The fecal–oral route (also called the oral–fecal route or orofecal route) describes a particular
route of transmission of a disease wherein
pathogens in
fecal particles pass from one person to the mouth of another person. Main causes of fecal–oral disease transmission include lack of adequate
sanitation
Sanitation refers to public health conditions related to clean drinking water and treatment and disposal of human excreta and sewage. Preventing human contact with feces is part of sanitation, as is hand washing with soap. Sanitation syste ...
(leading to
open defecation
Open defecation is the human practice of defecating outdoors ("in the open") rather than into a toilet. People may choose fields, bushes, forests, ditches, streets, canals, or other open spaces for defecation. They do so either because they d ...
), and poor
hygiene
Hygiene is a series of practices performed to preserve health.
According to the World Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases." Personal hygiene refer ...
practices. If soil or
water bodies are polluted with fecal material, humans can be infected with
waterborne diseases
Waterborne diseases are conditions (meaning adverse effects on human health, such as death, disability, illness or disorders) caused by pathogenic micro-organisms that are transmitted in water. These diseases can be spread while bathing, washin ...
or
soil-transmitted diseases. Fecal contamination of food is another form of fecal-oral transmission.
Washing hands properly after changing a baby's diaper or after performing
anal hygiene
Anal hygiene or anal cleansing refers to hygienic practices that are performed on a person's anus, usually shortly after defecation. Post-defecation cleansing is rarely discussed academically, partly due to the social taboo. The scientific object ...
can prevent
foodborne illness
Foodborne illness (also foodborne disease and food poisoning) is any illness resulting from the spoilage of contaminated food by pathogenic bacteria, viruses, or parasites that contaminate food,
as well as prions (the agents of mad cow ...
from spreading.
The common factors in the fecal-oral route can be summarized as five Fs: fingers, flies, fields, fluids, and food. Diseases caused by fecal-oral transmission include
typhoid
Typhoid fever, also known as typhoid, is a disease caused by '' Salmonella'' serotype Typhi bacteria. Symptoms vary from mild to severe, and usually begin six to 30 days after exposure. Often there is a gradual onset of a high fever over several ...
,
cholera,
polio
Poliomyelitis, commonly shortened to polio, is an infectious disease caused by the poliovirus. Approximately 70% of cases are asymptomatic; mild symptoms which can occur include sore throat and fever; in a proportion of cases more severe sym ...
,
hepatitis
Hepatitis is inflammation of the liver parenchyma, liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice), Anorexia (symptom), poor appetite ...
and many other infections, especially ones that cause
diarrhea
Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin ...
.
Background
Although fecal–oral transmission is usually discussed as a
route of transmission, it is actually a specification of the entry and exit portals of the pathogen, and can operate across several of the other routes of transmission.
[ ] Fecal–oral transmission is primarily considered as an indirect contact route through contaminated food or water. However, it can also operate through direct contact with feces or contaminated body parts, such as through
anal sex. It can also operate through
droplet or
airborne transmission through the
toilet plume
A toilet plume is the dispersal of microscopic particles as a result of flushing a toilet. Normal use of a toilet by healthy individuals is considered unlikely to be a major health risk. However this dynamic changes if an individual is fighting ...
from contaminated toilets.
F-diagram
The foundations for the "F-diagram" being used today were laid down in a publication by the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
(WHO) in 1958.
This publication explained transmission routes and barriers to the transmission of diseases from the focal point of
human feces
Human feces (or faeces in British English) is the solid or semisolid remains of food that could not be digested or absorbed in the small intestine of humans, but has been further broken down by bacteria in the large intestine. It also contains ...
.
Modifications have been made over the course of history to derive modern-looking F-diagrams. These diagrams are used in many sanitation publications.
They are set up in a way that fecal–oral transmission pathways are shown to take place via water, hands,
arthropod
Arthropods (, (gen. ποδός)) are invertebrate animals with an exoskeleton, a Segmentation (biology), segmented body, and paired jointed appendages. Arthropods form the phylum Arthropoda. They are distinguished by their jointed limbs and Arth ...
s and soil. To make it easier to remember, words starting with the letter "F" are used for each of these pathways, namely fluids, fingers,
flies
Flies are insects of the Order (biology), order Diptera, the name being derived from the Ancient Greek, Greek δι- ''di-'' "two", and πτερόν ''pteron'' "wing". Insects of this order use only a single pair of wings to fly, the hindwing ...
, food, fields,
fomites (objects and household surfaces).
Rather than only concentrating on human feces,
animal feces should also be included in the F-diagram.
The
sanitation
Sanitation refers to public health conditions related to clean drinking water and treatment and disposal of human excreta and sewage. Preventing human contact with feces is part of sanitation, as is hand washing with soap. Sanitation syste ...
and
hygiene
Hygiene is a series of practices performed to preserve health.
According to the World Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases." Personal hygiene refer ...
barriers when placed correctly prevent the transmission of an infection through hands, water and food. The F-diagram can be used to show how proper sanitation (in particular
toilet
A toilet is a piece of sanitary hardware that collects human urine and Human feces, feces, and sometimes toilet paper, usually for disposal. Flush toilets use water, while dry toilet, dry or non-flush toilets do not. They can be designed for ...
s,
hygiene
Hygiene is a series of practices performed to preserve health.
According to the World Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases." Personal hygiene refer ...
,
handwashing) can act as an effective barrier to stop
transmission of diseases via fecal–oral pathways.
Examples
Transmission
The process of transmission may be simple or involve multiple steps. Some examples of routes of fecal–oral transmission include:
* water that has come in contact with feces (for example due to
groundwater
Groundwater is the water present beneath Earth's surface in rock and soil pore spaces and in the fractures of rock formations. About 30 percent of all readily available freshwater in the world is groundwater. A unit of rock or an unconsolidat ...
pollution from
pit latrines) and is then not
treated properly before drinking;
* by shaking someone's hand that has been contaminated by stool, changing a child's diapers, working in the garden, or dealing with
domestic animals.
* food that has been prepared in the presence of fecal matter;
* eating soil (
geophagia)
* disease vectors, like
houseflies
The housefly (''Musca domestica'') is a fly of the suborder Cyclorrhapha. It is believed to have evolved in the Cenozoic Era, possibly in the Middle East, and has spread all over the world as a commensal of humans. It is the most common ...
, spreading contamination from inadequate fecal disposal such as
open defecation
Open defecation is the human practice of defecating outdoors ("in the open") rather than into a toilet. People may choose fields, bushes, forests, ditches, streets, canals, or other open spaces for defecation. They do so either because they d ...
;
* poor or absent
hand washing
Hand washing (or handwashing), also known as hand hygiene, is the act of cleaning one's hands with soap or handwash and water to remove viruses/bacteria/microorganisms, dirt, grease, or other harmful and unwanted substances stuck to the hand ...
after using the
toilet
A toilet is a piece of sanitary hardware that collects human urine and Human feces, feces, and sometimes toilet paper, usually for disposal. Flush toilets use water, while dry toilet, dry or non-flush toilets do not. They can be designed for ...
or changing diapers;
* poor or absent cleaning of anything that has been in contact with feces;
* sexual practices that may involve oral contact with feces, such as
anilingus ("Rimjobs"),
coprophilia or
A2M sexual intercourse.
* eating feces, in children, or in a mental disorder called
coprophagia
Prevention
One approach to changing people's behaviors and stopping
open defecation
Open defecation is the human practice of defecating outdoors ("in the open") rather than into a toilet. People may choose fields, bushes, forests, ditches, streets, canals, or other open spaces for defecation. They do so either because they d ...
is the
community-led total sanitation approach. In this process "live demonstrations" of flies moving from food to fresh human feces and back are used. This can "trigger" villagers into action.
[Kal, K and Chambers, R (2008]
Handbook on Community-led Total Sanitation
, Plan UK Accessed 2015-02-26
Diseases
The list below shows the main diseases that can be passed via the fecal–oral route. They are grouped by the type of pathogen involved in
disease transmission.
Bacteria
* ''
Vibrio cholerae'' (
cholera)
* ''
Clostridium difficile
''Clostridioides difficile'' (syn. ''Clostridium difficile'') is a bacterium that is well known for causing serious diarrheal infections, and may also cause colon cancer. Also known as ''C. difficile'', or ''C. diff'' (), is Gram-positive spec ...
'' (
pseudomembranous enterocolitis)
* ''
Shigella'' (
shigellosis / bacillary dysentery)
* ''
Salmonella typhii'' (
typhoid fever
Typhoid fever, also known as typhoid, is a disease caused by '' Salmonella'' serotype Typhi bacteria. Symptoms vary from mild to severe, and usually begin six to 30 days after exposure. Often there is a gradual onset of a high fever over severa ...
)
* ''
Vibrio parahaemolyticus''
* ''
Escherichia coli
''Escherichia coli'' (),Wells, J. C. (2000) Longman Pronunciation Dictionary. Harlow ngland Pearson Education Ltd. also known as ''E. coli'' (), is a Gram-negative, facultative anaerobic, rod-shaped, coliform bacterium of the genus '' Esc ...
''
[Intestinal Parasites and Infection]
fungusfocus.com – Retrieved on 2010-01-21
* ''
Campylobacter
''Campylobacter'' (meaning "curved bacteria") is a genus of Gram-negative bacteria. ''Campylobacter'' typically appear comma- or s-shaped, and are motile. Some ''Campylobacter'' species can infect humans, sometimes causing campylobacteriosis, a d ...
''
Viruses
*
Hepatitis A
Hepatitis A is an infectious disease of the liver caused by ''Hepatovirus A'' (HAV); it is a type of viral hepatitis. Many cases have few or no symptoms, especially in the young. The time between infection and symptoms, in those who develop the ...
*
Hepatitis E
*
Enteroviruses
*
Norovirus acute gastroenteritis
* ''
Poliovirus
A poliovirus, the causative agent of polio (also known as poliomyelitis), is a serotype of the species ''Enterovirus C'', in the family of '' Picornaviridae''. There are three poliovirus serotypes: types 1, 2, and 3.
Poliovirus is composed of a ...
'' (
poliomyelitis)
* Although most human
Coronaviruses are not transmitted fecally (
Feline coronavirus, in contrast, is), there have also been reports of
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is a strain of coronavirus that causes COVID-19 (coronavirus disease 2019), the respiratory illness responsible for the ongoing COVID-19 pandemic. The virus previously had a No ...
being found in stool samples.
*
Rotavirus gastroenteritis
*
Adenovirus gastroenteritis
Protozoans
* ''
Entameba histolytica''
[ ( amoebiasis / amoebic dysentery)
* '' Giardia'' ( giardiasis])
* '' Cryptosporidium'' ( cryptosporidiosis)
* ''Toxoplasma gondii
''Toxoplasma gondii'' () is an obligate intracellular parasitic protozoan (specifically an apicomplexan) that causes toxoplasmosis. Found worldwide, ''T. gondii'' is capable of infecting virtually all warm-blooded animals, but felids, such ...
'' ( toxoplasmosis)
Helminths
* Tapeworm
Eucestoda, commonly referred to as tapeworms, is the larger of the two subclasses of flatworms in the class Cestoda (the other subclass is Cestodaria). Larvae have six posterior hooks on the scolex (head), in contrast to the ten-hooked Cestod ...
s[
* Soil-transmitted helminths
]
Related diseases
Waterborne diseases
Waterborne diseases are conditions (meaning adverse effects on human health, such as death, disability, illness or disorders) caused by pathogenic micro-organisms that are transmitted in water. These diseases can be spread while bathing, washin ...
are diseases caused by pathogenic microorganisms that most commonly are transmitted in contaminated fresh water. This is one particular type of fecal-oral transmission.
Neglected tropical diseases also include many diseases transmitted via the fecal-oral route.
See also
* Basic reproduction number
* Toilet
A toilet is a piece of sanitary hardware that collects human urine and Human feces, feces, and sometimes toilet paper, usually for disposal. Flush toilets use water, while dry toilet, dry or non-flush toilets do not. They can be designed for ...
* Vector control
References
{{DEFAULTSORT:Fecal-Oral Route
Disease transmission
Parasitology
Sanitation