AAP Offers Guidance on Infectious Diseases in Organized Sports

H. Dele Davies, MD

A new clinical report from the American Academy of Pediatrics (AAP) provided guidance on preventing, identifying and treating infectious diseases associated with participation in organized sports.

H. Dele Davies, MD, of Pediatric Infectious Diseases and Public Health, University of Nebraska Medical Center, Omaha, and lead author of the report from the AAP Committee on Infectious Diseases, Council on Sports Medicine and Fitness, described his concerns to MD Magazine.

"There are many benefits to participation in sports by children and adolescents," Davies said. "However, there is also a risk of acquiring sports related infections, particularly in sports that require close contact such as wrestling and football."

While coaches and trainers have primary responsibility for maintaining safe equipment and facilities and promoting good hygiene behaviors in their athletes, there is also an important role for primary care pediatricians, Davies and colleagues reported.

"Although the primary care pediatrician may appear to be peripheral in this athletic milieu of organized sports, leadership from physicians has always been welcome and expected regarding issues of public health and safety," they noted.

The requirement for medical clearance to participate in organized sports provides an opportunity for clinicians to ensure the athlete does not have a communicable skin condition or infection, and that vaccinations are up to date.

Davies and colleagues also suggested this is an opportunity to counsel the athlete on personal hygiene, ranging from proper hand-washing and laundering of uniforms to the avoidance of sharing drinking vessels, braces, helmets and other protective equipment.

Coaches and trainers should follow guidelines such as those issued by the American College of Sports Medicine in regular cleaning of facilities including locker rooms, railings and showers, and equipment such as mats and blocking dummies. The AAP clinical report calls for special attention to proper management of blood and other body fluids.

The report lists several infectious pathogens spread by skin contact which are of particular concern in contact sports, including Staphyloccoccus aureus and group A ß-hemolytic Streptococcus (GABHS). Community-acquired methicillin resistant S aureus (MRSA) is a common cause of outbreaks of skin infections, particularly among football players and wrestlers, according to the report, and is associated with significant morbidity.

The report cited studies indicating that between 10% and 23% of football players or wrestlers have developed signs and symptoms during outbreaks of S. aureus infections. Risk factors include skin breaks associated with turf burns or trauma, skin-to-skin contact, sharing of equipment or clothing, as well as having a higher BMI.

GABHS has been associated with outbreaks of pharyngitis, and in 1 example, 12 of 23 judo club members in Tokyo, Japan presented with symptoms within a 15-day period.

According to the report, managing MRSA and GABHS outbreaks has been accomplished through “meticulous focus on hygiene education, good hygiene practices, prompt identification of infected people, limiting exposure to infected people and contaminated surfaces and objects, decontamination of the environment and proper treatment and close follow-up of infected people.”

"Most of these infections can be prevented through anticipatory guidance, good personal hygiene, regular cleaning and maintenance of equipment, and immunization against vaccine preventable infections," Davies said.

The report, "Infectious Diseases Associated With Organized Sports and Outbreak Control," was published online in the journal Pediatrics last month.

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