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

Progression of blood-borne viruses through bloodstream: A comparative mathematical study

BACKGROUND AND OBJECTIVES

Blood-borne pathogens are contagious microorganisms that can cause life-threatening illnesses, and are found in human blood. It is crucial to examine how these viruses spread through blood flow in the blood vessel. Keeping that in view, this study aims to determine how blood viscosity, and diameter of the viruses can affect the virus transmission through the blood flow in the blood vessel. A comparative study of bloodborne viruses (BBVs) such as HIV, Hepatitis B, and C, has been addressed in the present model. A couple stress fluid model is used to represent blood as a carrying medium for virus transmission. The Basset-Boussinesq-Oseen equation is taken into account for the simulation of virus transmission.

METHODS

An analytical approach to derive the exact solutions under the assumption of long wavelength and low Reynolds number approximations is employed. For the computation of the results, a segment (wavelength) of blood vessels about 120 mm with wave velocities in the range of 49 - 190 mm/sec are considered, where the diameter of BBVs ranges from 40-120 nm. The viscosity of the blood varies from 3.5-5.5 × 10^-3Ns/m² which affect the virion motion having a density range 1.03 - 1. 25 g/m³.

RESULTS

It shows that the Hepatitis B virus is more harmful than other blood-borne viruses considered in the analysis. Patients with high blood pressure are highly susceptible for transmission of BBVs.

CONCLUSIONS

The present fluid dynamics approach for virus spread through blood flow can be helpful in understanding the dynamics of virus propagation inside the human circulatory system.

Chronic Viral Hepatitis in Elite Athletes: Approaches to Risk Assessment, Prevention and Management

Elite athletes who participate in contact sports are at risk of bleeding injuries, leading to transmission of blood-borne viruses including hepatitis type B, C and D (HBV, HCV and HDV) capable of causing chronic liver disease, liver failure and liver cancer. In view of the significant advances in the viral hepatitis field over the past decade, more structured approaches should be in place to screen for and manage viral hepatitis in elite athletes. HBV status should be assessed in all elite athletes, and those infected should receive nucleos(t)ide analogues for viral suppression, while uninfected individuals should receive HBV vaccination. The all-oral direct acting antivirals for HCV are highly effective and safe, thus the remaining challenge with hepatitis C is case identification and linkage to care. HDV is only found in HBV-infected individuals, which is characterized by rapid disease progression and higher rates of cirrhosis and liver cancer in infected subjects. Pegylated interferon was the mainstay of treatment for HDV infection until bulevirtide, a viral entry inhibitor, was recently approved by the European Union (EMA) and FDA in America, while multiple novel therapies are already in clinical trials as part of the HBV cure program. Overall, awareness of chronic viral hepatitis in athletes should be improved. Prevention remains the cornerstone of the management of viral hepatitis in sport coupled with rigorous disease assessment in infected individuals, and antiviral therapy where indicated.

Injury Profile of Mixed Martial Arts Competitions in the United States

Background:

The popularity of mixed martial arts (MMA) continues to grow in the United States. Although prior work has provided valuable insight concerning injuries in the sport, much of the available literature is limited by factors such as small sample sizes, varying athlete demographics, and inconsistent data collection methods.

Purpose:

To report injury rates and types in MMA and analyze potential variance between competition and match variables.

Study Design:

Descriptive epidemiology study.

Methods:

We performed a retrospective review of injuries sustained by fighters during MMA contests between 2018 and 2019 using ringside physician postmatch injury reports from Wisconsin and Arizona. The prevalence of overall injuries and specific injury types was compared by location (Arizona vs Wisconsin), competition level (amateur vs professional), match result (decisions vs any other result), and match winners versus losers.

Results:

In 503 contests, 285 (57%) had at least 1 injury. In these 285 matches, participants experienced 401 injuries: 197 (49%) in professional bouts and 204 (51%) in amateur bouts. The match injury rate was higher in professional bouts than in amateur contests (68% vs 51%; P < .001). Amateur fighters had more contusions and hematomas (31% vs 22%; P < .001), while professional fighters had more lacerations (39% vs 23%; P < .001). Losers exhibited a higher match injury rate than winners (48% vs 24%; P < .001). Winners experienced a higher proportion of fractures (19% vs 9%; P = .005), and losers experienced more concussions (17% vs 2%; P < .001).

Conclusion:

Professional fighters and losers of MMA bouts exhibited higher injury rates relative to amateurs and winners. The prevalence of specific injury types varied by competition level, match result, and match winners versus losers. The results of this study may be used to better understand the current injury profile in MMA and to develop targeted strategies for injury prevention.

AMSSM Position Statement Update: Blood-Borne Pathogens in the Context of Sports Participation

This AMSSM position statement update is directed toward health care providers of patients involved in sport and exercise. There have been significant advances in clinical and scientific research in the understanding of blood-borne pathogens (BBPs), and this update incorporates these advancements. This document is intended as a general guide to clinical practice based on the current state of evidence, while acknowledging the need for modification as new knowledge becomes available. Confirmed transmission of BBPs during sport is exceedingly rare. There are no well-documented reports of HIV, hepatitis C virus, or hepatitis D virus transmission during sport. There is also no evidence for universal testing for BBPs as a specific requirement for participation in sports. Competitive athletes and nonathletes should follow appropriate general public health agency recommendations for screening for BBPs, considering their individual risk factors and exposures. Standard (universal) precautions must be followed by those providing care to athletes. Exercise and athletic participation can help promote a healthy lifestyle for persons living with BBPs. Those with acute symptomatic BBP infection should limit exercise intensity based on their current health status. Education is the key tool for preventing BBP transmission. Research gaps include evaluation of the prevalence of BBP infections in competitive athletes, the effects of long-term, intense training on infected athletes, and the effects of BBP treatment therapies on performance.

AMSSM position statement update: blood-borne pathogens in the context of sports participation

This American Medical Society for Sports Medicine position statement update is directed towards healthcare providers of patients involved in sport and exercise. There have been significant advances in clinical and scientific research in the understanding of blood-borne pathogens (BBPs), and this update incorporates these advancements. This document is intended as a general guide to clinical practice based on the current state of the evidence, while acknowledging the need for modification as new knowledge becomes available. Confirmed transmission of BBPs during sport is exceedingly rare. There are no well-documented reports of HIV, HCV or HDV transmission during sport. There is also no evidence for universal testing for BBPs as a specific requirement for participation in sports. Competitive athletes and non-athletes should follow appropriate general public health agency recommendations for screening for BBPs, considering their individual risk factors and exposures. Standard (universal) precautions must be followed by those providing care to athletes. Exercise and athletic participation can help promote a healthy lifestyle for persons living with BBPs. Those with acute symptomatic BBP infection should limit exercise intensity based on their current health status. Education is the key tool for preventing BBP transmission. Research gaps include evaluation of the prevalence of BBP infections in competitive athletes, the effects of long-term, intense training on infected athletes and the effects of BBP treatment therapies on performance.

Immunizations in Athletes

Context:

Immunizations are a cornerstone of preventive care and an important consideration for team physicians caring for athletes.

Evidence Acquisition:

A PubMed search was performed from August 2016 through May 2017 as well as a website review of the Centers for Disease Control and Prevention, World Health Organization, and Immunization Action Coalition.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

By keeping abreast of diseases endemic to nations to which athletes may be traveling as well as the vaccination status of the athletes, team physicians can provide appropriate advice regarding immunization and prevention of disease.

Conclusion:

There are a host of regularly updated reliable websites to assist the team physician in these recommendations.

Vaccination in elite athletes

Public health vaccination guidelines cannot be easily transferred to elite athletes. An enhanced benefit from preventing even mild diseases is obvious but stronger interference from otherwise minor side effects has to be considered as well. Thus, special vaccination guidelines for adult elite athletes are required. In most of them, protection should be strived for against tetanus, diphtheria, pertussis, influenza, hepatitis A, hepatitis B, measles, mumps and varicella. When living or traveling to endemic areas, the athletes should be immune against tick-borne encephalitis, yellow fever, Japanese encephalitis, poliomyelitis, typhoid fever, and meningococcal disease. Vaccination against pneumococci and Haemophilus influenzae type b is only relevant in athletes with certain underlying disorders. Rubella and papillomavirus vaccination might be considered after an individual risk–benefit analysis. Other vaccinations such as cholera, rabies, herpes zoster, and Bacille Calmette–Guérin (BCG) cannot be universally recommended for athletes at present. Only for a very few diseases, a determination of antibody titers is reasonable to avoid unnecessary vaccinations or to control efficacy of an individual’s vaccination (especially for measles, mumps, rubella, varicella, hepatitis B and, partly, hepatitis A). Vaccinations should be scheduled in a way that possible side effects are least likely to occur in periods of competition. Typically, vaccinations are well tolerated by elite athletes, and resulting antibody titers are not different from the general population. Side effects might be reduced by an optimal selection of vaccines and an appropriate technique of administration. Very few discipline-specific considerations apply to an athlete’s vaccination schedule mainly from the competition and training pattern as well as from the typical geographical distribution of competitive sites.

Knowledge, attitudes, and practice of medical students regarding occupational risks of hepatitis B virus in college of medicine, aljouf university

BACKGROUND

Medical students represent a population that is at high-risk group for acquiring and spreading hepatitis B infection (HBV).

AIM

This study was designed to evaluate the knowledge and attitudes among male student regarding occupational risks of HBV infection.

SUBJECTS AND METHODS

During March 2013, a descriptive cross-sectional study was conducted on medical students of AlJouf University College of Medicine. Structured questionnaires of 16 different statements concerning knowledge base of HBV, attitudes as well as practices toward occupational risks of hepatitis B were distributed to 120 students.

RESULTS

Response rate of 76.7% (92/120) yielded 92 questionnaires for analysis. Majority of the students surveyed 62.0% (57/92) perceived that they are at high risk of contracting and spreading HBV. The rate of this perception among students who had a history of training on universal precautions was more than that found among those who did not have (70.8% vs. 58.8%; P < 0.01). Most of the students surveyed 63.0% (58/92) considered vaccine is safe and more than half 52.2% (48/92) were vaccinated against HBV. There were a very strong agreement about needlestick 92.4% (85/92) and blood 87.0% (80/92) as efficient modes of HBV transmission. Seventy-two percent of the participants did not have any knowledge about post-exposure prophylaxis for hepatitis B. A significant relationship was found between students who had a history of training on universal precautions and knowledge about post needlestick injury (P < 0.01).

CONCLUSION

Infectious occupational risk of hepatitis B remains a challenge for medical students and the foundations of the medical institutes. Students must complete an infection control training before they start their clinical education.

Prevalence of sexually transmitted diseases in female athletes in São Paulo, Brazil

OBJECTIVE

To determine the prevalence of sexually transmitted diseases in female athletes.

METHODS

An observational, cross-sectional study was conducted including 50 female athletes with mean age of 20 ± 3 years. Colposcopy, pap smear, and polymerase chain reaction for Chlamydia trachomatis, human papillomavirus and Neisseria gonorrhoeae were performed. Blood samples were collected to test for the human immunodeficiency virus, syphilis, hepatitis B and C. The athletes presenting clinical diseases or conditions identifiable by laboratory tests were treated and followed up in the unit.

RESULTS

Forty-six percent of the participants were unaware of sexually transmitted diseases. The prevalence of sexually transmitted diseases among athletes was 48% (24 cases). Human papillomavirus was the most frequent agent (44%). Considering the human papillomavirus genotypes, subtype 16 was the most prevalent (53%), followed by 11-6 (22%) and 18 (13%). Two athletes tested positive for C. trachomatis. There were no cases diagnosed of infection by N. gonorrhoeae, syphilis, hepatitis B, hepatitis C and human immunodeficiency virus. However, only 26 athletes had been vaccinated for hepatitis B.

CONCLUSION

The prevalence of sexually transmitted diseases in female athletes was high. Primary prevention measures (hepatitis B and human papillomavirus vaccination) and secondary (serology, pap smears) must be offered to this specific group of women. The matter should be further approached in sports.

Knowledge, attitudes and practice of primary healthcare physicians concerning the occupational risks of hepatitis B virus in Al Jouf Province, Saudi Arabia

BACKGROUND

Hepatitis B virus (HBV) infection is a well-recognized occupational risk for all healthcare workers (HCWs) worldwide.

AIM

This study aimed to assess the knowledge, attitudes, and practices of primary healthcare (PHC) physicians regarding the occupational risks of HBV.

METHOD

In this cross-sectional study, a questionnaire survey was administered to 145 physicians of primary care centers in the Al Jouf Province of Saudi Arabia. The questionnaire contained questions concerning the knowledge base, attitudes and practices of physicians regarding the occupational risks of HBV.

RESULT

The response rate of 82.8% yielded 120 questionnaires for analysis. The majority of physicians surveyed, 99 (82.5%), felt at high risk of contracting and spreading HBV. The vast majority, 115 (95.6%), considered the HBV vaccine safe for all ages. Of the total, 101 (84.2%) were vaccinated. Only 44 (36.7%) physicians recognized that HBV is resistant to alcohol and to some detergents. During surgical procedures, only a minority of the physicians always use double gloves and wear glasses. Almost all physicians were willing to subscribe to regular training programs concerning HBV.

CONCLUSIONS

A lack of knowledge was determined, and the practices of our physicians concerning the occupational risks of HBV appeared inappropriate. More education focusing on HBV is recommended.

Common sports-related infections: a review on clinical pictures, management and time to return to sports

There is a relationship between exercise and changes in immunity. So athletes are prone to different medical problems such as injuries and infections. Infection is an important medical problem which could be a reason for athletes’ absence from training. The relationship between physical activity and immune system, characteristics of different types of infections in athletes with emphasis on special clinical presentations or complications, time to return to physical activity and training and strategies to prevent development and transmission of infections in athletes or physically active people are the main topics of this review.

Prevalence of fungal skin infections in Iranian wrestlers

PURPOSE

Fungal infections are one of the most common skin infections. Athletes, especially in contact sports such as wrestlers are the group at risk of fungal skin infections (FSI). The aim of this study was to determine prevalence of FSI and some effective factors in wrestlers in Tehran, Iran.

METHODS

This study was a cross-sectional descriptive study which was conducted in 2009 and subjects were wrestlers of wrestling clubs of Tehran, Iran. In this study the prevalence of FSI and its related factors was collected based on clinical history, physical examination and laboratory tests. We also determined the rate of dermatophytic contamination of wrestling mats. The relationship between independent variables and incidence of fungal infection analyzed by Chi square test and regression analysis.

RESULTS

In this study, out of 454 wrestlers, 111 (24.5%) subjects had suspicious fungal skin lesions on physical examination. The Prevalence of FSI was 8.2% in all of the wrestlers (34.2% of the wrestlers with suspicious lesion). Malassezia furfur (50%) and trichophyton tonsurans (30%) were the most common causative agents. Epidermophyton floccosum (7.5%), Trichophyton rubrum (5%), Candida albicans (5%) and Trichophyton mentagrophytes (2.5%) were other isolated fungi. Eleven wrestling mats (44%) were contaminated with different fungal organisms.

CONCLUSION

The prevalence of fungal skin infection in Iranian wrestlers is relatively high. Appropriate preventive measures need to be prepared and implemented to reduce incidence of FSI in wrestlers.

Percentage of body fat and weight gain in participants in the tehran high school wrestling championship

PURPOSE

Weight loss in wrestling has been found to be an interesting issue for researchers. In this regard, complications of weight loss in wrestlers before the competitions and their weight gain in course of competitions have been debated in previous studies. The objective of this study was to investigate the extent of weight gain and to estimate the percentage of body fat in participants in the Tehran high school male wrestling championship.

METHODS

This study was a cross sectional survey. Subjects were participants of the Tehran high school male wrestling championship (n = 365). Weight gain in course of competitions and body fat levels (based on skin fold measurements) of subjects were measured.

RESULTS

Between the first weigh-in of the wrestlers which was done one day before the competitions and the second weigh-in which was conducted immediately before the first round of their first competition (20 hours), 69% of subjects gained on average 1.3±0.9 kg (range: 0.1 to 6.10 kg) or 2.2±1.7% of the wrestler's weight (range: 0.1 to 9.3). Among the subjects, the mean of fat body percentage was found to be 15.2%.

CONCLUSIONS

Rapid weight loss for matches was prevalent among subjects. It was also found that Iranian wrestlers have a relatively higher body fat percentage in comparison to American wrestlers. Therefore, it can be concluded that weight loss behavior of these wrestlers should be changed from using dehydration methods to using gradual methods of weight loss such as fat reduction methods.

HIV and employment

According to 2009 statistics, the human immunodeficiency virus (HIV) infected an estimated 86,500 individuals within the UK, although around one-quarter were unaware of their infection. In the majority of cases, it is now considered a long-term controllable but incurable infection. Indeed, most HIV-positive individuals are able to work. Employment is across most, if not all, workforce sectors and protection against workplace discrimination is provided by the Equality Act 2010. Issues including confidentiality, workplace adjustments, vaccinations and travel restrictions may be relevant to the occupational health of HIV-positive workers. There are special considerations concerning HIV-infected health care workers, including avoidance of performing exposure-prone procedures. Prevention of HIV acquisition in the workplace is relevant to a diverse range of occupational environments, and HIV post-exposure prophylaxis should be considered after potential HIV exposure incidents. If a worker contracts HIV by occupational means, financial help may be available.

Risk of hepatitis B and C infections in Tehranian wrestlers

CONTEXT

Although bloodborne infections are among the most important global health issues, limited data are available on bloodborne infections in athletes.

OBJECTIVE

To determine and compare the prevalence of markers of hepatitis B (HBV) and hepatitis C (HCV) viruses and the risk factors for these infections among wrestlers in Tehran and among a control group of athletes in the same geographic area who took part in low- to moderate-contact sports (ie, volleyball and soccer).

DESIGN

Case-control study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 420 male wrestlers were randomly selected from 28 wrestling clubs in Tehran using a cluster-sample-setting method. The control group (205 volleyball players from 21 clubs and 205 soccer players from 16 clubs) was selected from the same geographic area.

MAIN OUTCOME MEASURE(S)

The risk factors for HBV and HCV and serum levels of anti-HBcAg (antibodies to the HBV core antigen), HBsAg (HBV surface antigen), and anti-HCV (antibodies to HCV) in both groups.

RESULTS

The prevalence of anti-HBcAg was 13.4% (95% confidence interval [CI] = 10.2%, 16.7%) in wrestlers and 10.9% (95% CI = 7.9%, 14.0%) in the control group. The prevalence of HBsAg was 1.2% (95% CI = 0.2%, 2.2%) in wrestlers and 0.5% (95% CI = -0.2%, 1.2%) in the control group. The prevalence of anti-HCV was 0.5% (95% CI = -0.2%, 1.1%) in wrestlers and 0 in the control group. Some risk factors for bloodborne infections were more common in the wrestlers than in the control group.

CONCLUSIONS

Within the limits of our study, we found no evidence that participation in Tehranian wrestling increased HBV or HCV transmission when compared with transmission in athletes participating in low- to moderate-contact sports. Prevention of bloodborne infections in Tehranian wrestlers should be focused not only on appropriate care for bleeding injuries but also on general risk factors for these conditions.

Travelling to India for the Delhi XIX Commonwealth Games 2010

The 19th Commonwealth Games, conducted once in every four years since 1930, will be held in New Delhi from the 3rd through until the 14th of October, 2010. There will be approximately 17 sports on display and there will also be 15 para-sporting events. This paper focuses on health and safety issues for travellers to India in general, although it provides specific references to advice for visiting Commonwealth Games athletes and team staff, who will be travelling to the games. Whilst it needs be remembered that travel health advice can change, travellers are advised to seek up-to-date travel health advice for India, from their professional providers, closer to their departure.

[Seroprevalence study of hepatitis B among orienteers]

BACKGROUND AND OBJECTIVE

Our objectives were to detect asymptomatic cases involved in an outbreak of hepatitis B, to assess the seroprevalence of hepatitis B (HB) in orienteers and to establish recommendations.

PATIENTS AND METHOD

One hundred sixteen orienteers who had competed in the categories involved in the previous outbreak as well as a stratified random sample of 166 of the remaining orienteers in other competition categories were included in a cross-sectional serological prevalence study. HB surface antigen (anti-HBs); total antibody to HB core antigen (total anti-HBc); HB surface antigen (Ag HBs); and antibody IgM to HB core antigen (anti-HBcIgM) along with the history of vaccination for hepatitis B were analyzed. The results were weighted.

RESULTS

The seroprevalence of HB (total anti-HBc positive) was 6.7% (n=12, 95% CI 0.6-12.9). No case of acute HB or chronic infection was observed. All the serological markers were negative for 61.1% (n=64, 95% CI 46.3-75.6), and 31.5% (n=29, 95% CI 18.2-46.4) had markers of immunity due to vaccination. Among individuals under 25 years of age, 28.4% were unvaccinated, although they were covered by vaccination programs.

CONCLUSION

Our results suggest that the seroprevalence of HB among orienteers is not different from the general population in Spain. However, it is necessary to reinforce the vaccination among adolescents and young adults. General recommendations for the prevention of HB were made to orienteering federations.

The prevalence of hepatitis B, hepatitis C and HIV infections in non-IV drug opioid poisoned patients in Tehran-Iran

The present study intends to look into the prevalence of these infections in the non-IVdrug abusing addicts whom were treated at our center. A pilot study was conducted on 20 patients who were admitted in poisoning center of Loghman-Hakim Hospital in Tehran due to non-IV drug overdose. One positive HIV antibody and one positive HBS antigen cases were found in this group. The pilot study was later expanded to a descriptive cross-sectional study on 214 patients. In this study 196 patients (91.6%) were male and 18 (8.4%) were female. The average age of subjects was 37.9, having the highest frequency between 20 to 30-years-old. The study showed that 14.48% (F = 31) had positive HCV antibody and 1.86% (F = 4) had positive HBS antigen and 1.4% (F = 3) had positive HIV antibody in their blood serum. One hundred and forty three patients (66.8%), were poisoned through oral opium consumption, 24 patients (11.2%) through inhalation and 18 (8.4%) both oral and inhalation. The remain; were IV-abuser or the manner of poisoning was unknown. This study signifies the need for heightened attention and preventive measures against the infection of the health care professionals by hepatitis C (HCV) virus.

[Liver and sport]

The liver is a vital organ and plays a central role in energy exchange, protein synthesis as well as the elimination of waste products from the body. Acute and chronic injury may disturb a variety of liver functions to different degrees. Over the last three decades, the effects of physical activity and competitive sport on the liver have been described by various investigators. These include viral hepatitis and drug-induced liver disorders. Herein, we review acute and chronic liver diseases potentially caused by sport. Team physicians, trainers and others, responsible for the health of athletes, should be familiar with the risk factors, clinical features, and consequences of liver diseases that occur in sports.

[Immune response to hepatitis B vaccine in elite athletes]

INTRODUCTION

Hepatitis B viral infection can create serious health problems, such as acute and chronic hepatitis, cirrhosis of liver and hepatocellular carcinoma. Athletes have bigger risk of hepatitis B infection due to frequent injuries with bleeding, their style of living (promiscuity), close contact with teammates, etc. The aim of this study was to investigate the immune response to hepatitis B vaccine among elite athletes, compared to corresponding control group of male subjects front general non-athlete population, and to test out reaction in relation to age.

METHOD

There were 21 elite football players and 30 control non-athlete males. After written consent, they all received three doses of hepatitis B vaccine (Euvax B, Sanofi Pasteur) during 6 months. Eight weeks later, their immune response (as anti-HBs antibody titre in serum) was assessed and statistical significance of the findings was tested. The level of immune response was also evaluated in different age clusters within test groups.

RESULTS

None of the footballers was without response to the vaccine. One of the subjects from the control group did not develop it. The group of athletes was with better mean values of antibody titre (1626621 mIU/ml vs. 1568455 mIU/ml), but without statistical significance (t = 0.375: p > 0.05), and with a greater deal of subjects who developed very good immune response (titre over 2000 mIU/ml). Younger football players had better immune reaction than older (age 18-24, 1795560 mIU/ml, vs. age 25-29 years, 1597470 mIU/ml vs. age 30 and more, 1360904 mIU/ml), but without statistical importance (H = 1.593; p > 0.05).

CONCLUSION

Our study has shown that elite athletes respond very well to hepatitis B vaccination and have good immune response. Vaccination against hepatitis B of elite athletes is very important, because viral infection can seriously affect their health and stop their careers.

Prevention of infectious diseases in athletes

The sports medicine physician may face challenging issues regarding infectious diseases when dealing with teams or highly competitive athletes who have difficulties taking time off to recover. One must treat the individual sick athlete and take the necessary precautions to contain the spread of communicable disease to the surrounding team, staff, relatives, and other contacts. This article reviews preventive strategies for infectious disease in athletes, including immunization recommendations and prophylaxis guidelines, improvements in personal hygiene and prevention of spread of infectious organisms by direct contact, insect-borne disease precautions, and prevention of sexually transmitted diseases. A special emphasis on immunizations focuses on pertussis, influenza, and meningococcal prophylaxis.

Boxing: medical care in and out of the ring

Boxing may well be the oldest sport known to mankind and probably the most controversial. Injuries are common in boxing, occurring most often to the head, neck, face, and hands. Brain injury, both acute and chronic, is the major risk for potential catastrophe. Medical care for the boxer extends beyond the competition in the boxing ring; the ringside physician is responsible for protecting both boxers and must make quick decisions about their continued participation based upon a limited examination. A thorough knowledge of the rules and regulations of boxing is necessary for the ringside physician to effectively care for the athlete. In spite of the perceived brutality associated with the sport, most injuries are minor, although serious injuries and deaths do occur, most commonly due to brain injury. Given the potential for catastrophic injury, the ringside physician must be prepared and equipped to care for the boxer.

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.

Risk of exposure to hepatitis B and other blood-borne viruses among Australians who travel abroad

BACKGROUND

European studies indicate that up to 67% of travelers traveling abroad participate in activities that put them at risk of exposure to hepatitis B. Australians are increasingly traveling to destinations where hepatitis B is highly endemic, such as Asia, and are likely to have similar levels of involvement in activities with an associated risk of hepatitis B exposure.

METHOD

A series of annual telephone surveys of approximately 500 randomly selected Australian overseas travelers have been conducted under the auspice of the Travel Health Advisory Group over the years 2001 to 2003. The surveys examined the extent to which travelers seek pretravel health advice, what immunizations they receive and what risks they are exposed to during travel including the risk of hepatitis B and other blood-borne virus acquisition.

RESULTS

In the 2003 survey, 281 (56%) of the 503 people interviewed had visited at least one country with high or medium hepatitis B endemicity on their most recent overseas trip in the past two years. Approximately a third of travelers undertook one or more activities that were considered to be associated with increased risk of potential hepatitis B exposure. Less than half the travelers (46%) had been vaccinated against hepatitis B.

CONCLUSIONS

The results have implications for the individual traveler, as well as to the broader community. Infected travelers can be an important source of hepatitis B into their own home communities. Improved advice and clear recommendations for hepatitis B vaccination are needed to avoid infection.