Kids are back in school and signing up for sports.
Some parents wonder about their infected children playing sports and possibly infecting others in the process. Parents also wonder how concerned they should be about their children becoming infected from other players living with undiagnosed or undisclosed infections.
We looked into this a while back and recently checked for updated information. Here’s what we’ve discovered over the years:
Playing sports can be risky in many ways and part of that risk is the potential to become infected with all sorts of germs.
Parents of children living with diagnosed infectious diseases worry that they may be responsible for infecting another child. They wonder if they should inform the coach or the school. They worry that the adults in charge don’t really follow standard precautions, thereby increasing the risk of infections. They want their kids to enjoy life and they want to do the right thing.
The American Academy of Pediatrics issued a policy statement on this dilemma in December, 1999: HIV and Other Blood-Borne Viral Pathogens in the Athletic Setting. In it, the Academy made clear, “Because of the low probability of transmission of their infection to other athletes, athletes infected with HIV, hepatitis B or hepatitis C should be allowed to participate in all sports.”
That participation, however, assumes all athletes and coaches will follow standard precautions to prevent and minimize exposure to blood-borne viruses.
There is no reason to exclude any student from sports if they’re infected with HIV, HBV or HCV. Nor is there a reason to disclose the infection. There are many people living with undiagnosed infections, so it is more prudent to ensure everyone is practicing standard precautions rather than simply excluding those with known infections and not properly protecting all athletes from undiagnosed infections.
Dr. Steven J. Anderson, a pediatrics professor at the University of Washington and a team doctor for many high school athletic teams, ballet companies and the U.S. Olympic Diving Team, suggests children should have access to any sport, except boxing, which the Academy opposes for all youths because of its physical risks.
Pediatricians can avoid reporting a student’s infection, the Academy noted, by making it clear on any participation forms that they support the Academy’s position that all students can participate in all sports and that pediatricians must respect an athlete’s right to confidentiality.
But strict compliance with standard precautions is critical for this open-embrace of all athletes, regardless of their infectious status. Dr. Anderson notes that, as a parent, he would make sure that there is a plan in place to handle blood spills, including latex gloves, occlusive dressings, appropriate sterilizing solutions, disposal bags and even a printed protocol for coaches, athletes and officials. (http://www.pkids.org/pdf/idw/text3.pdf )
Dr. Anderson does feel that students with infectious hepatitis A (spread through close physical contact with contaminated food, water or skin) or with liver or spleen enlargement should be restricted from contact or collision sports until the liver or spleen has returned to normal size, and the person is no longer contagious.
An article that ran in 2004 in the British Journal of Sports Medicine (http://bjsm.bmjjournals.com/cgi/content/abstract/38/6/678) talked about possible methods of transmission in sports and reported incidents of transmission:
Bleeding or oozing injuries could, in theory, transmit the virus through the mucous membrane or injured skin of other athletes. This risk is considered extremely low. However, contact and collision sports like wrestling or boxing increase that risk. The risk goes down a bit for those playing basketball or soccer, and those playing sports with little physical contact, such as tennis or baseball, are at the lowest risk.
There are no confirmed reports of HIV transmission during sports. It was reported that there was one case of seroconversion of HIV as a result of a bleeding injury during a football match in Italy, but transmission in a non-sports setting for this man, who worked in a drug dependency rehabilitation center, could not be ruled out.
Two papers, both from Japan, report HBV transmission in sport. One was a report of an outbreak of hepatitis B infection in a high school sumo wrestling club. Five of 10 members of the club developed hepatitis B during one year. They suggested that HBV was transmitted from the carrier to the others through skin cuts and abrasions caused by wrestling. Wrestlers in that club were known to continue to wrestle even when they were injured and bleeding from skin wounds.
More recently, an outbreak of HBV was reported among members of an American university football team. They detected 11 cases of HBV infection (five of acute hepatitis and six of subclinical infection) among 65 members of the team over a period of 19 months.
It has been suggested that bloodborne infections may be transmitted through sharing a water container, because bleeding around the mouth is common in contact sport. Therefore it is now recommended that water containers should be available individually for each player in contact sports. Athletes should use squeeze water bottles which they do not put in their mouth.
Bloodborne infections can be transmitted through blood doping. There is also a risk from sharing needles which may be associated with drug abuse in sport. Injectable drugs used in sports include steroids, hormones, and vitamins.
Three separate cases of HIV infection associated with sharing needles among bodybuilders have been reported, two in the United States and one in France.
It has also been reported that three soccer players from one amateur club were infected with HCV as a result of sharing a syringe to inject intravenous vitamin complexes. Syringes have often been shared by athletes who inject vitamins minutes before a game.
A 1993 study estimated that, in the United States, there were one million people who were either current or past users of anabolic androgenic steroids. Of these, 50% were intramuscular drug users, and about 25% had shared needles. Therefore it seems that the risk of transmission in this way may be considerable among athletes, especially bodybuilders.
So, if your family is getting involved in sports, it would be worth your time to:
• Get caught up on all vaccinations
• Practice standard precautions (http://www.pkids.org/pdf/idw/text21.pdf)
• Wash your hands a lot or, if hands aren’t visibly soiled, use alcohol handrubs
• Don’t share needles with anyone for any purpose