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 Adams; Lance Turtle; Miren Iturriza-Gómara; Tom Solomon; Nigel A. Cunliffe; Neil French; Daniel Hungerford; Daniel Hungerford; Roberto Vivancos; Mark Gabbay; Iain Buchan; Enitan D. Carrol; Carrol Gamble; Lynnette Crossley; Neil Joseph; 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; Jayne Jones; Iain Slack; Jessica Mason; Thomas Edwards; Claudia McKeown; Chris Williams; Rachel Byrne; Gala Garrod; Sophie Owen

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
, Wega Setiabudi
, Krishanthi Subramaniam
, Emily Adams
, Lance Turtle
, Miren Iturriza-Gómara
, Tom Solomon
, Nigel A. Cunliffe
, Neil French
, Daniel Hungerford
, Daniel Hungerford
, Roberto Vivancos
, Mark Gabbay
, Iain Buchan
, Enitan D. Carrol
, Carrol Gamble
, Lynnette Crossley
, Neil Joseph
, 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, Jayne Jones, Iain Slack, Jessica Mason, Thomas Edwards, Claudia McKeown, Chris Williams, Rachel Byrne, Gala Garrod, Sophie Owen

University of Liverpool
PATH
The Walton Centre NHS Foundation Trust

Research output: Contribution to journal › Article › peer-review

13 Citations (Scopus)

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 language	English
Article number	784
Pages (from-to)	784
Journal	BMC Infectious Diseases
Volume	21
Issue number	1
Early online date	9 Aug 2021
DOIs	https://doi.org/10.1186/s12879-021-06443-7
Publication status	E-pub ahead of print - 9 Aug 2021

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

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

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S12879-021-06443-7Final published version, 817 KBLicence: CC BY

Cite this

Vaselli, N. M., Setiabudi, W., Subramaniam, K., Adams, E., Turtle, L., Iturriza-Gómara, M., Solomon, T., Cunliffe, N. A., French, N., Hungerford, D., Hungerford, D., Vivancos, R., Gabbay, M., Buchan, I., Carrol, E. D., Gamble, C., Crossley, L., Joseph, N., Wilton, M., ... Owen, S. (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. Article 784. Advance online publication. https://doi.org/10.1186/s12879-021-06443-7

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

abstract = "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.",

keywords = "Asymptomatic, Cohort study, Community, COVID-19, Faecal shedding, Gastrointestinal, SARS-CoV-2, Transmission",

author = "Vaselli, \{Natasha Marcella\} and Wega Setiabudi and Krishanthi Subramaniam and Emily Adams and Lance Turtle and Miren Iturriza-G{\'o}mara and Tom Solomon and Cunliffe, \{Nigel A.\} and Neil French and Daniel Hungerford and Daniel Hungerford and Roberto Vivancos and Mark Gabbay and Iain Buchan and Carrol, \{Enitan D.\} and Carrol Gamble and Lynnette Crossley and Neil Joseph and Moon Wilton and Troughton, \{Lee D.\} and Samantha Kilada and Katharine Abba and Victoria Simpson and Tulloch, \{John S.P.\} and Lynsey Goodwin and Rachael Daws and Forootan, \{Shiva Seyed\} and Susan Dobson and Rachel Press and Vida Spaine and Lesley Hands and Kate Bradfield and Carol McNally and Tracy Moitt and Silviya Balabanova and Chloe Donohue and Lynsey Finnetty and Laura Marsh and William Greenhalf and Naisbitt, \{Dean J.\} and Shaw, \{Victoria E.\} and Jayne Jones and Iain Slack and Jessica Mason and Thomas Edwards and Claudia McKeown and Chris Williams and Rachel Byrne and Gala Garrod and Sophie Owen",

year = "2021",

month = aug,

day = "9",

doi = "10.1186/s12879-021-06443-7",

language = "English",

volume = "21",

pages = "784",

journal = "BMC Infectious Diseases",

issn = "1471-2334",

publisher = "BioMed Central Ltd",

number = "1",

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Vaselli, NM, Setiabudi, W, Subramaniam, K, Adams, E, Turtle, L, Iturriza-Gómara, M, Solomon, T, Cunliffe, NA, French, N, Hungerford, D, Hungerford, D, Vivancos, R, Gabbay, M, Buchan, I, Carrol, ED, Gamble, C, Crossley, L, Joseph, N, Wilton, M, Troughton, LD, Kilada, S, Abba, K, Simpson, V, Tulloch, JSP, Goodwin, L, Daws, R, Forootan, SS, Dobson, S, Press, R, Spaine, V, Hands, L, Bradfield, K, McNally, C, Moitt, T, Balabanova, S, Donohue, C, Finnetty, L, Marsh, L, Greenhalf, W, Naisbitt, DJ, Shaw, VE, Jones, J , Slack, I, Mason, J, Edwards, T , McKeown, C , Williams, C , Byrne, R, Garrod, G & Owen, S 2021, 'Investigation of SARS-CoV-2 faecal shedding in the community: a prospective household cohort study (COVID-LIV) in the UK', BMC Infectious Diseases, vol. 21, no. 1, 784, pp. 784. https://doi.org/10.1186/s12879-021-06443-7

TY - JOUR

T1 - Investigation of SARS-CoV-2 faecal shedding in the community: a prospective household cohort study (COVID-LIV) in the UK

AU - Vaselli, Natasha Marcella

AU - Setiabudi, Wega

AU - Subramaniam, Krishanthi

AU - Adams, Emily

AU - Turtle, Lance

AU - Iturriza-Gómara, Miren

AU - Solomon, Tom

AU - Cunliffe, Nigel A.

AU - French, Neil

AU - Hungerford, Daniel

AU - Vivancos, Roberto

AU - Gabbay, Mark

AU - Buchan, Iain

AU - Carrol, Enitan D.

AU - Gamble, Carrol

AU - Crossley, Lynnette

AU - Joseph, Neil

AU - Wilton, Moon

AU - Troughton, Lee D.

AU - Kilada, Samantha

AU - Abba, Katharine

AU - Simpson, Victoria

AU - Tulloch, John S.P.

AU - Goodwin, Lynsey

AU - Daws, Rachael

AU - Forootan, Shiva Seyed

AU - Dobson, Susan

AU - Press, Rachel

AU - Spaine, Vida

AU - Hands, Lesley

AU - Bradfield, Kate

AU - McNally, Carol

AU - Moitt, Tracy

AU - Balabanova, Silviya

AU - Donohue, Chloe

AU - Finnetty, Lynsey

AU - Marsh, Laura

AU - Greenhalf, William

AU - Naisbitt, Dean J.

AU - Shaw, Victoria E.

AU - Jones, Jayne

AU - Slack, Iain

AU - Mason, Jessica

AU - Edwards, Thomas

AU - McKeown, Claudia

AU - Williams, Chris

AU - Byrne, Rachel

AU - Garrod, Gala

AU - Owen, Sophie

PY - 2021/8/9

Y1 - 2021/8/9

N2 - 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.

AB - 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.

KW - Asymptomatic

KW - Cohort study

KW - Community

KW - COVID-19

KW - Faecal shedding

KW - Gastrointestinal

KW - SARS-CoV-2

KW - Transmission

U2 - 10.1186/s12879-021-06443-7

DO - 10.1186/s12879-021-06443-7

M3 - Article

SN - 1471-2334

VL - 21

SP - 784

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

IS - 1

M1 - 784

ER -

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

Abstract

UN SDGs

Keywords

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