Infectious Diseases Associated with Organized Sports and Outbreak Control
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CLINICAL REPORT Guidance for the Clinician in Rendering Pediatric Care Infectious Diseases Associated H. Dele Davies, MD, MS, MHCM, FAAP, a Mary Anne Jackson, MD, FAAP,b Stephen G. Rice, MD, PhD, MPH, FAAP,c WithCOMMITTEE ON INFECTIOUS Organized DISEASES, COUNCIL ON SPORTSSports MEDICINE AND FITNESSand Outbreak Control Participation in organized sports has a variety of health benefits but also has abstract the potential to expose the athlete to a variety of infectious diseases, some of which may produce outbreaks. Major risk factors for infection include skin- to-skin contact with athletes who have active skin infections, environmental exposures and physical trauma, and sharing of equipment and contact aPediatric Infectious Diseases and Public Health, University of with contaminated fomites. Close contact that is intrinsic to team sports Nebraska Medical Center, Omaha, Nebraska; bInfectious Diseases, Children’s Mercy Kansas City and Department of Pediatrics, School and psychosocial factors associated with adolescence are additional risks. of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Minimizing risk requires leadership by the organized sports community and cSports Medicine, Jersey Shore University Medical Center and Department of Pediatrics, Robert Wood Johnson Medical School, (including the athlete’s primary care provider) and depends on outlining key Rutgers University, Neptune, New Jersey hygiene behaviors, recognition, diagnosis, and treatment of common sports- Dr Davies was the lead author of the manuscript; Drs Jackson and related infections, and the implementation of preventive interventions. Rice were coauthors of the manuscript with substantial input into content and revision; and all authors approved the final manuscript as submitted. This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy INTRODUCTION of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. The definition of organized sports includes traditional team sports Clinical reports from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external commonly acknowledged as well as other types of sports (Table 1). reviewers. However, clinical reports from the American Academy of Participation in organized sports provides the benefits of (1) physical Pediatrics may not reflect the views of the liaisons or the organizations activity, by engaging in vigorous exercise, achieving fitness, and or government agencies that they represent. learning athletic skills; (2) socialization, by experiencing camaraderie The guidance in this statement does not indicate an exclusive course and learning teamwork and sportsmanship; and (3) competition, of treatment or serve as a standard of medical care. Variations, taking ’ into account individual circumstances, may be appropriate. by challenging oneself to perform against others, by striving to All clinical reports from the American Academy of Pediatrics continually improve oneself toward achieving one s full athletic 1 automatically expire 5 years after publication unless reaffirmed, potential, and by learning to win and lose with grace and dignity. revised, or retired at or before that time. Organized sports participation, however, can result in the acquisition of a variety of infectious diseases and conditions. Physical contact To cite: Davies HD, Jackson MA, Rice SG, AAP COMMITTEE among athletes, sharing of equipment (such as worn personal ON INFECTIOUS DISEASES, AAP COUNCIL ON SPORTS protective equipment or braces plus towels, drinking vessels, MEDICINE AND FITNESS. Infectious Diseases Associated showers, and locker rooms), and contact with– athletic surfaces (mats, With Organized Sports and Outbreak Control. Pediatrics. 2017;140(4):e20172477 artificial turf, dirt, grass, and gym or weight 2room9 equipment) can all be responsible for transmission of infection. In addition, certain organized sports carry specific additional risks; for example, wrestlers Downloaded from www.aappublications.org/news by guest on October 1, 2021 PEDIATRICS Volume 140, number 4, October 2017:e20172477 FROM THE AMERICAN ACADEMY OF PEDIATRICS Davies et al https://doi.org/10.1542/peds.2017-2477 October 2017 Infectious Diseases Associated With Organized Sports and Outbreak Control 4 140 Pediatrics 2017 ROUGH GALLEY PROOF Pediculosis capitis Pediculosis corporis Pediculosis pubis practicing in close quarters are and safety. Furthermore, because , especially 10,vulnerable 11 to skin pediatricians need to provide , and Escherichia), by infections. medical clearance to athletes to colicontaminatedShigella food orGiardia water (eg, participate in organized sports, Shiga-toxinCryptosporidium producing Athletes should be taught proper the preparticipation physical , species, personal hygiene (eg, hand-washing, examination is an opportunity to species, species, showering, and proper laundering– verify that the athlete does not and norovirus, which is further of uniforms and practice clothing 12 15 have a skin condition or infection propagated by the person-to-personNeisseria on a daily or regular basis). that could be transmitted to others. meningitidisroute), by respiratory droplet Avoidance of sharing of drinking This visit between the physician (eg, influenza, pertussis, vessels (water bottles, ladles, and the student athlete allows the , group A streptococcal or cups), mouth guards, towels, primary care pediatrician to deliver pharyngitis, mumps), by airborne braces, batting helmets, personal anticipatory guidance. Ensuring particles (eg, varicella, measles), or protective equipment, bars of soap, that immunizations are current per by certain vectors (eg, ticks) (Table 2). bath sponges, razors or electric recommendations of the Centers In the case of Epstein-Barr virus hair shavers, and– callus trimmers for Disease Control and Prevention, infection, close contact is required is also important2 9 in reducing the Advisory Committee on for transmission, and endemic infectious risk. In addition, Immunization Practices, and the disease within adolescent group athletic programs should ensure American Academy of Pediatrics is settings has been reported (Table 2). regular (daily, weekly, and monthly) important, and pediatric providers Although biologically plausible, cleaning of facilities and equipment should identify and document cases there have been no validated reports (eg, weight room,– railings, mats, in which vaccines are refused or of infections from transmission of blocking dummies,16 19 locker rooms, incomplete because of medical bloodborne pathogens, including and showers). Those who exemptions (eg, serious allergy to hepatitis B, hepatitis C, or HIV manage sports programs and a vaccine component). Coaches and during athletic competitions. facilities should develop a plan for trainers are primarily responsible Nonetheless, the American Academy proper cleaning and maintenance for reviewing and stressing to the of Pediatrics has previously issued of a sanitary sporting environment athlete the key hygiene behaviors specific detailed guidelines for by using guidelines such as those needed to minimize the risk of management of infections spread published by the American20 College obtaining or spreading infection by blood and body fluids, including of Sports Medicine. in organized sports. However, guidance for athletes who are primary care pediatricians can infected with HIV, hepatitis B virus, Special attention should be paid help reinforce such educational or hepatitis C virus, and these will to proper management of blood 21 21 messages. not be reiterated in this statement. and other body fluids. Just as ORGANISMS ASSOCIATED WITH hospitals in the United States have INFECTIONS IN ATHLETES Transmission of a specific infectious concentrated on preventing hospital- agent may be affected by a variety of associated infections in recent years, psychosocial (sexually transmitted the same level of focus on infection An athlete can acquire many infection), physical (trauma, prevention and control needs to different infections by participating closed community contact), and be present within the organized in organized sports. The pathogens environmental (soil, food, water, sports community, including ï include many that are prominent in vector) factors, especially in an among athletes, parents, coaches, outbreaks typically seen in crowded immunologically na ve population. athletic directors, equipment communities or closed community This policy will be focused on managers, certified athletic trainers, settings or that are facilitated by diagnosis, treatment, and prevention administrators, janitorial staff, team certain exposures specific to the of the most common infections that physicians, facility managers, and sport. may be encountered in the athlete league officials. participating in organized sports, Although the primary care StaphylococcusInfectious pathogens aureus include with an additional focus on factors pediatrician may appear to be those spread by skin contact (eg, that are potentially modifiable. peripheral in this athletic milieu Bacillus cereus , group It should be noted that some of of organized sports, leadership