Surreal illustration depicting the hidden risks of E. coli in common food settings.

Is 'Traveler's Diarrhea' Lurking in Your Backyard? The Rise of E. coli in the US

Lena Kashyap in Health & Wellness December 2025 • 5 min read.

"New research reveals a surprising prevalence of Enteroaggregative E. coli (EAEC) in the US, challenging assumptions about its association with international travel and prompting a re-evaluation of food safety and public health strategies."

For years, we've associated Escherichia coli (E. coli) infections, especially those causing diarrhea, with international travel. You eat something risky on vacation, and your gut pays the price. But what if a significant source of these infections is much closer to home? Enteroaggregative E. coli (EAEC), a specific type of diarrheagenic E. coli, is now increasingly recognized as a cause of diarrheal illness, and new research suggests it's more common in the United States than previously thought.

A recent study conducted in Minnesota between 2016 and 2017 sheds light on the prevalence and characteristics of EAEC infections. What makes this study particularly interesting is its focus on understanding the domestic transmission of EAEC, challenging the conventional wisdom that it's primarily a traveler's disease. The study dives deep into the frequency of EAEC among patients with reportable enteric pathogens, analyzes the demographic profiles of those affected, and explores potential food and environmental exposures that could be contributing to its spread.

This article breaks down the key findings of this research, highlighting the surprising frequency of EAEC in the US, examining the factors that contribute to its transmission, and discussing the implications for public health and food safety. Get ready to rethink what you know about 'traveler's diarrhea' and its potential origins.

EAEC: More Than Just a Traveler's Bug

Surreal illustration depicting the hidden risks of E. coli in common food settings.

The Minnesota study revealed that EAEC is surprisingly common among individuals experiencing gastrointestinal illness. In fact, within a network of healthcare systems able to detect it, EAEC emerged as the second most frequently reported enteric pathogen, surpassed only by Campylobacter. It was also the most commonly detected diarrheagenic E. coli pathotype. This high prevalence challenges the long-held assumption that EAEC is primarily an issue for international travelers.

One of the most striking findings of the study was the high percentage of EAEC cases that were not linked to international travel. A significant 68% of cases reported no international travel before the onset of illness, suggesting that a substantial portion of EAEC infections are acquired domestically. This discovery raises important questions about the sources of these infections and the pathways through which EAEC is spreading within the United States.

Foodborne Transmission: The study identified potential links between EAEC illness and the consumption of specific food items, including unpasteurized cider, cabbage, asparagus, and celery. This highlights the importance of food safety practices and the potential for contaminated produce to serve as a vehicle for EAEC transmission.
Environmental Factors: While less conclusive, the research also explored potential environmental exposures, such as swimming. Although inverse associations were noted, additional research is needed to fully understand the role of environmental factors in EAEC transmission.
Virulence Genes and Symptoms: The study also investigated the relationship between specific virulence genes in EAEC isolates and the severity of symptoms. Researchers identified several genes associated with outcomes such as bloody stool, hospitalization, and duration of diarrhea, offering valuable insights into the mechanisms through which EAEC causes illness.

These findings underscore the need for increased awareness of EAEC as a potential cause of diarrheal illness, even in the absence of international travel. They also emphasize the importance of practicing good food safety habits, such as thoroughly washing produce and avoiding unpasteurized products.

What's Next? Rethinking EAEC Prevention

The Minnesota study provides compelling evidence that EAEC is a significant cause of diarrheal illness in the United States, with a substantial portion of infections acquired domestically. These findings highlight the need for a multi-pronged approach to prevent and control EAEC infections.

Moving forward, it's crucial to enhance surveillance efforts to better track the prevalence and transmission patterns of EAEC in different regions of the country. This will involve improving laboratory detection methods, implementing more comprehensive reporting systems, and conducting epidemiological investigations to identify the sources of outbreaks.

Ultimately, by increasing awareness, improving food safety practices, and investing in research and surveillance, we can better protect ourselves from this increasingly common pathogen and reduce the burden of diarrheal illness in the United States.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1093/cid/ciy890, Alternate LINK

Title: High Relative Frequency Of Enteroaggregative Escherichia Coli Among Patients With Reportable Enteric Pathogens, Minnesota, 2016–2017

Subject: Infectious Diseases

Journal: Clinical Infectious Diseases

Publisher: Oxford University Press (OUP)

Authors: Aaron Beczkiewicz, Elizabeth Cebelinski, Marijke Decuir, Victoria Lappi, Xiong Wang, Kirk Smith, Dave Boxrud, Carlota Medus

Published: 2018-10-15

Everything You Need To Know

What is Enteroaggregative E. coli (EAEC), and why is it gaining attention in the United States?

Enteroaggregative E. coli (EAEC) is a specific type of diarrheagenic E. coli that is increasingly recognized as a cause of diarrheal illness. It's more common in the United States than previously thought, challenging the assumption that E. coli infections causing diarrhea are primarily linked to international travel.

What were the main findings of the Minnesota study regarding Enteroaggregative E. coli (EAEC) prevalence and travel history?

The Minnesota study revealed that Enteroaggregative E. coli (EAEC) is surprisingly common among individuals experiencing gastrointestinal illness. It was the second most frequently reported enteric pathogen, surpassed only by Campylobacter, and the most commonly detected diarrheagenic E. coli pathotype. A significant 68% of Enteroaggregative E. coli (EAEC) cases reported no international travel before the onset of illness.

What are the potential transmission routes and risk factors identified in the study regarding Enteroaggregative E. coli (EAEC)?

Potential links between Enteroaggregative E. coli (EAEC) illness and the consumption of specific food items, including unpasteurized cider, cabbage, asparagus, and celery, were identified. While less conclusive, research also explored potential environmental exposures, such as swimming. Researchers identified several genes associated with outcomes such as bloody stool, hospitalization, and duration of diarrhea.

What are the implications of the Minnesota study's findings for preventing and controlling Enteroaggregative E. coli (EAEC) infections in the US?

The Minnesota study provides compelling evidence that Enteroaggregative E. coli (EAEC) is a significant cause of diarrheal illness in the United States, with a substantial portion of infections acquired domestically. These findings highlight the need for a multi-pronged approach to prevent and control Enteroaggregative E. coli (EAEC) infections. Public health officials may need to rethink current strategies.

What specific aspects of Enteroaggregative E. coli (EAEC) infections were not fully explored in the study, and what further research could be conducted?

While the study identified several virulence genes in Enteroaggregative E. coli (EAEC) isolates associated with specific symptoms like bloody stool, hospitalization, and duration of diarrhea, it did not fully explore the long-term health consequences of Enteroaggregative E. coli (EAEC) infections. Future research could investigate potential links between Enteroaggregative E. coli (EAEC) and chronic gastrointestinal disorders or other long-term health issues to provide a more comprehensive understanding of the impact of Enteroaggregative E. coli (EAEC) on public health.