Investigation of SARS-CoV-2 faecal shedding in the community: a prospective household cohort study (COVID-LIV) in the UK
Authors: Vaselli Natasha Marcella , Setiabudi Wega , Subramaniam Krishanthi , Adams Emily R. , Turtle Lance , Iturriza-Gómara Miren , Solomon Tom , Cunliffe Nigel A. , French Neil , Hungerford Daniel ,   on behalf of the COVID-LIV Study Group, Turtle Lance , Hungerford Daniel , Subramaniam Krishanthi , Vivancos Roberto , Gabbay Mark , Buchan Iain , Carrol Enitan D. , Iturriza-Gómara Miren , Solomon Tom , Cunliffe Nigel A. , Adams Emily R. , Gamble Carrol , Crossley Lynnette , Joseph Neil , Setiabudi Wega , Vaselli Natasha Marcella , Wilton Moon , Troughton Lee D. , Kilada Samantha , Abba Katharine , Simpson Victoria , Tulloch John S. P. , Goodwin Lynsey , Daws Rachael , Forootan Shiva Seyed , Dobson Susan , Press Rachel , Spaine Vida , Hands Lesley , Bradfield Kate , McNally Carol , Moitt Tracy , Balabanova Silviya , Donohue Chloe , Finnetty Lynsey , Marsh Laura , Greenhalf William , Naisbitt Dean J. , Shaw Victoria E. , Aston Stephen , Platt Gareth , Dunn Christopher , Thomson Paul J. , Ogese Monday , Hammond Sean , Adair Kareena , Farrell Liam , Gardner Joshua , Jaruthamsophon Kanoot , Ali Serat-E , Lister Adam , Booth Laura , Ashworth Milton , Bullock Katie , Catterall Benjamin W. A. , Foster Terry , Lavelle-Langham Lara , Middleton Joanna , Reynolds William , Cass Emily , Carracedo Alejandra Doce , Davies Lianne , Flaherty Lisa , Oates Melanie , Maziere Nicole , Lloyd Jennifer , Jones Christopher , Massey Hannah , Holmes Anthony , Carlucci Nicola , Brammah Vanessa , Ramos Yasmyn , Allen Daniel , Armstrong Jane , Howarth Debbie , Wilcock Eve , Lowe Jenna , Jones Jayne , Wright Paula , Slack Iain , McLaughlin Simone , Mason Jessica , Edwards Thomas , McKeown Claudia , Hendrick Elysse , Williams Chris , Byrne Rachel , Buist Kate , Garrod Gala , Owen Sophie , Jones Ashley P. , Gkioni Efstathia 
Published: August 2021

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.