COVID-19: Fecal-Oral Transmission of SARS-CoV-2 In Children

COVID-19: Fecal-Oral Transmission of SARS-CoV-2 In Children. Jefferson T, Heneghan C.

https://www.cebm.net/study/covid-19-fecal-oral-transmission-of-sars-cov-2-in-children/

Published on July 2, 2020

Included in Transmission Dynamics of COVID-19

Reference	Donà, Daniele MD, PhD, MSc; Minotti, Chiara MD†; Costenaro, Paola MD; Da Dalt, Liviana MD‡; Giaquinto, Carlo MD* Fecal-Oral Transmission of SARS-CoV-2 In Children. The Pediatric Infectious Disease Journal: July 2020 - Volume 39 - Issue 7 - p e133-e134 2020
Study type
Country	Italy
Setting	Public/Hospital
Funding Details	Non reported
Transmission mode	Orofecal
Exposures

Bottom Line

In children, the orofecal route is an alternative route of transmission, regardless of presenting COVID 19 symptomatology. Exclusion of SARS-CoV-2 infection by single time point nasopharyngeal swabs should not be used in children.

Evidence Summary

In March 2020, two infants with SARS-CoV-2 infection were admitted

A 5-month-old boy, with respiratory and gastrointestinal symptoms with diarrhoea. Had positive nasopharyngeal and rectal swabs. The second a 2-months-old, with mild respiratory symptoms, tested positive for SARS-CoV-2 faecally on day 3 from the onset.

The authors also cite evidence from the SARS 1 that fecal excretion could be ongoing even after 30 days from symptom onset.

What did they do?

The study is a short case report of two infants aged 2 and 5 months admitted to hospital in Padova, Italy in March 2020. One had mild GI symptoms, the other mild respiratory symptoms. Both had COVID 19 with positive nasal and rectal swabs. Both were eventually discharged. Because at the time the MoH policy was only to monitor post-discharge using only nasal swabs, the authors undertook a review of the evidence for orofecal transmission.

Study reliability

There is no method chapter and the paper is a descriptive review of the evidence of orofecal transmission and anal shedding up to March. They do not report on whether stool isolates from the 2 children are viable.

Clearly defined setting	Demographic characteristics described	Follow-up length was sufficient	Transmission outcomes assessed	Main biases are taken into consideration
Unclear	Yes	Yes	No	No

What else should I consider?

This review of case series needs replication and more evidence must be accumulated.

Further evidence of SARS-CoV-2 Detection in Stools and Rectal Swabs in Adults and Children

SARS-CoV-2 turned positive in a discharged patient with COVID-19 arouses concern regarding the present standard for discharge. Int J Infect Dis. 2020 Mar 18. pii: S1201-9712(20)30126-0.
Case Investigation Team. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020;382:929–936.
Fecal specimen diagnosis 2019 Novel Coronavirus-Infected Pneumonia. J Med Virol. 2020 Mar 3. doi: 10.1002/jmv.25742.
Public health might be endangered by possible prolonged discharge of SARS-CoV-2 in stool. J infect. 2020 Mar 5. pii: S0163-4453(20)30111-0.
First pediatric case of Coronavirus Disease 2019 in Korea. J Korean Med Sci. 2020;35:e124.
Detection of Novel Coronavirus by RT-PCR in Stool Specimen from Asymptomatic Child, China. Emerg Infect Dis. 2020;26.

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.