American Journal of Infection Control
October 1998 * Volume 26 * Number 5
Risk of Infectious Disease Transmission from a Common Communion Cup
For more than 2 decades, the Centers for Disease Control and Prevention (CDC) has stated
an official position to inquirers (eg, lay public, physicians, nurses, and other health care
professionals) about the risk of infectious disease transmission from a common communion
cup. Although no documented transmission of any infectious disease has ever been traced
to the use of a common communion cup, a great deal of controversy surrounds this issue;
the CDC still continues to receive inquiries about this topic.
In this letter, the CDC strives to achieve a balance of adherence to scientific principles and respect for religious beliefs. Within the CDC, the consensus of the National Center for Infectious Diseases and the National Center for Human Immunodeficiency Virus, Sexually Transmitted Diseases, and
Tuberculosis is that a theoretic risk of transmitting infectious diseases by using a common
communion cup exists, but that the risk is so small that it is undetectable.
The CDC has not been called on to investigate any episodes or outbreaks of infectious diseases that
have been allegedly linked to the use of a common communion cup. However, outbreaks or
clusters of infection might be difficult to detect if: (1) a high prevalence of disease (eg,
infectious mononucleosis, influenza, herpes, strep throat, common cold) exists in the
community, (2) diseases with oral routes of transmission have other modes of transmission
(ie, fecal-oral, hand-to-mouth/nose, airborne), (3) the length of the incubation period for
the disease is such that other opportunities for exposure cannot be ruled out unequivocally, and (4) no incidence data exist for comparison purposes (ie, the disease is not on the reportable disease list and therefore is not under public health surveillance).
Experimental studies have shown that bacteria and viruses can contaminate a common
communion cup and survive despite the alcohol content of the wine. Therefore, an ill person
or asymptomatic carrier drinking from the common cup could potentially expose other
members of the congregation to pathogens present in saliva. Were any diseases
transmitted by this practice, they most likely would be common viral illnesses, such as the
common cold. However, a recent study of 681 persons found that people who receive
Communion as often as daily are not at higher risk of infection compared with persons
who do not receive communion or persons who do not attend Christian church services at
all.
In summary, 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 (ie, cold or flu) or moist or open sores on their lips (eg,
herpes).
Lilia P. Manangan, RN, MPH Lynne M. Sehulster,
PhD Linda Chiarello, RN, MS, CIC Dawn N.
Simonds, BS William R. Jarvis, MD Hospital Infections Program, National Center for
Infectious Diseases, Centers for Disease Control and Prevention, US Department of
Health and Human Services Atlanta, Georgia.
References
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Med 1993;118:572-3. MEDLINE
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© American Journal of Infection Control
