How Diseases Spread Through the Fecal-Oral Route

Hand Sanitizer
Hand Sanitizer. John Moore / Staff / Getty Images

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 disease spreads through the fecal-oral route, it means that contaminated feces from an infected person is somehow ingested by another person.

For obvious reasons, this almost never happens deliberately. Usually what happens is that an infected person might forget to properly wash his or her hands after using the toilet.

Anything he or she touches afterward might be contaminated with microscopic (invisible) germs that other people may encounter.

Imagine, for example, someone infected with a disease transmitted through the fecal-oral route uses the toilet, then opens the restroom door with his bare hands. 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.

What Are the 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 food borne illness outbreaks, poor hand hygiene is the precipitating factor.

While poor hand washing is a major cause of fecal-oral contamination in many places, there are other equally important ways.

Here are other ways microbes use the fecal-oral route to cause disease:

  • Drinking water contaminated with raw sewage.
  • Eating shell fish (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 from direct contact with infected blood, such as from sharing used needles; bodily fluid; or through childbirth.

Can I Prevent the Spread of Disease Through the Fecal-Oral Route?

Yes. 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.


Centers for Disease Control and Prevention. June 23, 2008. 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.

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