Table 1.

Policy summary table

Background	Systematic laboratory confirmation of suspected cholera cases is rare, which means the world’s limited supply of OCV may be delivered to geographic areas that do not have the highest true burden of V. cholerae.
Main findings and limitations	Our strategic modeling study in cholera-affected regions of Africa found that targeting vaccines on the basis of the burden of systematically confirmed cholera resulted in more averted cases per vaccine used, higher cost-effectiveness when accounting for the costs of testing and vaccine delivery, with a relatively small reduction in the absolute magnitude of averted cases across model settings. Limitations of this study include not accounting for annual variability in cholera burden and immunity and simplified assumptions of testing and vaccine targeting compared to reality. Due to the model assumptions, results should be interpreted relative to the other reported scenarios and not as absolute projections.
Policy implications	Introduction of systematic testing into cholera surveillance could improve efficiency and reach of global OCV supply for preventive vaccination. Future investigation should consider what drives country-level variability in the optimal systematic testing strategy to inform specific surveillance system designs.