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The enterotoxigenic *Escherichia coli* (ETEC) vaccine + cholera vaccine is an oral, killed whole-cell vaccine candidate designed to provide dual protection against ETEC-mediated diarrhea and cholera. The formulation consists of formalin-inactivated *E. coli* bacteria that over-express key colonization factor antigens (CFAs), including CFA/I, CS1, CS2, and CS3, which are essential for the bacteria to adhere to the intestinal mucosa. This bacterial component is combined with the recombinant B subunit of the cholera toxin (rCTB). The rCTB serves a dual purpose: it induces immunity against *Vibrio cholerae* and provides cross-protection against the ETEC heat-labile toxin (LT) due to the high degree of structural and antigenic homology between the two toxins. By inducing local intestinal IgA responses, the vaccine aims to prevent both bacterial colonization and toxin-induced secretory diarrhea.
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