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Just 28 human cases of Guinea worm disease were reported in 2018, down slightly from 30 cases reported in 2017. When The Carter Center began leading the international campaign to eradicate Guinea worm disease in 1986, there were an estimated 3.5 million cases annually in 21 countries.

During 2018, 17 cases were reported in Chad, 10 in South Sudan, and one in Angola.

"Each of these cases is a human being with a family and a life," said Adam Weiss, director of the Guinea Worm Eradication Program. "Tens of thousands of volunteers, technical advisers, and staff are working in thousands of villages to find and contain the last cases of this disease."

No cases were reported in Ethiopia, where there had been 15 in 2017, all linked to a single water source. Nor were any reported in Mali, where none have been reported since 2015. Mali continues to be recognized as an endemic country, however, because security problems make some areas inaccessible to the program.

While human cases dwindle, Guinea worm infections in animals continue to be reported. Most animal infections have been found in Chad, where 1,040 dogs and 25 cats were affected in 2018. Ethiopia reported infections in 11 dogs, five cats, and one baboon, all in one remote district in the southwest. In Mali, Guinea worm infections were found in 18 dogs and two cats. South Sudan had no animal infections.

The government of Angola, The Carter Center, the World Health Organization, and their partners are working to understand how an 8-year-old girl in southern Angola acquired a Guinea worm despite living more than 1,000 miles from the nearest known case and in a country where Guinea worm had never been detected before. DNA testing at the U.S. Centers for Disease Control and Prevention confirmed the parasite was a Guinea worm.

Kenya’s elimination of Guinea worm disease received WHO certification in 2018. The last reported indigenous case there was in 1994. The WHO has now certified 199 countries as free of the disease.

Another disease, smallpox, was eradicated in 1980 after a worldwide immunization campaign that stretched over many years. There is no vaccine for Guinea worm, nor medicine to treat it; it is being defeated by human behavioral change that interrupts the parasite’s life cycle.

Nigeriens Remember Final Guinea Worm Case

Yacouba Moustapha, 43, is a tailor in the village of Goulouské in Niger’s Zinder region. He sits for hours at his foot-powered sewing machine, making and mending dresses for women and shirts and pants for men, just as his father did.

Moustapha had plenty of time to learn the trade. Starting at age 14, he came down with a Guinea worm infection every year for several years at the start of growing season, forcing him to stay home instead of doing farm work like the rest of his family.

"It was a painful, good rest," he jokes, but admits that it bothered him that he couldn’t help his family in the arid fields.

Guinea worm is no laughing matter in a subsistence farming community.

"If you are a farmer and can't work, you don’t eat," said Moustapha’s uncle Ousseini Maman. "You must sell your possessions to buy food."

Maman, 80, is the chief of the village of 2,380 people. He also was the Carter Center-trained Guinea worm warrior in Goulouské, responsible for treating cases, teaching villagers how to avoid infection, and keeping meticulous records.

Those records, which he has to this day, show that the village's last case of Guinea worm occurred in 2005. That was also the last case in the entire Zinder region, which is about the size of the U.S. state of Illinois. That last worm emerged from the foot of his nephew, Yacouba Moustapha.