World Stroke Day — October 29, 2015
Authors: Donald Hopkins, Ernesto Ruiz-Tiben, Mark Eberhard, Sharon Roy, Thomas Frieden, Harold Jaffe, Joanne Cono, Chesley Richards, Michael Iademarco, Sonja Rasmussen, Charlotte Kent, Jacqueline Gindler, Teresa Rutledge, Douglas Weatherwax, Soumya Dunworth, Teresa Hood, Jude Rutledge, Martha Boyd, Maureen Leahy, Julia Martinroe, Stephen Spriggs, Moua Yang, Quang Doan, Phyllis King, Teresa Moreland, Terraye Starr, Timothy Jones, Matthew Boulton, Virginia Caine, Katherine Daniel, Jonathan Fielding, David Fleming, William Halperin, King Holmes, Robin Ikeda, Rima Khabbaz, Phyllis Meadows, Jewel Mullen, Jeff Niederdeppe, Patricia Quinlisk, Patrick Remington, Carlos Roig, William Roper, William Schaffner
Journal: MMWR Morbidity and Mortality Weekly Report (2015)

Dracunculiasis (Guinea worm disease) is caused by Dracunculus medinensis, a parasitic worm.Approximately 1 year after a person acquires infection from contaminated drinking water, the worm emerges through the skin, usually on the lower limb.Pain and secondary bacterial infection can cause temporary or permanent disability that disrupts work and schooling.The campaign to eradicate dracunculiasis worldwide began in 1980 at CDC.In 1986, the World Health Assembly called for dracunculiasis elimination (1), and the global Guinea Worm Eradication Program, led by the Carter Center and supported by the World Health Organization (WHO), United Nations Children's Fund (UNICEF), CDC, and other partners, began assisting ministries of health in countries where dracunculiasis was endemic.In 1986, an estimated 3.5 million cases occurred each year in 20 countries in Africa and Asia (1,2).Since then, although the goal of eradicating dracunculiasis has not been achieved, considerable progress has been made.Compared with the 1986 estimate, the annual number of reported cases in 2015 has been reduced by 99% and cases are confined to four endemic countries.This report updates published (3-5) and unpublished surveillance data reported by ministries of health and describes progress toward dracunculiasis eradication from January 2014 through June 2015.During 2014, a total of 126 cases were reported from four countries (Chad [13 cases], Ethiopia [three], Mali [40], and South Sudan [70]), compared with 148 cases reported in 2013, from the same four countries.The overall 15% reduction in cases during 2013-2014 was less than that experienced in recent years, but the rate of decline increased again to 70% in the first 6 months of 2015 compared with the same period during 2014.Continued active surveillance with aggressive detection and appropriate management of cases are essential program components; however, epidemiologic challenges and civil unrest and insecurity pose potential barriers to eradication.Because the life cycle of D. medinensis is complex, its transmission can be interrupted using several strategies (4).Dracunculiasis can be prevented with four main interventions: 1) educating residents in communities where the disease is endemic, particularly persons from whom worms are emerging, to avoid immersing affected body parts in sources of drinking water; 2) filtering potentially contaminated drinking water through a cloth filter or pipe filter; 3) treating potentially contaminated surface water with the insecticide temephos (Abate) to kill the copepods (small crustaceans that host D. medinensis larvae); and 4) providing safe drinking water from bore-hole or protected hand-dug wells (6).Containment of transmission* is