Guinea Worm Eradication Program at CDC
The global campaign to eradicate Guinea worm disease (GWD) began in 1980 at the U.S. Centers for Disease Control and Prevention (CDC). CDC suggested that the eradication of GWD (also known as dracunculiasis) would be an ideal indicator to measure the success of the United Nations’ International Drinking Water Supply and Sanitation Decade (1981–1990) because it was believed that people could only get GWD by drinking contaminated water. In 1984, the World Health Organization Collaborating Center for Research, Training, and Eradication of Dracunculiasis was established at CDC. This name would later change in 2017 to the World Health Organization Collaborating Center for Dracunculiasis Eradication (WHOCC). In 1986, the World Health Assembly (WHA) adopted a formal resolution calling for the elimination of GWD country by country and the Guinea Worm Eradication Program (GWEP) was born. The Carter Centerexternal icon (TCC) became the lead organization in this global effort. They direct a coalition of partners that includes Ministries of Health of endemic countries, the World Health Organization (WHOexternal icon), UNICEFexternal icon, and CDC along with thousands of village volunteers and supervisory health staff. Based on the success of the GWEP, the WHA adopted its first resolution to eradicate GWD from the world in 1991. The GWEP continues to receive support from numerous donor agencies, foundations, institutions, and governments.
Initial activities supported by the WHOCC provided the information used to develop the current program. Research projects included evaluating filter materials for straining water, studying the copepods (tiny “water fleas” too small to be clearly seen without a magnifying glass) involved in the Guinea worm lifecycle, testing potential drugs to treat GWD, and assessing different chemicals that could be added to drinking water to safely kill the copepods. The WHOCC also worked with partners to develop and publish training manuals for surveillance, health education, vector control, and case containment. Over the years, CDC staff members have provided technical assistance to national GWEPs and other partners on program planning, training, surveillance, case searches, health education, vector control, case containment, and case management.
The WHOCC at CDC currently focuses on the following activities:
- Providing laboratory diagnostic services to support the GWEP. The WHOCC provides laboratory confirmation of Dracunculus medinensis in all human cases of GWD and in certain animal infections of programmatic interest using microscopic examination and, if required, molecular assays (polymerase chain reaction—PCR). The WHOCC also works on the development of new laboratory methods to help support ongoing GWEP surveillance and research needs.
- Monitoring and reporting the extent of GWD around the world. The WHOCC distributes a monthly newsletter called the Guinea Worm Wrap-Up that is produced by The Carter Center with help from CDC and WHO. This newsletter summarizes the progress of the GWEP. CDC staff members have also co-authored other publications concerning the status of the GWEP, some of which can be found listed under Publications.
- Conducting research to improve GWEP implementation and surveillance. WHOCC research activities most recently include:
- 2011—Evaluation of knowledge, attitudes, and practices about GWD in Chad. Identification of at-risk localities at which to pre-position supplies for prevention and treatment of GWD and establish or strengthen surveillance for the 2011 transmission season
- 2011–present—Scientists at CDC began a longstanding partnership with the Wellcome Trust Sanger Institute to sequence the entire genome of D. medinensis as the program moves closer to global eradication. These collaborations are continuing as more in-depth evaluations of the genome are being undertaken to better understand human and animal infections.
- 2012—Evaluation of risk factors for GWD in Chad and potential links between 2010 and 2011 human GWD cases
- 2017—Evaluation of risk factors for human GWD in Chad and pilot study of an evaluation of risk factors for GWD in dogs
- 2018—Evaluation of risk factors for Guinea worm infections in dogs
- Ongoing since 2016—Development and validation of serologic assays to detect antibodies in humans and animals infected with Dracunculus medinensis.
- Providing expert technical advice on GWD eradication.
- The WHOCC laboratory examines suspected cases of GWD that occur in areas or countries already declared free from GWD to support ongoing global GWEP surveillance activities.
- CDC staff members participate in WHO-organized evaluations of the GWEP in countries that are either near to stopping GWD transmission or have already stopped transmission. Such evaluations are part of the process that countries must follow to obtain international certification of GWD-free status. CDC has participated in many of these evaluations, including in Benin (2006), Burkina Faso (2010), Chad (2008), Cote d’Ivoire (2013), Ethiopia (2008, 2018), Ghana (2011, 2014), Kenya (2017), Liberia (2006), Mali (2008), Mauritania (2006), Niger (2010, 2013), Nigeria (2007, 2010), Sierra Leone (2006), Togo (2011), and Uganda (2005).
- The WHOCC provides consultation on GWD surveillance issues. For example, the WHOCC partnered with Ministries of Health, The Carter Center, and WHO on international evaluations of the Ethiopian Dracunculiasis Eradication Programme’s surveillance system after a GWD outbreak in 2008 and in surveillance evaluations and outbreak investigations in Chad in 2011, 2017, 2018, and 2019.
- The WHOCC participates in meetings of the International Commission for the Certification of Dracunculiasis Eradication and in GWEP program review meetings with Ministries of Health, The Carter Center, WHO, UNICEF, and other partners.