Infected Kids and Sports

23 07 2012

While soccer, softball and gymnastics are a joyful rite of passage for many young children, athletic events carry a risk for all children, given the increased chance for mishaps, accidents and blood spills.

For parents of children with viral infectious diseases, including hepatitis B, hepatitis C and HIV/AIDS, these games often present a number of stressful issues.

  • What if my child is hurt and another child is exposed to his or her blood?
  • Should I tell the coach about my child’s infectious disease if it will spur him or her to practice standard (universal) precautions?
  • What if the coach or athletic director doesn’t know or practice standard precautions?
  • Should I attend every game in case there is an accident?
  • Should my child even be playing this sport?

The American Academy of Pediatrics tackled this difficult issue in December, 1999, with a policy statement on HIV and Other BloodBorne Viral Pathogens in the Athletic Setting. (This policy was reaffirmed in 2008.) 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 bloodborne viruses.

The Academy tackled each infectious disease individually.

HIV/AIDS: The risk of HIV infection through skin or mucous membrane exposure to infected blood or other infectious bodily fluids during sports events is very low. The Academy found the risk from damaged skin or mucous membrane exposure was one in 1,007 exposures or 0.1 percent.

Hepatitis B: While hepatitis B is more easily transmitted through exposure to infected blood than HIV, the Academy found only two documented sports transmission. A high school sumo wrestler with chronic hepatitis B was found to have transmitted the infection to a team member. Wrestling is the only sport that raised concern because herpes, impetigo and measles have been transmitted through skin-to-skin contact. However, there is no risk of bloodborne pathogens being contracted through wrestling, the Academy found.

An outbreak of hepatitis B occurred within an outdoor orienteering team in Sweden. Doctors believe the team members used a common cup of warm water to clean wounds caused by branches and thorns.

Hepatitis C: The risk of transmission is greater than for HIV but less than with hepatitis B. The Academy reported no documented cases of transmission in sports.

“There is clearly no basis for excluding any student from sports if they are infected,” said Dr. Steven J. Anderson, who was chair of the Academy’s Committee on Sports Medicine and Fitness when it drafted the Academy’s policy, “and we should also try to protect the confidentiality of each athlete.”

Dr. 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.

“I personally feel parents have no obligation to disclose the infectious status of their children to anyone,” said Dr. Anderson, “that includes their own physicians! While that may seem wrong, it is felt that if standard precautions are used for blood contact or contamination, the risk of contagion is adequately reduced.”

But strict compliance with standard precautions is critical for this open-embrace of all athletes, regardless of their infectious status. “As a parent, I would make sure that there is a plan in place to handle blood spills,” said Dr. Anderson, “including latex gloves, occlusive dressings, appropriate sterilizing solutions, disposal bags and event a printed protocol for coaches, athletes and officials.

“If standard precautions are not followed, I would recommend that the coaches or instructors are queried as to their familiarity with the precautions,” he added. “If they are not familiar with or following procedures, a higher up source needs to be consulted, such as a league office or school administrator.”

Parents should also contact the school or athletic league’s physician so he or she can also act as an advocate to ensure the coaches comply with the department or organization’s safety procedures.

But the Academy’s policy may not lessen the stress some parents feel when their very young children approach a soccer field for the first time. “When children are young, parents should educate their children about the dangers of blood contact,” said Dr. Anderson. “Despite the trauma that can accompany free play, I don’t hear of too many cases where two or more bleeding children mix their blood. I would also hope that an adult would be present when children are playing and would be consulted if there were an injury.”

Dr. Anderson feels it is not necessary to disclose a child’s infectious status to a coach. “Given the low risk of infecting other children, and the high risk of being shunned or ostracized. However, I think a responsible parent would be adamant about standard precautions being in place and followed. I supposed an astute coach might make inferences if a particular parent was a zealot about blood contamination. I would read that as a message that their child was infected and that they wanted their child to participate without creating a risk for others.”

Even when a child has an HIV infection, disclosure is not a requirement, explained Dr. Anderson, stating his personal opinion. “However, if a coach is educated about the risks, the necessary precautions and can be trusted to maintain confidentiality, disclosure may be appropriate. Unfortunately, most youth sports coaches are parent volunteers, non-professionals and are unlikely to have a long-term relationship with the athlete. In such cases, I recommend that standard precautions be followed.”

Dr. Anderson contends active contact sports, such as football, are also not off limits to athletes with infectious viral hepatitis. “However, 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,” he added, “and the person is no longer contagious.”

One mother whose son has hepatitis B commented, “I used to worry about my son infecting other children, but eventually I decided to make sports decisions based on what my kids risked catching from others.”

This post originates from PKIDs’ website.

Image courtesy of Rugby Pioneers





Chagas Disease is Not HIV/AIDS

4 06 2012

I sat up in my chair when I read this headline last week:  Chagas Disease: “The New HIV/AIDS of the Americas.”

I remember the early days of HIV and AIDS. Anyone infected seemed guaranteed a horrible, painful death, and the typical reaction of too many friends and family members was to refuse to give a last embrace lest they, too, acquire the infection.

To say that Chagas disease is the new HIV/AIDS is quite a statement. Or at least, a startling headline.

Chagas disease comes from a parasite. The disease spreads when a big, bloodsucking insect known as a triatomine bug bites a person or animal infected with the parasite, then bites an uninfected person or animal.

The bugs come out at night and love to bite humans and critters on the face—hence the nickname (shudder) “kissing bug.”

The bugs bite, eat (remember the bloodsucking), and poop on the skin, and it’s the poop that harbors the parasite. The poop gets into the body through skin breaks or mucous membranes.

Infections can also occur through transplantation of infected organs or transfusion of infected blood, as well as ingesting infected bug poop piggybacking on uncooked foods. Also, it can be passed through vertical transmission, from mom to baby.

Chagas disease, according to the CDC and PubMed, appears in the acute phase as a mishmash of symptoms, making it hard to diagnose. And sometimes, there are no symptoms at all. If symptoms appear, they can include “. . . fever, fatigue, body aches, headache, rash, loss of appetite, diarrhea, and vomiting.”

An exam might show a slightly enlarged spleen, liver or glands. A telltale sign, called Romaña’s sign, is a swollen eyelid where the bug bite occurred or the poop got onto the eye.

After several weeks or even months, the acute symptoms (if any) go away. If an antiparasitic treatment is used during this acute phase, there’s a good chance that it’ll be the end of the infection. Treatment is also occasionally successful later on in the disease.

If there is no treatment, the infection becomes chronic, but might never again cause problems. Or, it could flare up after several years or even decades and cause serious complications for the heart or intestines.

Death is sometimes the outcome in either the acute or chronic phase of this infection.

There’s no way to prevent infection, other than going after the bloodsucking bugs.

But, is Chagas disease the new HIV/AIDS? No, say Rick Tarleton, president of the Chagas Disease Foundation, and Dr. William Schaffner, president of the National Foundation for Infectious Diseases.

Champions of public health wrote the editorial with the eye-opening headline, which certainly brought attention to their case, but in this instance they went too far and made a claim that is more likely to raise alarm than awareness.

By Trish Parnell

Image courtesy of  duke.edu





Everyone Should Get Tested For HIV

23 06 2011

June 27, 2011, is the 17th annual National HIV Testing Day. It follows on the passing of the 30th anniversary of the day the Centers for Disease Control and Prevention announced a deadly new syndrome, acquired immune deficiency syndrome, or AIDS. Three decades later, many things have changed about infection with HIV, including life expectancy, groups that it infects the most, and ever-evolving treatment successes.

Why get tested? Because the earlier you get treated, the better it is for you and for people at risk of acquiring infection from you. People who are under treatment are less likely to pass HIV to others than people who are going untreated. Without getting tested, you can’t know if you’re infected. Without getting treatment, you can’t keep yourself healthy or avoid endangering others.

You may be thinking that you’re someone who doesn’t need to get tested. Think again. The CDC says that everyone between the ages of 13 and 64 should be tested at least once. If you’re sexually active or engaged in recreational drugs, you need to be tested. There are, of course, groups at higher risk for infection. According to the National Association of People with AIDS, these groups include:

  • younger sexually active teens
  • poor women of color
  • men who have sex with men
  • people who inject or snort drugs with others
  • sex workers or people who barter in sex for life necessities
  • people who live in HIV “hot spots,” places where infection rates are so high that anyone who is sexually active is at risk. These hotspots can sometimes encompass only a few city blocks.

How can you get tested? Depends on how you want to do it. It’s possible to test at home, sending in blood from a finger prick to a lab for analysis. You can buy such kits at drugstores, but doing it on your own means that you won’t receive appropriate counseling if the result comes back positive. In some places, people can get tested anonymously and still receive counseling. But for National HIV Testing Day, testing events are happening all over the United States. If you’re interested in finding a testing site near you, check this interactive map.

Each of the two types of tests available—one tests for antibodies the body makes if the virus is present, the other tests for the virus itself—requires only a blood draw or even just an oral swab for antibody testing. If you think you’ve recently been exposed to HIV, the viral load testing is the test you need. You can’t rely on the antibody test results if 3 to 6 months haven’t elapsed since exposure, as it takes that long for the antibodies to register.

An HIV test doesn’t take much investment in terms of money or blood or even time. But even in this age of improved therapies and life expectancies with infection, the results can literally mean life or death, not only for you but maybe for someone you love. If you haven’t been tested, isn’t that reason enough to make June 27, 2011, your day to get it done?

By Emily Willingham





April: STD Awareness Month

21 04 2011

There are an estimated 19 million new cases of STDs each year in the United States.  That’s too many.  We can significantly cut that number down.

April, the STD Awareness Month, is a time to shine a light on sex and disease.

STDs know no age limits, they can be visible or invisible and, yes, they can even affect our own sons and daughters. STDs also have a serious economic impact, with direct medical costs estimated at $17.0 billion annually  in this country alone.

The majority of STDs are preventable. Just by having a frank discussion with our partners, and using the appropriate protection, we can prevent most sexually transmitted diseases.

These are practical resources to help individuals and parents learn more about STDs and how to deal with current or potential infections:

There is never anything embarrassing about protecting our health. So wrap it up, protect yourself and keep STDs at bay!

(Photo courtesy of Andy54321)





Life On a Blog

24 03 2011

image by inju

Blogging is therapeutic. For those living with or affected by infectious diseases, it can be a way to connect with those whose lives mirror their own.

Brooke Davidoff, diagnosed HIV positive in January 2010, blogs about her life as a newlywed and a first-time mom. Brooke’s life turned upside down during her pregnancy, when she had a routine blood test for HIV and discovered she was positive. “If there was no baby, I’d still have no idea,” she blogged. 

Brooke started blogging “. . . to express myself, I don’t know how not to. When I was diagnosed, I searched for stuff written by other HIV positive females to relate to, and I had a very hard time finding what I was looking for. So I began to write it for other women like me who needed to know they are not alone.”

Sabina is a 15-year-old girl who loves volleyball and dancing. She’s slogging through a year of treatment for hepatitis C and blogs about it “. . .  to share my experience of HCV treatment for children or adults who are starting or already started their treatment. I know that treatment can be difficult and painful, I would just like to give another perspective. I just want to help out and be there for other kids or adults.”

Elizabeth Boskey, PhD, MPH, calls on her education and research experience each time she blogs about STDs. Ever the teacher, Elizabeth says, “There is a lot of secrecy and stigma surrounding STDs. I blog about STDs not only to address the misconceptions about them, but to make them a topic of discussion.

“Some people think that having an STD means that they’re dirty or ruined, that infection marks them as a slut or somehow undesirable—all of which is ridiculous. Still, these feelings are common in people who have had bad experiences disclosing an STD to a partner, or who have simply internalized the stigma that is widely present in American society.

“People make jokes, and not kind ones, about STD infection, but the truth is that STDs are just diseases like any other. Yes, they are often preventable, and people should do their best to prevent them, but acquiring an STD doesn’t make you a bad person.”

Are you ready to blog?
It’s easy to get started. There’s no cost, other than your time, and, if you’re speaking from personal experience, what it costs you to speak from your heart.

Brooke blogs to share with women like herself, and to let her friends and family know that she’s OK. “I think I’m helping other people feel more normal…the stigma hopefully will diminish in time.”

Blogging can be a positive experience, but there are emotional risks.

“I think that if more people blogged about STDs it might help reduce some of the stigma associated with them,” says Elizabeth. “However, I think it’s important to acknowledge that doing so is not without risks. Publicly acknowledging an STD infection may change the way that people around you treat you. It may even affect your employment—although it shouldn’t.”

Boundaries
It’s OK to not share every single thing in your life. Write honestly, but don’t fret about keeping some details private. It is your life, so you define the boundaries beyond which you’re not comfortable sharing.

Readers
If you write about it, they will come, but be prepared for the readers’ thoughts that may cascade upon you. Some comments you’ll treasure and some, well, let’s just say they’ll raise the eyebrows.

“I check daily for new comments and emails,” says Brooke. “The ones that touch me the most are people who found out the same way I did, or the ones who decided to have a baby after reading my story.”

There’s a yin yang to blogging, as there is elsewhere in life. Be prepared for the nasties you’ll find in the comments section of your blog.

“Although blogging can be a wonderful way to gather personal support, it may also have less positive results,” explains Elizabeth. “Comments can be negative, or even cruel and vindictive. It may be worth blogging anonymously if you are concerned about your privacy and the ramifications for exposure in your daily life; however, it is very difficult to ‘guarantee’ that your identity will not become known. This is particularly true if you are discussing sensitive issues such as those involving your sexuality.”

Last words
Bloggers always get the last word, and that’s no less true for our guests today.

Brooke on HIV: I live a normal life other than taking pills every day. I’m waiting to see what the disease does to me. I think all of us sit and wonder when it’s going to kick in, and what it’s going to do.
If you’re having unprotected sex, get tested. You never know. There are really no symptoms that would lead you to get the test, it’s better to know and get on meds now than find out when it’s too late and you’re really sick.

Sabina on HCV: [I want people to know] that we’re not harmful to others as long as we don’t share blood transferring items, such as razors, and toothbrushes. And that having HCV [hepatitis C virus] doesn’t set you apart from others even though it’s a serious virus.

Elizabeth on STDs: I don’t think you have to blog about STDs to help destigmatize them. Make a point of having open and honest discussions of sexuality with your partners and your family. Don’t allow people to get away with making cruel comments about infectious diseases or even “cute” jokes. And, finally, remember that a lot of the stigma surrounding STDs has to do with ignorance. Educate yourself—about how common STDs are, about testing, and about prevention—so that you can educate the people around you.





Over 50? Beware of STDs

6 01 2011

Did you ever think you’d be over 50, sexually active, and dealing with an STD?

Safer sex warnings should not only be directed at teens and younger Americans, but to those of us in the AARP crowd as well.

Americans over 50 are sexually active and many factors account for this, including divorce, the advent of prescriptions for erectile dysfunction, and an increased life expectancy.

And with sexual activity can come sexually transmitted diseases. Unfortunately, age is no protection against STDs. Many older adults assume that because they aren’t regularly practicing high risk behaviors such as IV drug use or sex with multiple partners, they are protected.

Older men and women tend to believe they are immune from “all of that,” speaking euphemistically. But it is that kind of thinking that is leading to an increase in STD infections—everything from herpes to HIV.

HIV/AIDS is rapidly spreading among men and women over 50.  The U.S. Centers for Disease Control and Prevention (CDC) now recommends routine HIV/AIDS testing for all Americans ages 13 to 64. Dr. John G. Bartlett, Chief of Infectious Diseases at the Johns Hopkins School of Medicine, sees the new guidelines as a “call to action that the test will be offered on a more regular basis.”

And some experts, including Dr. Veronica Miller, Director of the Forum for Collaborative HIV Research at George Washington University Medical Center, even feel HIV tests should be as “routine as a flu shot.”

The CDC estimates that those over 50 account for 15% of all new HIV/AIDS diagnoses and 24% of those living with HIV/AIDS in this country.

A quarter of a million people living with HIV are unaware of their infection status and are consequently not seeking help for themselves, and may not be ensuring protection from infection for their sexual partners.

Healthcare providers need to take note of the increasing risk of STD infections in their older patients, and  emphasize testing and sex education at every opportunity.





AIDS.gov Tweets Right!

4 11 2010

AIDS.gov, a coalition of several federal agencies, uses Twitter and other social media such as Facebook as cornerstones of their communications strategy.

These efforts support the President’s National HIV/AIDS Strategy, which has three primary goals

  1. Reduce new HIV infections
  2. Increase access to care and improve health outcomes for people living with HIV
  3. Reduce HIV-related health disparities

Such broad strokes are perfect for the likes of Twitter, according to the AIDS.gov team.  Twitter as a health communications tool is exemplified by the success of the recent National HIV Testing Day Twitter Town Hall.  

A Twitter Town Hall, a group of people tweeting about the same topic at the same time (and using key hashtags), is an excellent method to reach a wider audience using social media with a relatively low investment of organizational resources.

The types of Twitter interactions may vary—from dialogue, to link and picture-sharing, to retweeting—but one thing is clear: different demographics can be reached using Twitter, versus Facebook, radio and television. 

For health educators, a broader reach is always a good thing.

Try these tips from AIDS.gov to increase your organization’s Twitter effectiveness:

  • Integrating Twitter into an overall communications strategy
  • Consistently tweeting news and updates
  • Promoting your organization’s Twitter work on business cards, websites and other materials
  • Interacting with Twitter and making sure to share links and retweet information from those in your industry

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