Vibrio cholerae O1 transmission in Bangladesh: insights from a nationally representative serosurvey

Summary: Background: Pandemic Vibrio cholerae from cholera-endemic countries around the Bay of Bengal regularly seed epidemics globally. Without reducing cholera in these countries, including Bangladesh, global cholera control might never be achieved. Little is known about the geographical distribu...

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Main Authors: Andrew S Azman, PhD, Stephen A Lauer, PhD, Taufiqur Rahman Bhuiyan, PhD, Francisco J Luquero, PhD, Daniel T Leung, MD, Sonia T Hegde, PhD, Jason B Harris, MD, Kishor Kumar Paul, MPH, Fatema Khaton, MSc, Jannatul Ferdous, MSc, Justin Lessler, AA, Henrik Salje, PhD, Firdausi Qadri, PhD, Emily S Gurley, PhD
Format: Article
Language:English
Published: Elsevier 2020-12-01
Series:The Lancet Microbe
Online Access:http://www.sciencedirect.com/science/article/pii/S2666524720301415
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author Andrew S Azman, PhD
Stephen A Lauer, PhD
Taufiqur Rahman Bhuiyan, PhD
Francisco J Luquero, PhD
Daniel T Leung, MD
Sonia T Hegde, PhD
Jason B Harris, MD
Kishor Kumar Paul, MPH
Fatema Khaton, MSc
Jannatul Ferdous, MSc
Justin Lessler, AA
Henrik Salje, PhD
Firdausi Qadri, PhD
Emily S Gurley, PhD
spellingShingle Andrew S Azman, PhD
Stephen A Lauer, PhD
Taufiqur Rahman Bhuiyan, PhD
Francisco J Luquero, PhD
Daniel T Leung, MD
Sonia T Hegde, PhD
Jason B Harris, MD
Kishor Kumar Paul, MPH
Fatema Khaton, MSc
Jannatul Ferdous, MSc
Justin Lessler, AA
Henrik Salje, PhD
Firdausi Qadri, PhD
Emily S Gurley, PhD
Vibrio cholerae O1 transmission in Bangladesh: insights from a nationally representative serosurvey
The Lancet Microbe
author_facet Andrew S Azman, PhD
Stephen A Lauer, PhD
Taufiqur Rahman Bhuiyan, PhD
Francisco J Luquero, PhD
Daniel T Leung, MD
Sonia T Hegde, PhD
Jason B Harris, MD
Kishor Kumar Paul, MPH
Fatema Khaton, MSc
Jannatul Ferdous, MSc
Justin Lessler, AA
Henrik Salje, PhD
Firdausi Qadri, PhD
Emily S Gurley, PhD
author_sort Andrew S Azman, PhD
title Vibrio cholerae O1 transmission in Bangladesh: insights from a nationally representative serosurvey
title_short Vibrio cholerae O1 transmission in Bangladesh: insights from a nationally representative serosurvey
title_full Vibrio cholerae O1 transmission in Bangladesh: insights from a nationally representative serosurvey
title_fullStr Vibrio cholerae O1 transmission in Bangladesh: insights from a nationally representative serosurvey
title_full_unstemmed Vibrio cholerae O1 transmission in Bangladesh: insights from a nationally representative serosurvey
title_sort vibrio cholerae o1 transmission in bangladesh: insights from a nationally representative serosurvey
publisher Elsevier
series The Lancet Microbe
issn 2666-5247
publishDate 2020-12-01
description Summary: Background: Pandemic Vibrio cholerae from cholera-endemic countries around the Bay of Bengal regularly seed epidemics globally. Without reducing cholera in these countries, including Bangladesh, global cholera control might never be achieved. Little is known about the geographical distribution and magnitude of V cholerae O1 transmission nationally. We aimed to describe infection risk across Bangladesh, making use of advances in cholera seroepidemiology, therefore overcoming many of the limitations of current clinic-based surveillance. Methods: We tested serum samples from a nationally representative serosurvey in Bangladesh with eight V cholerae-specific assays. Using these data with a machine-learning model previously validated within a cohort of confirmed cholera cases and their household contacts, we estimated the proportion of the population with evidence of infection by V cholerae O1 in the previous year (annual seroincidence) and used Bayesian geostatistical models to create high-resolution national maps of infection risk. Findings: Between Oct 16, 2015, and Jan 24, 2016, we obtained and tested serum samples from 2930 participants (707 households) in 70 communities across Bangladesh. We estimated national annual seroincidence of V cholerae O1 infection of 17·3% (95% CI 10·5–24·1). Our high-resolution maps showed large heterogeneity of infection risk, with community-level annual infection risk within the sampled population ranging from 4·3% to 62·9%. Across Bangladesh, we estimated that 28·1 (95% CI 17·1–39·2) million infections occurred in the year before the survey. Despite having an annual seroincidence of V cholerae O1 infection lower than much of Bangladesh, Dhaka (the capital of Bangladesh and largest city in the country) had 2·0 (95% CI 0·6–3·9) million infections during the same year, primarily because of its large population. Interpretation: Serosurveillance provides an avenue for identifying areas with high V cholerae O1 transmission and investigating key risk factors for infection across geographical scales. Serosurveillance could serve as an important method for countries to plan and monitor progress towards 2030 cholera elimination goals. Funding: The Bill & Melinda Gates Foundation, National Institutes of Health, and US Centers for Disease Control and Prevention.
url http://www.sciencedirect.com/science/article/pii/S2666524720301415
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spelling doaj-0af29e0fb4e543a587a17ba2e41c9e422020-12-09T04:17:23ZengElsevierThe Lancet Microbe2666-52472020-12-0118e336e343Vibrio cholerae O1 transmission in Bangladesh: insights from a nationally representative serosurveyAndrew S Azman, PhD0Stephen A Lauer, PhD1Taufiqur Rahman Bhuiyan, PhD2Francisco J Luquero, PhD3Daniel T Leung, MD4Sonia T Hegde, PhD5Jason B Harris, MD6Kishor Kumar Paul, MPH7Fatema Khaton, MSc8Jannatul Ferdous, MSc9Justin Lessler, AA10Henrik Salje, PhD11Firdausi Qadri, PhD12Emily S Gurley, PhD13Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Correspondence to: Dr Andrew S Azman, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USADepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAicddr,b, Dhaka, BangladeshDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Epicentre, Paris, FranceDivision of Infectious Diseases and Division of Microbiology and Immunology, University of Utah School of Medicine, Salt Lake City, UT, USADepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USADivision of Infectious Diseases and Division of Global Health, Massachusetts General Hospital, Boston, MA, USA; Department of Pediatrics, Harvard School of Medicine, Boston, MA, USAicddr,b, Dhaka, Bangladeshicddr,b, Dhaka, Bangladeshicddr,b, Dhaka, BangladeshDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USADepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, Franceicddr,b, Dhaka, BangladeshDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; icddr,b, Dhaka, BangladeshSummary: Background: Pandemic Vibrio cholerae from cholera-endemic countries around the Bay of Bengal regularly seed epidemics globally. Without reducing cholera in these countries, including Bangladesh, global cholera control might never be achieved. Little is known about the geographical distribution and magnitude of V cholerae O1 transmission nationally. We aimed to describe infection risk across Bangladesh, making use of advances in cholera seroepidemiology, therefore overcoming many of the limitations of current clinic-based surveillance. Methods: We tested serum samples from a nationally representative serosurvey in Bangladesh with eight V cholerae-specific assays. Using these data with a machine-learning model previously validated within a cohort of confirmed cholera cases and their household contacts, we estimated the proportion of the population with evidence of infection by V cholerae O1 in the previous year (annual seroincidence) and used Bayesian geostatistical models to create high-resolution national maps of infection risk. Findings: Between Oct 16, 2015, and Jan 24, 2016, we obtained and tested serum samples from 2930 participants (707 households) in 70 communities across Bangladesh. We estimated national annual seroincidence of V cholerae O1 infection of 17·3% (95% CI 10·5–24·1). Our high-resolution maps showed large heterogeneity of infection risk, with community-level annual infection risk within the sampled population ranging from 4·3% to 62·9%. Across Bangladesh, we estimated that 28·1 (95% CI 17·1–39·2) million infections occurred in the year before the survey. Despite having an annual seroincidence of V cholerae O1 infection lower than much of Bangladesh, Dhaka (the capital of Bangladesh and largest city in the country) had 2·0 (95% CI 0·6–3·9) million infections during the same year, primarily because of its large population. Interpretation: Serosurveillance provides an avenue for identifying areas with high V cholerae O1 transmission and investigating key risk factors for infection across geographical scales. Serosurveillance could serve as an important method for countries to plan and monitor progress towards 2030 cholera elimination goals. Funding: The Bill & Melinda Gates Foundation, National Institutes of Health, and US Centers for Disease Control and Prevention.http://www.sciencedirect.com/science/article/pii/S2666524720301415