Dracunculiasis eradication: Global surveillance summary, 2017

Overview

On  the  recommendation  of  the  International Commission for the Certification of Dracunculiasis Eradication (ICCDE), WHO has certified 199 countries, areas and territories (including 187 WHO Member States) as free of dracunculiasis transmission, the latest being Kenya, in February 2018. Seven countries  remain  to  be  certified: Angola, Chad, Democratic Republic of the Congo, Ethiopia, Mali, South Sudan and Sudan. 
In  2017,  for  the  first  time,  South  Sudan reported  0  human  cases  of  dracunculiasis for  the  entire  year,  whereas  Mali  reported 0human cases in both 2016 and 2017. Indigenous transmission to humans was further reduced to limited areas in 2 countries: Chad and  Ethiopia,  each  of  which  reported 15 human cases in 2017. These 30 cases were reported from 20 villages. 
Insecurity  and  inaccessibility  due  to conflicts  continue  to  hinder  eradication efforts  in  certain  areas  of  Ethiopia,  Mali, South  Sudan  and  Sudan.  In  Mali,  United Nations   humanitarian   support   agencies   continue to facilitate intermittent surveillance;  however,  despite  some  improvement, security concerns in the regions of Gao,  Kidal,  Mopti  and  Ségou  remain  a challenge  to  effective  programme  implementation.  In  addition  to  insecurity  due to  conflict,  civil  unrest,  including  cattle raids,  and  massive  population  displacement in and from South Sudan continue to   hamper  programme  implementation and restrict  access  to  some  formerly endemic  areas  in  which  surveillance should  be  sustained  for  at  least  3  more years for certification purposes, including cross-border  vigilance  and  coordination. Alternative  means  of  surveillance  for dracunculiasis are being used in the areas concerned.
Dracunculus  medinensis  infection  in  dogs  remains a challenge to global eradication, particularly in Chad and to a lesser extent in  Ethiopia  and  Mali.  Interventions  and operational  research  are  being  conducted simultaneously to address the situation. In 2017, 817 dogs in  Chad,  11  dogs  in  Ethiopia  and  9  dogs  in  Mali  were reported to be infected with Guinea-worm. The monthly occurrence of human cases in 2017 by country and the number of worms by month of emergence  are  shown  in Tables  1b  and  1c,  respectively.  In 2017, an average of 1.63 worms was found per patient (maximum, 5 worms in 1 patient), as compared with an average of 1.76 worms per patient (maximum, 7 worms in  1    patient)  recorded  in  2016,  1.5 worms  (maximum, 3  worms in 4 patients) in 2015 and 1.3 worms (maxi-mum, 4 worms in 1 patient) in 2014. The average number of worms per patient varies by country, with, for example, 1.87 worms per patient (maximum, 5 worms in 1 patient) in  Ethiopia  and  1.4 worms  per  patient  (maximum, 3  worms in 2 patients) in Chad.