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Bloodborne pathogens and sports

Author
Christopher McGrew, MD
Section Editor
Francis G O'Connor, MD, MPH, FACSM
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

The bloodborne pathogens of greatest concern for potential transmission during sporting competition include human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). The epidemiology of these pathogens in sport, prevention of bloodborne infection in sport, and the screening and management of such infections in athletes are reviewed below. The diagnosis and management of specific bloodborne infections are reviewed separately. (See "Management of nonoccupational exposures to HIV and hepatitis B and C in adults" and "Epidemiology, transmission, and prevention of hepatitis B virus infection" and "Epidemiology and transmission of hepatitis C virus infection".)

EPIDEMIOLOGY AND TRANSMISSION RISK

Overall risk — The transmission of bloodborne infections during sport is rare. Bloodborne pathogens of concern for potential transmission in sport include human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). All three may cause symptomatic or asymptomatic acute infections. Once contracted, HIV is a lifelong illness, but the disease can be well controlled with medication and proper medical care. Acute HBV and HCV infections may spontaneously clear, but a variable number of individuals go on to develop chronic infection and remain infectious to others. (See "Acute and early HIV infection: Clinical manifestations and diagnosis" and "The natural history and clinical features of HIV infection in adults and adolescents" and "Epidemiology, transmission, and prevention of hepatitis B virus infection" and "Hepatitis B virus: Overview of management" and "Epidemiology and transmission of hepatitis C virus infection" and "Overview of the management of chronic hepatitis C virus infection".)

There is a theoretical risk of bloodborne infections being transmitted during sports from the bleeding or exudative skin wounds of an infected athlete to other athletes via injured skin or mucous membranes. Although data is limited, the general consensus is that the likelihood of such transmission is extremely low [1-5]. Combative sports (eg, boxing, mixed martial arts) represent the highest theoretical risk, because of the higher rates of bleeding injuries and prolonged close-body contact [6]. Although not the equivalent of sanctioned combative sports, such as boxing and mixed martial arts, street fights entail a risk of HIV and HCV transmission, as documented in case reports [7-9]. HBV transmission has been documented in Japan in five members of a high school sumo wrestling club [10].

The prevalence of bloodborne pathogens among athletes has not been studied extensively. A 1995 study evaluated the prevalence of HBV infection among South Australian football (soccer) players and found no difference with a group of blood donors of the same age [11]. A 2008 study examined the prevalence of HCV among 208 former professional and amateur Brazilian football (soccer) and basketball players and reported an overall prevalence of 7.2 percent, with values of 11 percent among professionals and 5.5 percent among amateurs [12]. The study found a close correlation between the use of injectable stimulants and HCV infection rates. Athletes who did not inject such drugs had a prevalence of only 0.6 percent, suggesting that sport participation itself had little to do with the relatively high overall prevalence rates. A 2011 study involving 420 male wrestlers and 205 volleyball and soccer players found no evidence that participation in wrestling entailed higher rates of HBV or HCV transmission compared with low- to moderate-contact sports [13].

HIV transmission in sports — There are no well-documented, confirmed reports of HIV transmission during sport. The theoretical risk for transmission of HIV during National Football League (NFL) matches has been calculated to be less than 1 per 85 million game contacts [14]. This estimate was calculated using the following data: (a) estimated prevalence of HIV among athletes; (b) risk of percutaneous HIV transmission in health care; and (c) risk of a bleeding injury in American football. However, this calculation may overestimate the risk because it involves extrapolation from reports of needlestick injuries, which are likely to pose a much greater risk than sport-related skin injuries [15]. Although not the equivalent of sanctioned combative sports such as boxing and mixed martial arts, street fights entail a risk of HIV transmission, as documented in case reports [7,8]. Of note, transmission risk is lower if the HIV-infected athlete is being treated. (See "HIV infection: Risk factors and prevention strategies".)

           

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