Citation
Azman, Andrew S.; Lessler, Justin; Luquero, Francisco J.; Bhuiyan, Taufiqur Rahman; Khan, Azharul Islam; Chowdhury, Fahima; Kabir, Alamgir; Gurwith, Marc; Weil, Ana A.; & Harris, Jason B., et al. (2019). Estimating Cholera Incidence with Cross-Sectional Serology. Science Translational Medicine, 11(480). PMCID: PMC6430585Abstract
The development of new approaches to cholera control relies on an accurate understanding of cholera epidemiology. However, most information on cholera incidence lacks laboratory confirmation and instead relies on surveillance systems reporting medically attended acute watery diarrhea. If recent infections could be identified using serological markers, cross-sectional serosurveys would offer an alternative approach to measuring incidence. Here, we used 1569 serologic samples from a cohort of cholera cases and their uninfected contacts in Bangladesh to train machine learning models to identify recent Vibrio cholerae O1 infections. We found that an individual's antibody profile contains information on the timing of V. cholerae O1 infections in the previous year. Our models using six serological markers accurately identified individuals in the Bangladesh cohort infected within the last year [cross-validated area under the curve (AUC), 93.4%; 95% confidence interval (CI), 92.1 to 94.7%], with a marginal performance decrease using models based on two markers (cross-validated AUC, 91.0%; 95% CI, 89.2 to 92.7%). We validated the performance of the two-marker model on data from a cohort of North American volunteers challenged with V. cholerae O1 (AUC range, 88.4 to 98.4%). In simulated serosurveys, our models accurately estimated annual incidence in both endemic and epidemic settings, even with sample sizes as small as 500 and annual incidence as low as two infections per 1000 individuals. Cross-sectional serosurveys may be a viable approach to estimating cholera incidence.URL
http://dx.doi.org/10.1126/scitranslmed.aau6242Reference Type
Journal ArticleYear Published
2019Journal Title
Science Translational MedicineAuthor(s)
Azman, Andrew S.Lessler, Justin
Luquero, Francisco J.
Bhuiyan, Taufiqur Rahman
Khan, Azharul Islam
Chowdhury, Fahima
Kabir, Alamgir
Gurwith, Marc
Weil, Ana A.
Harris, Jason B.
Calderwood, Stephen B.
Ryan, Edward T.
Qadri, Firdausi
Leung, Daniel T.