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Here we used a phenomenological model with subnational geographic targeting and fine-scale vaccine effects to model how expanding <jats:italic>V. cholerae<\/jats:italic> 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\u201312.6) cases per 1,000 fully vaccinated persons while the status quo scenario averted 6.9 (95% PI 6.0\u20137.8) cases per 1,000 fully vaccinated persons. In the testing scenario, testing costs increased by US$31 (95% PI 25\u201339) while vaccination costs reduced by US$248 (95% PI 176\u2013326) 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.<\/jats:p>","DOI":"10.1038\/s41591-024-02852-8","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T11:01:38Z","timestamp":1709636498000},"page":"1104-1110","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Enhanced cholera surveillance to improve vaccination campaign efficiency"],"prefix":"10.1038","volume":"30","author":[{"given":"Hanmeng","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2568-8193","authenticated-orcid":false,"given":"Kaiyue","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Dent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4093-4054","authenticated-orcid":false,"given":"Kirsten E.","family":"Wiens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Espoir Bwenge","family":"Malembaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8376-2857","authenticated-orcid":false,"given":"Godfrey","family":"Bwire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Placide Welo","family":"Okitayemba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee M.","family":"Hampton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8662-9077","authenticated-orcid":false,"given":"Andrew S.","family":"Azman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4156-9637","authenticated-orcid":false,"given":"Elizabeth C.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,5]]},"reference":[{"key":"2852_CR1","unstructured":"Cholera fact sheet. 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There are no competing interests from other authors.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}