{"doi":"10.1038/s41591-024-02810-4","title":"Clinical surveillance systems obscure the true cholera infection burden in an endemic region","abstract":"Our understanding of cholera transmission and burden largely relies on clinic-based surveillance, which can obscure trends, bias burden estimates and limit the impact of targeted cholera-prevention measures. Serological surveillance provides a complementary approach to monitoring infections, although the link between serologically derived infections and medically attended disease incidence-shaped by immunological, behavioral and clinical factors-remains poorly understood. We unravel this cascade in a cholera-endemic Bangladeshi community by integrating clinic-based surveillance, healthcare-seeking and longitudinal serological data through statistical modeling. Combining the serological trajectories with a reconstructed incidence timeline of symptomatic cholera, we estimated an annual Vibrio cholerae O1 infection incidence rate of 535 per 1,000 population (95% credible interval 514-556), with incidence increasing by age group. Clinic-based surveillance alone underestimated the number of infections and reported cases were not consistently correlated with infection timing. Of the infections, 4 in 3,280 resulted in symptoms, only 1 of which was reported through the surveillance system. These results impart insights into cholera transmission dynamics and burden in the epicenter of the seventh cholera pandemic, where >50% of our study population had an annual V. cholerae O1 infection, and emphasize the potential for a biased view of disease burden and infection risk when depending solely on clinical surveillance data.","journal":"Nature Medicine","year":2024,"id":421807,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":28,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9513,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":467696,"name":"Ashraful Islam Khan","orcid":"0000-0003-3751-1974","position":1,"is_corresponding":false},{"id":466089,"name":"Javier Perez‐Saez","orcid":"0000-0003-3909-2048","position":2,"is_corresponding":false},{"id":1169685,"name":"Ishtiakul Islam Khan","orcid":"0000-0001-9415-8113","position":3,"is_corresponding":false},{"id":1157931,"name":"Juan Dent Hulse","orcid":null,"position":4,"is_corresponding":false},{"id":780435,"name":"Md Taufiqul Islam","orcid":"0000-0003-1584-484X","position":5,"is_corresponding":false},{"id":908332,"name":"Zahid Hasan Khan","orcid":"0000-0002-8526-4165","position":6,"is_corresponding":false},{"id":1169686,"name":"Shakeel Ahmed","orcid":"0000-0002-3405-2146","position":7,"is_corresponding":false},{"id":1170230,"name":"Taner Bertuna","orcid":null,"position":8,"is_corresponding":false},{"id":1169687,"name":"Mamunur Rashid","orcid":"0000-0001-7558-4168","position":9,"is_corresponding":false},{"id":468919,"name":"Rumana Rashid","orcid":"0000-0001-6986-7209","position":10,"is_corresponding":false},{"id":1169688,"name":"Md Zakir Hossain","orcid":"0000-0002-6022-7835","position":11,"is_corresponding":false},{"id":422014,"name":"Tahmina Shirin","orcid":"0000-0002-5061-3783","position":12,"is_corresponding":false},{"id":48762,"name":"Kirsten E. Wiens","orcid":"0000-0003-4093-4054","position":13,"is_corresponding":false},{"id":328825,"name":"Emily S. Gurley","orcid":"0000-0002-8648-9403","position":14,"is_corresponding":false},{"id":352712,"name":"Taufiqur Rahman Bhuiyan","orcid":"0000-0003-3755-4763","position":15,"is_corresponding":false},{"id":62115,"name":"Firdausi Qadri","orcid":"0000-0002-8928-9888","position":16,"is_corresponding":false},{"id":78332,"name":"Andrew S. Azman","orcid":"0000-0001-8662-9077","position":17,"is_corresponding":false},{"id":352715,"name":"Sonia T. Hegde","orcid":"0000-0001-6426-0096","position":0,"is_corresponding":true}],"reference_count":60,"raw_metadata":null,"created_at":"2026-07-19T01:57:41.370244Z","pmid":"38378884","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}