The Associated Press - Sunday, December 12, 1999
Ira Dreyfuss, Associated Press Writer

Just the same, the physicians' group advises players and sports officials to be extra careful about the possibility of a transmitted infection.

"The potential is out there," said Dr. Steven Anderson of Seattle, who chairs the AAP's committee on sports medicine and fitness. "We feel the potential warrants this."

The AAP's latest position statement appears in the December issue of its journal, Pediatrics. The update of the 1991 policy statement adds two forms of hepatitis -- B and C -- to the watch list.

There is only scant evidence that these diseases can be through sports. And the recommendations are not a response to an emerging problem, the statement conceded. The authors simply believed it would be wise to have some precautions in place, Anderson said.

"I don't think anybody will feel comfortable relaxing the standards and having the responsibility for something that might have been preventable actually occurring," Anderson said.

"Athletic programs should inform athletes and parents that athletes have a very small but finite risk of contracting a blood-borne infection from another athlete," the statement said.

On the AIDS virus, "transmission of HIV in sports has not been documented," the article said.

Hepatitis B is considered more than 100 times more contagious than HIV, and there are a handful of known cases in which the liver infection was transmitted.

One high school sumo wrestler who had shown no symptoms transmitted his infection to team members, the report said. And some members of a Swedish orienteering team contracted the disease, apparently from shared water used to clean wounds caused by branches and thorns, it said.

The article had no reports of athlete-to-athlete transmission of hepatitis C. It said the transmission risk for the population in general is 10 times greater than that of HIV but lower than that of hepatitis B.

Because the risk is so low, athletes with these conditions can still play, and doctors should keep their knowledge of the athlete's disease confidential, the recommendations said.

But the staff of athletic programs should be able to head off the possibility of transmission if blood is spilled, it said. This would include taking players with active bleeding out of competition, disinfecting any equipment or playing surface that came in contact with blood and training support staffers in how to handle materials with blood on them.

The recommendations also call for players and coaches to get the multiple-shot vaccine for hepatitis B, the only one of the three diseases for which there is a vaccine approved by the Food and Drug Administration.

However, Barbara Loe Fisher, cofounder and president of the Virginia-based National Vaccine Information Center, was wary of that recommendation, because a small number might have an adverse reaction to the vaccine. "We need to pay attention to the individual and not adopt a one-size-fits-all approach," she said.

The National Federation of State High School Associations also lists procedures to minimize the risk of athlete-to-athlete transmission of blood-borne diseases. Jerry Diehl, the athletic organization's assistant director, said the doctors' recommendations fit well with his group's ideas.

The American College of Sports Medicine does not have such recommendations. ACSM officials have considered such a policy but opted not to state one, spokeswoman Gail Hunt said.

The group's immediate past president, cardiologist Paul Thompson of Hartford Hospital in Connecticut, didn't see much need.

"We thought it was pretty obvious that everybody should use precautions against blood exposure," Thompson said. "And I think we thought the risk was extremely low."
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