Beyond Reported Cases: Using Data from Serosurveys and Systematic Reviews to Improve Disease Burden Estimates

Infectious disease burden is often underestimated in passive surveillance due to mild and asymptomatic infections, barriers to healthcare access, and limited testing resources. This talk will begin with a discussion of a SARS-CoV-2 serosurvey conducted in Juba, South Sudan, which revealed widespread mild and asymptomatic infections and highlighted the need for population-specific validation of serological tests. The Juba study laid the groundwork for my current work on cholera, an enteric disease with a substantial burden in low-resource settings worldwide. I will discuss cholera transmission dynamics and present findings from a recent cholera serosurvey that, like the SARS-CoV-2 study, identified a significant number of unreported infections. Next, I will dive into the results of two systematic reviews and meta-analyses: 1) an analysis of cholera positivity rates to assess how well-suspected cases align with true cholera infections, and 2) a synthesis of data on care-seeking behavior for cholera and diarrheal diseases, integrating both quantitative and qualitative evidence to explore factors influencing healthcare utilization. By integrating data from multiple sources, my work aims to support more effective public health decision-making and distribution of mitigation resources through an improved understanding of disease burden.