Abstract
Biological confirmation of the presence of Vibrio cholerae in clinical and environmental samples is often constrained due to resource- and labor-intensive gold standard methods. To develop low-cost, simple, and sustainable surveillance techniques, we modified previously published specimen sampling and culture techniques and applied the use of enriched dipstick testing in conjunction with the use of filter paper for DNA specimen preservation during clinical and environmental surveillance in the Far North of Cameroon from August 2013 to October 2014. The enriched dipstick methodology during routine use in a remote setting demonstrated a specificity of 99.8% compared with polymerase chain reaction (PCR). The novel application of filter paper as a preservation method for cholera DNA specimens reduced the need for cold chain storage and allowed for PCR characterization and confirmation of V. cholerae. The application of basic technologies such as the enriched dipstick, the use of simplified gauze filtration for environmental sample collection, and the use of filter paper for sample preservation enabled early case identification with reduced logistics and supply cost while reporting minimal false-positive results. Simplified laboratory and epidemiological methodologies can improve the feasibility of cholera surveillance in rural and resource-constrained areas, facilitating early case detection and rapid response implementation.
Highlights
Accurate and reliable infectious disease burden data are often minimally available or nonexistent in developing countries
Most cases that are reported are based on clinical case definitions without laboratory confirmation; significantly more cases remain undetected and unreported every year because of the inability to confirm a case. This presents a challenge for proper disease surveillance and laboratory capacity requirements, especially in remote, rural areas and contributes to a lack of understanding of cholera disease burden
Clinical and environmental samples collected between August 2013 and October 2014 were used for these analyses
Summary
Accurate and reliable infectious disease burden data are often minimally available or nonexistent in developing countries. Cholera disease burden data are deficient due to lack of surveillance in endemic areas as well as a fear of economic repercussions from reporting outbreaks, resulting in reduced reporting at district and national levels.[1] Reporting is constrained by logistics and costs associated with transport of samples to a reliable microbiology laboratory. Most cases that are reported are based on clinical case definitions without laboratory confirmation; significantly more cases remain undetected and unreported every year because of the inability to confirm a case. This presents a challenge for proper disease surveillance and laboratory capacity requirements, especially in remote, rural areas and contributes to a lack of understanding of cholera disease burden
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