{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T16:52:11Z","timestamp":1789145531696,"version":"build-2803163510"},"update-to":[{"DOI":"10.12688\/f1000research.51592.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T00:00:00Z","timestamp":1635811200000}}],"reference-count":20,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T00:00:00Z","timestamp":1635811200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","award":["No2020\/1077093"],"award-info":[{"award-number":["No2020\/1077093"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013374","name":"NIHR SPCR","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100013374","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Background: Modes of transmission of SARS-CoV-2 are of key public health importance. SARS-CoV-2 has been detected in the feces of some COVID-19 patients, suggesting the possibility that the virus could, in addition to droplet and fomite transmission, be transmitted via the orofecal route.<\/ns3:p>\n                  <ns3:p>Methods: This review is part of an Open Evidence Review on Transmission Dynamics of COVID-19. We conduct ongoing searches using WHO COVID-19 Database, LitCovid, medRxiv, and Google Scholar; assess study quality based on five criteria and report important findings. Where necessary, authors are contacted for further details on the content of their articles.<\/ns3:p>\n                  <ns3:p>Results: We include searches up until 20 December 2020. We included 110 relevant studies: 76 primary observational studies or reports, and 35 reviews (one cohort study also included a review) examining the potential role of orofecal transmission of SARS-CoV-2. Of the observational studies, 37 were done in China. A total of 48 studies (n=9,081 patients) reported single cases, case series or cohort data on individuals with COVID-19 diagnosis or their contacts and 46 (96%) detected binary RT-PCR with 535 out of 1358 samples positive for SARS-CoV-2 (average 39.4%). The results suggest a long duration of fecal shedding, often recorded after respiratory samples tested negative, and symptoms of gastrointestinal disease were reported in several studies. Twenty-nine studies reported finding SARS-CoV-2 RNA in wastewater, river water or toilet areas. Six studies attempted viral culture from COVID-19 patients\u2019 fecal samples: culture was successful in 3 of 6 studies, and one study demonstrated invasion of the virus into intestinal epithelial cells.<\/ns3:p>\n                  <ns3:p>Conclusions: Varied observational and mechanistic evidence suggests SARS-CoV-2 can infect and be shed from the gastrointestinal tract, including some data demonstrating viral culture in fecal samples. To fully assess these risks, quantitative data on infectious virus in these settings and infectious dose are needed.<\/ns3:p>","DOI":"10.12688\/f1000research.51592.2","type":"journal-article","created":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T13:25:52Z","timestamp":1635859552000},"page":"231","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":36,"title":["SARS-CoV-2 and the role of orofecal transmission: a systematic review"],"prefix":"10.12688","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1009-1992","authenticated-orcid":false,"given":"Carl J.","family":"Heneghan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9079-8006","authenticated-orcid":false,"given":"Elizabeth A.","family":"Spencer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7812-6311","authenticated-orcid":false,"given":"Jon","family":"Brassey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Pl\u00fcddemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2420-0811","authenticated-orcid":false,"given":"Igho J.","family":"Onakpoya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5871-299X","authenticated-orcid":false,"given":"David H.","family":"Evans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Conly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Jefferson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2021,11,2]]},"reference":[{"key":"ref-2","article-title":"Extended data for SARS-CoV-2 and the role of orofecal transmission: a systematic review.","author":"C Heneghan","year":"2021","journal-title":"figshare."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"529-36","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS-2 Group. 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Sobsey, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, Chapel Hill, NC, USA, 07 Jan 2022, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/10-231\/v2#referee-response-98695","order":0,"name":"referee-response-98695","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.78110.r98696, Jennifer Audsley, Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia, 12 Nov 2021, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/10-231\/v2#referee-response-98696","order":1,"name":"referee-response-98696","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This study was commissioned and paid for by the World Health Organization (WHO), WHO registration No2020\/1077093. Copyright in the original work on which this article is based belongs to WHO. The authors have been given permission to publish this article. The authors alone are responsible for the views expressed in the publication, which do not necessarily represent views, decisions or policies of the World Health Organization.\nCH, ES and AP also receive funding support from the NIHR SPCR Evidence Synthesis Working Group project 390. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}