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The "F-diagram" (feces, fingers, flies, fields, fluids, food), showing pathways of fecal–oral disease transmission. The vertical blue lines show barriers: toilets, safe water, hygiene and handwashing.

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.^{[citation needed]}

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, 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.^[1] 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.^[2]^[3] It can also operate through droplet or airborne transmission through the toilet plume from contaminated toilets.^[4]^[5]

F-diagram

The foundations for the "F-diagram" being used today were laid down in a publication by the World Health Organization (WHO) in 1958.^[6] This publication explained transmission routes and barriers to the transmission of diseases from the focal point of human feces.^{[citation needed]}

Modifications have been made over the course of history to derive modern-looking F-diagrams. These diagrams are used in many sanitation publications.^[7] They are set up in a way that fecal–oral transmission pathways are shown to take place via water, hands, arthropods 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).^{[citation needed]}

Rather than only concentrating on human feces, feces from other animals should also be included in the F-diagram.^[7]

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.^{[citation needed]}

Examples

Transmission

The process of transmission may be simple or involve multiple steps. Some examples of routes of fecal–oral transmission include:^{[citation needed]}

water that has come in contact with feces (for example due to groundwater 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.^[8]

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.^{[citation needed]}

Bacteria

Vibrio cholerae (cholera)
Clostridium difficile (pseudomembranous enterocolitis)
Shigella (shigellosis / bacillary dysentery)^[9]
Salmonella typhii (typhoid fever)^[10]
Vibrio parahaemolyticus^[11]
Escherichia coli^[12]
Campylobacter^[13]

Viruses

Hepatitis A^[14]
Hepatitis E^[15]
Enteroviruses
Norovirus acute gastroenteritis
Poliovirus (poliomyelitis)
Although most human Coronaviruses are not transmitted fecally (Feline coronavirus, in contrast, is), there have also been reports of SARS-CoV-2 being found in stool samples.^[16]^[17]
Rotavirus gastroenteritis
Adenovirus gastroenteritis

Protozoans

Entamoeba histolytica^[12] (amoebiasis / amoebic dysentery)
Giardia (giardiasis^[18])
Cryptosporidium (cryptosporidiosis)
Toxoplasma gondii^[13] (toxoplasmosis)

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.^{[citation needed]}

Neglected tropical diseases also include many diseases transmitted via the fecal-oral route.^{[citation needed]}

References

^ "Principles of Epidemiology: Chain of Infection". U.S. Centers for Disease Control and Infection. 2019-02-18. Archived from the original on 2020-07-23. Retrieved 2020-07-21. This article incorporates text from this source, which is in the public domain.
^ LaMorte, Wayne W. (2016-01-06). "Common Vehicle Spread". Boston University School of Public Health. Archived from the original on 2020-05-14. Retrieved 2020-07-21.
^ Whittier, Christopher A (2017-04-16), "Fecal-Oral Transmission", in Bezanson, Michele; MacKinnon, Katherine C; Riley, Erin; Campbell, Christina J (eds.), The International Encyclopedia of Primatology, Hoboken, NJ, USA: John Wiley & Sons, Inc., p. 1, doi:10.1002/9781119179313.wbprim0193, ISBN 978-1-119-17931-3
^ Johnson, David L.; Mead, Kenneth R.; Lynch, Robert A.; Hirst, Deborah V.L. (March 2013). "Lifting the lid on toilet plume aerosol: A literature review with suggestions for future research". American Journal of Infection Control. 41 (3): 254–258. doi:10.1016/j.ajic.2012.04.330. PMC 4692156. PMID 23040490.
^ Jones, RM; Brosseau, L. M. (May 2015). "Aerosol transmission of infectious disease". Journal of Occupational and Environmental Medicine. 57 (5): 501–8. doi:10.1097/JOM.0000000000000448. PMID 25816216. S2CID 11166016.
^ Wagner, E. G., and Lanoix, L. N. (1958). Excreta disposal for rural and small communities (PDF). WHO, Geneva, Switzerland. p. 12. Archived from the original on 2020-04-12. Retrieved 2016-08-26.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c Penakalapati, Gauthami; Swarthout, Jenna; Delahoy, Miranda J.; McAliley, Lydia; Wodnik, Breanna; Levy, Karen; Freeman, Matthew C. (2017-10-17). "Exposure to Animal Feces and Human Health: A Systematic Review and Proposed Research Priorities". Environmental Science & Technology. 51 (20): 11537–11552. Bibcode:2017EnST...5111537P. doi:10.1021/acs.est.7b02811. ISSN 0013-936X. PMC 5647569. PMID 28926696.
^ Kal, K and Chambers, R (2008) Handbook on Community-led Total Sanitation Archived 2015-04-10 at the Wayback Machine, Plan UK Accessed 2015-02-26
^ Hale TL, Keusch GT (1996). Baron S, et al. (eds.). Shigella in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 978-0-9631172-1-2. (via NCBI Bookshelf).
^ Giannella RA (1996). Baron S; et al. (eds.). Salmonella:Epidemiology in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 978-0-9631172-1-2. (via NCBI Bookshelf).
^ Finkelstein RA (1996). Baron S; et al. (eds.). Cholera, Vibrio cholerae O1 and O139, and Other Pathogenic Vibrios in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 978-0-9631172-1-2. (via NCBI Bookshelf).
^ ^a ^b ^c Intestinal Parasites and Infection Archived 2010-10-28 at the Wayback Machine fungusfocus.com – Retrieved on 2010-01-21
^ ^a ^b "Stool-To-Mouth or Fecal–Oral Route of Transmission of Infection | Healthhype.com". www.healthhype.com. Archived from the original on 2020-02-05. Retrieved 2016-04-18.
^ Zuckerman AJ (1996). Baron S; et al. (eds.). Hepatitis Viruses in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 978-0-9631172-1-2. (via NCBI Bookshelf).
^ Wang L, Zhuang H (2004). "Hepatitis E: an overview and recent advances in vaccine research". World J Gastroenterol. 10 (15): 2157–62. doi:10.3748/wjg.v10.i15.2157. PMC 4724990. PMID 15259057.
^ Holshue ML, et al. (2020). "First Case of 2019 Novel Coronavirus in the United States". New England Journal of Medicine. 382 (10): 929–936. doi:10.1056/NEJMoa2001191. PMC 7092802. PMID 32004427.
^ Pinghui, Zhuang (2020-02-02). "Coronavirus: scientists identify possible new mode of transmission in human faeces". South China Morning Post. Archived from the original on 2021-03-08. Retrieved 2020-02-04.
^ Meyer EA (1996). Baron S; et al. (eds.). Other Intestinal Protozoa and Trichomonas Vaginalis in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 978-0-9631172-1-2. (via NCBI Bookshelf).

Wikipedia's health care articles can be viewed offline with the Medical Wikipedia app.

[:1-1] "Principles of Epidemiology: Chain of Infection". U.S. Centers for Disease Control and Infection. 2019-02-18. Archived from the original on 2020-07-23. Retrieved 2020-07-21. This article incorporates text from this source, which is in the public domain.

[2] LaMorte, Wayne W. (2016-01-06). "Common Vehicle Spread". Boston University School of Public Health. Archived from the original on 2020-05-14. Retrieved 2020-07-21.

[3] Whittier, Christopher A (2017-04-16), "Fecal-Oral Transmission", in Bezanson, Michele; MacKinnon, Katherine C; Riley, Erin; Campbell, Christina J (eds.), The International Encyclopedia of Primatology, Hoboken, NJ, USA: John Wiley & Sons, Inc., p. 1, doi:10.1002/9781119179313.wbprim0193, ISBN 978-1-119-17931-3

[Mead2013-4] Johnson, David L.; Mead, Kenneth R.; Lynch, Robert A.; Hirst, Deborah V.L. (March 2013). "Lifting the lid on toilet plume aerosol: A literature review with suggestions for future research". American Journal of Infection Control. 41 (3): 254–258. doi:10.1016/j.ajic.2012.04.330. PMC 4692156. PMID 23040490.

[Jon2015-5] Jones, RM; Brosseau, L. M. (May 2015). "Aerosol transmission of infectious disease". Journal of Occupational and Environmental Medicine. 57 (5): 501–8. doi:10.1097/JOM.0000000000000448. PMID 25816216. S2CID 11166016.

[6] Wagner, E. G., and Lanoix, L. N. (1958). Excreta disposal for rural and small communities (PDF). WHO, Geneva, Switzerland. p. 12. Archived from the original on 2020-04-12. Retrieved 2016-08-26.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: multiple names: authors list (link)

[Levy-7] Penakalapati, Gauthami; Swarthout, Jenna; Delahoy, Miranda J.; McAliley, Lydia; Wodnik, Breanna; Levy, Karen; Freeman, Matthew C. (2017-10-17). "Exposure to Animal Feces and Human Health: A Systematic Review and Proposed Research Priorities". Environmental Science & Technology. 51 (20): 11537–11552. Bibcode:2017EnST...5111537P. doi:10.1021/acs.est.7b02811. ISSN 0013-936X. PMC 5647569. PMID 28926696.

[CLTS-8] Kal, K and Chambers, R (2008) Handbook on Community-led Total Sanitation Archived 2015-04-10 at the Wayback Machine, Plan UK Accessed 2015-02-26

[Baron_c-9] Hale TL, Keusch GT (1996). Baron S, et al. (eds.). Shigella in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 978-0-9631172-1-2. (via NCBI Bookshelf).

[Baron_d-10] Giannella RA (1996). Baron S; et al. (eds.). Salmonella:Epidemiology in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 978-0-9631172-1-2. (via NCBI Bookshelf).

[Baron_e-11] Finkelstein RA (1996). Baron S; et al. (eds.). Cholera, Vibrio cholerae O1 and O139, and Other Pathogenic Vibrios in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 978-0-9631172-1-2. (via NCBI Bookshelf).

[fungusfocus-12] Intestinal Parasites and Infection Archived 2010-10-28 at the Wayback Machine fungusfocus.com – Retrieved on 2010-01-21

[healthhype.com-13] "Stool-To-Mouth or Fecal–Oral Route of Transmission of Infection | Healthhype.com". www.healthhype.com. Archived from the original on 2020-02-05. Retrieved 2016-04-18.

[Baron_b-14] Zuckerman AJ (1996). Baron S; et al. (eds.). Hepatitis Viruses in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 978-0-9631172-1-2. (via NCBI Bookshelf).

[Wang_2004-15] Wang L, Zhuang H (2004). "Hepatitis E: an overview and recent advances in vaccine research". World J Gastroenterol. 10 (15): 2157–62. doi:10.3748/wjg.v10.i15.2157. PMC 4724990. PMID 15259057.

[Holshue_2020-16] Holshue ML, et al. (2020). "First Case of 2019 Novel Coronavirus in the United States". New England Journal of Medicine. 382 (10): 929–936. doi:10.1056/NEJMoa2001191. PMC 7092802. PMID 32004427.

[Pinghui_2020-17] Pinghui, Zhuang (2020-02-02). "Coronavirus: scientists identify possible new mode of transmission in human faeces". South China Morning Post. Archived from the original on 2021-03-08. Retrieved 2020-02-04.

[Baron_a-18] Meyer EA (1996). Baron S; et al. (eds.). Other Intestinal Protozoa and Trichomonas Vaginalis in: Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch. ISBN 978-0-9631172-1-2. (via NCBI Bookshelf).

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-{{short description|Disease transmission via pathogens from fecal particles}}
+{{Short description|Disease transmission via pathogens from fecal particles}}
-[[File:F-diagram-01.jpg|thumb|upright=1.3|The "F-diagram" ([[feces]], [[fingers]], [[flies]], [[Field (agriculture)|fields]], [[fluids]], [[food]]), showing pathways of fecal–oral disease transmission. The vertical blue lines show barriers: [[toilet]]s, [[water supply|safe water]], [[hygiene]] and [[handwashing]].]]
+[[File:F-diagram-01.jpg|thumb|upright=1.3|The "F-diagram" ([[Human feces|feces]], [[fingers]], [[flies]], [[Field (agriculture)|fields]], [[fluids]], [[food]]), showing pathways of fecal–oral disease transmission. The vertical blue lines show barriers: [[toilet]]s, [[water supply|safe water]], [[hygiene]] and [[handwashing]].]]
-The '''fecal–oral route''' (also called the '''oral–fecal route''' or '''orofecal route''') describes a particular [[Transmission (medicine)|route of transmission]] of a disease wherein [[pathogens]] in [[Feces|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 pollution|water bodies are polluted]] with fecal material, humans can be infected with [[waterborne diseases]] or [[soil-transmitted helminthiasis|soil-transmitted diseases]]. Fecal contamination of food is another form of fecal-oral transmission. [[Hand washing|Washing hands]] properly after changing a baby's diaper or after performing [[anal hygiene]] can prevent [[foodborne illness]] from spreading.
+The '''fecal–oral route''' (also called the '''oral–fecal route''' or '''orofecal route''') describes a particular [[Transmission (medicine)|route of transmission]] of a disease wherein [[pathogens]] in [[Human feces|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 pollution|water bodies are polluted]] with fecal material, humans can be infected with [[waterborne diseases]] or [[soil-transmitted helminthiasis|soil-transmitted diseases]]. Fecal contamination of food is another form of fecal-oral transmission. [[Hand washing|Washing hands]] properly after changing a baby's diaper or after performing [[anal hygiene]] can prevent [[foodborne illness]] from spreading.{{cn|date=June 2022}}
-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 [[diarrhea]], [[typhoid]], [[cholera]], [[polio]] and [[hepatitis]].
+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]], [[polio]], [[hepatitis]] and many other infections, especially ones that cause [[diarrhea]].
 == Background ==
-[[File:Actions to end open defecation in a village in Malawi (2).jpg|thumb|Villagers during a [[Community-led total sanitation|CLTS]] triggering exercise go to the place where meals are prepared to observe how flies are attracted to [[human feces]] and carry diseases by landing on the food (village near Lake Malawi, Malawi)]]
+[[File:Actions to end open defecation in a village in Malawi (2).jpg|thumb|Villagers during a [[community-led total sanitation]] (CLTS) triggering exercise go to the place where meals are prepared to observe how flies are attracted to [[human feces]] and carry diseases by landing on the food (village near Lake Malawi, Malawi)]]
-[[File:CLTS triggering in Malda District, West Bengal, India.JPG|thumb|School children during a [[Community-led total sanitation|CLTS]] triggering event in West Bengal, India looking at a glass of water and fresh [[human feces]] where the flies pass from the water to the feces and back. This demonstrates how water can get polluted with pathogens.]]Although fecal–oral transmission is usually discussed as a [[Transmission (medicine)|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.<ref name=":1">{{Cite web|last=|first=|date=2019-02-18|title=Principles of Epidemiology: Chain of Infection|url=https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html|url-status=live|archive-url=|archive-date=|access-date=2020-07-21|website=U.S. Centers for Disease Control and Infection|language=en-us}} {{PD-inline}}</ref>  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]].<ref>{{Cite web|last=LaMorte|first=Wayne W.|date=2016-01-06|title=Common Vehicle Spread|url=https://sphweb.bumc.bu.edu/otlt/MPH-Modules/PH/PH709_Transmission/PH709_Transmission5.html|url-status=live|archive-url=|archive-date=|access-date=2020-07-21|website=Boston University School of Public Health}}</ref><ref>{{Citation|last=Whittier|first=Christopher A.|title=Fecal-Oral Transmission|date=2017-04-16|url=http://doi.wiley.com/10.1002/9781119179313.wbprim0193|work=The International Encyclopedia of Primatology|pages=1–1|editor-last=Bezanson|editor-first=Michele|place=Hoboken, NJ, USA|publisher=John Wiley & Sons, Inc.|language=en|doi=10.1002/9781119179313.wbprim0193|isbn=978-1-119-17931-3|access-date=2020-07-21|editor2-last=MacKinnon|editor2-first=Katherine C|editor3-last=Riley|editor3-first=Erin|editor4-last=Campbell|editor4-first=Christina J}}</ref>  It can also operate through [[Droplet transmission|droplet]] or [[airborne transmission]] through the [[toilet plume]] from contaminated toilets.<ref name="Mead2013">{{cite journal|last1=Johnson|first1=David L.|last2=Mead|first2=Kenneth R.|last3=Lynch|first3=Robert A.|last4=Hirst|first4=Deborah V.L.|date=March 2013|title=Lifting the lid on toilet plume aerosol: A literature review with suggestions for future research|journal=American Journal of Infection Control|volume=41|issue=3|pages=254–258|doi=10.1016/j.ajic.2012.04.330|pmc=4692156|pmid=23040490}}</ref><ref name="Jon2015">{{cite journal|last1=Jones|first1=RM|last2=Brosseau|first2=L. M.|date=May 2015|title=Aerosol transmission of infectious disease|url=|journal=Journal of Occupational and Environmental Medicine|volume=57|issue=5|pages=501–8|doi=10.1097/JOM.0000000000000448|pmid=25816216|via=}}</ref>
+[[File:CLTS triggering in Malda District, West Bengal, India.JPG|thumb|School children during a CLTS triggering event in West Bengal, India looking at a glass of water and fresh [[human feces]] where the flies pass from the water to the feces and back. This demonstrates how pathogens can pollute water.]]Although fecal–oral transmission is usually discussed as a [[Transmission (medicine)|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.<ref name=":1">{{Cite web|date=2019-02-18|title=Principles of Epidemiology: Chain of Infection|url=https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html|access-date=2020-07-21|website=U.S. Centers for Disease Control and Infection|language=en-us|archive-date=2020-07-23|archive-url=https://web.archive.org/web/20200723004047/https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html|url-status=live}} {{PD-inline}}</ref> 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]].<ref>{{Cite web|last=LaMorte|first=Wayne W.|date=2016-01-06|title=Common Vehicle Spread|url=https://sphweb.bumc.bu.edu/otlt/MPH-Modules/PH/PH709_Transmission/PH709_Transmission5.html|access-date=2020-07-21|website=Boston University School of Public Health|archive-date=2020-05-14|archive-url=https://web.archive.org/web/20200514021657/http://sphweb.bumc.bu.edu/otlt/MPH-Modules/PH/PH709_Transmission/PH709_Transmission5.html|url-status=live}}</ref><ref>{{Citation|last=Whittier|first=Christopher A|title=Fecal-Oral Transmission|date=2017-04-16|encyclopedia=The International Encyclopedia of Primatology|pages=1|editor-last=Bezanson|editor-first=Michele|place=Hoboken, NJ, USA|publisher=John Wiley & Sons, Inc.|language=en|doi=10.1002/9781119179313.wbprim0193|isbn=978-1-119-17931-3|editor2-last=MacKinnon|editor2-first=Katherine C|editor3-last=Riley|editor3-first=Erin|editor4-last=Campbell|editor4-first=Christina J}}</ref> It can also operate through [[Droplet transmission|droplet]] or [[airborne transmission]] through the [[toilet plume]] from contaminated toilets.<ref name="Mead2013">{{cite journal|last1=Johnson|first1=David L.|last2=Mead|first2=Kenneth R.|last3=Lynch|first3=Robert A.|last4=Hirst|first4=Deborah V.L.|date=March 2013|title=Lifting the lid on toilet plume aerosol: A literature review with suggestions for future research|journal=American Journal of Infection Control|volume=41|issue=3|pages=254–258|doi=10.1016/j.ajic.2012.04.330|pmc=4692156|pmid=23040490}}</ref><ref name="Jon2015">{{cite journal|last1=Jones|first1=RM|last2=Brosseau|first2=L. M.|date=May 2015|title=Aerosol transmission of infectious disease|journal=Journal of Occupational and Environmental Medicine|volume=57|issue=5|pages=501–8|doi=10.1097/JOM.0000000000000448|pmid=25816216|s2cid=11166016}}</ref>
-=== F-Diagram ===
+=== F-diagram ===
-The foundations for the "F-diagram" being used today were laid down in a publication by [[World Health Organization|WHO]] in 1958.<ref>{{cite book|url=http://apps.who.int/iris/bitstream/10665/41687/1/WHO_MONO_39_%28part1%29.pdf|title=Excreta disposal for rural and small communities.|last1=Wagner, E. G.|first1=and Lanoix, L. N.|date=1958|location=WHO, Geneva, Switzerland|page=12}}</ref> This publication explained transmission routes and barriers to the transmission of diseases from the focal point of [[human feces]].
+The foundations for the "F-diagram" being used today were laid down in a publication by the [[World Health Organization]] (WHO) in 1958.<ref>{{cite book|url=http://apps.who.int/iris/bitstream/10665/41687/1/WHO_MONO_39_%28part1%29.pdf|title=Excreta disposal for rural and small communities.|last1=Wagner, E. G.|first1=and Lanoix, L. N.|date=1958|location=WHO, Geneva, Switzerland|page=12|access-date=2016-08-26|archive-date=2020-04-12|archive-url=https://web.archive.org/web/20200412080323/https://apps.who.int/iris/bitstream/handle/10665/41687/WHO_MONO_39_(part1).pdf;jsessionid=1A7640C1E59C41B5E624F4EE54F288F7?sequence=1|url-status=live}}</ref> This publication explained transmission routes and barriers to the transmission of diseases from the focal point of [[human feces]].{{cn|date=June 2021}}
-Modifications have been made over the course of history to derive modern-looking F-diagrams. These diagrams are used in many sanitation publications.<ref name="Levy">{{Cite journal|last=Penakalapati|first=Gauthami|last2=Swarthout|first2=Jenna|last3=Delahoy|first3=Miranda J.|last4=McAliley|first4=Lydia|last5=Wodnik|first5=Breanna|last6=Levy|first6=Karen|last7=Freeman|first7=Matthew C.|date=2017-10-17|title=Exposure to Animal Feces and Human Health: A Systematic Review and Proposed Research Priorities|journal=Environmental Science & Technology|volume=51|issue=20|pages=11537–11552|doi=10.1021/acs.est.7b02811|pmid=28926696|pmc=5647569|issn=0013-936X}}</ref> They are set up in a way that fecal–oral transmission pathways are shown to take place via water, hands, [[arthropod]]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, [[Fly|flies]], food, fields, [[fomite]]s (objects and household surfaces).
+Modifications have been made over the course of history to derive modern-looking F-diagrams. These diagrams are used in many sanitation publications.<ref name="Levy">{{Cite journal|last1=Penakalapati|first1=Gauthami|last2=Swarthout|first2=Jenna|last3=Delahoy|first3=Miranda J.|last4=McAliley|first4=Lydia|last5=Wodnik|first5=Breanna|last6=Levy|first6=Karen|last7=Freeman|first7=Matthew C.|date=2017-10-17|title=Exposure to Animal Feces and Human Health: A Systematic Review and Proposed Research Priorities|journal=Environmental Science & Technology|volume=51|issue=20|pages=11537–11552|doi=10.1021/acs.est.7b02811|pmid=28926696|pmc=5647569|bibcode=2017EnST...5111537P|issn=0013-936X}}</ref> They are set up in a way that fecal–oral transmission pathways are shown to take place via water, hands, [[arthropod]]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, [[Fly|flies]], food, fields, [[fomite]]s (objects and household surfaces).{{cn|date=June 2022}}
-Rather than only concentrating on human feces, [[Feces|animal feces]] should also be included in the F-diagram.<ref name="Levy" />
+Rather than only concentrating on human feces, [[Feces|feces from other animals]] should also be included in the F-diagram.<ref name="Levy" />
-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 [[toilet]]s, [[hygiene]], [[handwashing]]) can act as an effective barrier to stop [[transmission (medicine)|transmission of diseases]] via fecal–oral pathways.
+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 [[toilet]]s, [[hygiene]], [[handwashing]]) can act as an effective barrier to stop [[transmission (medicine)|transmission of diseases]] via fecal–oral pathways.{{cn|date=April 2023}}
 == Examples ==
 === Transmission ===
-The process of transmission may be simple or involve multiple steps. Some examples of routes of fecal–oral transmission include:
+The process of transmission may be simple or involve multiple steps. Some examples of routes of fecal–oral transmission include:{{cn|date=June 2021}}
 * water that has come in contact with feces (for example due to [[groundwater]] pollution from [[pit latrines]]) and is then not [[water treatment|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]].
+* 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]])
+* eating soil ([[geophagia]]);
 * disease vectors, like [[Housefly|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]] ("Rimjobs"), [[coprophilia]] or [[ass to mouth|A2M]] [[sexual intercourse]].
+* sexual practices that may involve oral contact with feces, such as [[anilingus]], [[coprophilia]], or [[ass to mouth|A2M]].
 * eating feces, in children, or in a mental disorder called [[coprophagia]]
@@ Line 37: / Line 37: @@
 == 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 [[Transmission (medicine)|disease transmission]].
+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 [[Transmission (medicine)|disease transmission]].{{cn|date=June 2021}}
 ===Bacteria===
 * ''[[Vibrio cholerae]]'' ([[cholera]])
-* ''[[Clostridium difficile (bacteria)|Clostridium difficile]]'' ([[pseudomembranous enterocolitis]])
+* ''[[Clostridioides difficile (bacteria)|Clostridium difficile]]'' ([[pseudomembranous enterocolitis]])
 * ''[[Shigella]]'' ([[shigellosis]] / bacillary dysentery)<ref name=Baron_c>{{cite book |vauthors=Hale TL, Keusch GT | title =  ''Shigella'' ''in:'' Baron's Medical Microbiology| editor = Baron S| display-editors = etal| edition = 4th | publisher = Univ of Texas Medical Branch | year = 1996 | id = [https://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.1257 (via NCBI Bookshelf)]  | isbn =  978-0-9631172-1-2}}</ref>
 * ''[[Salmonella enterica subsp. enterica|Salmonella typhii]]'' ([[typhoid fever]])<ref name=Baron_d>{{cite book | author = Giannella RA | title = ''Salmonella'':Epidemiology ''in:'' Baron's Medical Microbiology| editor = Baron S| display-editors = etal| edition = 4th | publisher = Univ of Texas Medical Branch | year = 1996 | id = [https://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.1241 (via NCBI Bookshelf)]  | isbn = 978-0-9631172-1-2}}</ref>
 * ''[[Vibrio parahaemolyticus]]''<ref name=Baron_e>{{cite book | author = Finkelstein RA | title = Cholera, ''Vibrio cholerae'' O1 and O139, and Other Pathogenic ''Vibrio''s ''in:'' Baron's Medical Microbiology| editor = Baron S| display-editors = etal| edition = 4th | publisher = Univ of Texas Medical Branch | year = 1996 | id = [https://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.1358 (via NCBI Bookshelf)]  | isbn = 978-0-9631172-1-2}}</ref>
-*''[[Escherichia coli]]''<ref name=fungusfocus>[http://www.fungusfocus.com/html/flukes.htm Intestinal Parasites and Infection] {{Webarchive|url=https://web.archive.org/web/20101028013944/http://fungusfocus.com/html/flukes.htm |date=2010-10-28 }} fungusfocus.com – Retrieved on 2010-01-21</ref>
+* ''[[Escherichia coli]]''<ref name=fungusfocus>[http://www.fungusfocus.com/html/flukes.htm Intestinal Parasites and Infection] {{Webarchive|url=https://web.archive.org/web/20101028013944/http://fungusfocus.com/html/flukes.htm |date=2010-10-28 }} fungusfocus.com – Retrieved on 2010-01-21</ref>
-*''[[Campylobacter]]''<ref name="healthhype.com">{{Cite web|url=http://www.healthhype.com/stool-to-mouth-or-fecal-oral-route-of-transmission-of-infection.html|title=Stool-To-Mouth or Fecal–Oral Route of Transmission of Infection {{!}} Healthhype.com|website=www.healthhype.com|access-date=2016-04-18}}</ref>
+* ''[[Campylobacter]]''<ref name="healthhype.com">{{Cite web|url=http://www.healthhype.com/stool-to-mouth-or-fecal-oral-route-of-transmission-of-infection.html|title=Stool-To-Mouth or Fecal–Oral Route of Transmission of Infection {{!}} Healthhype.com|website=www.healthhype.com|access-date=2016-04-18|archive-date=2020-02-05|archive-url=https://web.archive.org/web/20200205121909/https://www.healthhype.com/stool-to-mouth-or-fecal-oral-route-of-transmission-of-infection.html|url-status=live}}</ref>
 ===Viruses===
 * [[Hepatitis A]]<ref name=Baron_b>{{cite book | author = Zuckerman AJ | title = Hepatitis Viruses ''in:'' Baron's Medical Microbiology| editor = Baron S| display-editors = etal| edition = 4th | publisher = Univ of Texas Medical Branch | year = 1996 | id = [https://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.3721 (via NCBI Bookshelf)]  | isbn = 978-0-9631172-1-2}}</ref>
-* [[Hepatitis E]]<ref name=Wang_2004>{{cite journal |vauthors=Wang L, Zhuang H | title = Hepatitis E: an overview and recent advances in vaccine research | journal = World J Gastroenterol | volume = 10 | issue = 15 | pages = 2157–62 | year = 2004 | pmid = 15259057 | pmc = 4724990 | doi = 10.3748/wjg.v10.i15.2157 }}</ref>
+* [[Hepatitis E]]<ref name=Wang_2004>{{cite journal |vauthors=Wang L, Zhuang H | title = Hepatitis E: an overview and recent advances in vaccine research | journal = World J Gastroenterol | volume = 10 | issue = 15 | pages = 2157–62 | year = 2004 | pmid = 15259057 | pmc = 4724990 | doi = 10.3748/wjg.v10.i15.2157 | doi-access = free }}</ref>
 * [[Enterovirus]]es
 * [[Norovirus#Pathophysiology|Norovirus acute gastroenteritis]]
 * ''[[Poliovirus]]'' ([[poliomyelitis]])
-* Although most human [[Coronavirus]]es are not transmitted fecally ([[Feline coronavirus]], in contrast, is), there have also been reports of [[SARS-CoV-2]] being found in stool samples.<ref name=Holshue_2020>{{cite journal |vauthors=Holshue ML et al | title = First Case of 2019 Novel Coronavirus in the United States | journal = New England Journal of Medicine | year = 2020 | doi = 10.1056/NEJMoa2001191 | doi-access = free }}</ref><ref name=Pinghui_2020>{{cite news |last=Pinghui |first=Zhuang  | title = Coronavirus: scientists identify possible new mode of transmission in human faeces | work = South China Morning Post | date = 2020-02-02| url = https://www.scmp.com/news/china/politics/article/3048611/coronavirus-scientists-identify-possible-new-mode-transmission |access-date=2020-02-04 }}</ref>
+* Although most human [[Coronavirus]]es are not transmitted fecally ([[Feline coronavirus]], in contrast, is), there have also been reports of [[SARS-CoV-2]] being found in stool samples.<ref name=Holshue_2020>{{cite journal |vauthors=Holshue ML et al | title = First Case of 2019 Novel Coronavirus in the United States | journal = New England Journal of Medicine | year = 2020 | volume = 382 | issue = 10 | pages = 929–936 | doi = 10.1056/NEJMoa2001191 | pmid = 32004427 | pmc = 7092802 | doi-access = free }}</ref><ref name=Pinghui_2020>{{cite news | last = Pinghui | first = Zhuang | title = Coronavirus: scientists identify possible new mode of transmission in human faeces | work = South China Morning Post | date = 2020-02-02 | url = https://www.scmp.com/news/china/politics/article/3048611/coronavirus-scientists-identify-possible-new-mode-transmission | access-date = 2020-02-04 | archive-date = 2021-03-08 | archive-url = https://web.archive.org/web/20210308200124/https://www.scmp.com/news/china/politics/article/3048611/coronavirus-scientists-identify-possible-new-mode-transmission | url-status = live }}</ref>
 * [[Rotavirus]] gastroenteritis
+* [[Adenovirus]] gastroenteritis
 ===Protozoans===
-*''[[Entameba histolytica]]''<ref name=fungusfocus/> ([[amoebiasis]] / amoebic dysentery)
+* ''[[Entamoeba histolytica]]''<ref name=fungusfocus/> ([[amoebiasis]] / amoebic dysentery)
 * ''[[Giardia]]'' ([[giardiasis]]<ref name="Baron_a">{{cite book | author = Meyer EA | title = Other Intestinal Protozoa and ''Trichomonas Vaginalis'' ''in:'' Baron's Medical Microbiology| editor = Baron S| display-editors = etal| edition = 4th | publisher = Univ of Texas Medical Branch | year = 1996 | id = [https://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.4202 (via NCBI Bookshelf)]  | isbn = 978-0-9631172-1-2}}</ref>)
 * ''[[Cryptosporidium]]'' ([[cryptosporidiosis]])
-*''[[Toxoplasma gondii]]''<ref name="healthhype.com"/> ([[toxoplasmosis]])
+* ''[[Toxoplasma gondii]]''<ref name="healthhype.com"/> ([[toxoplasmosis]])
 ===Helminths===
@@ Line 67: / Line 68: @@
 * [[Soil-transmitted helminth]]s
-=== Related diseases groupings ===
+=== 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.
+[[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.{{cn|date=April 2023}}
-[[Neglected tropical disease]]s also contains many diseases transmitted via the fecal-oral route.
+[[Neglected tropical disease]]s also include many diseases transmitted via the fecal-oral route.{{cn|date=April 2023}}
 ==See also==
+* [[Basic reproduction number]]
 * [[Toilet]]
 * [[Vector control]]
 ==References==
-{{reflist|30em}}
+{{Reflist|30em}}
 {{offline|med}}
 {{public health}}
+{{Concepts in infectious disease}}
 {{DEFAULTSORT:Fecal-Oral Route}}