Blood borne infections in sport: risks of transmission, methods of prevention, and recommendations for hepatitis B vaccination

Athletes are at risk of blood borne infections through bleeding injuries or injection of drugs with contaminated syringes. Prevention should focus on reducing non-sport associated risky behaviour, as well as dealing appropriately with bleeding injuries. The risk of transmission of hepatitis B virus is particularly high in athletes in contact and collision sports, those who live in or travel to endemic regions, injecting drug abusers, and those who practice first aid when there is no healthcare practitioner available. It is recommended that such athletes, and also adolescent athletes, should be vaccinated against the virus as a routine.     

Blood-borne infections

Blood-borne infections are transmitted by way of direct blood contact from one individual to another from injured skin or a mucous membrane. Blood-borne infections can also be transmitted through blood doping and drug abuse and through sexual contact. Risk factors for hepatitis B virus (HBV) HBV infection include travel to regions with endemic hepatitis. Prevention of blood-borne pathogens in the student-athlete should focus on traditional transmission routes and off-the-field behavior because experts believe that field transmission of blood-borne pathogens is minimal. Worldwide, HBV, hepatitis C virus (HCV), and HIV are the most common pathogens encountered. This article focuses on HBV and HCV as being the most prevalent in athletics.     

Work‐relief ratios and imbalances of load application in sport climbing: Another link to overuse‐induced injuries?

An imbalanced load application of the upper extremity may contribute to overuse‐induced injuries of the fingers. Thus, the present study evaluated load‐application symmetry between the right and the left hand and its work‐relief ratios (WRR) depending on climbing ability and pre‐exhaustion level. Twenty‐eight sport climbers (age: 29 ± 8 years; body mass index: 22 ± 2 kg/m²; years of climbing: 10 ± 6; climbing level: 6+ UIAA to 9 UIAA) were assigned to a group of recreational (≤8–UIAA, n = 14) or a group of ambitious (≥8 UIAA, n = 14) climbers. Blood lactate and perceived exertion level were recorded at the end of the climbing attempt. Load application and WRR were derived from video analysis separately for the left and the right hand. Differences in load‐application time between the left (47 ± 4%) and the right (53 ± 4%) hand (P < 0.001) were observed. Irrespective of side differences, the overall WRR was 5:1. Increasing climbing level leads to a more symmetric load application (r = ?0.42, P < 0.03). Differences of lactate concentration and exertion level were found between the pre‐ and the non‐pre‐exhausted group. Depending on climbing ability and exhaustion level, load application for the dominant hand (right) prevails. Further longitudinal studies should focus on imbalanced load application and overuse‐induced climbing injuries.     

Injury risk evaluation in sport climbing

The aim of this study was to quantify and rate acute sport climbing injuries. Acute sport climbing injuries occurring from 2002 to 2006 were retrospectively assessed with a standardized web based questionnaire. A total number of 1962 climbers reported 699 injuries, which is equivalent to 0.2 injuries per 1?000?h of sport participation. Most (74.4%) of the injuries were of minor severity rated NACA I or NACA II. Injury distribution between the upper (42.6%) and lower extremities (41.3%) was similar, with ligament injuries, contusions and fractures being the most common injury types. Years of climbing experience (p<0.01), difficulty level (p<0.01), climbing time per week during summer (p<0.01) and winter (p<0.01) months were correlated with the injury rate. Age (p<0.05 (p=0.034)), years of climbing experience (p<0.01) and average climbing level (p<0.01) were correlated to the injury severity rated through NACA scores. The risk of acute injuries per 1?000?h of sport participation in sport climbing was lower than in previous studies on general rock climbing and higher than in studies on indoor climbing. In order to perform inter-study comparisons of future studies on climbing injuries, the use of a systematic and standardized scoring system (UIAA score) is essential.     

Infectious disease outbreaks in competitive sports: a review of the literature

Recent outbreaks of infectious diseases in athletes in competitive sports have stimulated considerable interest. The environments in which these athletes compete, practice, receive therapy for injuries, and travel, both domestically and internationally, provide varied opportunities for the transmission of infectious organisms. The purpose of this medical literature review is to identify the agents most commonly reported in the medical literature as responsible for infectious disease outbreaks in specific sports and their modes of transmission and to guide targeted prevention efforts. A literature review of English-language articles in medical publications that reported outbreaks of infectious diseases in competitive athletes was conducted in PubMed MEDLINE from 1966 through May 2005. Outbreaks that were solely food borne were excluded. Fifty-nine reports of infectious disease outbreaks in competitive sports were identified in the published medical literature. Herpes simplex virus infections appear to be common among wrestlers and rugby players, with no single strain responsible for the outbreaks. Methicillin-resistant Staphylococcus aureus was responsible for several recent outbreaks of soft tissue and skin infections among collegiate and professional athletes. The most common mode of transmission in outbreaks was direct, person-to-person (primarily skin-to-skin) contact. Blood-borne exposure was implicated in 2 confirmed outbreaks of hepatitis. Airborne and vector transmissions were rarely reported. This review provides an overview of infectious disease outbreaks thought to be either serious enough or unusual enough to report. Appropriate surveillance of the frequency of infections will allow sports medicine staff to identify outbreaks quickly and take necessary measures to contain further transmission and prevent future outbreaks.     

Infectious disease in athletes

While orthopedic injuries most commonly are associated with sports, infectious diseases cause significant morbidity in athletes. Exercise improves immunity at moderate intensity but impairs immune function at extremes of duration and intensity. Respiratory infections are the most common, but skin, blood borne, sexually transmitted, and even cardiac infections occur. Infectious disease outbreaks are a constant concern. Treatment of such infections resembles those used in the general population. Return to play issues and prevention of infection are especially important in athletes.     

Practical management: community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA): the latest sports epidemic.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has gained international recognition as a superbug that causes serious infectious outbreaks in high-risk populations such as athletes. Clusters of cases in various athletic teams, particularly contact sports, have been reported since 1993 in the United States and more recently in Canada. CA-MRSA infections are not limited to North America, and all athletes are considered high risk. Skin-to-skin contact appears to be the primary mode of transmission. While typical infections are local skin and soft-tissue abscesses, CA-MRSA infections can spread systemically and lead to significant morbidity and mortality if not promptly identified and treated. The gold standard of treatment for all abscesses is incision and drainage with wound culture for bacterial identification and antibiotic sensitivity testing. A limited number of antibiotics are currently useful in the treatment of CA-MRSA and are reviewed. Geographical variation in patterns of antibiotic resistance further complicates the treatment. Meticulous, consistent use of infection prevention strategies is critical to control outbreaks in the athletic population. Good hygiene, prompt identification of infection, limited exposure to infected persons and contaminated objects, and proper treatment combined with close follow-up of infected athletes will help contain CA-MRSA outbreaks. Future research is needed to explore person-to-person and fomite transmission risks, to define the significance of nasal carriage and skin colonization in relation to CA-MRSA infections, and to further investigate antibiotic resistance patterns. Universal education is needed for all athletes and personnel who provide care in the athletic setting to help control this widespread epidemic.     

Haematological and biochemical screening of potential Royal Naval aircrew

The objective of this study was to determine which, if any, of a small range of haematological and biological tests would be of value in detecting disease risk factors as an addition to the Initial Flying Medical when screening potential Royal Naval aircrew. A retrospective review of results of haematological and biochemical profiles of 200 candidates screened at the Central Air Medical Board was used. Ninety nine candidates (49.5%) were found to have profiles outside the normal range on initial testing. Many of these were found to be normal on repeat testing or further investigation. One candidate was made permanently unfit to fly and three others had certain conditions put on their training or careers. It is concluded that most of the screening carried out serves only a limited function. It is recommended that screening should be stopped; however, should screening still be considered necessary only four tests are required, ie, fasting blood glucose, fasting total cholesterol and triglycerides, liver function test and full blood count.     

Gender verification of female Olympic athletes

Gender verification of female athletes has long been criticized by geneticists, endocrinologists, and others in the medical community. Problems include invalid screening tests, failure to understand the problems of intersex, the discriminatory singling out of women based only on laboratory results, and the stigmatization and emotional trauma experienced by individuals screened positive. Genuine sex-impostors have not been uncovered by laboratory-based genetic testing; however, gender verification procedures have resulted in substantial harm to a number of women athletes born with relatively rare genetic abnormalities. Individuals with sex-related genetic abnormalities raised as females have no unfair physical advantage and should not be excluded or stigmatized, including those with 5-alpha-steroid-reductase deficiency, partial or complete androgen insensitivity, and chromosomal mosaicism. In 1990, the International Amateur Athletics Federation (IAAF) called for ending genetic screening of female athletes and in 1992 adopted an approach designed to prevent only male impostors from competing. The IAAF recommended that the "medical delegate" have the ultimate authority in all medical matters, including the authority to arrange for the determination of the gender of the competitor if that approach is judged necessary. The new policy advocated by the IAAF, and conditionally adopted by the International Olympic Committee, protects the rights and privacy of athletes while safeguarding fairness of competition, and the American Medical Association recommends that it become the permanent approach.     

AIDS risk and risk reduction in the radiology department

As the AIDS epidemic progresses, concern about the risk of occupational transmission of the causative organism, human immunodeficiency virus (HIV), is increasing. In this article, we summarize the risk of occupational acquisition of HIV in the health care setting and specify protocol and equipment that can reduce this risk in the radiology department. Accidental needle-stick injury is the most common form of exposure to infected blood, which is the only body fluid implicated to date in the occupational transmission of HIV. Prospective cohort studies demonstrate a 0.3-0.4% risk of infection for each needle-stick event. The most important instruction to health care workers that can reduce this risk is the following: Do not recap needles. Other risk-reduction measures include the adoption of universal precautions against transmission of infectious disease; sharp-instrument precautions; the use of protective garb to prevent skin and mucous membrane contamination when blood or bloody body fluid may splash; the availability of stable, puncture-resistant disposal containers for sharp instruments; the exclusion of breakable glass syringes; and the accessibility of resuscitation equipment in all rooms in order to avoid direct mouth-to-mouth contact. These and other measures discussed here are designed to prevent exposure of skin or mucous membrane to blood. If exposure does occur, the contaminated area should be washed immediately. A multicenter research protocol to evaluate the effectiveness of zidovudine (AZT) therapy in preventing seroconversion after exposure to HIV-contaminated blood recommends AZT therapy after massive exposure (e.g., injection of measurable quantities of blood) and endorses it for serious parenteral exposure (e.g., deep needle sticks).     

Training effects of short bouts of stair climbing on cardiorespiratory fitness, blood lipids, and homocysteine in sedentary young women

Objectives: To study the training effects of eight weeks of stair climbing on VO₂MAX, blood lipids, and homocysteine in sedentary, but otherwise healthy young women. Methods: Fifteen women (mean (SD) age 18.8 (0.7) years) were randomly assigned to control (n = 7) or stair climbing (n = 8) groups. Stair climbing was progressively increased from one ascent a day in week 1 to five ascents a day in weeks 7 and 8. Training took place five days a week on a public access staircase (199 steps), at a stepping rate of 90 steps a minute. Each ascent took about two minutes to complete. Subjects agreed not to change their diet or lifestyle over the experimental period. Results: Relative to controls, the stair climbing group displayed a 17.1% increase in VO₂MAX and a 7.7% reduction in low density lipoprotein cholesterol (p<0.05) over the training period. No change occurred in total cholesterol, high density lipoprotein cholesterol, triglycerides, or homocysteine. Conclusions: The study confirms that accumulating short bouts of stair climbing activity throughout the day can favourably alter important cardiovascular risk factors in previously sedentary young women. Such exercise may be easily incorporated into the working day and therefore should be promoted by public health guidelines.     

Prävalenz von Hepatitis B, Hepatitis C und HIV-Infektionen bei Drogentodesfällen in Hamburg (1985 bis 1997) unter Berücksichtigung von epidemiologischen, forensischen und morphologischen Aspekten

The prevalence of hepatitis B, hepatitis C and HIV infections among drug abuse-related fatalities in Hamburg (1985–1997) was investigated with respect to epidemiological, forensic and morphological aspects. The purpose of this study was (1) to determine the prevalence of hepatitis B (HBV), hepatitis C (HCV) and HIV infections among drug abuse-related fatalities (drug deaths) in Hamburg from 1985 to 1997, (2) to assess the rate of multiple infections and (3) to analyze the liver histomorphology in 100 autopsied drug deaths. Furthermore, we discuss the epidemiological and forensic aspects. In this period 1469 drug deaths were registered with a prevalence for HBV of 35% (1997: 39%), for HCV 51% (1997: 58%), and for HIV 7% (1997: 15%). Co-infections were common (28%) and 19% of all cases were infected with HBV and HCV. The liver histology showed that hepatitis was frequently diagnosed (74%) and was associated with HBV and/or HCV infections (77% of all hepatitis cases). Only 9% showed a normal liverhistology. Forensic autopsies and monitoring of HBV, HCV and HIV infections in drug deaths represent an important tool to gain information about the individual case and the situation among i.v. drug abusers.     

Exercise and the hypertensive athlete.

Exercise helps to manage high blood pressure in most circumstances and should be encouraged in both hypertensive athletes and active individuals with this disease. Many physiologic mechanisms have been proposed that explain this benefit. Presently, it appears from both human and animal studies that exercise of moderate intensity may be optimal for control of high blood pressure. Exercise testing for the future prediction of hypertension is an intriguing concept, but more data needs to be gathered before screening can be recommended.     

Chronic Exercise Preserves Lean Muscle Mass in Masters Athletes

Magic Johnson's second retirement from the Los Angeles Lakers speaks to the fear athletes have of contracting HIV while participating in sports. Many of your patients may share the anxiety publicly expressed by a few professional basketball players about playing alongside Magic Johnson. Because athletes often turn to primary care physicians to address such concerns, we gathered two medical experts and a college athlete to discuss athletes' perceptions of HIV and the medical evidence of the transmission risk in sports.     

Preparticipation cardiovascular screening

Regular aerobic exercise provides many health benefits regardless of age, and should be promoted by health care providers to all patients. In older athletes, coronary artery disease is the most common cause of sudden death. There is widespread consensus, however, that the overall health benefits derived from exercise outweigh the risks of participation. Screening should focus on identifying signs and symptoms of underlying cardiovascular disease by obtaining a personal and family history and performing a focused physical examination according to the recommendations of the AHA. Exercise testing is recommended in males older than 40 and females older than 50, and individuals with cardiac risk factors. Cardiovascular PPE screening in young athletes remains a challenge, because potentially fatal abnormalities are uncommon and in some cases are undetectable without sophisticated testing. Most sudden cardiac deaths in athletes are caused by anomalies that are clinically silent, are rare, or are difficult to detect by history and physical examination. Many athletes may not experience symptoms consistent with heart disease or may not report family histories of sudden cardiac death. Important clues to a cardiac abnormality include history of syncope, chest pain, and family history of sudden death. Any underlying condition suspected on the basis of history or physical examination requires further diagnostic evaluation before the athlete can be cleared for activity. Currently there is considerable variability and inconsistency among state requirements for PPEs. A national adoption of a more uniform PPE screening process should be encouraged. The screening process should include the AHA's cardiovascular screening recommendations, as this would assist in closing the gap between screening practices recommended by sports medicine experts and the reality of current screening practices. Although the extent of screening continues to be debated, clinical guidelines for performing PPEs and determining clearance have been established. Without a uniform implementation of the current guidelines, it will not be possible to assess the value of the current cardiovascular screening recommendations in detecting and preventing cardiovascular death in young athletes. Physicians should be aware of the emerging role of genetic testing for cardiovascular diseases in athletes with a family history of heart disease or sudden death. Advances in the diagnosis and understanding of cardiovascular disease may provide better tools for preventing sudden death of young athletes in the future [11].     

Herpes and Tinea in Wrestling

The two most troublesome skin infections in wrestlers are herpes gladiatorum and tinea gladiatorum. Determining whether athletes should or should not be disqualified from practice or competition because of these infections requires some expertise. Recommendations are presented to assist the practitioner in the care of these conditions in wrestlers and other athletes who have frequent skin-to-skin contact.     

Sudden cardiac death: mandatory exclusion of athletes at risk is a step too far

Sudden cardiac death (SCD) in young athletes is a distressing event and it is not surprising that some physicians working with sports people are proposing that preventive action should be taken. There is a push for a system similar to that established in some countries, which involves screening and mandatory exclusion of those at risk. We argue that while screening can provide useful information to at-risk athletes making decisions about their future athletic careers, mandatory exclusion of athletes is paternalistic and such decisions are not rightfully within the domain of medicine.     

Life insurance and HIV testing: insurance theory, discrimination and solutions

Part 1 describes briefly how the market for life insurance deals with HIV infection and how society has reacted to its policies. Part 2 examines the arguments for and against HIV testing: does it discriminate against individuals or is it just a logical extension of risk estimation procedures and underwriting techniques? In part 3 possible solutions are considered. Are solutions in the private sector, like banning HIV testing, warranted, should we look for a public solution that does not burden the private insurance industry, or is a mixed public-private solution desirable?     

死胎大脑组织中HBsAg检测的临床和病理研究

 目的 观察乙型肝炎病毒是否通过产妇传播并在胎儿大脑组织表达。方法 采集40例乙型肝炎产妇产下的死胎,常规尸检,取大脑组织,SP法检测HBsAg;回访婴母产前静脉血HBV的检测结果。结果 HBsAg阳性颗粒在死胎的大脑胶质细胞浆、血管中点、灶状分布,大脑胶质细胞细胞核不着色。HBsAg阳性、(HBsAg、HBeAb、HBcAb皆阳性)、(HBsAg、HBeAg、HBcAb皆阳性)的婴母分娩的死胎大脑组织中HBsAg阳性几率分别为8／33、0／2、0／5例,三者比较,差异无统计学意义(P＞0.05)。结论 乙型肝炎病毒可以通过母婴垂直传播在胎儿大脑组织中表达;其表达与孕妇静脉中乙型肝炎病毒标志物(HBVM)无关。