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期刊来源：Nat Med

原文链接：https://doi.org/10.1038/s41591-024-02810-4

摘要内容如下：

我们对霍乱传播和负担的了解很大程度上依赖于基于临床的监测，这可能会掩盖趋势，使负担估计产生偏差，并限制有针对性的霍乱预防措施的影响。血清学监测为监测感染提供了一种补充方法，尽管血清学衍生的感染和医学关注的疾病发病率之间的联系（由免疫、行为和临床因素形成）仍然知之甚少。我们通过统计建模整合基于临床的监测、卫生保健寻求和纵向血清学数据，揭示了孟加拉国霍乱流行社区中的这种级联。将血清学轨迹与重建的症状性霍乱发病时间表相结合，我们估计O1群霍乱弧菌感染的年发病率为535/1，000人（95%可信区间514-556），发病率随年龄组的增加而增加。仅以临床为基础的监测低估了感染的数量，并且报告的病例与感染时间并不一致。在这些感染中，3280人中有4人出现症状，其中只有1人是通过监测系统报告的。这些结果有助于深入了解第七次霍乱大流行中心的霍乱传播动态和负担，我们的研究人群中超过50%的人每年都有O1群霍乱弧菌感染，并强调当仅依赖临床监测数据时，对疾病负担和感染风险的看法可能存在偏差。

英文原文如下：

Abstracts

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.

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