Open forum infectious diseases · 2025
Epidemiological and Clinical Features of Enterotoxigenic Escherichia coli (ETEC) Diarrhea in an Urban Slum in Dhaka, Bangladesh.
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Chowdhury Fahima, Islam Md Taufiqul, Ahmmed Faisal, Akter Afroza, Mwebia Martin Bundi, Im Justin, Rickett Natasha Y, Mbae Cecilia Kathure, Aziz Asma Binte, Ongadi Beatrice, Khanam Farhana, Khan Ashraful Islam, Firoj Md Golam, Rahman Sadia Isfat Ara, Park Se Eun, Haile Kassa, Mwangi Moses, Ngugi Benjamin, Behute Meseret Gebre, Kering Kelvin, Agampodi Suneth, Kanungo Suman, Zaman K, Kariuki Samuel, Qadri Firdausi, Clemens John D
Аннотация
BACKGROUND: Enterotoxigenic Escherichia coli (ETEC) is a major cause of diarrheal illness, and population-based data on the incidence of clinically significant ETEC diarrhea in developing countries are limited. We provide insight into ETEC epidemiology; we followed a population-based cohort in a vaccine trial.
METHODS: We analyzed data from a cluster-randomized controlled trial of an oral cholera vaccine conducted in an urban slum in Dhaka, Bangladesh. The study covers 90 geographical clusters with an average population of 2988 households/cluster (baseline population 268 896). Two cohort analyses were conducted, 1 as dynamic cohort that included all subjects at vaccination, in-migrants, and births over 4 years and a closed cohort, which included only individuals present at baseline. We evaluated individuals placed under treatment center-based diarrheal surveillance between 2011 and 2015.
RESULTS: In the dynamic cohort, the ETEC incidence was 150/100 000 person-years (PY; 95% CI, 141-159), with seasonal peaks during warmer months, and in the closed cohort, the incidence was 153/100 000 PY (95% CI, 140, 166). The highest rate was seen in children aged <1 year (2007; 95% CI, 1664-2402), then in those aged 1-4 years (314; 95% CI, 252-386), and again the rate rose in those aged >45 years (219/100 000 PY; 95% CI, 177-267). The rate of severe ETEC was ≤35/100 000 PY for persons aged ≤45 years (95% CI, 27-44), but rose to 82 for adults aged >45 years (95% CI, 58-113).
CONCLUSIONS: ETEC diarrhea is a major health problem in young children and older adults, prevention through vaccination and improved water, sanitation, and hygiene should target both age groups.
METHODS: We analyzed data from a cluster-randomized controlled trial of an oral cholera vaccine conducted in an urban slum in Dhaka, Bangladesh. The study covers 90 geographical clusters with an average population of 2988 households/cluster (baseline population 268 896). Two cohort analyses were conducted, 1 as dynamic cohort that included all subjects at vaccination, in-migrants, and births over 4 years and a closed cohort, which included only individuals present at baseline. We evaluated individuals placed under treatment center-based diarrheal surveillance between 2011 and 2015.
RESULTS: In the dynamic cohort, the ETEC incidence was 150/100 000 person-years (PY; 95% CI, 141-159), with seasonal peaks during warmer months, and in the closed cohort, the incidence was 153/100 000 PY (95% CI, 140, 166). The highest rate was seen in children aged <1 year (2007; 95% CI, 1664-2402), then in those aged 1-4 years (314; 95% CI, 252-386), and again the rate rose in those aged >45 years (219/100 000 PY; 95% CI, 177-267). The rate of severe ETEC was ≤35/100 000 PY for persons aged ≤45 years (95% CI, 27-44), but rose to 82 for adults aged >45 years (95% CI, 58-113).
CONCLUSIONS: ETEC diarrhea is a major health problem in young children and older adults, prevention through vaccination and improved water, sanitation, and hygiene should target both age groups.