A systematic review of ETEC epidemiology focusing on colonization factor and toxin expression

• Published in: Vaccine 2011-08, Vol.29 (37), p.6167-6178
• Main Authors: Isidean, S.D, Riddle, M.S, Savarino, S.J, Porter, C.K
• Format: Article
• Language: English
• Subjects: Allergy and Immunology; Applied microbiology; Bacterial Toxins - biosynthesis; Bacteriology; Biological and medical sciences; Colonization; Colonization factor; confidence interval; Confidence intervals; E coli; Enterotoxigenic Escherichia coli; Enterotoxigenic Escherichia coli - classification; Enterotoxigenic Escherichia coli - immunology; Enterotoxigenic Escherichia coli - isolation & purification; Enterotoxins - biosynthesis; Epidemiology; Escherichia coli; Escherichia coli Infections - epidemiology; Escherichia coli Proteins - biosynthesis; Escherichia coli Vaccines; Estimates; ETEC; Fimbriae Proteins - biosynthesis; Fundamental and applied biological sciences. Psychology; Genotype & phenotype; Heat-labile toxin; Heat-stable toxin; Heterogeneity; Humans; Medical research; Microbiology; Miscellaneous; Studies; systematic review; Toxins; Travel; vaccine development; Vaccines; Vaccines, antisera, therapeutical immunoglobulins and monoclonal antibodies (general aspects)
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2011.06.084

Abstract Introduction Vaccine development for enterotoxigenic Escherichia coli (ETEC) is dependent on in-depth understanding of toxin and colonization factor (CF) distribution. We sought to describe ETEC epidemiology across regions and populations, focusing on CF and toxin prevalence. Methods We conducted a systematic review of the published literature, including studies reporting data on ETEC CF and toxin distributions among those with ETEC infection. Point estimates and confidence intervals were calculated using random effects models. Results Data on 17,205 ETEC isolates were abstracted from 136 included studies. Approximately half of the studies (49%) involved endemic populations, and an additional 17% involved only travel populations. Globally, 60% of isolates expressed LT either alone (27%) or in combination with ST (33%). CFA/I-expressing strains were common in all regions (17%), as were ETEC expressing CFA/II (9%) and IV (18%). Marked variation in toxins and CFs across regions and populations was observed. Discussion/conclusions These results demonstrate the relative importance of specific CFs in achieving target product profiles for a future ETEC vaccine. However, heterogeneity across time, population, and region, confounded by variability in CF and toxin detection methodologies, obfuscates rational estimates for valency requirements.