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. ### Competing Interest Statement LH from Gavi was involved in the conceptualization and preparation of the manuscript. ### Funding Statement We received funding support from Gavi, the Vaccine Alliance (HX, ASA, ECL), the Bill & Melinda Gates Foundation (INV-044865) (KZ, ASA, ECL), and the Vaccine Impact Modelling Consortium (Bill & Melinda Gates Foundation INV-009125) (KZ, ASA, ECL). This work was carried out at the Advanced Research Computing at Hopkins (ARCH) core facility (rockfish.jhu.edu), which is supported by the National Science Foundation grant number OAC 1920103. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors. [https://github.com/HopkinsIDD/gavi\_vimc\_cholera][1] [1]: https://github.com/HopkinsIDD/gavi_vimc_cholera