{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T02:12:58Z","timestamp":1789783978388,"version":"4.0.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0012450","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:00:00Z","timestamp":1726185600000}}],"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T00:00:00Z","timestamp":1725321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","award":["5\/8-I (6)\/2019-20-ECD-II dated 27\/10\/2020"],"award-info":[{"award-number":["5\/8-I (6)\/2019-20-ECD-II dated 27\/10\/2020"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Indian subcontinent being an important region in the fight to eliminate cholera needs better cholera surveillance. Current methods miss most infections, skewing disease burden estimates. Triangulating serosurvey data, clinical cases, and risk factors could reveal India\u2019s true cholera risk.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We synthesized data from a nationally representative serosurvey, outbreak reports and risk factors like water, sanitation and the Multidimensional Poverty Index, to create a composite vulnerability index for assessing state-wise cholera risk in India. We tested 7,882 stored sera samples collected during 2017\u201318 from individuals aged 9\u201345 years, for vibriocidal antibodies to <jats:italic>Vibrio cholerae<\/jats:italic> O1 using a cut-off titre \u2265320 defining as elevated titre. We also extracted data from the 2015\u201319 Integrated Disease Surveillance Programme and published cholera reports.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Overall, 11.7% (CI: 10.4\u201313.3%) of the sampled population had an elevated titre of cholera vibriocidal antibodies (\u2265320). The Southern region experienced the highest incidence (16.8%, CI: 12.1\u201322.8), followed by the West (13.2%, CI: 10.0\u201317.3) and North (10.7%, CI: 9.3\u201312.3). Proportion of samples with an elevated vibriocidal titre (\u2265320) was significantly higher among individuals aged 18\u201345 years (13.0% CI: 11.2\u201315.1) compared to children 9\u201317 years (8.6%, CI 7.3\u201310.0, p&lt;0.05); we found no differences between sex or urbanicity. Between 2015\u20132019, the Integrated Disease Surveillance Program (IDSP) reported 29,400 cases of cholera across the country. Using the composite vulnerability index, we found Karnataka, Madhya Pradesh, and West Bengal were the most vulnerable states in India in terms of risk of cholera.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The present study showed that cholera infection is present in all five regions across India. The states with high cholera vulnerability could be prioritized for targeted prevention interventions.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0012450","type":"journal-article","created":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T17:40:07Z","timestamp":1725385207000},"page":"e0012450","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Analysis of Cholera Risk in India: Insights from 2017\u201318 Serosurvey Data Integrated with Epidemiologic data and Societal Determinants from 2015\u20132019"],"prefix":"10.1371","volume":"18","author":[{"given":"Suman","family":"Kanungo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjan Kumar","family":"Nandy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rounik","family":"Talukdar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Murhekar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew S.","family":"Azman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia T.","family":"Hegde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranab","family":"Chatterjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debjit","family":"Chakraborty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhuchhanda","family":"Das","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Kamaraj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muthusamy Santhosh","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Dengue Serosurvey Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6897-7390","authenticated-orcid":true,"given":"Shanta","family":"Dutta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,9,3]]},"reference":[{"issue":"Suppl 1","key":"pntd.0012450.ref001","doi-asserted-by":"crossref","first-page":"A18","DOI":"10.1016\/j.vaccine.2019.07.035","article-title":"Cholera in selected countries in Asia","volume":"38","author":"AL Lopez","year":"2020","journal-title":"Vaccine"},{"key":"pntd.0012450.ref002","doi-asserted-by":"crossref","DOI":"10.1126\/scitranslmed.aau6242","article-title":"Estimating cholera incidence with cross-sectional serology.","volume":"11","author":"AS Azman","year":"2019","journal-title":"Sci. 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