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The Christian sacrament of Holy Communion reenacts the Last Supper, at which Jesus Christ presided nearly 2,000 years ago. Today, many of the world's over two billion Christians consume consecrated bread and wine, some as often as twice daily. Sipping consecrated wine from a common chalice is a widespread custom throughout the world, although historical evidence, including Leonardo DaVinci's painting of "The Lord's Supper," indicates that individual cups were once customary. Concern about the possible spread of disease through shared communion cups dates back many years, with articles appearing in religious and scientific publications as early as 1887 (1).

In response to widespread concern about health risks, Christian leaders have frequently written about the common cup in religious journals and in the general media. Their articles attempt to quell fears of infectious diseases while imploring parishioners to attend church and receive the sacrament of Holy Communion (2-14).

The scientific community also has been involved, starting with physicians in the 19th century who cited the risk of, and advocated moving away from, the common cup, and continuing through this century with scrutiny of the religious rite from the perspective of hygienics (1,15-29). Wine in the chalice has been tested in both church and laboratory settings (16,20,22-24). Chalice rims have been tested for bacteria after people have sipped (12, 22, 24), as have the purificator cloths that are used to wipe chalice rims between sips (12, 26). The heavy metals used to make most chalices have been tested for antibacterial activity, as have glass and pottery (20, 26, 29). Wafers have been tested for sterility and for their ability to transfer microbes when dipped in wine (9, 27). Without exception, every one of these studies has drawn the same conclusion: Some bacteria do survive in the wine, on the chalice rim, or on a wine-soaked wafer significantly longer than the time that normally elapses between one parishioner's participation and the next. The potential for spread of infection during this religious ritual does exist.

In an attempt to decrease health risks while maintaining thespiritual nature of the sacrament, various methods of serving andreceiving the bread and wine have been developed over the years. Theseinclude bypassing the wine altogether; using fortified wine with ahigher alcohol content to increase antimicrobial action; usingindividual spoons or individual cups; using a specially designed chalicefrom which many people can sip from separate compartments around therim; intinction (the wafer is dipped into the wine either by theparishioner or by the priest); using chlorinated tap water during theconsecration of the wine (the chlorine could help kill bacteria);dipping the purificator cloth into vodka to provide antimicrobialaction; and distributing individually wrapped, sterile, disposable packsthat contain a wafer and a small cup of wine (5,9,16-18,26,27,30).

The actual foods consumed vary widely among the many Christian denominations. The bread may be freshly baked and broken into irregular pieces, or it may be highly processed and compressed into compact wafers. The alcohol content of the wine may vary, and alcohol-free grape juice may be used. In some churches the parishioners consume just the bread, while in others each person partakes of both the bread and the wine.

Concern about possible risks in receiving Holy Communion is extensive, as indicated by widespread coverage in the popular media (13, 14, 31-33). Although anecdotal information would seem to indicate that Christians who choose to receive bread and wine are no less healthy than their fellow human beings who choose not to participate in Holy Communion, no research was recorded in the literature. In the latter part of the 19th century, Dr. Howard S. Anders published widely, imploring Christians to use individual cups during Holy Communion to prevent the spread of disease. In response, Dr. Thomas J. Mays argued that no conclusion should be drawn about the communion cup producing "any special havoc" without statistics to prove this contention (18). Anders replied that he regretted being "unable to get statistics showing whether or not communicants are more [susceptible] to... diseases than noncommunicants," but remained steadfast in his resolve to convince the Christian population to use individual cups because "cleanliness is next to godliness" (15-18).

This investigation addresses the specific question raised more than 100 years ago, a question that laboratory studies, religious declarations, and the assertions of the lay public have failed to answer: Do Christians who receive Holy Communion get sick more often than those who do not receive, or than individuals who do not attend church? The question was confronted using a survey tool that asked three basic questions: Have you attended church? Have you received the sacraments? And have you been sick?


Human Subjects

Participants were enlisted through school, [TABULAR DATA FOR TABLE 1 OMITTED] [TABULAR DATA FOR TABLE 2 OMITTED] [TABULAR DATA FOR TABLE 3 OMITTED] college, business, church, and neighborhood networks. All volunteers were accepted into the study, regardless of age, gender, general health, race, or religious affiliation. Solicitation of volunteers from across the United States was not feasible because of funding limitations, so the participant pool was limited to New Jersey residents.

Approximately 1,050 surveys were distributed to individuals who indicated their willingness to participate. Of the 691 surveys that were returned, 681 were used; 10 were eliminated because they were incomplete.

Time Frame

Ideally, the survey would have run for a [TABULAR DATA FOR TABLE 4 OMITTED] full 52 weeks, encompassing all seasonal illnesses. However, maintaining the participation of the volunteers for an entire year would have been difficult, so the time frame was limited to 10 weeks. Everyone filled out the survey during the same 10 weeks, and since all participants lived in the same geographic area, there should have been similar exposure to prevailing illnesses, weather conditions, and other environmental factors.

Survey Tool

The survey included a demographic cover sheet [ILLUSTRATION FOR FIGURE 1 OMITTED] followed by 10 weekly survey pages, each of which clearly identified the week in progress [ILLUSTRATION FOR FIGURE 2 OMITTED].

Participants were not asked to indicate how the wine was taken (by sipping, individual cup, intinction, etc.), as this would have added complexity to the survey, perhaps unnecessarily. If results showed that wine-consuming Christians did not have a different illness rate than the rest of the population, wine-receiving methods would not matter. If the wine consumers reported a higher incidence of illness than did other groups, a follow-up study was planned to compare all methods of wine consumption during Holy Communion.

Results and Discussion

Preliminary Analyses

To begin the data analysis, simple descriptive statistics including frequencies, means, standard deviations, and medians were calculated for all variables (Table 1).

The reported ages of household members were used to form household categories from all possible combinations of the following:

1. infant through five years 2. six through 12 years 3. 13 through 18 years 4. 19 years or older

Using these four categories, household members were broken down into groups as shown in Table 2.

A final item on the demographic page gave respondents an opportunity to write any additional information they felt was pertinent. Only 8.0 percent chose to do so; 2.0 percent indicated that they were members of a religious order and living in a convent, and 6.0 percent provided additional health information.

Several variables were created from the weekly survey data: total visits to church; total number of times the wafer was taken; total number of times the wine was taken; and total incidence of respiratory, intestinal, skin, and systemic infections and other general illness problems. These data are presented in Tables 3 and 4.

Investigation of the Research Question

The research question was: Do Christians who receive Holy Communion get sick more often than those who do not receive, or than individuals who do not attend church? To investigate the research question, the total sample was divided according to how often respondents attended church and received the sacraments (Table 5).

For the first set of analyses, five analyses of variance were calculated using the five categories described above as the independent variables, and total respiratory, intestinal, skin, systemic, and general illness problems as dependent variables. For this sample, 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. Since no differences in health were reported among these groups, it was not necessary to determine which method individuals had used to receive the wine (sipping from a common cup, separate cups, intinction, etc.).

An analysis of variance was calculated to determine if those especially involved in religious life had a higher incidence of reported illness. These individuals attended church and received the sacraments as often as daily, and some consumed the "dregs" of the consecrated wine after all parishioners had sipped from the chalice. For all categories of health problems, no significant differences were found between participants with religious vocations and other respondents. No main effect exists for the church attendance categories (F[4,676] = 0.81, n.s.), nor any interaction term (F [23,676] = 1.03, n.s.).

An analysis of variance was calculated to determine if there were any differences in reported illness among the various household categories. The church attendance categories and the household categories were used as the independent variables, and a combined total-illness variable was calculated and used as the dependent variable. A main effect was found for the household category (F[7, 676] = 3.73, p [less than] 0.01). An examination of the cell means showed that households with children reported illness more than those without children. A comparison of this cell with the previous two analyses indicates that, according to these data, individuals living with children under the age of 12 are more likely to be ill than those who attend church and receive the sacraments as often as every day.


Previous studies have demonstrated the viability and transferability of microbes on the communion chalice, in the wine, and on the wafers. The results of this study indicate that fears from the last century, like those of Dr. Howard S. Anders (15-18), should not be of concern to individuals who attend church and receive Holy Communion. No significant differences were found in the rates of illness among Christians who receive Holy Communion, Christians who attend church but do not receive the sacraments, and people who do not attend Christian services. The only significant health factor found in this study was the presence of young children in the household, a commonly observed phenomenon. Replications in other seasons and in different locales might be warranted to further test this question. However, these data suggest that receiving Holy Communion as often as daily does not increase risk of infection.

TABLE 5 Number of Respondents Who Attended Church and/or Received Communion Participation Percentage Actual Number Usually Attended and Received 45.1% n = 307 Usually Attended and Did Not Receive 7.8% n = 53 Sometimes Attended and Received 12.2% n = 83 Sometimes Attended and Did Not Receive 4.0% n = 27 Did Not Attend Church 31.0% n = 211

Corresponding Author: Anne LaGrange Loving, M.S., M(ASCP), Assistant Professor of Microbiology, Felician College, 262 South Main Street, Lodi, NJ 07644.

Acknowledgment: The tireless support of B. A. Loving is gratefully acknowledged.


NOTE: This is a selected reference list. Anyone wishing to see an exhaustive list of international references may contact Anne LaGrange Loving.

1. Terry, Dr. (Jan. 1887), "Presentation to the Oneida County Medical Society, Utica, N.Y."

2. Anonymous (1985), "AIDS and Communion," Christian Century, 102:888.

3. Anonymous (1986), "Common Cup Supported," Christian Century, 103:169.

4. Anonymous (1986), "AIDS and the Common Cup," Living Church, 191:8.

5. Anonymous (April 29, 1996), "Prepacked Communion Takes Off," Christianity Today, 40:58.

6. Doyle, S.P. (Oct. 1995), "Must Wine be Used?" The Living Church, 22:9.

7. Hovda, R.W. (1986), "AIDS Hysteria and the Common Cup: Take and Drink," Worship, 60:67-73.

8. Keay, T. J. (1988), "The Common Chalice and the Spread of Disease: Saliva, Statistics, and Sanctification," Lutheran Forum, Lent:20-23.

9. Marty, M.E. (1992), "Intinct, I Think," Christian Century, 103:79.

10. McLean, D.M. (1987), "The Church in Our Time: Common Communion Cups as Possible Infection Hazard," CRUX, 23:226-227.

11. Morris, H.H. (1988), "A Look at Lutheran Worship in the Near Future: Celebrating the Sanitary Supper," Lutheran Forum, Lent:23-25.

12. Page, C.G. (June 27, 1925), "The Common Cup," The Churchman, p.13.

13. Sharrock, D. (Aug. 3, 1989), "Communion Wafers Cause Health Scare at Altar," The Guardian, p.7.

14. Wineke, W.R. (July 24, 1994), "How Safe is Common Cup?" Wisconsin State J., p.1 - C.

15. Anders, H. S. (September 26, 1894), "Prophylaxis in Churches Needed by the Adoption of Individual Communion Chalices or Cups," Proceedings from the Philadelphia County Medical Society, Vol. XV:345-352.

16. Anders, H.S. (April 3, 1897), "Infection by Common Cups," Public Health, p.662.

17. Anders, H.S. (1897), "The Progress of the Individual Cup Movement, Especially Among Churches. Proceedings from the Forty-Eighth Annual Meeting of the American Medical Association, held at Philadelphia, June 1-4," JAMA, 29:789-794.

18. Anders, H.S. (1900), "The Individual Communion Cup," JAMA, Nov. 17:1291.

19. Dancewicz, E.P. (1973), "What is the Risk of Infection from Common Communion Cups?" JAMA, 225:320.

20. Forbes, C. (March 7,1894), "Presentation to a Joint Meeting of the Session and Trustees of the Central Presbyterian Church of Rochester, N.Y."

21. Franklin, D. (1995), "Infectious Confession: Dunking Wafer is Safer," Hippocrates, 9:10.

22. Gill, O.N. (1988), "The Hazard of Infection from the Shared Communion Cup," J. Infect, 16:3-23.

23. Godfrey, W.H. (1939), "Communion Cup and Bacteria," JAMA, 112:2555.

24. Gregory, K.F., J.A. Carpenter, and G.C. Bending (1967), "Infection Hazards of the Common Communion Cup," Can. J. Public Health, 58:305310.

25. Gurevich, I. (1995), "This Common Religious Ceremony May Spread Disease," RN, 58:1.

26. Hobbs, B.C., J.A. Knowlden, and A. White (1967), "Experiments on the Communion Cup," J. Hyg. (Camb), 65:37-48.

27. Loving, A.L. (1995), "A Controlled Study on Intinction: A Safer Alternative Method for Receiving Holy Communion," J. Envtl. Health, 58:24-28.

28. Stebbins, Rev. Dr., and W.S. Ely (Dec. 7, 1893), "Danger Attending the Prevalent Custom of Passing the Cup," Meeting of the Rochester, N.Y., Pathologic Society.

29. Burrows, W., and E.S. Hemmens (1943), "Survival of Bacteria on the Silver Communion Cup," J. Infect. Dis., 73:180-190.

30. Heyen, W. (1991), "Communion Spoon," Four Quarters, 5(Fall):11.

31. Anonymous (May 30, 1995), "Snapshots: Altar Hazard," The Guardian, p.7.

32. Firestone, L. (Oct., 1993), "Safe Sacrament," Eating Well, p. 102.

33. Spohn, G. (June 9, 1995), "No Escape from Bacteria During the Eucharist," The Church Times (London), p.2.


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