Enhanced cholera surveillance as a tool for improving vaccination campaign efficiency

Systematic testing for Vibrio cholerae O1 is rare, which means that the world’s limited supply of oral cholera vaccines may not be delivered to areas with the highest true cholera burden. We modeled how expanding V. cholerae testing affected vaccine impact and cost-effectiveness across different bacteriological confirmation and vaccine targeting assumptions. Systematic testing yielded higher efficiency and cost-effectiveness and slightly fewer averted cases than status quo scenarios targeting suspected cholera. With a 10 per 10,000 incidence rate targeting threshold, testing and status quo scenarios averted 10.3 (95% PI: 8.3-13.0) and 5.6 (95% PI: 4.6-6.7) cases per 1,000 FVPs, respectively. Comparing these scenarios, testing costs increased by $37 (95% PI: 29-52) while vaccination costs reduced by $376 (95% PI: 275-556) per averted case. Introduction of systematic testing into cholera surveillance could improve efficiency and reach of global OCV supply for preventive vaccination.