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Clinical surveillance systems obscure the true cholera infection burden in an endemic region
Hegde, Sonia T. Khan, Ashraful Islam Perez-Saez, Javier Khan, Ishtiakul Islam Hulse, Juan Dent Islam, Md Taufiqul Khan, Zahid Hasan Ahmed, Shakeel Bertuna, Taner Rashid, Mamunur
Hegde, Sonia T.
Khan, Ashraful Islam
Perez-Saez, Javier
Khan, Ishtiakul Islam
Hulse, Juan Dent
Islam, Md Taufiqul
Khan, Zahid Hasan
Ahmed, Shakeel
Bertuna, Taner
Rashid, Mamunur
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Journal article
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2024-02-20
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Epidemiology
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https://doi.org/10.1038/s41591-024-02810-4
Abstract
Our understanding of cholera transmission and burden largely relies on clinic-based surveillance, which can obscure trends, bias burden estimates and limit the impact of targeted cholera-prevention measures. Serological surveillance provides a complementary approach to monitoring infections, although the link between serologically derived infections and medically attended disease incidence—shaped by immunological, behavioral and clinical factors—remains poorly understood. We unravel this cascade in a cholera-endemic Bangladeshi community by integrating clinic-based surveillance, healthcare-seeking and longitudinal serological data through statistical modeling. Combining the serological trajectories with a reconstructed incidence timeline of symptomatic cholera, we estimated an annual Vibrio cholerae O1 infection incidence rate of 535 per 1,000 population (95% credible interval 514–556), with incidence increasing by age group. Clinic-based surveillance alone underestimated the number of infections and reported cases were not consistently correlated with infection timing. Of the infections, 4 in 3,280 resulted in symptoms, only 1 of which was reported through the surveillance system. These results impart insights into cholera transmission dynamics and burden in the epicenter of the seventh cholera pandemic, where >50% of our study population had an annual V. cholerae O1 infection, and emphasize the potential for a biased view of disease burden and infection risk when depending solely on clinical surveillance data.
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Hegde, S.T., Khan, A.I., Perez-Saez, J. et al. Clinical surveillance systems obscure the true cholera infection burden in an endemic region. Nat Med 30, 888–895 (2024). https://doi.org/10.1038/s41591-024-02810-4
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Springer Science and Business Media
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Nature Medicine, Vol. 30, Iss. 3
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