Since 2021, a global resurgence of cholera has claimed thousands of lives in Africa, the Middle East and Asia. This ongoing crisis is fueled by persistent gaps in access to clean water and sanitation, problems exacerbated by recent humanitarian crises and extreme weather events such as floods, droughts and displacement.
Rapid identification of cholera cases is critical because if cholera is detected early and targeted by vaccination programs, fewer people will need vaccination to prevent widespread infections.
Cholera, a highly contagious and potentially fatal intestinal infection, is spread through water and food contaminated with bacteria. Vibrio cholerae. Early detection is essential to stopping outbreaks once they start and preventing them from spreading across state lines and borders. These surveillance data will help improve the planning of vaccination campaigns in response to current outbreaks and target future preventive vaccination efforts.
To achieve this goal, the GAVI-funded program has begun rolling out more than 1.2 million rapid cholera diagnostic tests in 14 countries, some of which are at high risk of cholera infection in the coming months. The first shipment is due to arrive in Malawi today.
Why do we need these tests?
In January 2023, the World Health Organization classified the global cholera outbreak as a Level 3 emergency, the highest domestic level of emergency. A large number of outbreaks in 31 countries has created unprecedented demand for oral cholera vaccines. Although their supply increased 18-fold between 2013 and 2023, continued high demand has led to available doses being prioritized for outbreak response, delaying preventive vaccination campaigns.
Rapid identification of cholera cases is critical because if cholera is detected early and targeted by vaccination programs, fewer people will need vaccination to prevent widespread infections.
How do the tests work?
The two tests used are lateral flow tests designed to detect Vibrio cholerae in stool samples from patients suspected of having cholera. They were developed by Arkray Healthcare and Abbott and have already been used by WHO and UNICEF during cholera outbreaks. The tests will now be used routinely in the 14 approved countries, building on lessons learned from ongoing pilot studies in the Democratic Republic of Congo (DRC), Niger and Nepal.
These tests are primarily intended for surveillance use by trained health care providers and surveillance managers to monitor trends in cholera incidence, detect outbreaks early, and inform future prevention strategies, including vaccination. Although diagnostic tests for radepid are not confirmatory, they can provide valuable information about trends over time. It is important to note that these tests should not be used to make clinical decisions.
The program aims to strengthen countries’ cholera surveillance capacity by building a strong evidence base to guide prevention efforts, including asking Gavi to introduce oral cholera vaccines as part of prevention campaigns. In addition, rapid identification of probable cholera cases aims to improve the speed of outbreak detection and response.
Where will they be deployed?
Trials will be conducted in 14 low-income countries and more than 1.2 million units will be delivered. The first shipments arrived in Malawi on April 5, 2024, followed by other shipments to countries currently severely affected by cholera outbreaks, such as Zambia, Syria, Somalia and Ethiopia.
Cameroon, Democratic Republic of Congo (DRC), Mozambique, Nigeria, Sierra Leone, Uganda and Zimbabwe will also receive rapid testing kits.
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