South Sudan ends Guinea-worm disease transmission

The world’s newest nation, South Sudan, has succeeded in interrupting transmission of Guinea worm disease, the country’s minister of health announced Wednesday at The Carter Center.

As of the end of February 2018, South Sudan, which gained independence from Sudan in 2011, has recorded zero cases of Guinea worm disease for 15 consecutive months. Because the Guinea worm life cycle is about a year, a 15-month absence of cases indicates the interruption of transmission.

“This is a great achievement for our young nation,” Dr. Riek Gai Kok, South Sudan’s health minister, said during the global Guinea Worm Eradication Program’s 22nd annual review at The Carter Center. “Our health workers and thousands of volunteers have done exemplary work eliminating this disease across our country, and I have no doubt that the World Health Organization will grant certification in due time.”

Dr. Tebebe Yemane Berhan, goodwill ambassador for Guinea worm eradication in Ethiopia, participated in the announcement, as did Dr. Gautam Biswas of the WHO. Representing The Carter Center were Dr. Ernesto Ruiz-Tiben and Dr. Donald R. Hopkins, both original architects of the Guinea worm eradication campaign.

The WHO has certified 199 countries, territories, and areas as free of Guinea worm disease. Kenya received WHO certification in February, having detected no cases since 1994. As South Sudan enters the precertification stage, the only countries remaining to be certified are Angola, Chad, the Democratic Republic of the Congo, Ethiopia, Mali, and Sudan.

Chad and Ethiopia each reported 15 cases in 2017. Those 30 were the only cases in the world in 2017; when The Carter Center began leading the Guinea worm eradication campaign in 1986, there were an estimated 3.5 million cases annually in 21 countries on two continents.

The most recent case in South Sudan was Maralina Buolaa, a 13-year-old girl who lives in Khor Jamus village, Jur River County, Western Bahr al Ghazal state; her worm emerged on November 20, 2016. Meet others affected by Guinea worm disease

Former U.S. President Jimmy Carter congratulated South Sudan.

“The people and government of South Sudan have achieved a great milestone in the worldwide effort to eradicate Guinea worm disease. Today’s news is the fruit of good faith shown by all parties that agreed to the 1995 cease-fire during Sudan’s terrible civil war, allowing health workers to start a campaign of interventions against this horrible parasitic disease,” said Carter, who negotiated the cease-fire.

“South Sudan’s success shows that people can collaborate for the common good. We look forward to certification by the WHO in the next few years that South Sudan has won the battle against this ancient scourge. We are within reach of a world free of Guinea worm disease.”

Guinea worm in South Sudan

South Sudan reported no cases in the entire 2017 calendar year, only 11 years after starting with 20,582 reported cases in 2006. This success in a country with few resources and a complicated epidemiology ranks high among the program’s major achievements, including elimination in 2008 in what was the world’s most endemic country, Nigeria.

“South Sudan prevailed despite the most complex Guinea worm transmission among humans of any country, peak prevalence during a long rainy season, vast territory, and poor infrastructure, as well as ongoing postwar insecurity,” said Hopkins, the Carter Center’s special advisor for Guinea worm eradication and former vice president for health.

The South Sudan Guinea Worm Eradication Program formally began operations after the 2005 Comprehensive Peace Agreement ended Sudan’s two-decade-long civil war, but “it got a 10-year head start” from the almost six-month-long “Guinea Worm Cease-Fire” in 1995, said Ruiz-Tiben, director of the Carter Center’s Guinea Worm Eradication Program. Southern Sudan continued to build on this initial success, and cases consequently declined sharply from 118,578 reported in 1996 to 54,890 reported in 2000.

“South Sudan has been buffeted by insecurity of all kinds, and political difficulties, and at times famine since 2006 when the program began,” Ruiz-Tiben noted.

The main factors in its success, Hopkins said, were the exceptionally strong and consistent political support provided to the program by the government of South Sudan, including South Sudanese President Salva Kiir Mayardit and national ministers of health, including Dr. Riek Gai Kok and his predecessors, the inspired leadership of Mr. Makoy Samuel Yibi, the national program’s director, and the dedicated service of more than 18,000 village volunteers.

The WHO is helping to monitor South Sudanese refugees in Ethiopia, Uganda, and other neighboring countries; no Guinea worm cases have been found among the refugee population.

The South Sudan program held a review in Juba in December 2017. Participants included First Vice President of the Republic of South Sudan Gen. Taban Deng Gai, the minister of health, and numerous other officials. The meeting recommended enhancing South Sudan’s collaboration with Ethiopia’s program to guard against cases along their mutual border.