Frequency, Dynamics, and Duration of Fecal Shedding in SARS-CoV-2 Infected Individuals, a Scoping Review

To estimate illness incidence or prevalence from wastewater data, modeling approaches may benefit from incorporating fecal shedding parameters. We systematically searched PubMed and a public repository on shedding data and included 33 studies meeting at least one of our objectives. Among 32 studies, the proportion of SARS-CoV-2-infected individuals with detectable virus in stool ranged from 18–100%, with a pooled estimate of 54% (95% CI: 52–56%). Stratification by four clinical severity categories, ranging from asymptomatic to critically ill, showed no significant differences among categories (p-value = 0.49). The proportion of individuals with detectable SARS-CoV-2 RNA in stool was higher in children (61%) than in adults (53%; p-value = 0.02). In half of the individuals who initially shed the virus in stool, it remained detectable for an estimated 22 days post-symptom onset. Three studies documented viral load kinetics, indicating a peak between days 3 and 9. Twenty-five studies reported maximum shedding durations ranging from 2 to 12 weeks. Our review presents a summary of the frequency, dynamics, and duration of SARS-CoV-2 shedding in stool and may serve as a valuable foundation for modeling efforts involving fecal shedding indicators.