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We engineered an attenuated Shigella flexneri 2a expressing colonization factor antigen 1 (CFA\/I) and heat-labile enterotoxin B subunit (LTB) from ETEC and conducted a first-in-human randomized-controlled trial of ascending doses of the vaccine (CVD 1208S-122).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Dose-escalating cohorts received a single oral dose of 108\u20131010 colony-forming units (CFU) of CVD 1208S-122 or placebo. A fourth cohort received 1 or 2 oral doses of 108 CFU CVD 1208S-122 or placebo. We measured the safety and clinical acceptability of the vaccine, genetic stability of fecally shed vaccine organisms, and immune responses elicited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 108 CFU doses were well tolerated (100%, 6\/6). One recipient of 109 CFU (20%, 1\/5) manifested diarrhea and 4 individuals who ingested 1010 CFU had either fever or diarrheal reactogenicity (67%, 4\/6). Fecal shed vaccine organisms were genetically stable. Responses were observed to the lipopolysaccharide (LPS) and invasion plasmid antigen B (IpaB) of Shigella and CFA\/I fimbriae and LTB of ETEC in serum, among antibody secreting cells, antibody in lymphocyte supernatant, and fecal samples. Serum antibodies exhibited Shigella bactericidal activity and inhibition of ETEC adherence in vitro.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrates safety with low-dose but unacceptable reactogenicity following highest-dose ingestion, genetic stability of all recovered fecal isolates, and immunogenicity of a prototype combined monovalent Shigella-ETEC vaccine. These results encourage expansion to a multivalent formulation to elicit broader protection against the most prevalent Shigella serotypes and ETEC CFA types that cause diarrheal disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trials Registration<\/jats:title>\n                    <jats:p>NCT04634513.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiag220","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T11:40:51Z","timestamp":1776253251000},"page":"9-19","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of the Safety, Genetic Stability, and Immunogenicity of an Attenuated\n                    <i>Shigella<\/i>\n                    Live Vector Expressing Enterotoxigenic\n                    <i>Escherichia coli<\/i>\n                    Antigens, Vaccine Strain CVD 1208S-122"],"prefix":"10.1093","volume":"234","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7741-5536","authenticated-orcid":false,"given":"Wilbur H","family":"Chen","sequence":"first","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5326-0047","authenticated-orcid":false,"given":"Eileen M","family":"Barry","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9439-0828","authenticated-orcid":false,"given":"Franklin R","family":"Toapanta","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0894-4009","authenticated-orcid":false,"given":"Marcela F","family":"Pasetti","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8282-860X","authenticated-orcid":false,"given":"Marcelo B","family":"Sztein","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland ,","place":["USA"]},{"name":"Program in Oncology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0278-1292","authenticated-orcid":false,"given":"Jasnehta","family":"Permala-Booth","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0651-5748","authenticated-orcid":false,"given":"Sharon M","family":"Tennant","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3138-5965","authenticated-orcid":false,"given":"Justin R","family":"Ortiz","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance","family":"Thomas","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5455-957X","authenticated-orcid":false,"given":"Megan","family":"McGilvray","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4881-0845","authenticated-orcid":false,"given":"Lynnee","family":"Roane","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland 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