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

on behalf of the COVID-LIV Study Group, Natasha Marcella Vaselli, Wega Setiabudi, Krishanthi Subramaniam, Emily R. Adams, Lance Turtle, Miren Iturriza-Gómara, Tom Solomon, Nigel A. Cunliffe, Neil French, Daniel Hungerford, Roberto Vivancos, John S.P. Tulloch

Research output: Contribution to journalArticlepeer-review

Abstract

Background: SARS-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. 

Methods: In 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. 

Results: A 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. 

Conclusions: Faecal 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.

Original languageEnglish
Article number784
JournalBMC Infectious Diseases
Volume21
Issue number1
DOIs
Publication statusPublished - 9 Aug 2021

Bibliographical note

Funding Information: This study is co-funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, a partnership between Public Health England, the University of Liverpool and the University of Warwick; the NIHR HPRU in Emerging and Zoonotic Infections, a partnership between Public Health England, the University of Liverpool in collaboration with the Liverpool School of Tropical Medicine and the University of Oxford; the Centre of Excellence in Infectious Disease Research (CEIDR); and the Alder Hey Charity. Grant number for the funding is not applicable.

NF is funded by the NIHR HPRU in Emerging and Zoonotic Infections, the CEIDR and the Alder Hey Charity. We also acknowledge the support of Liverpool Health Partners and the Liverpool-Malawi-Covid-19 Consortium. LT is supported by a Wellcome Trust fellowship (205228/Z/16/Z). For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. WS is funded by the Ministry of Finance, the Republic of Indonesia through the Indonesia Endowment Fund for Education (Lembaga Pengelola Dana Pendidikan or LPDP) scholarship for doctoral study (201807220413052). DH is funded by an NIHR Postdoctoral Fellowship (PDF-2018-11-ST2–006). KS is funded by a HEFCE-funded University of Liverpool Tenure Track Fellowship. LT is also supported by the NIHR HPRU in Emerging and Zoonotic Infections (NIHR200907).

The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, PHE or other funding bodies. The study funders had no role in study design, data collection, data analysis, data interpretation or writing of the manuscript.

Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Publisher Copyright: © 2021, The Author(s).

Citation: Vaselli, N.M., Setiabudi, W., Subramaniam, K. et al. Investigation of SARS-CoV-2 faecal shedding in the community: a prospective household cohort study (COVID-LIV) in the UK. BMC Infect Dis 21, 784 (2021).

DOI: https://doi.org/10.1186/s12879-021-06443-7

Keywords

  • Asymptomatic
  • COVID-19
  • Cohort study
  • Community
  • Faecal shedding
  • Gastrointestinal
  • SARS-CoV-2
  • Transmission

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