A transformation in cholera surveillance

Abstract

The integration of rapid diagnostic tests (RDTs) into cholera surveillance marks a pivotal shift in global cholera control strategies. In 2024, Gavi, the Vaccine Alliance initiated the shipment of cholera RDTs to cholera-endemic countries via Gavi diagnostic support, aligning with the publication of the Global Task Force for Cholera Control (GTFCC) surveillance for cholera guidance. The GTFCC guidance recommends systematically testing suspected cases of cholera with RDTs. Implementing these tests at scale requires substantial changes to health systems spanning logistics, operations, and finance, such as supply chain adaptations, training key personnel, and integrating RDTs into national surveillance systems. Competing health priorities and declining global health funding further complicate implementation efforts. Additionally, although RDTs are valued for their speed and accessibility, concerns about their diagnostic accuracy remain. This is despite GTFCC guidance-based on prospective studies and systematic reviews-confirming that their performance is sufficient to support expanded use for early outbreak detection and monitoring. This Personal View argues that RDT-driven surveillance can close long-standing data gaps, refine burden estimates, and improve targeted interventions, such as vaccines, through early outbreak detection and rapid response. Despite complex factors that must be accounted for during implementation, with sustained support from Gavi and the GTFCC, the roll-out of RDTs for cholera is a major step towards achieving the 2030 cholera elimination goals.