Cholera has re-emerged as a major global public health threat. Orally administered attenuated or inactivated vaccines offer protection against enteric pathogens such as Vibrio cholerae, and several World Health Organization-prequalified oral cholera vaccines are used globally as part of international cholera prevention and control measures.
However, vaccine effectiveness, particularly in young children in low- and middle-income countries, is often lower than in adults, leaving this vulnerable age group at greater risk of cholera. The heat-labile toxin (LT) of enterotoxigenic Escherichia coli (ETEC) has strong mucosal adjuvant properties, and in detoxified form (double-mutant LT), it has been shown to safely improve immune responses to protein and somatic lipopolysaccharide antigens in children in Bangladesh who received the oral inactivated whole-cell enterotoxigenic ETEC vaccine ETVAX.
Subsequent field trials of ETVAX in children in Zambia and The Gambia have also further demonstrated safety and immunogenicity in this difficult-to-immunize age group.
Frontiers in Immunology published a clinical update in Infectious Disease on 20 Apr 2026.
The item focuses on The case for evaluation of double mutant heat-labile toxin as an adjuvant to improve oral cholera vaccine immunogenicity.
Review the original article for the full source wording and details.