Enterotoxigenic Escherichia coli's endemicity in developing countries and its emergence during diarrheal epidemics and natural disasters

Abstract

Vulnerable people who ingest contaminated water and food may become ill with diarrhea, infect more people, and continue the viscous cycle of fecal-oral contamination. Once the pathogen passes through the host, it becomes hyperinfective and more virulent (Merrell et al., 2002). During floods, when a large reservoir of the pathogen is present in sewage-contaminated water, a state of hyperinfectivity may already exist and the passage through the host is probably not needed to further augment these infections. This situation of higher infection rates is different from that seen during seasonal epidemic and endemic diarrheal diseases. Thus, this was the point at which it became obvious that ETEC, which has endemic and epidemic potentials, is also a major cause of relatively serious disease during natural disasters. Between July and August 2004, there was a 40% increase in the number of patients compared to that seen in 2003 (ICDDRB, 2004). Equal proportions of children (51%) and adults (49%) seek treatment at the ICDDR,B hospital. Large numbers of patients were more severely dehydrated (39%) and the need for intravenous rehydration therapy increased tremendously (ICDDRB, 2004; Qadri et al., 2005a). © 2008 Springer US.