Neglected tropical diseases

Dracunculiasis eradication: Mali reports zero cases in 2016

Sudan conveys its readiness for WHO verification for certification


11 January 2017 | Geneva

In 2016, a total of 25 human cases of dracunculiasis1 (guinea-worm disease) were reported to the World Health Organization (WHO); Mali reported zero cases for the first time.

“Mali’s success in 2016 marks an important milestone in overcoming dracunculiasis as it was the only country with local transmission of the disease in West Africa” said Dr Dieudonné Sankara, head of the WHO Dracunculiasis Eradication Team. “However, this great news is mitigated by challenges in ascertaining whether transmission has been interrupted, particularly because there are limitations to surveillance posed by insecurity and population displacement in the Kidal and Gao regions of the country as well as the detection of infections in a small number of dogs in Mali.”

Mali reported 5 human cases in 2015; the last known case was reported on 17 November 2015 in Gourma Rharous district in Timbuktu Region.

In 2016, dracunculiasis of humans and animals was reported in three other countries, namely:

  • Chad: 16 human cases and 1013 infected dogs
  • Ethiopia: 3 human cases and 14 infected dogs
  • South Sudan: 6 human cases and zero dog infections

In 2015, only 22 human cases were reported to WHO.

On 11 January 2017, the Federal Ministry of Health of Sudan officially confirmed the country's readiness to receive members of the International Certification Team (ICT) mission to evaluate Sudan’s eligibility for certification as free of guinea-worm disease.

Challenges

Finding and containing the last remaining cases, often in settings where there are security concerns and displaced population, are the most difficult stages of the eradication process; detecting Dracunculus medinensis infection in dogs poses another challenge. WHO and its main partners – The Carter Center and the United States Centers for Disease Control and Prevention – are working together to assist health ministries in the three remaining endemic countries to implement the recommendations of a scientific meeting on D. medinensis infection in dogs (Geneva, March 2016).

Certification

Since 1995, the International Commission for the Certification of Dracunculiasis Eradication has met 11 times and, on its recommendation, WHO has certified 198 countries, territories and areas (belonging to 186 Member States) as free of dracunculiasis transmission.

Twelve of these countries are in the African risk belt for dracunculiasis and therefore at risk of reinfection as a result of the poor water infrastructure and high population movement across the region. These countries include Burkina Faso, Benin, Cameroon, Central Africa Republic, Côte d’Ivoire, Ghana, Mauritania, Nigeria, Niger, Togo, Uganda and Senegal. Some of them, notably Burkina Faso, Cameroon, Central African Republic, Mauritania, Nigeria, Niger and Uganda are at very high risk because they neighbour endemic countries or host refugees from these neighbouring endemic countries.

WHO is assisting these countries to maintain surveillance of dracunculiasis through full integration with the Integrated Disease Surveillance and Response (IDSR) systems. Intelligence and alerts are maintained through reviews of weekly and/or monthly IDSR reports. Any rumours reported are followed up and investigated.

In September 2016, WHO conducted evaluation missions in Angola, the Democratic Republic of the Congo and Sudan to assess their level of readiness to finalize dossiers for submission to WHO, ahead of visits by the International Certification Team. In Angola and the Democratic Republic of the Congo, WHO has supported efforts by both countries to implement their certification roadmap.

Angola and the Democratic Republic of the Congo have intensified searches for the disease; zero cases have been reported to date.

WHO is the only organization mandated to certify countries as free of transmission of the disease following the recommendations of the Commission.