{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:02:37Z","timestamp":1788566557708,"version":"build-2803163510"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP 50419"],"award-info":[{"award-number":["OPP 50419"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-062435"],"award-info":[{"award-number":["INV-062435"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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\u2013based diarrheal surveillance between 2011 and 2015.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In the dynamic cohort, the ETEC incidence was 150\/100 000 person-years (PY; 95% CI, 141\u2013159), 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 &amp;lt;1 year (2007; 95% CI, 1664\u20132402), then in those aged 1\u20134 years (314; 95% CI, 252\u2013386), and again the rate rose in those aged &amp;gt;45 years (219\/100 000 PY; 95% CI, 177\u2013267). The rate of severe ETEC was \u226435\/100 000 PY for persons aged \u226445 years (95% CI, 27\u201344), but rose to 82 for adults aged &amp;gt;45 years (95% CI, 58\u2013113).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf375","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T07:58:24Z","timestamp":1750838304000},"source":"Crossref","is-referenced-by-count":6,"title":["Epidemiological and Clinical Features of Enterotoxigenic <i>Escherichia coli<\/i> (ETEC) Diarrhea in an Urban Slum in Dhaka, Bangladesh"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7082-0720","authenticated-orcid":false,"given":"Fahima","family":"Chowdhury","sequence":"first","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka ,","place":["Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Taufiqul","family":"Islam","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka ,","place":["Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal","family":"Ahmmed","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka ,","place":["Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afroza","family":"Akter","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka ,","place":["Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9932-2453","authenticated-orcid":false,"given":"Martin Bundi","family":"Mwebia","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute (KEMRI) , Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3762-084X","authenticated-orcid":false,"given":"Justin","family":"Im","sequence":"additional","affiliation":[{"name":"Research Investment for Global Health Technology (RIGHT) Foundation , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3172-1877","authenticated-orcid":false,"given":"Natasha Y","family":"Rickett","sequence":"additional","affiliation":[{"name":"International Vaccine Institute , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia Kathure","family":"Mbae","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute (KEMRI) , Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0203-5744","authenticated-orcid":false,"given":"Asma Binte","family":"Aziz","sequence":"additional","affiliation":[{"name":"International Vaccine Institute , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6687-6927","authenticated-orcid":false,"given":"Beatrice","family":"Ongadi","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute (KEMRI) , Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4158-5995","authenticated-orcid":false,"given":"Farhana","family":"Khanam","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka ,","place":["Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraful Islam","family":"Khan","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka ,","place":["Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Golam","family":"Firoj","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka ,","place":["Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadia Isfat Ara","family":"Rahman","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka ,","place":["Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Se Eun","family":"Park","sequence":"additional","affiliation":[{"name":"International Vaccine Institute , Seoul ,","place":["Republic of Korea"]},{"name":"Yonsei University Graduate School of Public Health , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kassa","family":"Haile","sequence":"additional","affiliation":[{"name":"Armauer Hansen Research Institute , Addis Ababa ,","place":["Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses","family":"Mwangi","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute (KEMRI) , Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Ngugi","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute (KEMRI) , Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meseret Gebre","family":"Behute","sequence":"additional","affiliation":[{"name":"International Vaccine Institute , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin","family":"Kering","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute (KEMRI) , Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suneth","family":"Agampodi","sequence":"additional","affiliation":[{"name":"International Vaccine Institute , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suman","family":"Kanungo","sequence":"additional","affiliation":[{"name":"ICMR\u2014National Institute for Research in Bacterial Infections , Kolkata ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Zaman","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka ,","place":["Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3209-9503","authenticated-orcid":false,"given":"Samuel","family":"Kariuki","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute (KEMRI) , Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firdausi","family":"Qadri","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka ,","place":["Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D","family":"Clemens","sequence":"additional","affiliation":[{"name":"International Vaccine Institute , Seoul ,","place":["Republic of Korea"]},{"name":"UCLA Fielding School of Public Health , Los Angeles, California ,","place":["USA"]},{"name":"Korea University School of Medicine Vaccine Innovation Center , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"2025071806515096300_ofaf375-B1","author":"World Health Organization"},{"key":"2025071806515096300_ofaf375-B2","doi-asserted-by":"crossref","first-page":"e321","DOI":"10.1016\/S2214-109X(18)30483-2","article-title":"Burden of enterotoxigenic Escherichia coli and Shigella non-fatal diarrhoeal infections in 79 low-income and lower middle-income countries: a modelling analysis","volume":"7","author":"Anderson","year":"2019","journal-title":"Lancet Glob Health"},{"key":"2025071806515096300_ofaf375-B3","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1128\/CMR.18.3.465-483.2005","article-title":"Enterotoxigenic Escherichia coli in developing countries: epidemiology, microbiology, clinical features, treatment, and prevention","volume":"18","author":"Qadri","year":"2005","journal-title":"Clin Microbiol Rev"},{"key":"2025071806515096300_ofaf375-B4","author":"Bramlitt"},{"key":"2025071806515096300_ofaf375-B5","doi-asserted-by":"crossref","first-page":"e999","DOI":"10.1371\/journal.pntd.0000999","article-title":"Impact of rapid urbanization on the rates of infection by Vibrio cholerae O1 and enterotoxigenic Escherichia coli in Dhaka, Bangladesh","volume":"5","author":"Chowdhury","year":"2011","journal-title":"PLoS Negl Trop Dis"},{"key":"2025071806515096300_ofaf375-B6","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.3201\/eid1107.041266","article-title":"Enterotoxigenic Escherichia coli and Vibrio cholerae diarrhea, Bangladesh, 2004","volume":"11","author":"Qadri","year":"2005","journal-title":"Emerg Infect Dis"},{"key":"2025071806515096300_ofaf375-B7","doi-asserted-by":"crossref","first-page":"1132927","DOI":"10.3389\/fpubh.2023.1132927","article-title":"A snap-shot of a diarrheal epidemic in Dhaka due to enterotoxigenic Escherichia coli and Vibrio cholerae O1 in 2022","volume":"11","author":"Tauheed","year":"2023","journal-title":"Front Public Health"},{"key":"2025071806515096300_ofaf375-B8","doi-asserted-by":"crossref","first-page":"321","DOI":"10.3390\/tropicalmed8060321","article-title":"Detecting enteric pathogens in low-risk drinking water in Dhaka, Bangladesh: an assessment of the WHO water safety categories","volume":"8","author":"Saima","year":"2023","journal-title":"Trop Med Infect Dis"},{"key":"2025071806515096300_ofaf375-B9","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/S1473-3099(18)30475-4","article-title":"Morbidity and mortality due to Shigella and enterotoxigenic Escherichia coli diarrhoea: the Global Burden of Disease Study 1990\u20132016","volume":"18","author":"Khalil","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2025071806515096300_ofaf375-B10","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1016\/S0140-6736(15)61140-0","article-title":"Feasibility and effectiveness of oral cholera vaccine in an urban endemic setting in Bangladesh: a cluster randomised open-label trial","volume":"386","author":"Qadri","year":"2015","journal-title":"Lancet"},{"key":"2025071806515096300_ofaf375-B11","doi-asserted-by":"crossref","first-page":"e3031","DOI":"10.1371\/journal.pntd.0003031","article-title":"Shift in phenotypic characteristics of enterotoxigenic Escherichia coli (ETEC) isolated from diarrheal patients in Bangladesh","volume":"8","author":"Begum","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"key":"2025071806515096300_ofaf375-B12","author":"World Health Organization"},{"key":"2025071806515096300_ofaf375-B13","volume-title":"Epidemiology: An Introduction","author":"Rothman","year":"2012"},{"key":"2025071806515096300_ofaf375-B14","volume-title":"The Statistical Analysis of Failure Time Data","author":"Kalbfleisch","year":"2011"},{"key":"2025071806515096300_ofaf375-B15","doi-asserted-by":"crossref","first-page":"e0000711","DOI":"10.1371\/journal.pgph.0000711","article-title":"Mapping climate change's impact on cholera infection risk in Bangladesh","volume":"2","author":"Kruger","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"2025071806515096300_ofaf375-B16","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1080\/21645515.2019.1578922","article-title":"A roadmap for enterotoxigenic Escherichia coli vaccine development based on volunteer challenge studies","volume":"15","author":"Levine","year":"2019","journal-title":"Hum Vaccin Immunother"},{"key":"2025071806515096300_ofaf375-B17","doi-asserted-by":"crossref","first-page":"359","DOI":"10.3390\/microorganisms12020359","article-title":"Epidemiology of enterotoxigenic Escherichia coli among children and adults seeking care at hospitals in two geographically distinct rural areas in Bangladesh","volume":"12","author":"Chakraborty","year":"2024","journal-title":"Microorganisms"},{"key":"2025071806515096300_ofaf375-B18","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.4269\/ajtmh.2011.11-0171","article-title":"Examining the use of oral rehydration salts and other oral rehydration therapy for childhood diarrhea in Kenya","volume":"85","author":"Blum","year":"2011","journal-title":"Am J Trop Med Hyg"},{"key":"2025071806515096300_ofaf375-B19","first-page":"15","article-title":"Childhood diarrheal morbidity in the Accra Metropolitan Area, Ghana: socio-economic, environmental and behavioral risk determinants","volume":"7","author":"Boadi","year":"2005","journal-title":"J Health Popul Dev Ctries"},{"key":"2025071806515096300_ofaf375-B20","doi-asserted-by":"crossref","first-page":"6783","DOI":"10.1016\/j.vaccine.2017.07.036","article-title":"Global burden of diarrheal diseases among children in developing countries: incidence, etiology, and insights from new molecular diagnostic techniques","volume":"35","author":"Kotloff","year":"2017","journal-title":"Vaccine"},{"key":"2025071806515096300_ofaf375-B21","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1017\/S0950268814002295","article-title":"Toxins and virulence factors of enterotoxigenic Escherichia coli associated with strains isolated from indigenous children and international visitors to a rural community in Guatemala","volume":"143","author":"Torres","year":"2015","journal-title":"Epidemiol Infect"},{"key":"2025071806515096300_ofaf375-B22","doi-asserted-by":"crossref","first-page":"709907","DOI":"10.3389\/fitd.2021.709907","article-title":"Confronting challenges to enterotoxigenic Escherichia coli vaccine development","volume":"2","author":"Fleckenstein","year":"2021","journal-title":"Front Trop Dis"},{"key":"2025071806515096300_ofaf375-B23","doi-asserted-by":"crossref","first-page":"4266","DOI":"10.1016\/j.vaccine.2021.04.018","article-title":"Enterotoxigenic Escherichia coli (ETEC) vaccines: priority activities to enable product development, licensure, and global access","volume":"39","author":"Khalil","year":"2021","journal-title":"Vaccine"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofaf375\/63629651\/ofaf375.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/7\/ofaf375\/63629651\/ofaf375.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/7\/ofaf375\/63629651\/ofaf375.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T10:51:58Z","timestamp":1752835918000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofaf375\/8178799"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,30]]},"references-count":23,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,6,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofaf375","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,7]]},"published":{"date-parts":[[2025,6,30]]},"article-number":"ofaf375"}}