and UNICEF Country Representative Mrs. Hamida R.
Lasseko. SSGWEP Director Makoy stated a clear take home message at the end of the meeting:
“We need to interrupt transmission of Guinea worm disease as soon as possible”. Dr. Margaret
Itto, vice-chairperson and former State Commissioner for Health of Eastern Equatoria, led a
meeting of the South Sudan National Committee for Documentation of Dracunculiasis Elimination
at the same hotel on December 8.

MALI: 19 GW INFECTIONS; 12 KNOWN SOURCES, 11 CONTAINED

The Mali Guinea Worm Eradication Program (MGWEP) reported Guinea worm
infections in 2 humans, 16 dogs, and 1 cat in 2021, compared to 1 human and 9
dogs in 2020 (Table 1). Eleven (58%) of the infections in 2021 were contained
and presumed sources of 12 (63%) infections were identified. A line list of the
2021 infections was included in Guinea Worm Wrap-Up #283, except the latest
infected dog, which had an indigenous, contained infection in Kolongo Bozo
village on December 25, 2021.

On October 13 Segou’s Regional Director of Health Dr. Drissa Toure visited Sansanding village
in Markala district where both human Guinea worm cases in 2021 occurred. In follow-up to the
Ministry of Health meeting in late October on preventing dogs’ exposure to Guinea worm
infections, the MGWEP held workshops on December 9 and 11 with village chiefs, mayors, deputy
prefets, veterinarians, relais, and dog traders at Fangasso and Yasso health zones in Segou Region.
Participants at the workshops discussed Guinea worm’s epidemiology, strategies to interrupt
transmission of Guinea worm infections, and the system of rewards for reporting and proactive
tethering of animals at risk. The meetings recommended presenting all imported dogs to the relais
and village chief, burying fish guts, and sustaining the involvement of dog traders. Technical
advisors and/or Guinea worm focal points met with dog traders and inspected dogs in Macina,
Tominian, and San districts of Segou Region in October. Mali began proactive tethering of dogs
in endemic villages in November. The MGWEP plans to hold its annual national program review
meeting on February 8-9, 2022, in Bamako.

5
 CHAD: 7 HUMAN CASES, 855 INFECTED ANIMALS

Chad’s Guinea Worm Eradication Program (CGWEP) has provisionally reported

7 confirmed human cases (71% contained) in 7 villages, 790 infected dogs (82%
contained) in 326 villages, and 65 infected cats (76% contained) in 53 villages in
2021, compared to 12 humans, 1,508 dogs, and 63 cats in 436 villages in 2020.
The presumed sources of two human infections are known. The vast majority of
animal infections occurred in villages that also reported Guinea worm infections
in 2020 and presumably were infected in their respective villages. A list of Chad’s human cases is
in Table 1. Cameroon reported 10 infected dogs in border villages that were probably infected in
Chad.

From 10 to 24 December 2021, the Guinea Worm Eradication Program national coordinator, Dr.
Tchindebet OUAKOU, and the WHO focal point, Dr. Ibrahim DJEOMBORO, conducted a
supervisory visit in 4 refugee camps of Haraze in Salamat Province (Moyo, Masmaigne, Daha 1
and 2). During the mission, knowledge about Guinea worm disease and the cash reward scheme
was raised; four mobilization meetings with traditional leaders and chiefs were organized; four
mass sensitization sessions with more than 1000 people reached. Also, knowledge of 120
community relays was strengthened on Guinea worm disease surveillance. No Guinea worm
disease case or infected animal was recorded.

The CGWEP plans to hold its annual national review meeting on February 2-3, 2022 in
N’Djamena.

ANGOLA

The country continues to strengthen community-based surveillance and has

benefited from a WHO technical support mission led by two international
consultants, one each from Mali and Niger. This mission was mainly focused on
vector control, specifically mapping out and treatment of water sources in
endemic localities, capacity building of health professionals and community
health workers on temephos (Abate®) management and application.

The visits carried out in the province of Cunene, specifically in the villages under active
surveillance (endemic and villages at risk), allowed identification and updating the mapping of 80
unsafe water sources (potential sources of contamination), comprising of ponds, wells, stagnant
irrigation canals and river retention basins, of the 34 villages located in 4 municipalities
(Namacunde, Cuanhama, Cuvelai and Ombadja). This included the identification of 23 additional
surface water points.

6
 Figure 3. Geolocation map of mapped water points

- 30 health professionals were trained on vector control, and 24 community agents on

Community Based Surveillance of GW in the province of Namibe-where active
surveillance is being extended.
- 1 intersectoral advocacy and mobilization meeting with the provincial directorates of
Agriculture and Energy and Water.
- Several advocacy meetings with local and traditional administrative authorities of the
communities visited.

In addition, the following activities were carried out:

- 2 human rumors recorded and investigated (100%) within 24 hours (Cuanhama and
Namacunde Municipalities); GW diagnostic ruled out.
- 1 rumor reported on a dead dog since July 2021, with report that a worm allegedly emerged,
in Ohangwa locality/Namacunde Municipality, Cunene province; An in-depth
epidemiological investigation on Guinea worm is ongoing in this village.
- 2 surveillance visits and follow-up of former cases (2019, 2020).
- Ongoing weekly WHO-The Carter Center virtual meetings ensure partnership exchange
and allow The Carter Center to assist the program remotely, pending its setting up in
Angola.

7
 DONATION

John and Kathleen Schreiber, who partner with The Carter Center personally and through their
family foundation, recently donated $2 million toward Guinea worm eradication. That donation
was matched by the Carter Center Board of Trustees Challenge Fund. The fund matches, dollar
for dollar, donations of $100,000 or more. The Challenge Fund marks a historic and unique
opportunity for supporters to multiply the impact of their contributions through August 2022.

8
 Number of Laboratory-Confirmed Cases of Guinea Worm Disease, and Number Reported Contained by Month during 2021*
(Countries arranged in descending order of cases in 2020)

COUNTRIES WITH
NUMBER OF CASES CONTAINED / NUMBER OF CASES %
TRANSMISSION OF
REPORTED CONT.
GUINEA WORMS

JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER TOTAL*
CHAD 0/0 1/1 1/1 1/2 0/0 0/0 1/2 0/0 0/0 1/1 0/0 0/0 5/7 71%
ETHIOPIA 0/0 1/1 0/0 0/0 0/0 0/0 0/0 0/0 0/0 0/0 0/0 0/0 1/1 100%
SOUTH SUDAN 0/0 0/0 0/0 0/0 0/0 0/0 1/2 1/1 0/0 0/1 0/0 0/0 2/4 50%
ANGOLA 0/0 0/0 0/0 0/0 0/0 0/0 0/0 0/0 0/0 0/0 0/0 0/0 0/0 N/A
MALI 0/0 0/0 0/0 0/0 0/0 0/0 0/0 0/1 1/1 0/0 0/0 0/0 1/2 50%
TOTAL* 0/0 2/2 1/1 1/2 0/0 0/0 2/4 1/2 1/1 1/2 0/0 0/0 9 / 14 64%
% CONTAINED N/A 100% 100% 50% N/A N/A 50% 50% 100% 50% N/A N/A 64%
*Provisional

Cells shaded in black denote months when zero indigenous cases were reported. Numbers indicate how many cases were contained and reported that month.
Shaded cells denote months when one or more cases of GWD did not meet all case containment standards.

Number of Laboratory-Confirmed Cases of Guinea Worm Disease, and Number Reported Contained by Month during 2020
(Countries arranged in descending order of cases in 2019)

COUNTRIES WITH
NUMBER OF CASES CONTAINED / NUMBER OF CASES %
TRANSMISSION OF
REPORTED CONT.
GUINEA WORMS

JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER TOTAL
CHAD^ 1/1 0/2 0/3 1/2 2/2 0/0 0/1 0/1 0 /0 1/1 0/0 0/0 5 / 13 38%
SOUTH SUDAN 0/0 0/0 0/0 0/0 0/0 0/0 1/1 0/0 0 /0 0/0 0/0 0/0 1 / 1 100%
ANGOLA 0/0 0/0 0/1 0/0 0/0 0/0 0/0 0/0 0 /0 0/0 0/0 0/0 0 / 1 0%
ETHIOPIA 0/0 0/0 0/0 7/7 0/0 0/0 0/0 2/2 1 /1 1/1 0/0 0/0 11 / 11 100%
MALI § 0/0 0/0 0/1 0/0 0/0 0/0 0/0 0/0 0 /0 0/0 0/0 0/0 0 / 1 0%
TOTAL 1/1 0/2 0/5 8/9 2/2 0/0 1/2 2/3 1 /1 2/2 0/0 0/0 17 / 27 63%
% CONTAINED 100% 0% 0% 89% 100% 100% 50% 67% 100% 100% 100% 100% 63%

Cells shaded in black denote months when zero indigenous cases were reported. Numbers indicate how many cases were contained and reported that month.
Shaded cells denote months when one or more cases of GWD did not meet all case containment standards.
§Reports include Kayes, Koulikoro, Segou, Sikasso, and Mopti, Timbuktu and Gao Regions, contingent on security conditions. The GWEP continued to deploy one technical advisor to Kidal Region to oversee the
program.

^ Cameroon reported one case in February that was most likely infected in Chad.

9
RECENT PUBLICATIONS

World Health Organization, 2021. Monthly report on dracunculiasis cases, January-September

2021. Wkly Epidemiol Rec 96(46):567-568.

Inclusion of information in the Guinea Worm Wrap-Up does not

constitute “publication” of that information.
In memory of BOB KAISER

Note to contributors: Submit your contributions via email to Dr. Sharon Roy (gwwrapup@cdc.gov) or to Adam Weiss
(adam.weiss@cartercenter.org), by the end of the month for publication in the following month’s issue. Contributors
to this issue were: the national Guinea Worm Eradication Programs, Dr. Donald Hopkins and Adam Weiss of The
Carter Center, Dr. Sharon Roy of CDC, and Dr. Dieudonne Sankara of WHO.

WHO Collaborating Center for Dracunculiasis Eradication, Center for Global Health, Centers for Disease Control and
Prevention, Mailstop A-06, 1600 Clifton Road NE, Atlanta, GA 30329, USA, email: gwwrapup@cdc.gov, fax: 404-728-
8040. The GW Wrap-Up web location is http://www.cdc.gov/parasites/guineaworm/publications.html#gwwp
Back issues are also available on the Carter Center web site English and French are located at
http://www.cartercenter.org/news/publications/health/guinea_worm_wrapup_english.html.
http://www.cartercenter.org/news/publications/health/guinea_worm_wrapup_francais.html

CDC is the WHO Collaborating Center for Dracunculiasis Eradication

10