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

Natasha Marcella Vaselli; Wega Setiabudi; Krishanthi Subramaniam; Emily R Adams; Lance Turtle; Miren Iturriza-Gómara; Tom Solomon; Nigel A Cunliffe; Neil French; Daniel Hungerford; COVID-LIV Study Group

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

BMC Infect Dis. 2021 Aug 9;21(1):784. doi: 10.1186/s12879-021-06443-7.

Authors

Natasha Marcella Vaselli¹, Wega Setiabudi¹, Krishanthi Subramaniam¹, 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

COVID-LIV Study Group:
Lance Turtle, Daniel Hungerford, Krishanthi Subramaniam, Roberto Vivancos, Mark Gabbay, Iain Buchan, Enitan D Carrol, Miren Iturriza-Gómara, Tom Solomon, Nigel A Cunliffe, Emily R Adams, Carrol Gamble, Lynnette Crossley, Neil Joseph, Wega Setiabudi, Natasha Marcella Vaselli, Moon Wilton, Lee D Troughton, Samantha Kilada, Katharine Abba, Victoria Simpson, John S P Tulloch, Lynsey Goodwin, Rachael Daws, Shiva Seyed Forootan, Susan Dobson, Rachel Press, Vida Spaine, Lesley Hands, Kate Bradfield, Carol McNally, Tracy Moitt, Silviya Balabanova, Chloe Donohue, Lynsey Finnetty, Laura Marsh, William Greenhalf, Dean J Naisbitt, Victoria E Shaw, Stephen Aston, Gareth Platt, Christopher Dunn, Paul J Thomson, Monday Ogese, Sean Hammond, Kareena Adair, Liam Farrell, Joshua Gardner, Kanoot Jaruthamsophon, Serat-E Ali, Adam Lister, Laura Booth, Milton Ashworth, Katie Bullock, Benjamin W A Catterall, Terry Foster, Lara Lavelle-Langham, Joanna Middleton, William Reynolds, Emily Cass, Alejandra Doce Carracedo, Lianne Davies, Lisa Flaherty, Melanie Oates, Nicole Maziere, Jennifer Lloyd, Christopher Jones, Hannah Massey, Anthony Holmes, Nicola Carlucci, Vanessa Brammah, Yasmyn Ramos, Daniel Allen, Jane Armstrong, Debbie Howarth, Eve Wilcock, Jenna Lowe, Jayne Jones, Paula Wright, Iain Slack, Simone McLaughlin, Jessica Mason, Thomas Edwards, Claudia McKeown, Elysse Hendrick, Chris Williams, Rachel Byrne, Kate Buist, Gala Garrod, Sophie Owen, Ashley P Jones, Efstathia Gkioni

Affiliations

¹ Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK.
² NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool, Liverpool, UK.
³ Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK.
⁴ Current address: Centre for Vaccine Innovation and Access, PATH, Geneva, Switzerland.
⁵ Walton Centre NHS Foundation Trust, Liverpool, UK.
⁶ NIHR Health Protection Research Unit in Gastrointestinal Infections at the University of Liverpool, Liverpool, UK.
⁷ Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK. d.hungerford@liverpool.ac.uk.
⁸ NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool, Liverpool, UK. d.hungerford@liverpool.ac.uk.
⁹ NIHR Health Protection Research Unit in Gastrointestinal Infections at the University of Liverpool, Liverpool, UK. d.hungerford@liverpool.ac.uk.

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.

Publication types

Observational Study

MeSH terms

COVID-19*
Cohort Studies
Humans
Prospective Studies
RNA, Viral
SARS-CoV-2*
United Kingdom / epidemiology
Virus Shedding

Substances

RNA, Viral

Abstract

Publication types

MeSH terms

Substances

Grants and funding