How Diseases Spread Through the Fecal-Oral Route

Proper Handwashing Is Your Best Defense

Hand Sanitizer being used on an airplane
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Viruses, bacteria, fungi, and parasites spread from person to person, sometimes causing diseases as they move in and out of people's bodies along various routes. When the disease spreads through the fecal-oral route, it means that contaminated feces from an infected person are somehow ingested by another person.

For obvious reasons, this almost never happens deliberately. Usually, the situation occurs when an infected person might forget to properly wash his hands after using the toilet. Anything he or she touches afterward might be contaminated with microscopic germs that other people may encounter.

Imagine, for example, someone infected with a disease transmitted through the fecal-oral route uses the bathroom and then opens the restroom door. The cycle is complete when another person comes along, touches that contaminated doorknob, and then nervously bites on a fingernail. The microbe has spread to another person through the fecal-oral route.

Most Common Environments for Fecal-Oral Microbe Transmission

Food workers must be extra diligent about hand hygiene because they are in a position to easily spread a fecal-oral disease through the food they prepare to anyone who eats it. In many cases of foodborne illness outbreaks, poor hand hygiene is the precipitating factor.

While poor hand washing is a major cause of fecal-oral contamination, there are other equally important considerations. Here are other ways microbes use the fecal-oral route to cause disease:

  • Drinking water contaminated with raw sewage.
  • Eating shellfish (such as oysters and clams) that have been harvested from contaminated water.
  • Eating raw fruits or vegetables washed in contaminated water.
  • Sexual activity that allows direct mouth-to-anus contact or indirect contact (touching the mouth to something that touched the anus).
  • Swimming pools that aren't properly disinfected.

Is Viral Hepatitis a Fecal-Oral Disease?

There are many microbes that can be passed along through the fecal-oral route, including two of the hepatitis viruses: Hepatitis A and Hepatitis E. The other hepatotropic viruses spread by direct contact with infected blood, such as from sharing used needles, bodily fluid, or through childbirth.


Good hand washing is a tremendously effective way to break the fecal-oral cycle. Other important tools for preventing the spread of disease through fecal-oral transmission include:

  • Using instant hand sanitizers when soap and water are not available.
  • Practicing safe and careful food-handling practices.
  • Avoiding ingestion of water in pools or from other non-potable sources.
  • Using disposable towels.
  • Cleaning or disinfecting commonly touched, infected surfaces such as doorknobs, faucet handles, remote controls, etc.
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Article Sources

  • Centers for Disease Control and Prevention. (December 2016). Viral Hepatitis.
  • Dienstag, JL. Acute Viral Hepatitis. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrison’s Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008.
  • Sjogren, MH. Hepatitis A. In: M Feldman, LS Friedman, LJ Brandt (eds), Gastrointestinal and Liver Disease, 8e. Philadelphia, Elsevier, 2006. 1639.