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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

Organized Sports and the Threat of Infectious Diseases

Whether it was Little League, college-level soccer, or another sport, chances are we have all participated in organized sports at one point or another. There are, of course, perks of partaking in such activities, such as health benefits, socialization with our peers, the fun of friendly competition, etc. Unfortunately, the close contact and common sharing of equipment and surfaces that goes along with participating in these activities ultimately carry inherent risks for infectious diseases. To this end, the authors of a new study took a deep dive into the realm of organized sports across North America and highlighted the common diseases that are likely to be transmitted when participating in these activities as well as which sporting events tended to carry a greater risk.

The investigators evaluated traditional team sports (such as football, soccer, basketball, wrestling, etc) and other organized sports (boxing, figure skating, martial arts, dance, etc). Based on the results of their investigation, the authors stressed that two of the biggest lessons they learned from their research was: (1) emphasis should be placed on teaching athletes proper personal hygiene; and (2) standard precautions should be used for the management of blood and other body fluids emitted during these activities, including treating all blood and other potentially infectious material as containing a blood-borne pathogen, such as HIV.

Not surprisingly, the investigators found that certain sports inherently carried with them more potential for disease transmission than others. They broke out this potential by mode of transmission and which organisms were commonly associated with organized sporting activities. Although the investigators did not address the exact organisms associated with each sport, knowing the mode of transmission can help to predict which sports would put an individual at greater risk of contracting that organism. For example, because those who participate in wrestling would have more skin-to-skin contact, they are at greater risk of infections with pathogens that spread via that mode of transmission.

The authors write, “infectious pathogens include those spread by skin contact (eg, Staphylococcus aureus, group A streptococcal skin infections, Bacillus cereus, herpes simplex virus [HSV], Tinea capitisTinea corporisTinea pedisTinea crurisPediculosis capitisPediculosis corporis, and Pediculosis pubis), by contaminated food or water (eg, Shiga-toxin producing Escherichia coliShigella species, Giardia species, Cryptosporidium species, and norovirus, which is further propagated by the person-to-person route), by respiratory droplet (eg, influenza, pertussis, Neisseria meningitidis, group A streptococcal pharyngitis, mumps), by airborne particles (eg, varicella, measles), or by certain vectors (eg, ticks).” Many sports present the possibility of an individual becoming infected with multiple pathogens.

Within the article, the investigators evaluated each organism and provided outbreak control measures. Although there is an inherent risk with sporting events, certain sports carried with them more risk for communicable diseases. Those sports that require close contact and frequent physical contact, such as wrestling, increase the risk for skin infections. Physical contact and sharing of equipment or frequent contact with athletic surfaces (mats, gym equipment, etc) are also mechanisms for disease transmission.

Before you think of banning your child from participating in all organized sports, the investigators acknowledged that it’s unrealistic to avoid many of these pathogens if a person is to participate in such sports. This is why the investigators emphasized standard precautions and attention to personal hygiene. 

Although this research focuses on organized sports as a risk factor for disease transmission among children, the same concerns apply to adults. In truth, exposure can come from anywhere, as was seen during the 2016 Summer Olympics in Brazil, which highlighted concerns about environmental exposure during water events and even vector-borne diseases like Zika virus. More recently, 30 adult athletes were hit with norovirus at a world athletics championship in London.

In short, although there is an intrinsic risk of disease transmission during close-contact sporting events, there are several prevention and control mechanisms that can minimize this risk. Regardless of age or what sport is being played, we can all benefit from stronger attention to personal hygiene and infection control measures.  
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