ETEC (Enterotoxigenic Escherichia Coli)

Escherichia coli (E. coli) is a bacterium that normally lives in the intestines of humans and animals. Most types of E. coli are harmless, however some cause disease. Enterotoxigenic E. coli (ETEC) is the most common cause of diagnosed travelers’ diarrhea. It is also a major cause of diarrheal disease in developing countries, especially among children. In countries with poor sanitation, ETEC is a major cause of infant death. Every year, ETEC causes 210 million diarrhea episodes and approximately 380,000 deaths worldwide. ETEC is transmitted by food or water contaminated with animal or human feces. ETEC strains adhere to the small intestinal mucosa and produce toxins that act on mucosal cells to lose water and cause diarrhea. The bacteria do not invade the intestinal mucosa.

In most cases, ETEC infections are self-limiting characterized by a few days of watery diarrhea, abdominal cramps, and sometimes a low-grade fever or nausea. However, in some cases, especially in infants or immunocompromised individuals, ETEC can cause severe illness resembling cholera and lasting up to 19 days. Antibiotics are usually not required in ETEC infections, but can be effective in reducing the duration and severity of illness. Clear liquids and oral rehydration solution are recommended to prevent dehydration and loss of electrolytes.

For travelers in developing countries, ETEC infection can be prevented by avoiding foods and beverages that could be contaminated with bacteria and by drinking bottled water.

There is no global control target for ETEC specifically, but the Integrated Global Action Plan for the Prevention & Control of Pneumonia and Diarrhea calls for the elimination of preventable child deaths from diarrhea by 2025. Their goal is to reduce mortality from diarrhea in children under five years of age to fewer than 1 death per 1,000 live births by 2025.

Currently no vaccines for ETEC are available. However, there are several candidates in development.