Vibrio cholerae O1 transmission in Bangladesh: insights from a nationally representative serosurvey.
Vibrio cholerae O1 transmission in Bangladesh: insights from a nationally representative serosurvey.
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孟加拉国霍乱弧菌 O1 传播：来自全国代表性血清调查的见解。
DOI：
10.1016/s2666-5247(20)30141-5
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发表时间：
2020-12
期刊：
影响因子：
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通讯作者：
Gurley ES
中科院分区：
文献类型：
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作者：
Azman AS;Lauer SA;Bhuiyan TR;Luquero FJ;Leung DT;Hegde ST;Harris JB;Paul KK;Khaton F;Ferdous J;Lessler J;Salje H;Qadri F;Gurley ES
来自孟加拉湾周围霍乱流行国家的流行性霍乱弧菌定期在全球范围内传播。如果不减少包括孟加拉国在内的这些国家的霍乱，全球霍乱控制可能永远无法实现。关于全国V型霍乱传播的地理分布和规模知之甚少。我们的目的是描述整个孟加拉国的感染风险，利用霍乱血清流行病学的进步，从而克服了目前基于诊所的监测的许多局限性。我们测试了来自孟加拉国全国代表性血清调查的血清样本，其中有8种霍乱弧菌特异性检测。使用这些数据和先前在一组确诊霍乱病例及其家庭接触者中验证的机器学习模型，我们估计了前一年有霍乱弧菌感染证据的人口比例（年度血清发病率），并使用贝叶斯地理统计模型创建高分辨率的国家感染风险地图。在2015年10月16日至2016年1月24日期间，我们从孟加拉国70个社区的2930名参与者（707个家庭）中获得并检测了血清样本。我们估计全国霍乱弧菌O 1感染的年血清发病率为17.3%（95%CI 10.5 - 24.1）。我们的高分辨率地图显示了感染风险的巨大异质性，抽样人群中社区水平的年度感染风险范围为4.3%至62.9%。在整个孟加拉国，我们估计在调查前一年发生了2810万（95% CI 171 - 392）例感染。尽管霍乱弧菌O 1感染的年血清发病率低于孟加拉国大部分地区，但达卡（孟加拉国首都和该国最大城市）在同一年有200万（95%CI 0.6 - 3.9）人感染，主要是因为其人口众多。血清监测提供了一种途径，以确定高V霍乱O 1传播的地区和调查的关键风险因素的感染跨越地理尺度。血清监测可作为各国规划和监测实现2030年消除霍乱目标进展情况的重要方法。比尔和梅林达盖茨基金会，美国国立卫生研究院和美国疾病控制和预防中心。
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. 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. 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. 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. The Bill & Melinda Gates Foundation, National Institutes of Health, and US Centers for Disease Control and Prevention.