Model outputs from Xu and Zou et al. "Enhanced cholera surveillance to improve vaccination campaign efficiency"

Systematic testing for <i>Vibrio cholerae</i> O1 is rare, which means that the world’s limited supply of oral cholera vaccines (OCV) may not be delivered to areas with the highest true cholera burden. We used a phenomenological model with sub-national geographic targeting and fine-scale vaccine effects to model how expanding V. cholerae testing affected impact and cost-effectiveness for preventive vaccination campaigns across different bacteriological confirmation and vaccine targeting assumptions in 35 African countries. Systematic testing followed by OCV targeting based on confirmed cholera yielded higher efficiency and cost-effectiveness and slightly fewer averted cases than status quo scenarios targeting suspected cholera. Targeting vaccine to populations with an annual incidence rate greater than 10 per 10,000, the testing scenario averted 10.8 (95% prediction interval (PI): 9.4-12.6) cases per 1,000 fully vaccinated persons (FVP) while the status quo scenario averted 6.9 (95% PI: 6.0-7.8) cases per 1,000 FVP. In the testing scenario, testing costs increased by $31 (95% PI:25-39) while vaccination costs reduced by $248 (95% PI: 176-326) per averted case compared to the status quo. Introduction of systematic testing into cholera surveillance could improve efficiency and reach of global OCV supply for preventive vaccination.针对O1群霍乱弧菌（Vibrio cholerae O1）的系统性检测十分稀缺，这意味着全球有限的口服霍乱疫苗（oral cholera vaccines, OCV）供给可能无法覆盖实际霍乱负担最高的地区。本研究采用纳入次国家级地理靶向与精细化疫苗效应的现象学模型，针对35个非洲国家，在不同细菌学确诊标准与疫苗靶向假设下，模拟扩大霍乱弧菌检测对预防性疫苗接种运动的效果与成本效益的影响。相较于以疑似霍乱为靶向的现状情景，基于确诊霍乱结果开展系统性检测后再分配OCV的策略，具备更高的效率与成本效益，且可减少少量可避免的病例数。当将疫苗靶向接种于年发病率高于10/10000的人群时，检测情景下每1000名完全接种者（fully vaccinated persons, FVP）可避免10.8例（95%预测区间（prediction interval, PI）：9.4-12.6）病例，而现状情景下该数值为6.9例（95% PI：6.0-7.8）。与现状情景相比，检测情景下每避免1例病例的检测成本增加31美元（95% PI：25-39），但疫苗接种成本减少248美元（95% PI：176-326）。将系统性检测纳入霍乱监测体系，可提升全球OCV供给在预防性疫苗接种中的利用效率与覆盖范围。