COVID-19 Evidence Alerts
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Prognosis Zhang Y, Cen M, Hu M, et al. Prevalence and Persistent Shedding of Fecal SARS-CoV-2 RNA in Patients With COVID-19 Infection: A Systematic Review and Meta-analysis. Clin Transl Gastroenterol. 2021 Apr 9;12(4):e00343. doi: 10.14309/ctg.0000000000000343.

INTRODUCTION: The prevalence and shedding of fecal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA indicate coronavirus disease 2019 (COVID-19) infection in the gastrointestinal (GI) tract and likely infectivity. We performed a systemic review and meta-analysis to evaluate the prevalence and the duration of shedding of fecal RNA in patients with COVID-19 infection.

METHODS: PubMed, Embase, Web of Science, and Chinese databases Chinese National Knowledge Infrastructure and Wanfang Data up to June 2020 were searched for studies evaluating fecal SARS-CoV-2 RNA, including anal and rectal samples, in patients with confirmed COVID-19 infection. The pooled prevalence of fecal RNA in patients with detectable respiratory RNA was estimated. The days of shedding and days to loss of fecal and respiratory RNA from presentation were compared.

RESULTS: Thirty-five studies (N = 1,636) met criteria. The pooled prevalence of fecal RNA in COVID-19 patients was 43% (95% confidence interval [CI] 34%-52%). Higher proportion of patients with GI symptoms (52.4% vs 25.9%, odds ratio = 2.4, 95% CI 1.2-4.7) compared with no GI symptoms, specifically diarrhea (51.6% vs 24.0%, odds ratio = 3.0, 95% CI 1.9-4.8), had detectable fecal RNA. After loss of respiratory RNA, 27% (95% CI 15%-44%) of the patients had persistent shedding of fecal RNA. Days of RNA shedding in the feces were longer than respiratory samples (21.8 vs 14.7 days, mean difference = 7.1 days, 95% CI 1.2-13.0). Furthermore, days to loss of fecal RNA lagged respiratory RNA by a mean of 4.8 days (95% CI 2.2-7.5).

DISCUSSION: Fecal SARS-CoV-2 RNA is commonly detected in COVID-19 patients with a 3-fold increased risk with diarrhea. Shedding of fecal RNA lasted more than 3 weeks after presentation and a week after last detectable respiratory RNA.

Discipline / Specialty Area Score
Pediatrics (General)
Infectious Disease
Pediatric Neonatology
Hospital Doctor/Hospitalists
Internal Medicine
Pediatric Hospital Medicine
Public Health
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Comments from MORE raters

Infectious Disease rater

This article is super interesting to me, but it might have less relevance to practitioners. The reason is that we are not routinely checking fecal shedding of coronavirus and are not likely to start. It is somewhat unclear if this has implications for transmission via aerosol of feces in a person with diarrhea and a funny plumbing system. For the most part, it shows consistent evidence for prolonged fecal carriage of viral RNA.

Pediatric Hospital Medicine rater

This is good information to have synthesized into a review. Heavily china region based data.. Western diets and lifestyles may influence results for different population; therefore, more data are required.

Public Health rater

Certainly, the findings of this study can help those working in the field of preventive medicine in terms of the duration of isolation of patients who present with gastrointestinal symptoms.