Journal Article Epublish
PubMed: 39618115 DOI: 10.1017/S0950268824000888
Inferring the proportion of undetected cholera infections from serological and clinical surveillance in an immunologically naive population.
Epidemiol Infect 152:e149
Authors: Flavio Finger, Joseph Lemaitre, Stanley Juin, Brendan Jackson, Sebastian Funk, Justin Lessler, Eric Mintz, Patrick Dely, Jacques Boncy, Andrew S Azman
Affiliations
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.
- Epicentre, Paris, France.
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Ministère de la Santé Publique et de la Population, Port au Prince, Haiti.
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.
- Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.
Abstract
Most infections with pandemic are thought to result in subclinical disease and are not captured by surveillance. Previous estimates of the ratio of infections to clinical cases have varied widely (2 to 100 infections per case). Understanding cholera epidemiology and immunity relies on the ability to translate between numbers of clinical cases and the underlying number of infections in the population. We estimated the infection incidence during the first months of an outbreak in a cholera-naive population using a Bayesian vibriocidal antibody titer decay model combining measurements from a representative serosurvey and clinical surveillance data. 3,880 suspected cases were reported in Grande Saline, Haiti, between 20 October 2010 and 6 April 2011 (clinical attack rate 18.4%). We found that more than 52.6% (95% Credible Interval (CrI) 49.4-55.7) of the population ≥2 years showed serologic evidence of infection, with a lower infection rate among children aged 2-4 years (35.5%; 95%CrI 24.2-51.6) compared with people ≥5 years (53.1%; 95%CrI 49.4-56.4). This estimated infection rate, nearly three times the clinical attack rate, with underdetection mainly seen in those ≥5 years, has likely impacted subsequent outbreak dynamics. Our findings show how seroincidence estimates improve understanding of links between cholera burden, transmission dynamics and immunity.
MeSH
Epidemiology, Incidence, Cholera, Immunity, Communicable Diseases, Infections