• 
• 

Three Part Question

In [patients taking Holy Communion] does [sharing the communion cup] [lead to infections]

Clinical Scenario

A patient develops flu-like symptoms 3 days after taking Holy Communion at church. You wonder whether in the current climate of coronavirus (Covid-19) risk does the sharing of a communion cup practiced by millions of Christains around the world put it's participants at risk of infection?

Search Strategy

(Allied and Complementary Medicine) <1985 to March 2020>(0)
Embase <1974 to 2020 March 05>(9)
Ovid Emcare <1995 to 2020 week 09>(6)
HMIC Health Management Information Consortium <1979 to January 2020>(0)
Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) <1946 to March 05, 2020>
1. holy communion.mp. [mp=tx, bt, ti, ab, ct, hw, tn, ot, dm, mf, dv, kw, fx, dq, nm, kf, ox, px, rx, ui, sy]
2. communion.mp. [mp=tx, bt, ti, ab, ct, hw, tn, ot, dm, mf, dv, kw, fx, dq, nm, kf, ox, px, rx, ui, sy]
3. eucharist.mp. [mp=tx, bt, ti, ab, ct, hw, tn, ot, dm, mf, dv, kw, fx, dq, nm, kf, ox, px, rx, ui, sy]
4. infection risk.mp. [mp=tx, bt, ti, ab, ct, hw, tn, ot, dm, mf, dv, kw, fx, dq, nm, kf, ox, px, rx, ui, sy]
5. 1 or 2 or 3
6. 4 and 5

Search Outcome

13 papers of which 1 answered the clinical question

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Loving AL; Wolf LF 1997 USA	681 volunteers were accepted into the study, regardless of age, gender, general health, race, or religious affiliation.	Detailed survey of 681 individuals divided into groups. 1. Usually Attended church and Received communion n = 307 (45.1%) 2. Usually Attended and Did Not Receive n = 53 (7.8%) 3. Sometimes Attended and Received 12.2% n = 83 4. Sometimes Attended and Did Not Receive Communion n = 27 (4.0%) 5. Did Not Attend Church n = 211 (31.0%)	Illness amongst volunteers	At alpha = 0.01, no differences in illness were reported among those who received communion, those who attended but did not receive communion, and those who never attended church.	Survey only run for 10 weeks so didn't account for seasonal variations of illness. Didn't document if Communion was taken from sipping from a common cup, separate cups or intinction. Relied on self reporting of illness. No clinical testing of illness.

Comment(s)

There is evidence that bacteria are present on the communion cup and therefore there is a theoretical risk of infection. Hobbs BC, Knowlden JA, White A. Experiments on the communion cup. J Hyg 1967;65:37-48. Burrows W, Hemmons ES. Survival of bacteria on the silver communion cup. J Infect Dis 1943;73:180-90. Gregory KF, Carpenter JA, Bending GC. Infection hazards of the common communion cup. Can J Public Health 1967;58:305-10. Furlow TG, Dougherty MJ. Bacteria on the common communion cup [letter]. Ann Intern Med 1993;118:572-3. The study did not demonstrate an increased risk of infection with volunteers taking communion compared to those not taking communion although there were weaknesses in the methodology.

Clinical Bottom Line

No evidence exists that sharing a Communion Cup or intinction have caused infections. In 1998 The Centres for Disease Control (CDC) stated that the risk for infectious disease transmission by a common communion cup is very low, and appropriate safeguards — that is, wiping the interior and exterior rim between communicants, use of care to rotate the cloth during use, and use of a clean cloth for each service — would further diminish this risk. In addition, churches may wish to consider advising their congregations that sharing the communion cup is discouraged if a person has an active respiratory infection (i.e., cold or flu) or moist or open sores on their lips (e.g., herpes). https://www.ajicjournal.org/article/S0196-6553(98)70029-X/fulltext. At present there's no direct evidence that cases of Covid-19 have been transmitted through communion cups but there is evidence that Covid-19 virus is transmitted through saliva so there is a theoretical risk of disease transmission. https://www.nature.com/articles/s41368-020-0075-9

References

1. Loving AL; Wolf LF The effects of receiving Holy Communion on health. Journal of Environmental Health Jul/Aug1997; 60(1): 6-24. (7p)