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

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Vaselli, NM ORCID: 0000-0003-0220-9249, Setiabudi, W ORCID: 0000-0003-2510-0318, Subramaniam, K ORCID: 0000-0002-1734-9351, Adams, ER ORCID: 0000-0002-0816-2835, Turtle, L ORCID: 0000-0002-0778-1693, Iturriza-Gómara, M ORCID: 0000-0001-5816-6423, Solomon, T ORCID: 0000-0001-7266-6547, Cunliffe, NA ORCID: 0000-0002-5449-4988, French, N ORCID: 0000-0003-4814-8293, Hungerford, D ORCID: 0000-0002-9770-0163 et al (show 83 more authors) , Vivancos, R, Gabbay, M ORCID: 0000-0002-0126-8485, Buchan, I ORCID: 0000-0003-3392-1650, Carrol, ED ORCID: 0000-0001-8357-7726, Gamble, C ORCID: 0000-0002-3021-1955, Crossley, L, Joseph, N, Wilton, M ORCID: 0000-0003-4052-7918, Troughton, LD, Kilada, S, Abba, K ORCID: 0000-0001-9894-8577, Simpson, V, Tulloch, JSP ORCID: 0000-0003-2150-0090, Goodwin, L, Daws, R, Forootan, SS, Dobson, S ORCID: 0000-0002-4958-0021, Press, R, Spaine, V, Hands, L, Bradfield, K, McNally, C, Moitt, T ORCID: 0000-0002-5579-996X, Balabanova, S ORCID: 0000-0001-6989-8099, Donohue, C, Finnetty, L, Marsh, L, Greenhalf, W ORCID: 0000-0002-1865-3195, Naisbitt, DJ, Shaw, VE ORCID: 0000-0002-0429-0186, Aston, S ORCID: 0000-0002-0701-8364, Platt, G ORCID: 0000-0002-6687-0012, Dunn, C, Thomson, PJ ORCID: 0000-0001-5431-0459, Ogese, M ORCID: 0000-0002-1873-4032, Hammond, S, Adair, K ORCID: 0000-0001-9884-2094, Farrell, L ORCID: 0009-0002-6213-6694, Gardner, J ORCID: 0000-0002-4520-108X, Jaruthamsophon, K, Ali, SE ORCID: 0000-0002-9806-8796, Lister, A, Booth, L, Ashworth, M, Bullock, K ORCID: 0000-0002-5758-0179, Catterall, BWA ORCID: 0000-0002-6751-4300, Foster, T ORCID: 0000-0001-7725-7902, Lavelle-Langham, L, Middleton, J, Reynolds, W, Cass, E, Carracedo, AD, Davies, L, Flaherty, L, Oates, M, Maziere, N, Lloyd, J, Jones, C, Massey, H, Holmes, A, Carlucci, N, Brammah, V, Ramos, Y, Allen, D, Armstrong, J, Howarth, D, Wilcock, E ORCID: 0000-0002-3567-7025, Lowe, J, Jones, J, Wright, P, Slack, I, McLaughlin, S, Mason, J, Edwards, T, McKeown, C, Hendrick, E, Williams, C, Byrne, R, Buist, K ORCID: 0000-0002-8004-6329, Garrod, G, Owen, S, Jones, AP and Gkioni, E (2021) Investigation of SARS-CoV-2 faecal shedding in the community: a prospective household cohort study (COVID-LIV) in the UK BMC Infectious Diseases, 21 (1). 784-. ISSN 1471-2334, 1471-2334

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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.

Item Type:	Article
Uncontrolled Keywords:	SARS-CoV-2, COVID-19, Cohort study, Faecal shedding, Transmission, Community, Asymptomatic, Gastrointestinal
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Infection, Vet & Ecological Sciences
Depositing User:	Symplectic Admin
Date Deposited:	11 Aug 2021 08:25
Last Modified:	01 Mar 2026 02:18
DOI:	10.1186/s12879-021-06443-7
Open Access URL:	https://doi.org/10.1186/s12879-021-06443-7
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3133030
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