WHO continues dracunculiasis eradication effort

Hopkins DR. MMWR. 2010;59(38):1239-1242.

Worldwide Dracunculus medinensis incidence hit an all-time low of fewer than 3,200 cases in 2009, and just 766 cases were reported from January to June 2010, according to a CDC report published this week in the Morbidity and Mortality Weekly Report.

From 2008 to 2009, there was a 31% decrease in overall incidence, and the trend appears to be continuing in 2010. Among the 766 cases this year, 745 were reported from 380 villages in Sudan. There were 12 cases in Ethiopia, eight cases in Ghana and one case in Mali.

The first call for elimination of dracunculiasis came in 1986 at the World Health Assembly. Goals and targets changed over the years, but by the end of 2009, the disease remained endemic in only Ethiopia, Ghana, Mali and Sudan. Although total eradication remains the endpoint, a date for that goal has not been set.

Sporadic violence and civil unrest in parts of Mali and Sudan are the most serious obstacles to eradication in those countries, according to WHO officials. In all four endemic countries, ongoing challenges exist for surveillance and reporting of incidence.

Precertification for eradication is granted about 1 year after the last indigenous case. Burkina Faso, Chad, the Ivory Coast, Kenya, Niger, Nigeria and Togo are in the precertification stage. Niger and Nigeria reported zero cases for all of 2009 and January to June 2010.

Criteria for full eradication certification include 3 years without indigenous disease and ongoing adequate nationwide surveillance. As of October 2009, Benin, Mauritania and Uganda were designated as free of the disease by WHO’s International Commission for the Certification of Dracunculiasis Eradication, bringing the global total to 187 countries where the disease has been eliminated.

CDC researchers noted that Ethiopia and Mali may be closest to eradicating transmission, but that Mali is currently in peak transmission season, which generally runs from June to November.