Enterotoxigenic Escherichia coli infections and diarrhea in a cohort of young children in Guinea-Bissau

Hans Steinsland, Palle Valentiner-Branth, Michael Perch, Francisco Dias, Thea K Fischer, Peter Aaby, Kåre Mølbak, Halvor Sommerfelt


In an effort to describe the natural history of enterotoxigenic Escherichia coli (ETEC) infection and diarrhea, 200 children in Guinea-Bissau, West Africa, were followed up from birth until up to age 2 years with weekly stool specimen collection, regardless of whether the children had diarrhea. ETEC isolates were tested for the presence of the porcine and human heat-stable toxins (STp and STh), the heat-labile toxin (LT), and 18 of 21 known colonization factors (CFs). The rate of primary infections increased substantially after age 3 or 6 months (depending on the type of ETEC causing the infection). The pathogenicity of STh-containing ETEC was substantially higher than that of STp-containing ETEC, and STp and STh were associated with separate sets of CFs. Small epidemics were observed, mainly caused by STh-containing ETEC. The difference in epidemic propensity, CF association, and pathogenicity suggests that STh- and STp-containing ETEC represent 2 different groups of human ETEC. Vaccines should primarily target STh-containing ETEC.

Original languageEnglish
JournalThe Journal of infectious diseases
Issue number12
Pages (from-to)1740-7
Number of pages8
Publication statusPublished - 15 Dec 2002
Externally publishedYes


  • Cohort Studies
  • Diarrhea/epidemiology
  • Diarrhea, Infantile/epidemiology
  • Disease Outbreaks
  • Enterotoxins/analysis
  • Escherichia coli/isolation & purification
  • Escherichia coli Infections/epidemiology
  • Feces/microbiology
  • Fimbriae Proteins/analysis
  • Guinea-Bissau/epidemiology
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Prospective Studies
  • Seasons


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