Your Student Athlete

27 08 2013

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.

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.”

The AAP’s Redbook still supports this policy.

Participation, however, assumes all athletes and coaches will follow standard precautions to prevent and minimize exposure to bloodborne 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.

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 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.

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 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
  • Wash your hands a lot or, if hands aren’t visibly soiled, use alcohol handrubs
  • Don’t share needles with anyone for any purpose




Meningitis: A College Memory You Don’t Want

21 04 2010

Going away to school is a lifechanging experience. For many students, four years disappear into a haze of studying, working, and partying with their classmates. It’s a chaotic time where everything is shared: space, feelings, clothes, cars, and germs.

When a meningitis outbreak shows up in the news, it’s a good bet that it showed up at a school. Any shared spaces like schools, dorms, or barracks where crowds of young adults converge are favorite territories for bacteria and viruses to spread.

Meningitis, a serious but rare infection, is an inflammation of the membranes covering the brain and spinal cord. It affects about 1,500 Americans each year.

Meningitis is commonly mistaken for the flu in its early stages, and therefore left untreated. When this happens, it can do a lot of damage within hours, sometimes causing confusion, seizures, and brain damage. Survivors are often left with amputated limbs—permanent reminders of their experience.

So what does meningitis act like and why are colleges a prime environment for it?

Most meningitis patients complain of excruciating headaches, unyielding fevers, nausea, and vomiting. Sound like just a bad case of the flu? More telling are other symptoms, which include stiffness and pain in the neck (due to the swelling around the spinal cord and brain), sensitivity to light, numbness or loss of sensation in limbs, rashes, mental confusion, and convulsions and seizures.

Most at risk are college students. Busy, exhausted, and stressed students often have lowered immune systems. A wide variety of lifestyles and health choices create a melting pot of germs, especially when bathrooms and eating areas are shared. Meningitis is spread through contact with an infected person’s bodily fluid: a shared cigarette or drink, a kiss, a cough. It’s possible to carry a germ that causes meningitis and never be sick, while unknowingly passing it on to someone else. There are lots of ways to spread it.

Many such infections could be prevented with vaccination. Some schools are now requiring proof of vaccination; others only provide information about meningitis. Before heading off to college, make sure you’re protected and know what the warning signs are. Parents, if you’re reading this, make sure your son or daughter is protected before they leave you.  It could be the most important going-away gift you give your child.

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