ETEC Vaccine: A New Solution for Preventing Foodborne Disease

Analysis

Authors

  • Ninda Inayah Faculty of Medicine Universitas Islam Negeri Syarif Hidayatullah Jakarta
  • Fajria Shofa Faculty of Medicine Universitas Islam Negeri Syarif Hidayatullah Jakarta
  • Tiara Alfiattutthoyyibah Faculty of Medicine Universitas Islam Negeri Syarif Hidayatullah Jakarta
  • Fitria Mahrunnisa Department of Pediatrics Faculty of Medicine UIN Syarif Hidayatullah Jakarta

DOI:

https://doi.org/10.55175/cdk.v52i9.1621

Keywords:

ETEC, foodborne disease, vaccine

Abstract

Diarrhea remains a leading cause of under-fve mortality globally and in Indonesia. In 2020, the mortality rate for children aged 12-59 months due to diarrhea was 4.55%. Enterotoxigenic Escherichia coli (ETEC) is estimated to cause approximately 220 million episodes of diarrhea annually worldwide. ETEC vaccines are being developed to prevent the acute disease burden and long-term sequelae such as growth and cognitive impairment linked to repeated infections. Public health models suggest that an ETEC vaccine has the potential to reduce 4.2%–6.0% of deaths due to diarrhea, particularly among infants and children in low-resource settings, and decrease antibiotic use, thereby improving treatment cost efciency. This paper reviews ETEC structure and pathogenesis, clinical features, and the current vaccine pipeline focused on colonization factor (CF) antigens and LT/ST toxins. The highlighted leading candidates, including ETVAX (an oral inactivated whole-cell vaccine currently in phase 2b), and multivalent approaches targeting the most prevalent CFs, which could theoretically protect against 70%-80% of circulating disease-causing strains in at-risk populations.

Downloads

Download data is not yet available.

References

Mirhoseini A, Amani J, Nazarian S. Review on pathogenicity mechanism of enterotoxigenic Escherichia coli and vaccines against it. Microb Pathog. 2018;117:162-9. doi: 10.1016/j.micpath.2018.02.032.

World Health Organization (WHO). WHO preferred product characteristics for vaccines against enterotoxigenic Escherichia coli [Internet]. Geneva: WHO; 2021. Available from: https://www.who.int/publications/i/item/who-preferred-product-characteristics-for-vaccines-against-enterotoxigenic-escherichia-coli.

Kementerian Kesehatan RI. Laporan kinerja Kementerisn Kesehatan tahun 2022 [Internet]. Jakarta: Kemenkes; 2023. Available from: https://ppid.kemkes.go.id/toapsoot/2022/06/LAKIP-KEMENKES-2022_compressed-2-242.pdf.

P Rahayu W, Nurjannah S, Komalasari E. Escherichia coli: patogenitas, analisis dan kajian risiko. Bogor: Penerbit ITB Press; 2018.

Mueller M, Tainter CR. Escherichia coli infection [Internet]. 2023. Available from: https://pubmed.ncbi.nlm.nih.gov/33231968/.

World Health Organization. Diarrhoeal disease [Internet]. Geneva: WHO; 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease.

Fleckenstein JM, Kuhlmann FM. Enterotoxigenic Escherichia coli infections. Curr Infect Dis Rep. 2019;21(3):9. doi: 10.1007/s11908-019-0665-x.

Zheng Y, Han F, Ho A, Xue Y, Wu Z, Chen X, et al. Role of MAIT cells in gastrointestinal tract bacterial infections in humans: more than a gut feeling. Mucosal Immunol. 2023;16(5):740-52. doi:10.1016/j.mucimm.2023.06.005.

Khalil I, Walker R, Porter CK, Muhib F, Chilengi R, Cravioto A, et al. Enterotoxigenic Escherichia coli (ETEC) vaccines: priority activities to enable product development, licensure, and global access. Vaccine. 2021;39(31):4266-77. doi:10.1016/j.vaccine.2021.04.018

Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. 8th ed. Elsevier; 2016.

Zhang Y, Tan P, Zhao Y, Ma X. Enterotoxigenic Escherichia coli: intestinal pathogenesis mechanisms and colonization resistance by gut microbiota. Gut Microbes. 2022;14(1):2055943. doi: 10.1080/19490976.2022.2055943.

Radlovic N, Lekovic Z, Vuletic B, Radlovic V, Simic D. Acute diarrhea in children. Srp Arh Celok Lek. 2015;143(11-12):755-62. doi: 10.2298/sarh1512755r.

Anggraini D, Kumala O. Diare pada anak. Scient. J. 2022;1(4):311-2. https://doi.org/10.56260/sciena.v1i4.60.

Akhtar M, Basher SR, Nizam NN, Hossain L, Bhuiyan TR, Qadri F, et al. T helper cell responses in adult diarrheal patients following natural infection with enterotoxigenic Escherichia coli are primarily of the Th17 type. Front Immunol. 2023;14: 1220130. doi: 10.3389/fimmu.2023.1220130.

Khalil I, Anderson JD, Bagamian KH, Baqar S, Giersing B, Hausdorff WP, et al. Vaccine value profile for enterotoxigenic Escherichia coli (ETEC). Vaccine. 2023;41 Suppl 2:S95-113. doi:10.1016/j.vaccine.2023.02.011.

Anderson JD, Bagamian KH, Muhib F, Baral R, Laytner LA, Amaya M, et al. Potential impact and cost-effectiveness of future ETEC and Shigella vaccines in 79 low- and lower middle-income countries. Vaccine X. 2019; 2:100024. doi:10.1016/j.jvacx.2019.100024.

World Health Organization. Future directions for research on Enterotoxigenic Escherichia coli vaccines for developing countries [Internet]. Geneva: WHO; 2006. Available from: https://iris.who.int/handle/10665/233043.

Kantele A, Riekkinen M, Jokiranta TS, Pakkanen SH, Pietilӓ J, Patjas A, et al. Safety and immunogenicity of ETVAX®, an oral inactivated vaccine against enterotoxigenic Escherichia coli diarrhoea: a double-blinded, randomized, placebo-controlled trial amongst Finnish travellers to Benin, West Africa. J Travel Med. 2023;30(7): taad045. doi:10.1093/jtm/taad045.

Harutyunyan S, Neuhauser I, Mayer A, Aichinger M, Szijarto V, Nagy G, et al. Characterization of ShigETEC, a novel live attenuated combined vaccine against Shigellae and ETEC. Vaccines (Basel). 2020;8(4):689. doi: 10.3390/vaccines8040689.

Barry E, Cassels F, Riddle M, Walker R, Wierzba T. Vaccines against Shigella and Enterotoxigenic Escherichia coli: a summary of the 2018 VASE conference. Vaccine. 2019;37(34):4768-4774. doi:10.1016/j.vaccine.2019.02.070.

Vidal RM, Muhsen K, Tennant SM, Svennerholm A, Sow SO, Sur D, et al. Colonization factors among enterotoxigenic Escherichia coli isolates from children with moderate-to-severe diarrhea and from matched controls in the Global Enteric Multicenter Study (GEMS). PLoS Negl Trop Dis. 2019;13(1):22. doi:10.1371/journal.pntd.0007037.

Published

08-09-2025

How to Cite

Inayah, N., Shofa, F., Alfiattutthoyyibah, T., & Mahrunnisa, F. (2025). ETEC Vaccine: A New Solution for Preventing Foodborne Disease: Analysis. Cermin Dunia Kedokteran, 52(9), 619–623. https://doi.org/10.55175/cdk.v52i9.1621

Issue

Section

Articles