Latest situation as of 31 December 2023

In 2023, 5 countries reported a total of 14 human cases of dracunculiasis in a total of 11 villages, namely, Chad (9 cases), South Sudan (2 cases), Mali (1  case) and 1 case each in Cameroon and Central African Republic (CAR), which was certified as dracunculiasis-free in 2007. The case in CAR was probably linked to population movements with Chad.

Insecurity and inaccessibility due to conflicts continue to hinder elimination in certain areas of Mali, South Sudan and Sudan while accessibility and instability persist in certified countries such as CAR. Security has been improving in Mali; however, the regions of Gao, Kidal, Mopti and Ségou are still difficult to access because of security concerns, which have affected programme implementation.

Dracunculus medinensis infection of domestic dogs remains a challenge to global eradication in Angola, Chad, Cameroon at its border with Chad, Ethiopia and Mali.

In 2023, additional interventions were made, the full results of which will be seen in 2024. In 2023, 406  dogs in Chad, 85 dogs in Angola, 251 dogs in Cameroon, 1 dog in Ethiopia and 41 dogs in Mali were reported to be infected.

The global burden of dracunculiasis has fallen significantly since the launch of eradication efforts in the 1980s when 20 countries were endemic for the disease.

In 1986, an estimated 3.5 million new cases occurred.

In 1989, based on active village-based searches, 892 055 cases were reported to have occurred in 15 of the 20 endemic countries (excluding data from Chad, the Central African Republic, Senegal and Sudan).

In 2022, 4 countries reported a total of 13 human cases of dracunculiasis, namely, Chad (6 cases), Ethiopia (1 case), South Sudan (5 cases) and the Central African Republic (CAR), which was certified as dracunculiasis-free in 2007, also reported 1 case, an infection linked to Chad, in a total of 11 villages. Insecurity and inaccessibility due to conflicts continue to hinder elimination and certification in certain areas of Mali, South Sudan and Sudan and in certified countries such as CAR. Security has been improving in Mali; however, the regions of Gao, Kidal, Mopti and Ségou are still difficult to access because of security concerns, which has affected programme implementation. Intermittent surveillance in Mali is being supported by United Nations humanitarian assistance and Mali’s Peace Health initiative that is being assisted by the Carter Center. In South Sudan, insecurity due to conflict, civil unrest (including cattle raids) and massive population displacement continue to challenge programme implementation and restrict access to some endemic and formerly endemic areas. Security concerns also undermine cross-border surveillance and coordination among endemic countries and non-endemic countries such as CAR’s border with Chad, the border of Sudan with South Sudan, and the borders of Niger and Burkina Faso with Mali.

Alternative means of surveillance for dracunculiasis are being used in the areas concerned, including involvement of and ownership by local communities as well as working with nongovernmental organizations.

Dracunculus medinensis infection of domestic dogs remains a challenge to global eradication in Angola, Chad, Cameroon at its border with Chad, Ethiopia and Mali. In 2022, however, additional interventions were made, the full results of which remain to be seen in 2023. In 2022, 521 dogs in Chad, 1 dog in Ethiopia and 39 dogs in Mali were reported to be infected.

The monthly occurrence of human cases in 2022 by country and the number of worms by month of emergence are shown in Tables 1a and 1b, respectively. In 2022, an average of 1.2 worms was found per patient (maximum of 6 worms in 1 patient) as compared with an average of 1.1 worms per patient (maximum, 2  worms in 1 patient) in 2021. As in previous years, the average number of worms per patient differed by country and by epidemiological zone within countries.

Reports on surveillance indicators by country are presented in Table 4. The integrated disease surveillance and response (IDSR) system and the health management information system (HMIS) continue to include reports on dracunculiasis in humans. In endemic districts, the proportions of health facilities (IDSR reporting units) that reported monthly, including those with 0 cases, were as follows: Chad (13%), Ethiopia (100%), Mali (85%) and South Sudan (100%). During 2022, a total of 7181 villages were under active surveillance and were submitting monthly reports in those countries. The proportions of endemic districts that submitted at least 9 monthly reports were 100% in Angola, 100% in Chad, 100% in Ethiopia, 100% in Mali and 100% South Sudan.

All the countries that have not yet been certified as free of dracunculiasis offer cash rewards for voluntary reporting of cases and animal infections, and monitor and report the level of awareness of individuals about the reward. In endemic and pre-certification countries, over >200, 000 rumours of human cases were reported in 2022 from both endemic and non-endemic districts; of these, 99% were investigated within 24 h. In comparison, 117 232 rumours were reported in 2021. In 2022, >65 000 rumours were reported from non-endemic districts, of which 2 (1 each in Central Africa Republic and South Sudan) were confirmed as human cases of dracunculiasis. Of the 136,000 rumours reported in 2022 in endemic districts, 11 were confirmed as cases. Improved community awareness about the cash rewards and more rigorous recording and documentation of the disease in endemic and non-endemic areas of these countries have resulted in the reporting and investigation of increasingly more rumours, as well as stronger surveillance systems.

In 2022, all 7 countries that were yet to be certified (Angola, Chad, DRC, Ethiopia, Mali, South Sudan, Sudan) carried out active case searches through standalone house-to-house surveys, national immunization days or mass drug distribution campaigns, in addition to passive rumour reporting. Endemic countries sustained information-sharing with neighbouring countries and have continued to strengthen cross-border surveillance with countries that are free of dracunculiasis.

Of the countries in the post-certification stage, 13 (Benin, Burkina Faso, Cameroon, CAR, Côte d’Ivoire, Ghana, Kenya, Mauritania, Namibia, Niger, Nigeria, Senegal and Togo) submitted quarterly reports in 2022. A total of 1512 rumours were reported and investigated in these countries in 2022 (1 in Benin, 15 in Burkina Faso, 1448 in Cameroon, 1 in Côte d’Ivoire, 4 in Kenya, 0 in Namibia, 17 in Niger, 23 in Nigeria, 0 in Senegal, and 3 in Togo), of which, 99.6% were investigated within 24 h, while, in 2021, 1257 rumours were reported.