The fecal-oral route is a common way for pathogens to be transmitted and can cause serious infections. Below are some examples of bacteria and viruses which are spread through the fecal-oral route. Some of these are healthcare acquired infections (HCAIs), infections which are contracted within a hospital or other care environment.
Clostridium difficile
Clostridium difficile, or C. diff, is a common and dangerous HCAI that can be transmitted through the fecal-oral pathway. Patients who have taken antibiotics for other conditions are more likely to contract Clostridium difficile. Around half a million people are estimated to contract Clostridium difficile in the USA every year, of which 29,000 will die from the infection (Lesser et al., 2015). Clostridium difficile is also notoriously difficult to clean: spores require heating at 96° for two minutes or 85°C for 15 minutes for elimination. If only heated to 63°C, studies have proven a 30% increase of 20 week-old dormant spores (Rodriguez-Palacios et al. 2011). It can be spread through direct or indirect contact with spores.
Cholera (Vibrio cholerae)
Cholera is a waterborne disease associated with contamination through poor water or sewage treatment systems. There are an estimated 1.3-4 million cases and up to 143,000 deaths per year associated with Cholera (Ali et al. 2015). These cases are mostly concentrated in parts of Africa, south Asia and Latin America due to poor local water sanitation. The Global Task Force on Cholera Control and associated partners are carrying out a global strategy to cut 90% of cholera incidences by 2030.
COVID-19
COVID-19, or ‘coronavirus’ as it is commonly known, is a rapidly spreading global pandemic. Many countries are affected, most notably China, Iran, Italy and South Korea. For updated information, this map gives a useful indication of the global spread of cases. COVID-19 is predominantly spread through the respiratory pathway, however a recent study by the Chinese Centre for Disease Control and Prevention has suggested that COVID-19 could be spread through fecal-oral transmission (Zhang et al. 2020 123-4). While the extent to which coronavirus is spread via the fecal-oral transmission route is yet unclear, these pathways should be considered and managed securely.
Norovirus
Norovirus is a dangerous HCAI which causes diarrhoea and vomiting and affects most countries worldwide. Annually, norovirus is responsible for over 200,000 deaths and costs over $60billion (PLOS). It is easily transmitted, through the fecal-oral route, contaminated food and water, infected surfaces and through vomit aerosols.
Hepatitis A and E
Both Hepatitus A and E are transmitted through a fecal-oral route. Both diseases are predominantly concentrated in developing countries and are caused by contamination of water or food supplies. Hepiatitus A is also spread through close contact with a carrier or an infected person. Hepatitis is inflammation of the liver and may be symptomless or cause jaundice, vomiting, tiredness and diarrhoea.
Shigella
Shigella is a bacterium which cases up to 165 million cases of diarrhoea and up to 600,000 deaths annually (Bowen, 2016). It is generally transmitted through a fecal-oral infection pathway directly, or indirectly through touching or ingesting contaminated substances (eg foods, contaminated water sources). Young children are a particularly high-risk group for contracting Shigella. The majority of cases are concentrated to developing countries, or areas with poor sanitation.
Further reading
Ali, Mohammad, Allyson R. Nelson, Anna Lena Lopez, and David A. Sack. “Updated Global Burden of Cholera in Endemic Countries.” PLOS Neglected Tropical Diseases 9, no. 6 (April 2015). https://doi.org/10.1371/journal.pntd.0003832.
“Burden of Clostridium Difficile Infection in the United States.” New England Journal of Medicine 372, no. 24 (November 2015): 2368–70. https://doi.org/10.1056/nejmc1505190.
Yong Zhang, Cao Chen, Shuangli Zhu, Chang Shu, Dongyan Wang, Jingdong Song, et al. Isolation of 2019-nCoV from a Stool Specimen of a Laboratory-Confirmed Case of the Coronavirus Disease 2019 (COVID-19)[J]. China CDC Weekly, 2020, 2(8): 123-124
“The Global Burden of Norovirus and Prospects for Vaccine Development”, PLOS. https://collections.plos.org/norovirus. Accessed March 12 2020.
Bowen A (2016). "Chapter 3: Infectious Diseases Related to Travel". The Yellow Book: Health Information for International Travel. CDC. ISBN 978-0-19-937915-6. Accessed 22 June 2016.
