Sustained fecal-oral human-to-human transmission following a zoonotic event

de Graaf, Miranda; Beck, Relja; Caccio, Simone M; Duim, Birgitta; Fraaij, Pieter LA; Le Guyader, Françoise S; Lecuit, Marc; Le Pendu, Jacques; de Wit, Emmie; Schultsz, Constance

Bacterial, viral and parasitic zoonotic pathogens that transmit via the fecal-oral route have a major impact on global health. However, the mechanisms underlying the emergence of such pathogens from the animal reservoir and their persistence in the human population are poorly understood. Here, we present a framework of human-to-human transmission of zoonotic pathogens that considers the factors relevant for fecal-oral human-to-human transmission route at the levels of host, pathogen, and environment. We discuss current data gaps and propose future research directions.