A parasitologist examines a worm under a microscope in Bongor, Chad. Multiple examination methods are used to confirm specimens are Guinea worms. (Photo: The Carter Center/J. Hahn)

Our Goal Since 1986, The Carter Center has led the international campaign to eradicate Guinea worm disease, working closely with ministries of health and local communities, the U.S. Centers for Disease Control and Prevention, the World Health Organization, UNICEF, and many others. Guinea worm disease could become the second human disease in history, after smallpox, to be eradicated. It would be the first parasitic disease to be eradicated and the first disease to be eradicated without the use of a vaccine or medicine.

What is Guinea Worm Disease? Considered a neglected tropical disease, Guinea worm disease (dracunculiasis) is a parasitic infection caused by the nematode roundworm parasite Dracunculus medinensis. It is contracted when people consume water from stagnant sources contaminated with Guinea worm larvae. Inside a human's abdomen, Guinea worm larvae mate and female worms mature and grow. After about a year of incubation, the female Guinea worm, one meter long, creates an agonizingly painful lesion on the skin and slowly emerges from the body. Guinea worm sufferers may try to seek relief from the burning sensation caused by the emerging worm and immerse their limbs in water sources, but this contact with water stimulates the emerging worm to release its larvae into the water and begin the cycle of infection all over again. Guinea worm is a particularly devastating disease that incapacitates people for extended periods of time, making them unable to care for themselves, work, grow food for their families, or attend school. How Widespread is the Disease? In 1986, the disease afflicted an estimated 3.5 million people a year in 21 countries in Africa and Asia. Today, thanks to the work of The Carter Center and its partners — including the countries themselves — the incidence of Guinea worm has been reduced by more than 99.99 percent to 54 provisional* cases in 2019. The Carter Center works to eradicate Guinea worm in five countries affected by the disease: South Sudan, Mali, Chad, Ethiopia, and Angola.

A surveillance team from the South Sudan Guinea Worm Eradication Program, led by Makoy Samuel Yibi (far left), explores an area of Eastern Equatoria state. The goal is to follow up on every reported or rumored case within 24 hours. (Photo: The Carter Center/L. Gubb)

Our Strategy There is no known curative medicine or vaccine to prevent Guinea worm disease — the same treatment for emerging worms has been used for thousands of years. Traditional removal of a Guinea worm consists of winding the worm around a piece of gauze or small stick and manually extracting it — a slow, painful process that often takes weeks. The skin lesions often develop secondary bacterial infections, which exacerbate the suffering and prolong the period of disability. The Center's strategy is to work with ministries of health to stop the spread of Guinea worm disease by providing health education and helping to maintain political will. The Guinea Worm Eradication Program is wiping out this ancient disease mainly through community-based interventions to educate and change behavior, such as teaching people to filter all drinking water and preventing transmission by keeping anyone with an emerging worm from entering water sources. A challenge to eradication has been the emergence of numerous Guinea worm infections in animals, mainly domesticated dogs in Chad. Guinea worm infections were first detected in animals in 2012. Most of those infections were believed linked to dogs' consumption of fish and fish entrails containing Guinea worm larvae. Volunteers trained by Chad’s Guinea Worm Eradication Program with the Carter Center’s help have encouraged people in those areas to bury fish discards, and cash rewards are being paid for reporting infected animals and for keeping them away from water sources. Researchers are actively seeking a remedy for canine infections, including the use of established veterinary deworming drugs. Few animal infections have occurred in other countries during the eradication campaign. In 2019, Ethiopia reported eight animal infections; Mali reported nine; Angola reported one. Another challenge is insecurity. Parts of some affected countries are inaccessible to the program because of internal conflict that makes these areas unsafe to enter or travel through. Guinea worm elimination cannot be confirmed until surveillance can be carried out in all areas. For the eradication campaign to continue successfully, enormous dedication and attention to detail is critical for all field supervisors and the thousands of community-based volunteers charged with executing the campaign.

Carter Center technical advisor Laurès Dossou (foreground) and volunteer supervisor Mende Kelmane Alphonso instruct a crowd on how to detect Guinea worm disease during a 2018 cash rewards ceremony in Dangabol Village, Chad. People who report suspected Guinea worm infections and take appropriate measures can receive rewards of up to $100. (Photo: The Carter Center/J. Hahn)