Dec. 7, 1999 (Atlanta) -- Student athletes and their coaches should take special steps to protect themselves from infection -- not just from HIV but also from Hepatitis B and C, which are more easily transmitted via exposure to infected blood, according to a statement issued by the American Academy of Pediatrics (AAP) in this month's journal Pediatrics.
The report also underscores the point that "there is no basis for excluding any student from sports if they are infected, and that we should also try to protect the confidentiality of that athlete," Steven Anderson, MD, chairman of the Committee on Sports Medicine and Fitness that drafted the policy, tells WebMD in an interview.
"Of course, we can't legislate whether people worry or not, but there's not the concern that there was five or six years ago. We're beyond that point, where kids are afraid to get on the same court with someone who is HIV-positive," says Anderson, a pediatrics professor at the University of Washington in Seattle -- as well as team doctor for numerous high school athletic teams, ballet companies, and the U.S. Olympic Diving Team.
The risk of HIV infection via skin or mucous membrane exposure to blood or other infectious bodily fluids during sports is "very low," says Anderson. "HBV [Hepatitis B] is more easily transmitted via exposure to infected blood than is HIV."
Immunization is the most effective way of preventing HBV infection. Although transmission is "rare" in sports, the AAP statement cites two cases. In one U.S. incident, a high school sumo wrestler transmitted HBV to other members of his team. In Sweden, an HBV epidemic occurred among a group of track athletes (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).
Although the transmission risks of Hepatitis C (HCV) infection are not completely understood, the risk of exposure via infected blood is estimated to be 10 times greater than that of HIV but lower than that of HBV.
The statement, which updates the AAP's 1991 policy on this subject, advises clinicians and staff of athletic programs to:
- aggressively promote HBV immunization among athletes, coaches, trainers, and other persons at risk of exposure to athletes' blood.
- educate athletes about precautions and about the greater risk of transmission of HIV and other blood-borne pathogens through sexual activity and needle-sharing during the use of illicit drugs, including anabolic steroids.
- tell athletes not to share personal items, such as razors, toothbrushes, and nail clippers that might be contaminated with blood.
- take precautions such as using bleach solutions to clean equipment and playing areas contaminated with blood.
"Certainly we're dealing with a population of kids in which HIV, HBV, HCV is very uncommon, and in sports where potential for transmission is very low," Robert Janssen, MD, acting director of the CDC's HIV/AIDS Prevention Division, tells WebMD. "But there's very real risk if there's overbleeding, and overbleeding does occur in some sports. I think these guidelines are very useful in dealing with those situations."
All students -- not just athletes -- should be educated about precautions against the "greater risk transmission through sex and needle-sharing, and use of illicit drugs including anabolic steroids," says Janssen. "Students in general need to be aware of the risks."