
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 (leading to
open defecation), and poor
hygiene practices. If soil or
water bodies are polluted with fecal material, humans can be infected with
waterborne diseases 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 can prevent
foodborne illness from spreading..Toilet flushing & subsequent inhaled aerosols is another potential route.
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,
cholera
Cholera () is an infection of the small intestine by some Strain (biology), strains of the Bacteria, bacterium ''Vibrio cholerae''. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea last ...
,
polio,
hepatitis and many other infections, especially ones that cause
diarrhea.
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 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 list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
(WHO) in 1958.
This publication explained transmission routes and barriers to the transmission of diseases from the focal point of
human feces.
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 ( ) are invertebrates in the phylum Arthropoda. They possess an arthropod exoskeleton, exoskeleton with a cuticle made of chitin, often Mineralization (biology), mineralised with calcium carbonate, a body with differentiated (Metam ...
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, food, fields,
fomites (objects and household surfaces).
Rather than only concentrating on human feces,
feces from other animals should also be included in the F-diagram.
The
sanitation and
hygiene 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
toilets,
hygiene,
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 Pore space in soil, soil pore spaces and in the fractures of stratum, rock formations. About 30 percent of all readily available fresh water in the world is groundwater. A unit ...
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, spreading contamination from inadequate fecal disposal such as
open defecation;
* poor or absent
hand washing after using the
toilet 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,
coprophilia, or
A2M.
* eating feces, in children, or in a mental disorder called
coprophagia
Prevention

One approach to changing people's behaviors and stopping
open defecation 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
Cholera () is an infection of the small intestine by some Strain (biology), strains of the Bacteria, bacterium ''Vibrio cholerae''. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea last ...
)
* ''
Clostridioides difficile'' (
pseudomembranous enterocolitis)
* ''
Shigella'' (
shigellosis / bacillary dysentery)
* ''
Salmonella typhii'' (
typhoid fever)
* ''
Vibrio parahaemolyticus''
* ''
Escherichia coli''
[Intestinal Parasites and Infection]
fungusfocus.com – Retrieved on 2010-01-21
* ''
Campylobacter''
Viruses
*
Hepatitis A
*
Hepatitis E
*
Enteroviruses
*
Norovirus acute gastroenteritis
* ''
Poliovirus'' (
poliomyelitis)
* Most human
Coronaviruses are transmitted fecally including
Feline coronavirus, there have also been reports of
SARS-CoV-2 being found in stool samples.
*
Rotavirus
Rotaviruses are the most common cause of diarrhea, diarrhoeal disease among infants and young children. Nearly every child in the world is infected with a rotavirus at least once by the age of five. Immunity (medical), Immunity develops with ...
gastroenteritis
*
Adenovirus gastroenteritis
Protozoans
* ''
Entamoeba histolytica''
[ ( amoebiasis / amoebic dysentery)
* '' Giardia'' ( giardiasis])
* '' Cryptosporidium'' ( cryptosporidiosis)
* '' Toxoplasma gondii'' ( toxoplasmosis)
Helminths
* Tapeworms[
* Soil-transmitted helminths
]
Related diseases
Waterborne diseases 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
* Vector control
* Hookworm
References
{{DEFAULTSORT:Fecal-Oral Route
Disease transmission
Parasitology
Sanitation