Infection protection: Anticipatory guidance for young athletes should include infectious disease prevention
H. DeleDavies, M.D., M.S., M.H.C.M., FAAP
AAP Clinical Report
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
Major pathogens and conditions associated with skin infections in organized sports
bacterial — Staphylococcus aureus (cellulitis and skin abscesses) and group A streptococcus (pyoderma, cellulitis,
viral — herpes simplex virus(HSV)(herpesgladiatorum, herpes rugbiorum or conjunctivitis), Molluscum contagiosum and verruca
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
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
avoid sharing drinking vessels, mouthguards, towels, braces, batting helmets, personal
protective equipment, bars of soap, sponges, razors or electric hair shavers, and
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.