ArticlePLoS neglected tropical diseases2019
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).
Article in PLoS neglected tropical diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 71 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
71 citing papers in PubMed, 1 synthesis or guideline pooled it, 93 citations in OpenAlex.
- Association of enteropathogen detection with diarrhoea by age and high versus low child mortality settings: a systematic review and meta-analysis.The Lancet. Global health · 2021Pooled it
- Evaluation of the Safety, Genetic Stability, and Immunogenicity of an Attenuated Shigella Live Vector Expressing Enterotoxigenic Escherichia coli Antigens, Vaccine Strain CVD 1208S-122.The Journal of infectious diseases · 2026Trial
- Efficacy of ETVAX, a vaccine against enterotoxigenic Escherichia coli-positive diarrhoea in Gambian children: a double-blind, randomised, placebo-controlled, phase 2b trial.The Lancet. Infectious diseases · 2026Trial
- Use of a TaqMan Array Card for identification of enterotoxins and colonization factors directly from stool samples in an enterotoxigenicMicrobiology spectrum · 2025Trial
- Trial
- Oral delivery of Hyperimmune bovine serum antibodies against CS6-expressing enterotoxigenicGut microbes · 2020Trial
- A new human challenge model for testing heat-stable toxin-based vaccine candidates for enterotoxigenic Escherichia coli diarrhea - dose optimization, clinical outcomes, and CD4+ T cell responses.PLoS neglected tropical diseases · 2019Trial
- Emerging and Underdetected Colonization Factors in EnterotoxigenicMicroorganisms · 2026Review
- One Health Perspective on the EnterotoxigenicMicroorganisms · 2026Review
- Vaccine Candidates Designed to Prevent Enterotoxigenic Escherichia coli Diarrhoea: A Scoping Review of Clinical Trials Evaluating Vaccine Candidates in Development.Tropical medicine & international health : TM & IH · 2026Article
- Systemic and mucosal immunity to enterotoxigenicFrontiers in immunology · 2026Review
- An Asset for Food Safety: The Knowledge Behind the Physiological Alterations Induced by ETEC Enterotoxins.Foods (Basel, Switzerland) · 2025Review
- Genomic insights into a diarrheal outbreak in Bangladesh reveal novel ETEC lineages and expansion of CS23 colonization factor.Microbiology spectrum · 2025Article
- ETEC biofilms are regulated by magnesium and lactate bioavailability.Infection and immunity · 2025Article
- Enhancing oxacillin efficacy against planktonic and biofilms of foodborne Enterobacteriaceae by hylin-a1-derived peptide.Future medicinal chemistry · 2025Article
- Clinico-Epidemiological Characteristics of Symptomatic and Asymptomatic Enterotoxigenic and Enteropathogenic Escherichia Coli Diarrhea and Impact on Child Growth.The American journal of tropical medicine and hygiene · 2025Article
- Building a Broader Understanding of EnterotoxigenicOpen forum infectious diseases · 2025Article
- Genomic features of three major diarrhoeagenicMicrobial genomics · 2025Article
- Genome Sequencing and Assembly of EnterotoxigenicMicroorganisms · 2025Article
- Review
11 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
48 authors at 13 institutions in 13 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEnterotoxigenic Escherichia coli (ETEC) encoding heat-stable enterotoxin (ST) alone or with heat-labile enterotoxin (LT) cause moderate-to-severe diarrhea (MSD) in developing country children. The Global Enteric Multicenter Study (GEMS) identified ETEC encoding ST among the top four enteropathogens. Since the GEMS objective was to provide evidence to guide development and implementation of enteric vaccines and other interventions to diminish diarrheal disease morbidity and mortality, we examined colonization factor (CF) prevalence among ETEC isolates from children age <5 years with MSD and from matched controls in four African and three Asian sites. We also assessed strength of association of specific CFs with MSD. METHODOLOGY/PRINCIPAL
findingsMSD cases enrolled at healthcare facilities over three years and matched controls were tested in a standardized manner for many enteropathogens. To identify ETEC, three E. coli colonies per child were tested by polymerase chain reaction (PCR) to detect genes encoding LT, ST; confirmed ETEC were examined by PCR for major CFs (Colonization Factor Antigen I [CFA/I] or Coli Surface [CS] antigens CS1-CS6) and minor CFs (CS7, CS12, CS13, CS14, CS17, CS18, CS19, CS20, CS21, CS30). ETEC from 806 cases had a single toxin/CF profile in three tested strains per child. Major CFs, components of multiple ETEC vaccine candidates, were detected in 66.0% of LT/ST and ST-only cases and were associated with MSD versus matched controls by conditional logistic regression (p≤0.006); major CFs detected in only 25.0% of LT-only cases weren't associated with MSD. ETEC encoding exclusively CS14, identified among 19.9% of 291 ST-only and 1.5% of 259 LT/ST strains, were associated with MSD (p = 0.0011). No other minor CF exhibited prevalence ≥5% and significant association with MSD. CONCLUSIONS/SIGNIFICANCE: Major CF-based efficacious ETEC vaccines could potentially prevent up to 66% of pediatric MSD cases due to ST-encoding ETEC in developing countries; adding CS14 extends coverage to ~77%.
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