Surface polysaccharides of Gram-negative enteric pathogens, in the form of capsule or lipopolysaccharide, are both essential virulence factors and protective antigens. The immunogenicity of these polysaccharides were enhanced by binding to carrier proteins. Sequential clinical studies in adults and in children in Vietnam, an area with a high attack rate of typhoid, showed that the capsular polysaccharide (Vi) conjugates bound to the recombinant Pseudomonas aeruginosa exoprotein A (rEPA) elicited high responses against typhi. In a Phase III trial, About 12,000 2-5 years old children injected with the conjugate vaccine showed no significant side reaction. The efficacy of Vi-rEPA was 91% after 27 months active and 85% after 28-48 months passive surveillance. Chidren in the pacebo group were given the conjugate vaccine 2.5 years later. Salmonella paratyphi A, the second most common cause of enteric fever in Southeast Asia, conjugate vaccine was found to be safe and immunogenic in adults, teenagers and then 2-4 year old children. In southeast China, cases of paratyphi A has exceeded those of typhi. A phase III clinical trial is planned. Escherichia coli O157, an emerging pathogen, causes hemolytic uremic syndrome in young children. Phase 1 study of E. coli O157 O-specific polysaccharide-rEPA conjugate demonstrated safety and immunogenicity in adult volunteers. The phase II study of E. coli O157 conjugate in 2-5 years old children is underway. Children injected once or twice showed that the vaccine was safe. Immunogenicity data are to be measured. Non-toxic shiga toxin I and II are purified from mutant E. coli O157 and will be conjugated with O-specific polysaccharide for a bivalent vaccine. The major reservoir of E.coli O157 is cattle. LPS-protein conjugate showed to be immunogenic in cattle and a challenge study is planned to demonstrate the clearance of the carriage state in cattle. Vibrio cholera O1 and O139 are the major sero types in cholera infections. Conjugates synthesized with capsular polysaccharide of O139 and O-specific polysaccharide of LPS of O1 elicited vibriocidal antibodies in mice. Detoxified LPS from both Inaba and Ogawa serotypes have been used as a base for conjugate vaccine. In animal study, the conjugates elicited higher antibody level than LPS alone. A chemical synthesized O-specific polysaccharide for Ogawa will be prepared and conjugated to protein carrier. The immunogenicity of cholera vaccine prepared with naturally purified or chemically synthesized O-specific polysaccharide will be compared. Clinical trials of these conjugates are planned. One of the most common Salmonella infection in developed country is Salmonella typhimurium. Antibiotic resistant strains have been common in disease isolates. We have compared the O-specific polysaccharide structure of the most common and antibiotic resistant strains. We found that the O-acetyl group on the abequose is a major antigenic determinant for various strains: O-acetyl positive strains cross react with O-acetyl negative strains poorly. Selection of strains for vaccine preparation will therefore rely on the epidemiology survey and bacteriology identification. Campylobacter infection is one of the most common enteric infection in the US. Little is known about the prevalent type that causes disease or the protective antigens. We have started to collect epidemiology data and experimenting with various growth conditions.
