Childhood Diseases Reaching Out to Adults

16 12 2014

Angelina Jolie has chickenpox, and a passel of NHL players suffers at home with mumps. What’s going on?

Adults are getting knocked sideways by childhood illnesses because (1) when they were children, they missed one or more recommended vaccines, (2) there were no vaccines for certain diseases when they were young, or (3) the protection they received as children from vaccines is waning.

It’s also possible that a vaccine simply didn’t work for this or that person. It happens.

I was already an adult when the chickenpox vaccine first became available. A couple of years prior to the release of that vaccine, my little nephew became infected. He was miserable, and as his parents were out of town, I was the go-to person.

I bathed him in cool water to help bring down his temperature (does that really work?). I cuddled with him, and generally took care of him until his parents came home.

A couple of weeks later, my face erupted in what I thought were spectacularly huge pimples. They flattered my shiny new adult braces and first-ever pair of glasses.

I could not understand why I was breaking out, and then I remembered. My nephew.

I called my mom to see if I’d had chickenpox as a kid, and you already know the answer.

Well, that was a long time ago, and I can happily report my nephew and I had complete recoveries.

All this is to say that diseases lurk. It doesn’t matter how old or young we are, if we’re not protected, we’re open to infection. And, diseases from our childhood pose just as much risk to us as adults.

It takes one phone call or email to the healthcare provider’s office. Ask about all vaccine-preventable diseases, and where you are in your level of protection.

 

 

by Trish Parnell





Oops Not Acceptable!

5 08 2013

One of the many reasons our family likes to stay out of hospitals is to avoid nosocomial infections.  Those are infections you get while you’re in the hospital (not what sent you to the hospital in the first place).

And there are other reasons to steer clear of hospitals.  Do you recall the study in the April 2008 issue of Pediatrics that tells us one out of 15 hospitalized kids are harmed by hospital errors, including mix-ups of medicines, bad drug reactions and overdoses?

As parents, we ask of no one in particular and everyone in general:  What are we supposed to do?  We want to take our sick or hurt children to a place that will, at the bare minimum, do no harm, and in theory, do some good.  But the risks associated with a hospital stay are pretty serious.

The National Initiative for Children’s Healthcare Quality worked on a tool that helped investigators get a more accurate count of numbers of children harmed while in the hospital.  Prior to the use of this tool, the count of children harmed by hospital error was much lower because errors were supposed to be voluntarily reported, and we now know that wasn’t happening.

I can accept the fact that no one is perfect, but the bar for standard of care is pretty low.  As our children’s advocates, we have the responsibility to insist that bar be raised.

Hospital staff: please worry less about political fall-out and more about doing what you have to do to stop mistakes from occurring, or worse, reoccurring.  And strive for transparency – it will relieve unnecessary suspicion and mistrust on the part of patients and their families and will serve to keep everyone working toward an error-free environment.  Ask questions, involve the family in patient care, stay focused on the tasks at hand, and communicate thoroughly with those taking over your patients when shifts change.

Families: as much as possible, stay with your loved one in the hospital and ask questions about everything that is being done. If something doesn’t seem right, don’t be afraid to ask about it. If someone’s feathers get ruffled because you ask questions about what they’re doing, just remember: better that than a mistake.

 

By Trish Parnell





Sports and Infectious Diseases – Part 2 of 3

10 04 2013

bloodborneWhat risk does an athlete with a bloodborne pathogen pose?

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.  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: The risk of HIV infection via skin or mucous membrane exposure to blood or other infectious bodily fluids during sports participation is very low . . . such transmission appears to require, in addition to a portal of entry, prolonged exposure to large quantities of blood.  Transmission through intact skin has not been documented: no HIV infections occurred after 2,712 such exposures in 1 large prospective study.  Transmission of HIV in sports has not been documented.  One unsubstantiated report describes possible transmission during a collision between professional soccer players.

Hepatitis B: HBV [hepatitis B virus] is more easily transmitted via exposure to infected blood than is HIV . . . the risk of infection [is] greater if the blood [is] positive for HBV e antigen . . . transmission of infection by contamination of mucous membranes or broken skin with infected blood has been documented, but the magnitude of risk has not been quantified.

Although transmission of HBV is apparently rare in sports, 2 reports document such transmission.  An asymptomatic high school sumo wrestler who had a chronic infection transmitted HBV to other members of his team.  An epidemic of HBV infection occurred through unknown means among Swedish athletes participating in track finding (orienteering).  The epidemiologists concluded that the most likely route of infection was the use of water contaminated with infected blood to clean wounds caused by branches and thorns.

An effective way of preventing HBV transmission in the athletic setting is through immunization of athletes.  The American Academy of Pediatrics (AAP) recommends that all children and adolescents be immunized.  Clinicians and the staff of athletic programs should aggressively promote immunization.

Hepatitis C: Although the transmission risks of HCV infection are not completely understood, the risk of infection from percutaneous [through the skin] exposure to infected blood is estimated to be 10 times greater than that of HIV but lower than that of HBV.  Transmission via contamination of mucous membranes or broken skin also probably has a risk intermediate between that for blood infected with HIV and HBV.

“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 students should have access to any sport, except boxing, which the Academy opposes for all youths because of its physical risks.

“I personally feel parents have no obligation to disclose the infectious status of their children to anyone,” said Dr. Anderson.  Strict compliance with standard precautions is critical for this open-embrace of all athletes, regardless of their infectious status.  Coaches and teachers must have a plan in place to handle blood spills, said Dr. Anderson, including latex [or non-permeable] gloves, occlusive dressings, appropriate sterilizing solutions, disposal bags and even a printed protocol for coaches, athletes and officials.

The following is an excerpt of a sample school policy, used by numerous public school districts and in compliance with ADA that addresses HIV infection:

“The privilege of participating in physical education classes, programs, competitive sports and recess is not conditional on a person’s HIV status.  School authorities will make reasonable accommodations to allow students living with HIV infection to participate in school-sponsored physical activities.

“All employees must consistently adhere to infection control guidelines in locker rooms and all play and athletic settings.  Rulebooks will reflect these guidelines.  First aid kits and standard precautions equipment must be on hand at every athletic event.

“All physical education teachers and athletic program staff will complete an approved first aid and injury prevention course that includes implementation of infection control guidelines.  Student orientation about safety on the playing field will include guidelines for avoiding HIV infection.”

In addition to the Academy, several sports and other health organizations have also weighed in on this issue.  According to the NCAA, National Football League (NFL) and World Health Organization, athletes with HIV should be permitted to participate in all competitive sports at all levels.

These organizations all endorse immunization against hepatitis B for all athletes.

The National Athletic Trainers’ Association (NATA) echoes Dr. Anderson’s suggestion that coaches, trainers, athletic directors, school officials and others take the lead in educating themselves, their teams, parents and their communities about the importance of effective disease prevention.

Trainers and coaches, they suggest, should provide the following information in age-appropriate terms to all participants before or during any competition :

  • The risk of transmission or infection during competition.
  • The risk of transmission or infection generally.
  • The availability of HIV testing (for teens and adults).
  • The availability of hepatitis B vaccination and testing (for parents, teens and adults).

“Athletic trainers who have educational program responsibility should extend educational efforts to include those, such as the athletes’ families and communities, who are directly or indirectly affected by the presence of bloodborne pathogens in athletic competitions,” the NATA stated in a position paper.

See PKIDs’ Infectious Disease Workshop for more information.

Photo courtesy of Lolie Smith





Airplane Cabins and Your Health

30 08 2012

Do you remember SARS (Severe Acute Respiratory Syndrome)? It popped up in China in 2002 and spread to more than 25 countries before we could blink.

PKIDs landed a group of disease prevention educators in China just as the world became aware of this outbreak that would rapidly become an epidemic. It was coincidence, of course. The trip had been planned for months.

But, our proximity to the SARS outbreak was a reminder to us of how efficient air travel is at spreading germs.

In 2009, there were 2.5 billion airline passengers and that number is expected to increase to 3.3 billion by 2014. That’s a lot of sneezing, coughing, and just plain touching of armrests, overheads, and other surfaces going on in small spaces.

Dr. Alexandra Mangili and Dr. Mark Gendreau wrote a piece for the Lancet in 2005 that talks about the mechanics of disease transmission in an airplane. It’s very good, if you have a few minutes to read it.

They explain air flow patterns and how much air is recirculated (50% and that’s through filters). Turns out, air does not flow the length of the plane, but rather in sections or pockets along the width of the plane. Still an efficient method of disease transmission for airborne and large droplet transmission, but not the only way germs are spread onboard.

According to the article, the most common infections on aircraft have been via the fecal-oral route through contaminated food, although that has diminished in the last few years, possibly due to prepackaged food products and more care in the prepping and handling of food.

Mosquitos, a common vector for diseases such as dengue and malaria, often hitch rides on airplanes. Mangili and Gendreau point out that, “Many cases of malaria occurring in and around airports all over the world in people who had not travelled to endemic areas, known as airport malaria, is evidence that malaria-carrying mosquitoes can be imported on aircraft.”

The cabins of airplanes cannot be thoroughly disinfected between flights. Many times, a plane lands, passengers disembark, and more passengers are seated within 30 minutes. Think of all the droplets of goo left behind that the cleaning crew cannot remove, and the many surfaces that can’t be disinfected.

Keeping one’s hands clean throughout the flight will go a long way toward preventing transmission, and staying up-to-date on your vaccinations for your home country and your destination. As for masks, the authors say, “Although masks play a crucial part in infection control in health care settings, their use is unproven in disease control within the aircraft cabin.” But they do recommend masking and isolating someone suspected of having SARS.

The CDC has quite a bit more to say about air travel and travelers’ health in general, if you’re looking for more details.

How do you prevent infections during air travel? What do you do to protect yourself? We’d love to hear! Please share your tips in the comment section.

By Trish Parnell
Image courtesy of WHO





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





The end in sight – eliminating seven diseases plaguing half a billion kids

5 04 2012

(Welcome to End7. Thank you for sharing information about your work through this guest post!)

Moms and Dads from every country want one thing; healthy kids.  That’s why groups like PKIDs form—to help educate parents and the general public about specific diseases and to provide families with the support they need.

While the languages, food and clothes may be quite different for some of the kids we work with, we have a lot in common with PKIDs. Unfortunately, for families living in the poorest communities in the world, there is little in the way of support networks or treatment programs for children and adults who have neglected tropical diseases—or NTDs.

NTDs are a group of parasitic and bacterial diseases that infect half a billion kids around the world, most coming from families living on less than a $1.25 a day. These kids don’t always have shoes or clean water, which is a problem since they can get NTDs just by doing the things that kids love to do—playing, swimming and other daily activities.

When kids get sick with NTDs like hookworm, whipworm and roundworm, parasitic worms grow in their stomachs, robbing them of food and energy and making them too weak to pay attention in school. For those who live near water sources, flies may carry a disease called River Blindness, which causes rashes and severe itching and can eventually lead to blindness. These NTDs disable and debilitate their victims, keeping children out of school and preventing parents from working. They take away any chance that families have of lifting themselves out of poverty.

But this is a major global health issue that actually has a simple, cost-effective solution.  It costs just 50 cents for a packet of pills that treats and protects a child for a year. Since the drugs are donated by major pharmaceutical companies, we just need the funds to get them to the people that need them most and set up treatment and education programs that communities can run themselves.  Even better, the medicine is so easy to administer that communities don’t even need medical professionals—who are often in very short supply in developing countries—to administer them to sick kids.  The medicine can be dispensed right in schools or community centers.

The END7 campaign is working to raise awareness and donations in order to actually eliminate seven of these NTDs by 2020—the WHO said it could be done and we accepted the challenge.

To learn more about NTDs and to join the movement to eliminate them, visit our campaign on  Facebook and tell your friends to do the same. We need help in taking the “neglected” out of NTDs and that starts with you.

Together we can see the end.

By Mara Veraar, Social Media Officer at Sabin

Image courtesy of Esther Havens





Contact Sports and Skin Infections

6 02 2012

(Welcome to guest blogger Rebecca Kreston, MSPH and thanks, Rebecca, for sharing this post from your blog: bodyhorrors!)

In honor of one of the most lucrative American events that happened just yesterday, I thought I’d explore sports and infectious diseases. Specifically, contact sports and skin infections!

Since starting this blog, I’ve gathered that readers just love reading about transmissible skin infections, so what could be better than watching the Super Bowl and knowing just exactly what kind of diseases could possibly be smeared between the players of the Patriots and Giants?

There is a glut of infectious diseases that one can acquire from dabbling in combat or contact sports such as American or Aussie-style football, rugby, wrestling, and sumo. In fact, skin infections are the most common injury associated with all sports (1). All that body bashing and face-to-face smearing in contact sports does wonders for spreading skin or cutaneous infections. A number of these ailments are common to us non-athletic mortals—athlete’s foot, jock rash and ringworm (or tinea corporis). Two diseases in particular, with the marvelous potential to initiate larger epidemics within and beyond the locker room, form the focus of this article.

Herpes gladiatorum is a wonderfully evocative name used to describe an athlete’s infection with herpes simplex virus 1 (HVS-1), a terribly contagious virus that many have the misfortune of being acquainted with; it’s estimated that 65% of people will become infected with the virus by the time they reach their 40s (2). Symptoms can include painful, blistery cold sores on the face and neck, along with a sore throat, infected lymph nodes and malaise.

It’s a tricky little bugger of a virus. It can remain dormant, hiding away in nerve cells known as sensory ganglia, only to spring out on one’s face or genitals during periods of physical or emotional stress or, say, when you’re sunbathing in tropical locales on vacation. It has an uncanny sense of knowing when to erupt at the most inappropriate of times, though I’ve been unable to track down any research examining the molecular basis of how it goes about conducting this remarkable mechanism.

Most people rightfully assume that HSV-1 infection is a rather personal, intimate matter: we hear about transmission between a mother and her child, between romancing couples and so on. This makes sense considering that it’s spread by respiratory droplets or direct contact with infected lesions; you’ve really got to get up close and personal in someone’s face if you want to get a sense of what HSV-1 infection feels like (2). But given social situations with a generous amount of skin-to-skin contact with many individuals—sports, for instance—the virus will happily engage in a bit of unplanned host-hopping. As such, it has a frustrating tendency to erupt into outbreaks in sports team and during competitions.

Many athletes may sport micro-abrasions and skin breaks stemming from turf burns, powerful body-to-body collisions, facial stubble or beard burn, and shaving. Depending upon the level of protective clothing and gear, these athletes can experience substantial exposure with their opponent’s infected HSV-1 lesions, not to mention the respiratory droplets, spit and mucus that may transmit other types of infections. Charming! Among teammates, a grab-bag of infections can also be spread by sharing towels, water bottles, clothing, equipment, and hygiene and cosmetic products.

HSV-1 is considered to be particularly endemic in rugby players due to the style of the sport and the lack of protective gear (3). Its rampant presence in rugby leagues has earned it the moniker “herpes rugbiorum” or “scrum pox” (“scrum strep”, caused by the bacterium Streptococcus pyogenes, can also plague rugby players).

In rugby, the “scrum” is a type of huddle maneuver used to return the ball into play. It is a sensational way to spread HSV-1: players in the forward position interlock their heads with their opponents in facing rows before the ball is launched between them. These forwards are the most likely of their teammates to contract scrum pox due to their prominent role in scrums and the increased prospect of serious face-to-face contact. The fact that rugby players do not use protective gear, including helmets, exposes a greater part of their body to physical contact and further increases their risk.

HSV-1 regularly rears its ulcerous face on wrestlers as well. A research group checking serum samples from wrestlers to determine previous HSV 1 exposure found that 29.8% of college wrestlers had reported previous HSV infection (4).

The level of intimacy required in grappling almost makes it inevitable that something is going to be transmitted between two athletes, whether that be sweat, saliva or HSV-1. Indeed, in a 1989 outbreak in high-school wrestling camp for boys, 34% of participants were diagnosed with HSV-1 (5). Lesions commonly appeared on regions of the body most likely to encounter direct skin-to-skin contact with their opponents – 73% on the head, 42% on the extremities and 28% on the trunk of the body.

How do you tell if a wrestler is right or left-handed? Check which side of their face, head, neck and arms has the greatest amount of lesions. Athletes will tend to prominently use the most powerful sides of their body, regardless of which sport, and it will be this side that can receive the greatest amount of skin-to-skin contact with opponents.

Getting a touch of HSV-1 and sharing it with your teammates may be the least of an athlete’s problems. In 2003, a ghastly outbreak of methicillin-resistant Staphylococcus aureus (MRSA) emerged during a college football camp in Connecticut (6). Ten players were infected, of whom two required hospitalization. The infection was discovered to have spread due to the combination of body shaving and turf burns from the artificial grass. Infections were most commonly located at the elbow, thigh, hip, chin, forearm and knee, parts of the body most likely to incur abrasions on the turf. Those players with turf burns had a seven-fold risk of acquiring MRSA infection than those who emerged from scrimmage and active play unscathed (6). Cornerbacks and wide receivers were particularly susceptible due to their frequent body contact during drills and scrimmage play.

A quick browse through the research literature pulls up dozens of MRSA outbreaks like this. In 2002, two college football players in Los Angeles were hospitalized due to MRSA infection (7). A one-year surveillance of a football team at an unnamed major university in the southeastern United States found that 19% of the players showed evidence of nasal colonization of the bacteria at the end of the football season; though the high prevalence of MRSA among these men did not yield any active skin and soft tissue infections, it goes to show how endemic of a problem this really is (8). In 2007, six football players on a Brooklyn high school football team showed evidence of MRSA skin and soft tissue infection; the players had just recently returned from a preseason training camp (9). The infections were serious enough that they generated abscesses requiring surgical incision and drainage.

MRSA colonization of football players is apparently becoming so commonplace that some researchers have suggested using them as human sentinels for public health surveillance of outbreaks within the surrounding community (10). It is regrettably becoming a rather conventional type of emerging infection in athletes.

These infections aren’t just unseemly looking but can be disfiguring, have long-lasting effects within the body and can temporarily disqualify an athlete from practice and competition to prevent localized outbreaks. Hell, some of them can kill ya! These outbreaks can ruin seasons for the team while for salaried athletes, these kinds of infections have serious economic, professional and personal repercussions. Medical professionals recommend that players abstain from play until they’ve started antiviral medications or antibiotics, they are free of systemic symptoms – fever, malaise and lymph node swelling – and until any moist lesions have subsided. Seems reasonable, no?

Infectious diseases are always context specific and spread through particular practices. In the case of contact sports, there are several variables at play that help to spread some nasty infections. While there isn’t a lot we can do about changing how a sport is played (or can we?), coaches and referees can keep an eye out for athletes who seem ill or are showing visible evidence of infection. Fighting against poor hygiene practices and ensuring that wounds are cleaned and dressed immediately can also keep these kinds of sticky situations in line. Game on!

RESOURCES
A mission statement and guidelines on how to deal with herpes gladiatorum from the Sports Medicine Advisory Committee at the National Federation of State High School Associations.
Wrestlers filed a “herpes lawsuit” in 2008 against their coach and trainer holding them responsible for a localized HSV-1 outbreak.
In 2008, researchers discovered a unique herpes strain that only affects sumo wrestlers.

REFERENCES
1. BB Adams. (2010) Skin Infections in Athletes. Expert Rev Dermatol. 5(5): 567-577
2. R Sharma et al. (2011) Herpes Simplex in Emergency Medicine. Accessed online on Feb 2, 2012. Link.
3. BB Adams. (2000) Transmission of cutaneous infections in athletes. Br J Sports Med. 34(6): 413–414
4. B.J. Anderson (2008) Managing Herpes Gladiatorum Outbreaks in Competitive Wrestling: The 2007 Minnesota Experience. Curr Sports Med Rep. 7(6): 323-7
5. Belongia EA, Goodman JL, Holland EJ, et al. (1991) An outbreak of herpes gladiatorum at a high-school wrestling camp. N Engl J Med. 325(13): 906-10
6. EM Begier et al. (2004) A High-Morbidity Outbreak of Methicillin-Resistant Staphylococcus aureus among Players on a College Football Team, Facilitated by Cosmetic Body Shaving and Turf Burns. Clin Infect Dis. 39(10): 1446-1453
7. DM Nguyen et al. (2005) Recurring Methicillin-resistant Staphylococcus aureus Infections in a Football Team Emerg Infect Dis. 11(4): 526-32
8. CB Creech (2010) One-year surveillance of methicillin-resistant Staphylococcus aureus nasal colonization and skin and soft tissue infections in collegiate athletes. Arch Pediatr Adolesc Med. 164(7): 615-20
9. Centers for Disease Control & Prevention (CDC). (2009) Methicillin-resistant Staphylococcus aureus among players on a high school football team–New York City, 2007. MMWR Morb Mortal Wkly Rep. 58(3): 52-5
10. B Barr, M Felkner & PM Diamond. (2006) High school athletic departments as sentinel surveillance sites for community-associated methicillin-resistant staphylococcal infections. Tex Med. 102(4):56-61