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
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
Open Forum Infect Dis. 2025 Jun 30;12(7):ofaf375. doi: 10.1093/ofid/ofaf375. eCollection 2025 Jul.
Enterotoxigenic (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.
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.
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).
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.
产肠毒素大肠杆菌（ETEC）是腹泻病的主要病因，而发展中国家基于人群的具有临床意义的ETEC腹泻发病率数据有限。我们深入研究了ETEC的流行病学情况；在一项疫苗试验中对一个基于人群的队列进行了跟踪研究。
我们分析了在孟加拉国达卡一个城市贫民窟开展的口服霍乱疫苗群组随机对照试验的数据。该研究涵盖90个地理群组，平均每个群组有2988户家庭（基线人口268896人）。进行了两项队列分析，一项作为动态队列，包括接种疫苗时的所有受试者、迁入者以及4年期间的新生儿，另一项为封闭队列，仅包括基线时就已存在的个体。我们评估了2011年至2015年期间接受基于治疗中心的腹泻监测的个体。
在动态队列中，ETEC发病率为150/10万人工年（PY；95%置信区间，141 - 159），在较温暖月份出现季节性高峰，在封闭队列中，发病率为153/10万PY（95%置信区间，140, 166）。发病率最高的是<1岁儿童（2007；95%置信区间，1664 - 2402），其次是1 - 4岁儿童（314；95%置信区间，252 - 386），45岁以上人群的发病率再次上升（219/10万PY；95%置信区间，177 - 267）。45岁及以下人群的重症ETEC发病率≤35/10万PY（95%置信区间，27 - 44），但45岁以上成年人的发病率升至82（95%置信区间，58 - 113）。
ETEC腹泻是幼儿和老年人的主要健康问题，通过接种疫苗以及改善水、环境卫生和个人卫生进行预防应针对这两个年龄组。
