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Risk of Transmission of Blood Borne Infections in Climbing - Consensus Statement of UIAA Medcom
Abstract
Blood borne infections such as hepatitis B, C (HBV, HBC) and human immunodeficiency disease (HIV) are major health problems globally. As the number of blood borne infections is postulated to increase among athletes, the question to the UIAA Medical Commission arises as to whether there is a risk of transmission in climbing. Using a nominal group consensus model approach a working group was formed during the UIAA Medical Commission's meeting in Adršpach-Zdoóov, in the Czech Republic, 2008. A working document was prepared and circulated via email. After several revisions the following final form was approved by written consent in lieu of a live meeting of the UIAA MedCom on 31st May, 2010: The main pathways of transmission of blood borne infections in athletes are similar to those experienced in the general population. The greatest risk to the athlete for contracting any blood borne pathogen infection is through sexual activity and parenteral drug use, and not in the sporting arena. The transmission risk in climbing is even smaller compared to contact sports. Mandatory HIV, HBV or HCV testing or widespread screening is not recommended, voluntary testing is recommended for all high risk athletes in the same way as for non-athletes. HIV and HBV positive climbers should not be banned from climbing or climbing competitions. The risk of transmission from infected athletes to other athletes is very low, the focus should be on preventive activities and education.
... One athlete had never been vaccinated at all because the family was firmly set against vaccinations. While this did not result in any illness or transferring illnesses to other athletes it still raises the debate whether vaccinations should be mandatory for high level athletes competing in Olympic sports [11]. Certain vaccinations such as Hepatitis B are recommended internationally in all athletes [11] and should be present in all athletes. ...
... While this did not result in any illness or transferring illnesses to other athletes it still raises the debate whether vaccinations should be mandatory for high level athletes competing in Olympic sports [11]. Certain vaccinations such as Hepatitis B are recommended internationally in all athletes [11] and should be present in all athletes. For a thorough history the HEADSS (Home, Education, Activities, Depression, Drugs, Suicide, and Sex) mnemonic can be used in order to assess the patients psychological status. ...
Objective This article presents the results of the yearly medical examination performed on all our national climbing athletes in 2016 and 2017.
Methods Our yearly athlete examination follows the Olympic guidelines and those of the Medical Commission of the International Federation of Sport Climbing. It consists of echocardiography, spiroergometry, a general blood examination, body fat measurement as well as a paediatric and orthopaedic clinical examination. In addition, a yearly ultrasound examination is performed on the fingers to detect pathologies and measure the width of the growth plates. The years 2016/2017 were evaluated.
Results Team examinations were undertaken in 17 girls and 23 boys. The mean age was 17.5 years (18.3 years for the boys and 17.4 years for the girls). They had been climbing for 10.9 years on average (the boys for 11.3 and the girls for 10.3 years). Typical findings were susceptibility to infection, musculoskeletal injuries and, in one case, severe headaches. 36 % of our athletes had to take a break from climbing due to injury or illness. Most of these breaks were due to infections (7 in total), most of them minor inspiratory or gastrointestinal. One athlete suffered from severe pneumonia during a World Cup in Japan. The other pauses were due to finger injuries (2), foot injuries (2), and injuries to the shoulder and biceps (2).
Conclusion The yearly team examination plays an important role in early injury detection. It helps to establish a relationship based on trust, encouraging athletes to approach the team physician openly with questions or concerns.
... Waiver.pdf). Common risk factors for many types of viral, bacterial, and fungal infections include direct and indirect personal contact, swimming in water containing microbial, animal, human, or chemical contaminants, skin abrasions and lacerations, and food and beverage contamination (8,53,67,76,86,112), all of which may exist at obstacle course events. Individuals should therefore strive to minimize risks, by taking the following precautions: ensure an updated immunization status, minimize person-to-person contact, cover all existing wounds with occlusive dressings, promptly clean any wounds incurred during the event, avoid ingesting food and water handled carelessly in crowded areas, and maintain as high a level of personal hygiene as possible (e.g., avoid remaining in dirty clothing for extended periods, avoid walking barefoot on unsanitary grounds, etc.) (8,53,67,76). ...
The purpose of this article is to provide background information on the historical use of obstacle courses for physical conditioning, and to subsequently address the following questions regarding modern obstacle course challenges: 1. What makes obstacle course challenges so popular? 2. What traits and abilities characterize top performers? 3. What should effective training entail? 4. What characterizes well-designed obstacle courses? The primary objectives are to comprehensively review the literature relevant to obstacle course training and competition, and to integrate the established exercise-related science with practical information to help others prepare for the obstacle course challenges.
... While the surface allows for better grip, it can also lead to tears in the skin. Such abrasions may allow an entry point for pathogens [51] or may make the transfer of blood borne pathogens a possible, albeit unlikely, concern [50]. Outbreaks of communityacquired bacterial infections have been previously associated with athletes and equipment used in athletic facilities [2,6,[10][11][12]42]. Possible vectors of transmission in these cases include skin-to-skin contact, abrasions/skin damage, respiratory pathways, sharing of equipment such as hygiene products and clothing, and contact with surfaces such as mats, pads, weights, and exercise equipment [12]. ...
Artificial climbing walls represent a unique indoor environment in which humans interact closely with a variety of surface types. Climbing wall holds may mediate transmission of organisms between individuals, and yet there are no studies that identify microorganisms present on these surfaces. In the current study, the microorganisms found on climbing wall holds were characterized by analysis of amplified SSU rRNA gene sequences. In contrast to many other studies of built environments, the majority of microorganisms on holds were most closely related to microbes annotated as being recovered from environmental sources, such as soil, with human skin also representing an important source. Regional patterns were evident as rRNA gene sequences from the marine cyanobacterium Prochlorococcus were abundant in gyms found within 16 km of the ocean. Enterobacteriaceae were present on 100 % of holds surveyed, and the members detected are commonly associated with fecal matter.
Conducting yearly team examinations and serving as a medical officer at climbing competitions are central elements in taking care of competitive climbers. The team examination plays an important role in early injury detection and is an opportunity to establish a trusting relationship so that the athletes approach the team physician openly with questions or concerns. It is based on the recommendations of the national Olympic Committees and the Medical Commission of the IFSC, which recommend performing a sports-medical and an orthopedic exam, a resting ECG, a spiroergometry with stress ECG, a cardiac echography, a laboratory analysis, and body fat measurement. In climbers, we also always perform an ultrasound examination of the hand and fingers. During climbing competitions, the most frequent treatments are the care of acute traumata need and many superficial skin bleeds. Nevertheless, the occasional internal medical condition also occurs. A central part in being an effective medical supervisor in competitions is organization and coordination of the whole medical team and the communication with athletes, judges, and other officials—it is always teamwork. To achieve this, specific insight into climbing medicine is essential.KeywordsSpiroergometryCardiac echographyCompetitionAnti-dopingTeam examination
Der Kaderuntersuchung und der Wettkampfbetreuung kommt bei der sportmedizinischen Kaderbetreuung zentrale Stellung zu. Die Kaderuntersuchungen erfolgen auf nationalem und Landesniveau auf der Basis der Empfehlungen des Deutschen Olympischen Sportbunds (DOSB) und beinhalten neben der allgemeinmedizinischen und orthopädischen Untersuchung die Spiroergometrie mit Belastungs-EKG, ein Ruhe-EKG, eine kardiale Echokardiographie sowie eine Labor- und Körperfettuntersuchung. Zusätzlich erfolgt immer eine sonographische Untersuchung der Hände und Finger. Im Rahmen der aktiven Betreuung von Kletterwettkämpfen werden vor allem akute Traumata versorgt, aber auch internistische Probleme gesehen. Zentrale Inhalte einer effektiven Wettkampfbetreuung sind immer Teamarbeit, Planung, Koordination der Einsatzkräfte und fachliches Know-how.
Background: Sport has the capability to unite a country. To achieve winning teams, athletes have to rely on each other and often have close physical contact. Disclosure of a positive human immunodeficiency virus (HIV) status may be problematic for athletes in contact sports as they may suffer discrimination and stigmatisation which may impact their relationship behaviours. This may impact frontline nursing and medical staff dealing with on-field ‘blood’ injuries.
Objectives: The purpose of this study was to determine if individuals who participate in football and rugby are aware of the risk of HIV infection in contact sports and their perceptions and reported behaviour towards HIV-positive athletes.
Method: A cross-sectional survey design with a qualitative element. Quantitative data were analysed using descriptive statistics, while thematic content analysis was used to analyse qualitative data.
Non-proportional quota sampling was used for male rugby (n = 23) and football (30) players registered at the University of Limpopo (Turfloop campus).
Results: The results supported previous research in that there are gaps in HIV knowledge. For instance, not knowing that anal sex may cause HIV infection and believing that saliva can transmit HIV and that blood transfusions are unsafe.
Conclusion: Problematic findings were that a portion of the sample believed that having sex with a virgin could cure HIV and the majority of the sample believed that being ‘bewitched’ could cause HIV and acquired immunodeficiency syndrome (AIDS).
Consensus methods are being used increasingly to solve problems in medicine and health. Their main purpose is to define levels of agreement on controversial subjects. Advocates suggest that, when properly employed, consensus strategies can create structured environments in which experts are given the best available information, allowing their solutions to problems to be more justifiable and credible than otherwise. This paper surveys the characteristics of several major methods (Delphi, Nominal Group, and models developed by the National Institutes of Health and Glaser) and provides guidelines for those who want to use the techniques. Among the concerns these guidelines address are selecting problems, choosing members for consensus panels, specifying acceptable levels of agreement, properly using empirical data, obtaining professional and political support, and disseminating results.
Athletes are at risk of blood borne infections through bleeding injuries or injection of drugs with contaminated syringes. Prevention should focus on reducing non-sport associated risky behaviour, as well as dealing appropriately with bleeding injuries. The risk of transmission of hepatitis B virus is particularly high in athletes in contact and collision sports, those who live in or travel to endemic regions, injecting drug abusers, and those who practice first aid when there is no healthcare practitioner available. It is recommended that such athletes, and also adolescent athletes, should be vaccinated against the virus as a routine.
More than 500 million people worldwide are persistently infected with the hepatitis B virus (HBV) and/or hepatitis C virus (HCV) and are at risk of developing chronic liver disease, cirrhosis and hepatocellular carcinoma. Despite many common features in the pathogenesis of HBV- and HCV-related liver disease, these viruses markedly differ in their virological properties and in their immune escape and survival strategies. This review assesses recent advances in our understanding of viral hepatitis, contrasts mechanisms of virus-host interaction in acute hepatitis B and hepatitis C, and outlines areas for future studies.
To determine the risk for bleeding injuries in professional football and to estimate the risk for transmission of the human immunodeficiency virus (HIV) through such injuries.
A prospective, observational study.
Professional football players from 11 teams of the National Football League were observed during 155 regular season games from September through December 1992.
The frequencies of bleeding injuries were calculated in association with environmental and athletic factors. Using this information, HIV prevalence, and data on transmission of HIV in other circumstances, the risk for transmission of HIV during football games was estimated.
575 bleeding injuries (average, 3.7 per game for each team) involving 538 players (average, 3.5 players on each team per game) were observed. Approximately 88% of the bleeding injuries were abrasions; the remainder were lacerations. Bleeding injuries were markedly more frequent during games played on artificial surfaces, during games played in domed stadiums, and on teams with a final win/loss percentage of 0.500 or lower. Using data on the prevalence of HIV among college men and rates of HIV transmission in the health care setting, the risk for HIV transmission to each player was estimated to be less than 1 per 85 million game contacts.
Although injuries occur in professional football competitions, bleeding injuries, especially lacerations, occur infrequently. We estimate that the risk for HIV transmission during such competition is extremely remote. The role of artificial playing surfaces on the incidence or severity of bleeding injuries should be investigated.
he human immunodeficiency virus (HIV) and competitive athletics have had an uneasy association. Much of the debate about whether HIV-infected athletes should be permitted to compete has been shrouded in myth. The medical community, athletic administrators, and the courts have debated whether competitive athletics places both HIV-infected and noninfected participants in significant danger, yet both the public and those directly involved in the administration of competitive sports often appear uncertain of both the actual risk of transmission of HIV infection in the athletic setting and the risk of exercise for immunocompromised individuals. The public is acquainted intimately with HIV-positive athletes who have continued to compete while infected with the virus. On November 7, 1991, when Earvin “Magic” Johnson announced that he had tested positive for HIV antibodies, increased HIV awareness and an indelible linking of HIV and athletes ensued. The HIV infection of diver Greg Louganis, retired tennis player Arthur Ashe, and more than 30 male ice skaters has provided public verification of the reality that HIV-infected athletes compete at the high school, intercollegiate, professional, and amateur international level. Recently, boxer Tommy Morrison’s infection and return to the ring has placed another prominent athlete on the front pages of newspapers throughout the country. This article will address current knowledge concerning HIV infection and competitive sports, including the prevalence of HIV among athletes, the risk of infection during competition, the effect of exercise in HIV-infected individuals, and suggested guidelines for athletes, coaches, and health personnel.
A variety of infectious diseases can be transmitted during competitive sports. Modes of transmission in athletic settings include person-to-person contact, common-source exposures and airborne/droplet spread. This paper reviews the most commonly reported infectious diseases among athletes and discusses the potential for transmission of bloodborne diseases in sports. Guidelines are provided regarding measures to prevent transmission of infectious diseases in athletic settings, including hygiene and infection control practices, vaccination, and education of officials, coaches, trainers and sports participants.
Great concern is often expressed over the possibility of contagion among athletes in competitive sports, particularly sports with much person-to-person contact. Human immunodeficiency virus (HIV) is only the most notorious of infectious agents; potentially, other viruses, bacteria, and even fungi may be involved. Because of the concern, however, special attention is paid to HIV and hepatitis B infections. For most of the infections considered, the athlete is more at risk during activities off the playing field than while competing. Inclusion of immunizations against measles and hepatitis B among prematriculation immunization requirements (PIRs) for colleges and universities would eliminate these two diseases from the list of dangers to college athletes and all students. Education, rather than regulations, should remain the cornerstone in considering the risks to athletes from contagious diseases.
Worldwide, hepatitis B virus (HBV) accounts for an estimated 370 million chronic infections, hepatitis C virus (HCV) for an estimated 130 million, and HIV for an estimated 40 million. In HIV-infected persons, an estimated 2-4 million have chronic HBV co-infection and 4-5 million have HCV co-infection. HBV, HCV and HIV share common routes of transmission, but they differ in their prevalence by geographic region and the efficiency by which certain types of exposures transmit them. Among HIV-positive persons studied from Western Europe and the USA, chronic HBV infection has been found in 6-14% overall, including 4-6% of heterosexuals, 9-17% of men who have sex with men (MSM), and 7-10% of injection drug users. HCV infection has been found in 25-30% of HIV-positive persons overall; 72-95% of injection drug users, 1-12% of MSM and 9-27% of heterosexuals. The characteristics of HIV infected persons differ according to the co-infecting hepatitis virus, their epidemiologic patterns may change over time, and surveillance systems are needed to monitor their infection patterns in order to ensure that prevention measures are targeted appropriately.
To evaluate the injury risk associated with indoor rock climbing competition.
All injuries reported to medical personnel at the 2005 World Championships in Rock Climbing were recorded and analyzed.
Four hundred forty-three climbers (273 men, 170 women) from 55 countries participated in 3 separate disciplines totaling 520 climbing days. Only 4 of 18 acute medical problems that were treated were significant injuries, resulting in an injury rate of 3.1 per 1000 hours.
Indoor rock climbing competition has a low injury risk and a very good safety profile.
HIV/AIDS is considered a worldwide pandemic, with continued increases in the number of newly diagnosed cases and persons living long-term with the disease. Athletes may be at risk of infection based on behaviors associated with participation in their sport and away from competition. The sports medicine physician must be aware of the risk of HIV/AIDS in the athlete, diagnosis and treatment options, the effect of HIV/AIDS on exercise, and strategies for prevention of HIV/AIDS in athletic competition.
Bleeding facial injuries are not uncommon in competitive karate. Nevertheless, the risk of an infection with HIV is extremely low. Guidelines about the prevention of HIV infections are presented. Especially in contact sports and martial arts the athletes, judges and staff have to recognize and employ these recommendations. Bleeding wounds of the hands due to contact with the opponents teeth can be minimized by fist padding.
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