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Shigellosis and enterotoxigenic Escherichia coli (ETEC)

Shigella and enterotoxigenic Escherichia coli (ETEC) are two of the leading bacterial causes of diarrhea worldwide, and, together, they account for about one billion cases of diarrhea annually. Insufficient data exist, but conservative estimates suggest that, combined, Shigella and ETEC are responsible for almost one-third of the nearly 600,000 child deaths from diarrhea each year, as well as many deaths in older age groups. Shigellosis and illness from ETEC usually follow the ingestion of contaminated food or water. Shigella can also be transferred by person-to-person contact. ETEC can usually be treated through rehydration therapy, and both Shigella and ETEC can be treated with antibiotics, although the rate of resistance to the most commonly used antibiotics is sharply on the rise for Shigella. Currently, no licensed vaccines targeting Shigella or ETEC exist; however, vaccines against both bacteria are in development.

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Shigellosis and ETEC disease

  • Shigella and ETEC are two of the leading bacterial causes of diarrhea worldwide. Insufficient data exist, but conservative estimates suggest that, together, these bacteria are responsible for almost one-third of the nearly 600,000 child deaths from diarrhea each year. Millions more are hospitalized with these infections, which can lead to dehydration and malnutrition as well as impaired physical and cognitive development in young children.
  • Estimates indicate that Shigella and ETEC may also be important causes of diarrhea and dysentery in age groups older than 5 years, with 100 million episodes occurring annually among children and adolescents in the 5 to 14 year age group.
  • Results from the Global Enterics Multicenter Study confirmed that both ETEC and Shigella remain within the top four pathogens causing moderate-to-severe diarrhea among children in Africa and South Asia.
  • Shigellosis is endemic worldwide and is responsible for an estimated 120 million cases of severe dysentery annually, the overwhelming majority of which occur in children in the developing world. Additionally, it is a major illness among military personnel, and travelers from industrialized countries are also at risk.
  • ETEC may be the first enteric illness encountered by many infants, and it causes several hundred million cases of diarrhea each year, mostly in children. Repeated ETEC infections among children in developing countries are not rare, and the peak incidence of ETEC diarrhea in these areas occurs in the first two years of life. ETEC is also the most common cause of travelers' diarrhea that affects individuals from industrialized countries visiting endemic areas.
  • Shigella and ETEC infections usually follow the ingestion of contaminated food or water. Shigella can also be transferred by person-to-person contact. ETEC can usually be treated through rehydration therapy, and both Shigella and ETEC can be treated with antibiotics, although the rate of resistance to the most commonly used antibiotics is sharply on the rise for Shigella.

Shigella and ETEC vaccines

  • Prevention through vaccination is a critical part of the strategy to reduce the incidence and severity of diarrheal disease, particularly among children in low-resource settings.
  • Both Shigella and ETEC have been longstanding World Health Organization targets for vaccine development, and sharp declines in age-specific diarrhea/dysentery attack rates for each pathogen indicate that natural immunity does develop following exposure; thus, vaccination to prevent disease should be feasible.
  • Currently, no licensed vaccines targeting Shigella or ETEC exist. The development of vaccines against these infections has been hampered by technical constraints, insufficient support for coordination, and a lack of market forces for research and development.
  • Most vaccine development efforts are taking place in the public sector or as research programs within biotechnology companies. Several vaccine candidates against Shigella and ETEC are currently in various phases of research and development, including a number of ongoing clinical trials.

Related diseases

Diarrheal disease is a leading cause of death in children in developing countries. In addition to Shigella and ETEC, there are many other pathogens that contribute to morbidity and mortality from diarrheal disease, including rotavirus, which is the leading viral cause of severe diarrheal disease in infants. Learn more about rotavirus.

References

Page last updated: November 2013.

Photo: PATH/Mike Wang.