Global deployment of rapid diagnostic tests to strengthen the fight against cholera

Through this effort, the two manufacturers' rapid diagnostic tests—which to date have been supplied through WHO and UNICEF for use in the outbreak response—will now be routinely used for cholera surveillance. Pilot studies in the Democratic Republic of the Congo (DRC), Niger, and Nepal, funded by Gavi and led by the US Centers for Disease Control and Prevention (CDC), Johns Hopkins University (JHU), and Epicenter/Doctors Without Borders, have helped increase understanding of effective strategies rapid testing. Preliminary insights from these studies, which are still ongoing, have helped shape the program – making the rollout of these tests more effective.

Cholera is on the rise globally as of 2021, with high mortality rates despite the availability of simple, effective and affordable treatment. The large number of epidemics has led to an unprecedented demand for vaccines from the affected countries. While the global supply of oral cholera vaccine increased eighteen-fold between 2013 and 2023, a large and sustained increase in demand compared to current availability has strained global supplies. Preventive vaccination campaigns had to be postponed in order to save doses for the emergency response to the epidemic. Recurring outbreaks in countries where emergency vaccination campaigns have already been implemented further highlight the need for improved speed and accuracy in identifying areas of new or persistent transmission – allowing these areas to be targeted during initial outbreak response efforts.

In 2021, the Gavi Committee approved US$55 million in funding to support a diagnostic program between 2022 and 2025 to combat cholera, yellow fever, measles, rubella, meningococcal meningitis and typhoid – with the aim of improving disease surveillance, outbreak detection and response and designing preventive programs. Gavi then opened an application window for cholera diagnostics in June 2023 – which is still open – and so far 14 countries have submitted applications and been approved by the Independent Expert Review Panel. In 2023, Gavi also launched a preventive cholera vaccination program to support countries with long-term cholera control – a strategy that has successfully reduced outbreaks of diseases such as yellow fever and meningitis.

Cholera is an acute intestinal infection that spreads through food and water contaminated with faeces containing the bacteria Vibrio cholerae. The rise of cholera has been fueled by persistent deficiencies in access to safe water and sanitation, and a failure to quickly detect outbreaks and limit their spread. Affected communities often lack access to basic health services, and the situation is exacerbated by climate-related factors, conflict and population displacement. In the face of the ongoing wave, partners working to control cholera have urgently called on countries, producers and other partners to invest in timely outbreak response and case management, rapid access to treatment, increased production of affordable vaccines and urgent improvements in access to basic water and sanitation services in affected communities.

To be effective, these multisectoral strategies for cholera control must be guided by timely and reliable cholera surveillance data. Surveillance not only supports early detection and rapid outbreak response, but also plays a central role in providing stakeholders in the other pillars of cholera prevention and control with the data they need to target, design, implement and evaluate interventions. In 2023, the GTFCC updated recommendations in favor of strategic, routine and systematic testing of suspected cholera cases and expanded use of RDTs to strengthen cholera surveillance. The Global Cholera RDT Procurement Program provides the additional support needed by eligible countries to implement these recommendations.

“We are experiencing an unprecedented multi-year increase in cholera cases worldwide, and today's announcement provides a critical boost in the fight against the disease. The rise in infections is fueled by persistent shortages in access to safe water and sanitation and our inability to reach vulnerable communities that are even more at risk due to climate change, conflict and displacement,” he said. Aurelia NguyenChief Program Officer Gavi, Vaccine Alliance. “Routine use of diagnostics will enhance cholera surveillance in affected countries and must be used to better target vaccination efforts, which play a key role in multisectoral cholera prevention and control programs.”

“Despite cholera being preventable and easily treated, children continue to suffer from this potentially deadly disease. This is why we are working with partners on all fronts and in new ways to stop epidemics,” he said Leila Pakkala, UNICEF Director of Supply. “Surveillance diagnostics help determine hot spots with great precision. This allows partners to target cholera vaccines at exactly the time and place where limited supply will save the most lives.”

“The tragedy is that cholera — a disease that can be prevented and treated — still affects and kills today. We need urgent action on all fronts, including countries' commitment to clean water, sanitation and hygiene,” he said. dr. Michael Ryan, Executive Director of WHO's Health Emergencies Programme. “WHO welcomes the introduction of these rapid cholera tests. They will provide health workers with the critical and timely data needed to stop outbreaks early and focus efforts on better cholera prevention and treatment.”

“Cholera is now spreading to areas that have been free of the disease for many years, requiring a rapid, multifaceted strategy to direct limited resources to critical areas and save lives. Accurate and high-quality testing and surveillance measures are critical to spotting the disease where it occurs, confirming cholera cases in the midst of other diarrheal diseases, and assessing the success of preventive measures such as vaccines,” he said. dr. Sergio Carmona, Acting Executive Director and Chief Medical Officer of FIND.

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