Clinical surveillance systems obscure the true cholera infection burden in an endemic region.

Autor: Hegde ST; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA., Khan AI; Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh., Perez-Saez J; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA.; Unit of Population Epidemiology, Geneva University Hospitals, Geneva, Switzerland.; Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland., Khan II; Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh., Hulse JD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA., Islam MT; Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh., Khan ZH; Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh., Ahmed S; Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh., Bertuna T; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA., Rashid M; Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh., Rashid R; Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh., Hossain MZ; Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh., Shirin T; Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh., Wiens KE; Department of Epidemiology, Temple University, Philadelphia, PA, USA., Gurley ES; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA., Bhuiyan TR; Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh., Qadri F; Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh. fqadri@icddrb.org., Azman AS; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA. azman@jhu.edu.; Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland. azman@jhu.edu.; Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland. azman@jhu.edu.
Jazyk: angličtina
Zdroj: Nature medicine [Nat Med] 2024 Mar; Vol. 30 (3), pp. 888-895. Date of Electronic Publication: 2024 Feb 20.
DOI: 10.1038/s41591-024-02810-4
Abstrakt: 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.
(© 2024. The Author(s).)
Databáze: MEDLINE
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