Dracunculiasis (Guinea-worm) eradication

WHO certifies Ghana free of dracunculiasis

16 January 2015 | Geneva

Continued drop in number of cases amid new challenges

Dr Margaret Chan, signing Ghana's certification.
From left: Dr A. Assamoa-Baah, WHO Deputy Director-General; Dr Abdul Al-Awadi, Chair ICCDE and Dr Joel Breman, Member ICCDE

The Director-General of WHO has certified Ghana as free of dracunculiasis transmission following the recommendation of the International Commission for the Certification of Dracunculiasis Eradication (ICCDE). Ghana was the second most endemic country in the world in the 1990s after Nigeria, which was certified free of transmission in December 2013.

Ghana’s achievement should inspire the four remaining endemic countries to achieve the target of zero transmission,” said Dr Abdul Al-Awadi, Chair of the ICCDE. “In Chad, however, a unique epidemiology in dogs poses a challenge that requires further research to better understand and deal with the transmission pattern of the disease”.

Ghana reported more than 179 000 cases in 1989. The last case was recorded in May 2010 after which Ghana was in the precertification phase. To be declared free of dracunculiasis transmission, a country must have reported zero indigenous cases for at least 3 consecutive years and sustained robust surveillance throughout the country. It took Ghana two decades of committed hard work to achieve zero transmission.

We methodically assessed the adequacy of Ghana’s surveillance system, and reviewed the records of past transmission and investigations of rumoured cases,” said Dr Joel Breman, the ICCDE Member who led the International Certification Team to Ghana in July 2014 to verify the absence of transmission. “We unanimously concluded that transmission there had been interrupted according to established criteria, and I extend my hearty congratulations to the Government of Ghana, its national Guinea-worm Eradication Programme and to all of WHO’s partners for this major public-health victory”.

Dracunculiasis remains endemic in four countries in Africa: Chad, Ethiopia, Mali and South Sudan. All four countries reported a total of 126 cases1 in 2014, with majority of cases reported largely from Mali and South Sudan, where until recently restricted access to endemic areas hampered eradication efforts. Combined these two countries accounted for 110 cases last year. Chad reported 13 cases while Ethiopia reported 3 cases from the Gambella Region.

WHO has so far declared a total of 198 countries, territories and areas (belonging to 186 Member States) as free of dracunculiasis transmission.

International Commission for the Certification of Dracunculiasis Eradication

WHO established the ICCDE in 1995. The Commission comprises 9 public-health experts and meets regularly. Its main objective is to evaluate the claims of countries and the status of transmission in those countries applying for certification of dracunculiasis eradication. After careful examination of the evidence provided by countries – and sometimes accompanied by an evaluation conducted by international certification teams – the Commission makes recommendations about whether a particular country should be certified free of transmission.

A country reporting zero cases for at least one year is considered to have interrupted transmission of dracunculiasis and is classified as being in the precertification stage. After completing a 3-year precertification of reporting zero indigenous cases, it becomes eligible for certification.

The disease

Dracunculiasis, a water-borne disease found in the most deprived regions of Africa, is transmitted uniquely by drinking contaminated water. People affected by the disease are often unable to attend school, to farm or to do other work, resulting in increased poverty. The disease is easily prevented through simple measures such as wider access to improved water sources, filtering unsafe drinking-water, detecting and containing cases as well as educating infected people never to wade into water, which perpetuates the life-cycle of the disease.

At the start of the eradication campaign in 1986, there were an estimated 3.5 million dracunculiasis cases. Dracunculiasis is expected to become the second human disease after smallpox to be eradicated – and the first parasitic disease to have been eradicated without any medicine or vaccine.

1 Provisional figure

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