COVID-19: Children with negative nasal specimens excrete SARS‐CoV‐2 in stools

Children with negative nasal specimens excrete SARS‐CoV‐2 in stools.  Jefferson T, Heneghan C.

Published on June 30, 2020

Reference Zhang T, Cui X, Zhao X, et al. Detectable SARS-CoV-2 viral RNA in feces of three children during recovery period of COVID-19 pneumonia. J Med Virol. 2020;92(7):909-914. 2020
Study type
Country China
Setting Public/Hospital, Tianjin,
Funding Details Program of Tianjin Science and Technology Plan (grant no. 18ZXDBSY00170)
Transmission mode Orofecal
Exposures Hospital

Bottom Line

Three children with mild symptoms who were SARS‐CoV‐2 throat swab specimen negative on discharge from hospital were stool positive 10 days post-discharge

Evidence Summary

Case series of three male children aged 6, 8  and 9 whose parents had COVID-19. The children were admitted to hospital with mild symptoms and given a variety of treatments, after which they tested negative throat swab nucleic acid at 7, 11 and 14 7 days, and were discharged from hospital.  On follow up they again tested negative at 9, 13 and 16, 13 days respectively.

Post-discharge stool SARS‐CoV‐2 nucleic acid tests were positive at 10 days. The three patients were readmitted with no clinical symptoms nor pathological changes in lung Imaging. Post readmission the stools were negative at 4, 5, and 10 days. 

Stool positivity can, therefore, persist up to 20 days form symptom onset, and recovered patients might be possible carriers of the virus. 

What did they do?

The study describes the clinical pathway followed by the three boy cases. Histories, imaging and lab results are reported.

Study reliability

The case series is small.

Clearly defined setting Demographic characteristics described Follow-up length was sufficient Transmission outcomes assessed Main biases are taken into consideration
Yes Yes Yes Yes Yes

What else should I consider?

The results of this small case series need replicating. No mention of the viability of Co-V recovered from stools is made.

About the authors

Carl Heneghan

Carl is Professor of EBM & Director of CEBM at the University of Oxford. He is also a GP and tweets @carlheneghan. He has an active interest in discovering the truth behind health research findings

Tom Jefferson

Tom Jefferson, epidemiologist.