Persistent viral shedding of SARS‐CoV‐2 in faeces – a rapid review

Abstract

Aim In addition to respiratory symptoms, COVID‐19 can present with gastrointestinal complaints suggesting possible faeco‐oral transmission. The primary aim of this review was to establish the incidence and timing of positive faecal samples for SARS‐CoV‐2 in patients with COVID‐19. Methods A systematic literature review identified studies describing COVID‐19 patients tested for faecal virus. Search terms for MEDLINE included ‘clinical’, ‘faeces’, ‘gastrointestinal secretions’, ‘stool’, ‘COVID‐19’, ‘SARS‐CoV‐2’ and ‘2019‐nCoV’. Additional searches were done in the American Journal of Gastroenterology, Gastroenterology, Gut, Lancet Gastroenterology and Hepatology, the World Health Organization Database, the Centre for Evidence‐Based Medicine, New England Journal of Medicine, social media and the National Institute for Health and Care Excellence, bioRxiv and medRxiv preprints. Data were extracted concerning the type of test, number and timing of positive samples, incidence of positive faecal tests after negative nasopharyngeal swabs and evidence of viable faecal virus or faeco‐oral transmission of the virus. Results Twenty‐six relevant articles were identified. Combining study results demonstrated that 53.9% of those tested for faecal RNA were positive. The duration of faecal viral shedding ranged from 1 to 33 days after a negative nasopharyngeal swab with one result remaining positive 47 days after onset of symptoms. There is insufficient evidence to suggest that COVID‐19 is transmitted via faecally shed virus. Conclusion There is a high rate of positive polymerase chain reaction tests with persistence of SARS‐CoV‐2 in faecal samples of patients with COVID‐19. Further research is needed to confirm if this virus is viable and the degree of transmission through the faeco‐oral route. This may have important implications on isolation, recommended precautions and protective equipment for interventional procedures involving the gastrointestinal tract.

SARS-CoV-2 in wastewater settled solids is associated with COVID-19 cases in a large urban sewershed

“…It is therefore no surprise that wastewater has been tapped as an epidemiological tool to gauge aspects of public health, such as narcotics usage 1,2 , the reemergence of poliovirus 3,4 , and infection rates of viral 5,6 and bacterial 7,8 diseases. COVID-19 has accelerated the interest in wastewater-based epidemiology (WBE) due to the fact that SARS-CoV-2 genes are detected in the feces of many infected individuals [9][10][11] . More established epidemiological tools used to track cases in a community have been hindered during the COVID-19 pandemic by diagnostic kit shortages 12 , asymptomatic or mild cases that do not encounter the medical system or delay seeking medical attention 13 , and the lag times between testing and reporting 14 .…”

Highly predictive regression model of active cases of COVID-19 in a population by screening wastewater viral load

“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel member of the Coronaviridae family and is the pathogen responsible for coronavirus disease 2019 (COVID- 19), which has led to a worldwide pandemic. Patients may present with a wide variety of symptoms and the prognosis ranges from mild or moderate disease, to severe disease and death 1 .…”

“…Conversely, SARS-CoV-2 RNA has been found in the faeces of people without gastrointestinal symptoms [13][14][15][16][17][18] . A systematic literature review found that more than half (53.9%) of those tested for faecal viral RNA were positive, and noted that the virus is excreted in the stool for long periods, in some cases a month or more after the individual has tested negative for their respiratory samples 15,[19][20][21][22][23][24] . The fact that the virus can grow in enterocytes of human small intestine organelles 25,26 and the discovery of infectious virus in faeces highlights the potential for replication in the gastrointestinal epithelium of patients.…”

“…The fact that the virus can grow in enterocytes of human small intestine organelles 25,26 and the discovery of infectious virus in faeces highlights the potential for replication in the gastrointestinal epithelium of patients. However, despite several studies suggesting that transmission of the virus could take place through the faecal-oral axis 27,28 , there is so far insufficient evidence to confirm this method of contagion 19,29 . Similarly, there has been no evidence of contagion through wastewater, which might reflect SARS-CoV-2's instability in water and its sensitivity to disinfectants 9,[29][30][31][32][33][34] .…”

Частота выявления SARS-CoV-2 в фекалиях детей с инфекционными диареями в дебюте эпидемии COVID-19

“…течении COVID-19, которое часто наблюдается у детей, позволяет использовать данный тип материала для выявления скрытой циркуляции SARS-CoV-2 на территориях и оценки объективности регистрируемых уровней заболеваемости [2]. Инфекционные диареи являются наиболее распространенной группой нозологий, надзор за которыми обеспечивает доступность материала для проведения данного мониторинга.…”