disease, causing substantial disability in around half of those infected. People with worms emerging can be disabled for the three to ten weeks it takes the worms to fully emerge. When worms emerge near joints, the inflammation around a dead worm, or infection of the open wound can result in permanent stiffness, pain, or destruction of the joint. Some people with dracunculiasis have continuing pain for 12 to 18 months after the worm has emerged. Around 1% of dracunculiasis cases result in death from secondary infections of the wound. When dracunculiasis was widespread, it would often affect entire villages at once. Outbreaks occurring during planting and harvesting seasons severely impair a community's agricultural operations – earning dracunculiasis the moniker "empty granary disease" in some places. Communities affected by dracunculiasis also see reduced school attendance as children of affected parents must take over farm or household duties, and affected children may be physically prevented from walking to school for weeks. Infection does not create immunity, so people can repeatedly experience dracunculiasis throughout their lives. Prevention There is no vaccine for dracunculiasis, and once infected with D. medinensis there is no way to prevent the disease from running its full course. Consequently, nearly all effort to reduce the burden of dracunculiasis focuses on preventing the transmission of D. medinensis from person to person. This is primarily accomplished by filtering drinking water to physically remove copepods. Nylon filters, finely woven cloth, or specialized filter straws are all effective means of copepod removal. Sources of drinking water can be treated with the larvicide temephos, which kills copepods. Where possible, open sources of drinking water are replaced by deep wells that can serve as new sources of clean water. Public education campaigns inform people in affected areas how dracunculiasis spreads and encourage those with the disease to avoid soaking their wounds in bodies of water that are used for drinking. Epidemiology Dracunculiasis is nearly eradicated, with just 15 cases reported worldwide in 2021 and 13 in 2022. This is down from 27 cases in 2020, and dramatically less than the estimated 3.5 million annual cases in 20 countries in 1986 – the year the World Health Assembly called for dracunculiasis' eradication. Dracunculiasis remains endemic in just four countries: Chad, Ethiopia, Mali, and South Sudan. Dracunculiasis is a disease of extreme poverty, occurring in places where there is poor access to clean drinking water. Cases tend