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Observational Study
. 2021 Aug 9;21(1):784.
doi: 10.1186/s12879-021-06443-7.

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

Natasha Marcella Vaselli  1 , Wega Setiabudi  1 , Krishanthi Subramaniam  1 , Emily R Adams  2   3 , Lance Turtle  1   2 , Miren Iturriza-Gómara  1   4 , Tom Solomon  1   2   5 , Nigel A Cunliffe  1   6 , Neil French  1   2 , Daniel Hungerford  7   8   9 ; COVID-LIV Study Group
Collaborators, Affiliations
Observational Study

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

Natasha Marcella Vaselli et al. BMC Infect Dis. .

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.

Keywords: Asymptomatic; COVID-19; Cohort study; Community; Faecal shedding; Gastrointestinal; SARS-CoV-2; Transmission.

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Conflict of interest statement

NF reports research grant support from the Alder Hey Charity. MIG reports other financial or non-financial interests in V-PLEX Th17 Panel 1 Human Kit. LT reports research grant support from NIHR HPRU in Emerging and Zoonotic Infections related to this study. Unrelated to this study LT also reports fees paid to University of Liverpool from Eisai for providing a lecture on COVID-19 and cancer. WS reports scholarship for doctoral study at the University of Liverpool from the Ministry of Finance, Republic of Indonesia through the Indonesia Endowment Fund for Education program. DH, NAC, ERA, TS, KS and NMV have nothing to disclose.

Figures

Fig. 1
Fig. 1
Stool samples and SARS-CoV-2 PCR test results among COVID-LIV participants. (123 participants took part in the stool sampling at both time points)
Fig. 2
Fig. 2
Background rate of SARS-CoV-2 cases in the Liverpool City Region in relation to the timing of COVID-LIV cases, stool sampling and public health measures. (SARS-CoV-2 case data for the Liverpool City Region adapted from https://coronavirus.data.gov.uk/details/download [accessed 09/12/2020])
See this image and copyright information in PMC

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