News & Publications

Guinea Worm Eradication Program - Articles By Carter Center Experts

1 June 2008
Dracunculiasis, Onchocerciasis, Schistosomiasis, and Trachoma (PDF)
Annals of the New York Academy of Sciences, 1136: 45-52 (2008), Issue - Reducing the Impact of Poverty on Health and Human Development: Scientific Approaches,
Donald R. Hopkins, Frank O. Richards, Jr, Ernesto Ruiz-Tiben, Paul Emerson, P. Craig Withers, Jr. Published Online: 25 Jul 2008. The definitive version is available at www.wileyinterscience.com.

17 August 2007
Progress Toward Global Eradication of Dracunculiasis, January 2005--May 2007
Aug. 17, 2007. Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention. Reported by: DR Hopkins, MD, E Ruiz-Tiben, PhD, The Carter Center, Atlanta, Georgia. ML Eberhard, S Roy, Div of Parasitic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, CDC.

1 July 2006
Uganda's Successful Guinea Worm Eradication Program (PDF) 
Am. J. Trop. Med. Hyg., 75(1), 2006, pp. 3-8. Copyright © 2006 by The American Society of Tropical Medicine and Hygiene. JOHN B. RAWKIMARI, DONALD R. HOPKINS, and ERNESTO RUIZ-TIBEN; Ministry of Health, Entebbe, Uganda; The Carter Center, Atlanta, Georgia. Abstract. Having begun its national Guinea Worm Eradication Program (UGWEP) in 1991 (1991 population, 16.6 million) with the third-highest number of cases reported by any endemic country, and ranked as the second-highest endemic country in the world in 1993, by 2004, Uganda celebrated it first full calendar year with no indigenous cases of the disease. Systematic interventions began in 1992 and were gradually intensified until the final indigenous case occurred in July 2003. The favorable concentration of most cases in relatively few northern districts of the country was partly offset by chronic insecurity in much of the endemic area by repeated importation of cases from neighboring Sudan. Strong support and dedicated leadership by government officials and external partners were keys to this program's dramatic success. The program cost approximately US$5.6 million.

28 October 2005
Progress Toward Global Eradication of Dracunculiasis, January 2004 - July 1005
Oct. 28, 2005. Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention. Reported by: The Carter Center, Atlanta, Georgia; World Health Organization Collaborating Center for Research, Training, and Eradication of Dracunculiasis; Div of Parasitic Diseases, National Center for Infectious Diseases, CDC.   

1 October 2005
Dracunculiasis Eradication: The Final Inch (PDF)
Am. J. Trop. Med. Hyg., 73(4), 2005, pp. 669–675 Copyright © 2005 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS,* ERNESTO RUIZ-TIBEN, PHILIP DOWNS, P. CRAIG WITHERS, JR., AND JAMES H. MAGUIRE; The Carter Center, Atlanta, Georgia; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. Abstract. This report summarizes the status of the Dracunculiasis Eradication Program as of early 2005. Nine of the 20 countries that were endemic for this disease when the program began have already interrupted transmission, Asia is free of Guinea worm, and five of the remaining disease-endemic countries reported less than 50 cases each in 2004. Ghana and Sudan each reported 45% of the 16,026 cases in 2004. Except for Sudan, whose reports are delayed, cases in the remaining disease-endemic countries were reduced by 61% during the first quarter of 2005 compared with the same period of 2004. With accelerating momentum towards zero cases in all countries, the recent settlement of Sudan's north-south civil war, and a new challenge grant from the Bill & Melinda Gates Foundation, the way now seems clear to finish eradicating dracunculiasis by 2009 in Sudan and earlier elsewhere. "The rule of the final inch . . . The work has been almost completed, the goal almost attained . . . In that moment of fatigue and self-satisfaction it is especially tempting to leave the work without having attained the apex of quality . . . In fact, the rule of the Final Inch consists in this: not to shirk this crucial work. Not to postpone it . . . And not to mind the time spent on it, knowing that one's purpose lies . . . in the attainment of perfection." —Alexander Solzhenitzyn, The First Circle

10 May 2005
Differentiating Dracunculus medinesis from D. insignis, by the sequence analysis of the 18S rRNA gene (PDF)
Published in the Annals of Tropical Medicine & Parasitology, Vol. 99, No. 5, 511-517 (2005). Authors: L. BIMI*, A. R. FREEMAN*, M. L. EBERHARD*, E. RUIZ-TIBEN (The Carter Center) and N. J. PIENIAZEK* (all others, Parasitic Diseases Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention). Received 15 February 2005, Revised 9 May 2005, Accepted 10 May 2005. ABSTRACT: This study, undertaken as a component of the global Dracunculiasis Eradication Program (DEP), was designed to provide molecular tools to distinguish Dracunculus medinensis, the nematode causing human dracunculiasis, from other tissue-dwelling nematodes, including other Dracunculus species that infect humans and other animals. DNA was extracted from D. medinensis and from a closely related species that infects North American carnivores, D.insignis, so that the genes coding for the small-subunit ribosomal RNA (18S rRNA) of the parasites could be amplified, sequenced and compared. Sequences were obtained for 20 specimens of D. medinensis (from humans in Pakistan, Yemen and six African countries endemic for dracunculiasis) and three of D. insignis (from raccoons trapped in the state of Georgia in the southern U.S.A.). All of the D. medinensis 18S-rRNA sequences were found to be 1819 bases long and identical. The three D. insignis 18S-rRNA sequences were also found to be identical to each other but were 1821 bases long and differed from the D. medinensis 18S- rRNA sequence at eight positions (representing a difference of 0.44%). The 18S-rRNA coding region of a Guinea worm extracted from a dog in Ghana was indistinguishable from that of the D. medinensis isolates from human cases. These results provide the basis for the molecular differentiation of D. medinensis that will permit the DEP to determine, rapidly and accurately, whether a worm recovered from an area considered dracunculiasis-free is a specimen of D. medinensis or not.

18 March 2003
Guinea Worm and Sudan: Center Experts Featured in The Lancet
Feature article by Dr. Donald R. Hopkins and P. Craig Withers, Jr., originally published in the Dec. 2002 supplement to The Lancet.

October 2002 

DRACUNCULIASIS ERADICATION: AND NOW, SUDAN (PDF)
Am. J. Trop. Med. Hyg., 67(4), 2002, pp. 415-422. Copyright © 2002 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS, ERNESTO RUIZ-TIBEN, NWANDO DIALLO, P. CRAIG WITHERS, JR., and JAMES H. MAGUIRE; Global 2000 Program of The Carter Center, Atlanta, Georgia; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. ABSTRACT: This paper summarizes the status of the global dracunculiasis eradication campaign as of early 2002. Of the 20 countries that were endemic when the campaign began, seven have already interrupted transmission, four countries reported less than 100 cases each, and only five countries reported more than 1,000 cases each in 2001. Only 14,000 cases remained outside Sudan in 2001. Sudan reported 78% of all cases of dracunculiasis in 2001, and virtually all of Sudan's cases were in the southern states, where the long-standing civil war limits accessibility to endemic areas. A political settlement of the waris now urgently needed, since it will be impossible to complete the eradication of dracunculiasis without peace in Sudan.

February 2000
Dracunculiasis Eradication: Delayed, Not Denied (PDF)
Am. J. Trop. Med. Hyg., 62(2), pp. 163-168. Copyright © 2000 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS, ERNESTO RUIZ-TIBEN, TRENTON K. RUEBUSH NWANDO DIALLO, ANDREW AGLE, and P. CRAIG WITHERS JR.; Global 2000 Program of The Carter Center, Atlanta, Georgia; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. ABSTRACT: By the end of 1998, Asia was free of dracunculiasis (Guinea worm disease), with Pakistan, India, and Yemen having interrupted transmission in 1993, 1996, and 1997, respectively. Transmission of the disease was also interrupted in Cameroon and Senegal during 1997.

September 1997
Dracunculiasis Eradication: Almost a Reality (PDF)
Am. J. Trop. Med. Hyg., 57(3), pp. 252-259. Copyright © 1997 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS, ERNESTO RUIZ-TIBEN, and TRENTON K. RUEBUSH; Global 2000 Program, The Carter Center, Atlanta, Georgia; Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. ABSTRACT: The idea of a global campaign to eradicate dracunculiasis was first proposed by the Centers for Disease Control and Prevention in 1980, during the advent of the International Drinking Water Supply and Sanitation Decade (IDWSSD) (1981-1990). In 1981, the Steering Committee of the IDWSSD adopted eradication of dracunculiasis as a subgoal of their efforts to provide safe drinking water to unserved populations.

1 July 1997
Cost-Benefit Analysis of the Global Dracunculiasis Eradication Campaign (PDF)
An analysis prepared by the Africa Human Development Department at the World Bank. By Aehyung Kim and Ajay Tandon, The World Bank, and Ernesto Ruiz-Tiben, The Carter Center. July 1997. ABSTRACT This paper is a cost-benefit analysis of the Global Dracunculiasis Eradication Campaign (GDEC). Dracunculiasis (or Guinea worm disease) has been endemic in several African countries as well as in Yemen, Pakistan, and India. In the past decade, the incidence of dracunculiasis has seen a remarkable decline as a result of GDEC. This paper compares expenditure on GDEC activities with estimates of increased agricultural production due to reductions in infection-related morbidity resulting from the eradication program. Using a project horizon of 1987-1998, the Economic Rate of Return (ERR) is 29%, under conservative assumptions regarding the average degree of incapacitation caused by Guinea worm infection (5 weeks). In addition, our results indicate that eradication must be achieved in Sudan -- which is projected to be the sole endemic country after 1998 -- at the very latest by the year 2001 in order for economic returns there to be consistent with those obtained in other endemic countries.

2 September 1995
Eradication of dracunculiasis from Pakistan (PDF)
Hopkins, D.R.; Azam, M; Ruiz-tiben, E; Kappus, KD. Lancet Sept 1995 issue 346 vol 8975 pp. 621-624. Summary: In 1986 the World Health Organization targeted dracunculiasis (Guinea-worm disease), which seriously impairs socioeconomic development in 16 African countries, India, Pakistan, and Yemen, to be eradicated globally. The target date for eradication by the end of 1995 was established in 1991. Pakistan eradicated dracunculiasis from the country in October, 1993, after a national campaign which began in 1987 with a nationwide village-by-village search for cases. The infection, which is transmitted by drinking water from ponds containing infected water fleas, was eradicated by using health education, cloth filters, and the cyclopsicide, temephos; and in the later stages, by case containment. Methods pioneered in Pakistan's National Guinea Worm Eradication Program are now being applied in remaining endemic countries.


March 1994
Dracunculiasis Eradication: March 1994 Update (PDF)
Am. J. Trop. Med. Hyg., 52(1), pp. 14-20. Copyright © 1995 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS, ERNESTO RUIZ-TIBEN, TRENTON RUEBUSH II, ANDREW N. AGLE, and P. CRAIG WITHERS, JR; Global 2000, Inc., The Carter Center, Atlanta, Georgia; World Health Organization Collaborating Center for Research, Training and Eradication of Dracunculiasis, Centers for Disease Control and Prevention, Atlanta, Georgia. ABSTRACT: Substantial progress has been realized in the global campaign to eradicate dracunculiasis by the end of 1995 since a previous review of the subject was published in this journal a year ago. All known endemic countries are now engaged in the eradication effort, and one or more control measures are now in place in 93% of endemic villages.

September 1993
Dracunculiasis Eradication: Beginning of the End (PDF)
Am. J. Trop. Med. Hyg., 49(3), pp. 281-289. Copyright © 1993 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS, ERNESTO RUIZ-TIBEN, ROBERT L. KAISER, ANDREW N. AGLE, and P. CRAIG WITHERS, JR; Global 2000, Inc., The Carter Center, Atlanta, Georgia; World Health Organization Collaborating Center for Research, Training and Eradication of Dracunculiasis, Centers for Disease Control and Prevention, Atlanta, Georgia. ABSTRACT:  Beginning with the International Drinking Water Supply and Sanitation Decade (1981-1990), an increasingly broad coalition of international and bilateral agencies, organizations, private companies, and other institutions have joined forces to eradicate draculiasis (Guinea worm disease).

June 1992
Homing In On Helminths (PDF)
Am. J. Trop. Med. Hyg., 46(6), pp. 626-634. Copyright © 1992 by The American Society of Tropical Medicine and Hygiene. DONALD R. HOPKINS; Global 2000, Inc., The Carter Center, Atlanta, Georgia

January 1992
Guinea Worm No One Should Suffer (PDF)
Encyclopaedia Britannica Inc., Copyright  © 1991.  In this article Dr. Donald Hopkins and Dr. Ernestine Hopkins present a history of Guinea worm disease.  The article highlights both early and more recent eradication efforts, focusing on the successful approaches of the early 1980s through 1991, which resulted in dramatic declines in the incidence of Guinea worm disease.  The piece also recognizes many of the initial donors who supported the campaign in its earliest days.  The article includes a forward by former U.S. President Jimmy Carter.