Shedding of SARS-CoV-2 in feces and urine and its potential role in person-to-person transmission and the environment-based spread of COVID-19.
Shedding of SARS-CoV-2 in feces and urine and its potential role in person-to-person transmission and the environment-based spread of COVID-19.
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SARS-CoV-2在粪便和尿液中的脱落及其在COVID-19人际传播和环境传播中的潜在作用。
DOI：
10.1016/j.scitotenv.2020.141364
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发表时间：
2020-12-20
期刊：
影响因子：
--
通讯作者：
Farkas K
中科院分区：
文献类型：
--
作者：
Jones DL;Baluja MQ;Graham DW;Corbishley A;McDonald JE;Malham SK;Hillary LS;Connor TR;Gaze WH;Moura IB;Wilcox MH;Farkas K
最近在粪便中检测到SARS-CoV-2 RNA，导致人们猜测它可以通过粪便-口/眼途径传播。本综述旨在批判性地评估胃肠道（GI）症状的发生率、粪便和尿液中SARS-CoV-2的数量和传染性，以及这些症状是否在卫生设施、污水管网、污水处理厂和更广泛的环境（如河流、湖泊和海水）中构成感染风险。对48项独立研究的回顾显示，仅在少数COVID-19病例中明显存在严重的胃肠道功能障碍，其中11±2%表现为腹泻，12±3%表现为呕吐和恶心。除了这些病例外，在一些无症状、轻度和症状前个体的粪便中也可以检测到SARS-CoV-2 RNA。病毒的粪便脱落在症状期达到高峰，可持续数周，但在症状后阶段丰度下降。偶尔在尿液中检测到SARS-CoV-2 RNA，但在粪便样本中报告更为频繁。尿液（约102-105 gc/ml）和粪便（约102-107 gc/ml）中病毒遗传物质的丰度远低于鼻咽液（约105-1011 gc/ml）。有强有力的证据表明，SARS-CoV-2在肠道中繁殖，传染性病毒偶尔会从尿液和粪便样本中检出。呕吐物中SARS-CoV-2的水平和感染能力尚不清楚。与通过粪口途径传播的肠道病毒（如诺如病毒、腺病毒）相比，由于粪便/尿液中存在的病毒相对较少，SARS-CoV-2通过粪便或尿液传播的可能性似乎要低得多。最大的传播风险将发生在临床和护理家庭环境中，在这些环境中发生人员和尿液/粪便的二次处理。此外，虽然在废水中可以检测到SARS-CoV-2 RNA遗传物质，但常规处理大大降低了这一信号。我们的分析还表明，由于接触受污水污染的水（例如游泳、冲浪、钓鱼）或食物（例如沙拉、贝类）而感染的可能性极低或可以忽略不计，这是基于非常低的预测丰度和有限的SARS-CoV-2环境存活。这些结论得到了以下事实的证实：全球发生了数千万例COVID-19病例，但接触粪便或废水从未被认为是传播媒介。
The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). A review of 48 independent studies revealed that severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 102–105 gc/ml) and feces (ca. 102–107 gc/ml) is much lower than in nasopharyngeal fluids (ca. 105–1011 gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the gut and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears much lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that tens of million cases of COVID-19 have occurred globally, but exposure to feces or wastewater has never been implicated as a transmission vector.
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影响因子：
6.9
作者：
Booth, C. Makison;Frost, G.
通讯作者：
Frost, G.
影响因子：
8.1
作者：
Caruso BA;Clasen TF;Hadley C;Yount KM;Haardörfer R;Rout M;Dasmohapatra M;Cooper HL
通讯作者：
Cooper HL
影响因子：
3.7
作者：
Bertram S;Heurich A;Lavender H;Gierer S;Danisch S;Perin P;Lucas JM;Nelson PS;Pöhlmann S;Soilleux EJ
通讯作者：
Soilleux EJ
DOI：
10.1016/s0002-9343(99)00128-x
发表时间：
1999-06
期刊：
The American journal of medicine
影响因子：
--
作者：
Aranda-Michel J;Giannella RA
通讯作者：
Giannella RA
DOI：
10.1016/j.jes.2017.07.015
发表时间：
2018-05
期刊：
Journal of environmental sciences (China)
影响因子：
--
作者：
Brisebois E;Veillette M;Dion-Dupont V;Lavoie J;Corbeil J;Culley A;Duchaine C
通讯作者：
Duchaine C