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Rapid loss of immunity is necessary to explain historical cholera epidemics

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Survivors of severe cholera infections receive long-lasting immunity to reinfection. The epidemiological significance of this immunity is unclear, however, due to the large fraction of cholera cases that are mild or asymptomatic. We analyzed 50 years of cholera mortality data from 26 districts in historic Bengal using mechanistic models and recently-developed likelihood-based inference techniques. Our models fit the data dramatically better than all previously presented models and robustly predict that most exposures result not in infection but in short-term immunity, which wanes on a timescale of weeks to months. Our results suggest a new model structure for diseases with inapparent infection and a new focus for future investigations of cholera immunology and control.

This talk is part of the Worms and Bugs series.

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