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Infection protection: Anticipatory guidance for young athletes should include infectious disease prevention :

September 25, 2017

Millions of U.S. children participate in organized sports each year. While these sports provide numerous health benefits, there also are infectious disease risks that the pediatrician should be aware of. For example, sports-related skin infections spread by contact are associated with 10%-15% of time-loss injuries among college athletes.

The new AAP clinical report Infectious Diseases Associated with Organized Sports and Outbreak Control provides guidance on risk factors, preventive measures and management of such diseases.

The report, from the Committee on Infectious Diseases and Council on Sports Medicine and Fitness, is available at https://doi.org/10.1542/peds.2017-2477 and will be published in the October issue of Pediatrics.

Common causes of sports-related infections

The most common risk factors for sports-related infections involve skin-to-skin contact with athletes (e.g., football players, wrestlers, rugby players) who have active skin infections, environmental exposures associated with physical trauma, sharing of equipment, and contact with contaminated fomites such as towels. Underlying eczema also is a risk factor.

Major pathogens and conditions associated with skin infections in organized sports include:

  • bacterial — Staphylococcus aureus (cellulitis and skin abscesses) and group A streptococcus (pyoderma, cellulitis, impetigo);
  • viral — herpes simplex virus (HSV) (herpes gladiatorum, herpes rugbiorum or conjunctivitis), Molluscum contagiosum and verruca vulgaris (warts);
  • fungal — Trichophyton and Microsporum species (tinea corporis, capitis and pedis); and
  • parasitic — Pediculosis capitis (scalp lice), P. corporis (body lice) and Sarcoptes scabiei (scabies).

S. aureus and group A strep infections also can be associated with severe invasive diseases such as pneumonia, bacteremia and myositis. Contaminated food and water also pose a risk for spread of certain pathogens (e.g., shiga-toxin producing Escherichia coli, Shigella species, Giardia species, Cryptosporium species and norovirus).

Other means of transmission include respiratory droplet (influenza, pertussis, Neisseria meningitides, group A streptococcal pharyngitis, mumps), airborne particles (varicella, measles) and vectors (ticks, mosquitoes).

Transmission of blood-borne pathogens, while feasible, has not been validated as resulting from sports-related contact. However, decontamination is recommended for management of environmental contamination when there is a spill of blood or body fluids.

Guidance on when to return to play

Management of sports-related infections depends on the suspected etiology, which is primarily based on clinical appearance, with laboratory testing primarily used for confirmation. In general, empiric treatment should be started as soon as possible for the suspected pathogen, and the athlete should be isolated from further participation in practice or competition until the risk of spread is deemed minimal.

Some conditions such as strep, staph infections, HSV and tinea capitis are best managed by orally administered systemic antibiotic, antiviral or antifungal agents, while others (tinea corporis, pedis, warts, scabies and lice) may be managed by topical therapy.

The clinical report summarizes return-to-practice and competition guidelines from three major governing bodies — the National Collegiate Athletic Association, National Federation of State High School Associations and the National Athletic Trainers Association.

Ounce of prevention 

Prevention of sports-related infections is most effectively accomplished through regular education of all athletes and athletic programs. Important messages include:

  • practice proper personal hygiene (e.g., wash hands and shower frequently, wear rubber soled flip-flops or sandals in communal showers, and launder uniforms and practice clothing);
  • avoid sharing drinking vessels, mouthguards, towels, braces, batting helmets, personal protective equipment, bars of soap, sponges, razors or electric hair shavers, and callus trimmers;
  • clean facilities and equipment regularly, including mats, railings, weight rooms, blocking dummies, locker rooms and showers; and
  • dispose of and disinfect blood and body fluid spills promptly.

Immunizations also provide an effective and efficient vehicle for preventing the spread of many viral and bacterial pathogens. Pediatricians can play an important role in providing anticipatory guidance to athletes, especially during the annual preparticipation physical examination visit.

Dr. Davies is a lead author of the clinical report and a former member of the AAP Committee on Infectious Diseases.

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