Investigation of SARS-CoV-2 faecal shedding in the community: a prospective household cohort study (COVID-LIV) in the UK

Journal article

BackgroundSARS-CoV-2 is frequently shed in the stool of patients hospitalised with COVID-19. The extent of faecal shedding of SARS-CoV-2 among individuals in the community, and its potential to contribute to spread of disease, is unknown.MethodsIn this prospective, observational cohort study among households in Liverpool, UK, participants underwent weekly nasal/throat swabbing to detect SARS-CoV-2 virus, over a 12-week period from enrolment starting July 2020. Participants that tested positive for SARS-CoV-2 were asked to provide a stool sample three and 14 days later. In addition, in October and November 2020, during a period of high community transmission, stool sampling was undertaken to determine the prevalence of SARS-CoV-2 faecal shedding among all study participants. SARS-CoV-2 RNA was detected using Real-Time PCR.ResultsA total of 434 participants from 176 households were enrolled. Eighteen participants (4.2%: 95% confidence interval [CI] 2.5–6.5%) tested positive for SARS-CoV-2 virus on nasal/throat swabs and of these, 3/17 (18%: 95% CI 4–43%) had SARS-CoV-2 detected in stool. Two of three participants demonstrated ongoing faecal shedding of SARS-CoV-2, without gastrointestinal symptoms, after testing negative for SARS-CoV-2 in respiratory samples. Among 165/434 participants without SARS-CoV-2 infection and who took part in the prevalence study, none had SARS-CoV-2 in stool. There was no demonstrable household transmission of SARS-CoV-2 among households containing a participant with faecal shedding.ConclusionsFaecal shedding of SARS-CoV-2 occurred among community participants with confirmed SARS-CoV-2 infection. However, during a period of high community transmission, faecal shedding of SARS-CoV-2 was not detected among participants without SARS-CoV-2 infection. It is unlikely that the faecal-oral route plays a significant role in household and community transmission of SARS-CoV-2.

Authors: Vaselli, NM; Setiabudi, W; Subramaniam, K; Adams, ER; Turtle, L

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BioMed Central
• Journal: BMC Infectious Diseases
• Volume: 21
• Issue: 1
• Pages: 784-784
• Publication date: 2021-08-09
• DOI: 10.1186/s12879-021-06443-7
• EISSN: 1471-2334
• ISSN: 1471-2334
• Language: English
• Keywords: Virology; Medical microbiology; Coronavirus disease 2019 (COVID-19); Virus; Biology; Confidence interval; Viral shedding; Prospective cohort study; Disease; Surgery; Internal medicine; Medicine; Feces; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Throat; Cohort; Cohort study; Young adult; Transmission (telecommunications); Infectious disease (medical specialty)