Is sharing a cup in Holy Communion an infection risk?
Date First Published:
February 28, 2020
Last Updated:
April 23, 2020
Report by:
Dr Peter Hulme, Consultant Emergency Medicine (Manchester Royal Infirmary)
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>t
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>t
Search Details:
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 3t
6. 4 and 5
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 3t
6. 4 and 5
Outcome:
13 papers of which 1 answered the clinical question
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The effects of receiving Holy Communion on health. 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. |
Author Commentary:
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.
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.
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
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:
- Loving AL; Wolf LF. The effects of receiving Holy Communion on health.