Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Research Highlight
  • Published:

INFECTION

COVID-19: faecal–oral transmission?

Nature Reviews Gastroenterology & Hepatology volume 17, page 259 (2020)Cite this article

Subjects

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), first emerged in China in December 2019 and has now spread worldwide, with a reported 351,731 confirmed cases and 15,374 deaths as of 23 March 2020 according to John Hopkins University. The infection is typically characterized by respiratory symptoms, which indicates droplet transmission. However, several case studies have reported gastrointestinal symptoms and/or evidence that some patients with SARS-CoV-2 infection have viral RNA or live infectious virus present in faeces, which suggests that another possible route might be faecal–oral transmission.

There had been earlier reports, particularly in adults, of gastrointestinal symptoms and of the possibility of a faecal–oral route of transmission. In a cohort of 1,099 patients with COVID-19 from 552 hospitals in China, published in the New England Journal of Medicine, 5.0% of patients presented with nausea or vomiting and 3.8% presented with diarrhoea. Also, preliminary findings published in the American Journal of Gastroenterology found that of 204 patients with COVID-19 (mean age 54.9 years) who presented to three hospitals in China, 99 (48.5%) patients presented with digestive symptoms as their chief complaint. 60% of patients without digestive symptoms were cured and discharged, compared with 34.3% of patients with digestive symptoms. In a short Research Letter published in the Journal of the American Medical Association, different tissues of patients with COVID-19 (n = 1,070 specimens from 205 patients of mean age 44 years) were tested by RT–PCR. 32% of pharyngeal swabs (126 of 398) and 29% of faecal samples (44 of 153) tested positive. Electron microscopy of four SARS-CoV-2-positive faecal specimens detected live virus in stool samples from two patients who did not have diarrhoea.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

References

Original article

Related articles

Download references

Author information

Authors and Affiliations

  1. Nature Reviews Gastroenterology & Hepatology http://www.nature.com/nrgastro/

    Jordan Hindson

Authors
  1. Jordan Hindson
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Jordan Hindson.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hindson, J. COVID-19: faecal–oral transmission?. Nat Rev Gastroenterol Hepatol 17, 259 (2020). https://doi.org/10.1038/s41575-020-0295-7

Download citation

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41575-020-0295-7

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing