COVID-19: fecal shedding in children

COVID-19: Fecal shedding in children. Jefferson T, Heneghan C

Published on June 30, 2020

Reference Santos VS, Gurgel RQ, Cuevas LE, Martins-Filho PR. Prolonged fecal shedding of SARS-CoV-2 in pediatric patients. A quantitative evidence synthesis. J Pediatr Gastroenterol Nutr. 2020;10.1097/MPG.0000000000002798.  2020
Study type
Country Brazil/Global
Setting Hospital
Funding Details Non reported
Transmission mode Orofecal
Exposures Hospitalised children

Bottom Line

Fecal shedding in children with COVID-19 occurs on average nine days longer than by the respiratory route

Evidence Summary

On admission, SARS-CoV-2 RNA was detected respectively in 95% (34/36) and 69% (22/32) of respiratory and fecal samples by RT-PCR. This a lower detection rate than in SARS (86%) but higher than MERS (15%).

Three times as many children had SARS-CoV-2 shedding in stools after 14 days of symptoms onset compared to respiratory samples, RR= 3.2 (95%CI 1.2 to 8.9).

Viral RNA shedding was approximately 9 days in fecal samples (mean difference = 8.6, 95%CI 1.7 to 15.4) compared with respiratory samples.

What did they do?

The study is a systematic review of 4 case series (36 children, 15 boys and 21 girls, aged 56 to 91 months) aimed at investigating differences in viral shedding in respiratory and fecal samples from children with COVID-19. All children had mild symptoms and none died.

The duration of viral shedding in respiratory swabs and stool samples was defined as the number of days from symptoms onset to the day when the last specimen in which SARS-CoV-2 was detected.

Study reliability

The circumstances of selection and settings of the children in the original case series are unclear and the testing is not described in any great detail. The authors of the review are unsure whether the fecally shed viruses were viable and hence infectious.

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

What else should I consider?

The results of this review are preliminary but potentially very important but need verification and development.

Included studies 

  • Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med 2020; 26 (4):502–505. doi:10.1038/s41591-020-0817-4. 
  • A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis 2020; doi:10.1093/cid/ciaa198.  
  • Do children need a longer time to shed SARS-CoV-2 in stool than adults? J Microbiol Immunol Infect 2020; doi:10.1016/j.jmii.2020.03.010. 
  • Epidemiologic and clinical characteristics of 10 children with coronavirus disease 2019 in Changsha, China. J Clin Virol 2020; 127:104353.doi:10.1016/j.jcv.2020.104353. 

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.