The fecal–oral route (or alternatively the oral–fecal route or orofecal route) is a route of transmission of a disease, when pathogens in fecal particles passing from one host are introduced into the oral cavity of another host. One main cause of fecal-oral disease transmission in developing countries is lack of adequate sanitation and, often connected to that problem, water pollution with fecal material.
The "F-diagram" explaining transmission routes and barriers was first proposed in a publication by Hesperian Foundation for the United Nations Development Programme (UNDP) in 2005. It has been widely used in many other sanitation publications since then. It was set up in a way that fecal-oral transmission pathways are shown to take place via nouns that start with the letter F: fingers, flies, fields, foods, and fluids (fluids stands here for polluted water - be it polluted drinking water, surface water or groundwater).
One approach to changing people's behaviors and stopping open defecation, the community-led total sanitation approach, uses "live demonstrations" of flies moving from food to fresh human feces and back to "trigger" villagers into action.
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 pollution from pit latrines) and is then not treated properly before drinking;
- food that has been prepared in the presence of fecal matter;
- disease vectors, like houseflies, spreading contamination from inadequate fecal disposal such as open defecation;
- poor or absent hand washing after using the toilet or handling feces (such as 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 "ass to mouth".
Diseases by pathogen type
Some of the diseases that can be passed via the fecal-oral route are (grouped by the type of pathogen involved in disease transmission):
- vibrio cholerae (Cholera)
- Clostridium difficile
- Shigella (Shigellosis / bacillary dysentery)
- Salmonella typhii (Typhoid fever)
- Vibrio parahaemolyticus
- Escherichia coli
- Hepatitis A
- Hepatitis E
- Norovirus acute gastroenteritis
- Poliovirus (Poliomyelitis)
- Rotavirus - Most of these pathogens cause gastroenteritis.
- Tape worms
- Ascariasis and other soil transmitted helminthiasis
- Cryptosporidium (Cryptosporidiosis)
- Giardia (Giardiasis)
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