Epidemiological and Clinical Features of Enterotoxigenic Escherichia coli (ETEC) Diarrhea in an Urban Slum in Dhaka, Bangladesh

Abstract

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.