Be Blood Aware !

Protect yourself in sport and play...
Be Blood Aware!
• INFECTIONS
• TRANSMISSION
• PREVENTION
• RISK
• DISCRIMINATION
Information about infectious diseases in sport
INFORMA
for players, coaches, trainers, first aid
personnel, officials and club administrators.
TION
BOOKLET

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Acknowledgments
This booklet is part of an education resource kit developed for the Australian National
Council on AIDS, Hepatitis C and Related Diseases, by the Australian Institute for
Primary Care and with the guidance of an Advisory Committee. Thank you to the
committee members:
Kay Copeland
Sports Medicine Australian (Victoria)
Dr. Brendon De Morton
Australian Football League
Peter Gourlay
Equal Opportunity Commission Victoria
Kenneth Hancock & Terry O’Meara
Australian Sports Trainers Association
Diana Readshaw, Paul Halton & Kate Jarvis
Commonwealth Department of Health
and Aged Care
Phil Stevens
Victorian Amateur Football Association
Shaun Wendt
National Rugby League
The Project Team
Russell Renhard
Mark Waters
Kristan Baker
Bronwyn Upston
Contributing Writers
Beth Crisp
Judith Jones
Bronwyn Upston
Editor
Bronwyn Upston
Web research
Infolyte
Design
Keith Downes Design
Printers
The Cleveland Printing Company Pty. Ltd.
Produced by
Australian Institute for Primary Care
Level 5 Health Sciences Building 2
La Trobe University, Bundoora, Victoria, 3083
Telephone: 03 9479 3700
Email: aipc@latrobe.edu.au
Disclaimer
Medicine is an ever-changing science. New research and clinical experience lead to new
knowledge and changes in treatment and prevention strategies. The writers, editors and
publishers of this work have checked with sources believed to be reliable in their efforts
to provide information that is complete and generally in accord with the standards
accepted at the time of publication. However, in view of the possibility of human error or
changes in medical sciences, the writers, editors, nor the publisher warrant that the
information contained herein is in every respect accurate or complete. Readers are
encouraged to confirm the information contained herein with other sources.
© Commonwealth of Australia, 2000.
ISBN 0 64 273546 8 PAN 2850

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CONTENTS
Introduction........................................................................................2
Infections and how They’re Transmitted ..........................................5
Prevention on the Field......................................................................9
Discrimination and Exclusion of Players ........................................11
Risk of Infection Through Sport ......................................................13
Prevention off the Field ...................................................................15
Becoming a “Blood Aware” Club ....................................................17
Maintain a Clean Environment ........................................................19
Fact Sheets.......................................................................................22
Where to Go for Further Information...............................................25
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INTRODUCTION
Why do I need to be Blood Aware?
Although we usually think of sport as healthy activity, people have become much more
aware and concerned about the transmission of diseases through participation in sport.
A number of blood-borne viruses have the potential to be transmitted during sporting
contact. The more serious ones, HIV, hepatitis B and hepatitis C, can greatly affect
your health. Even the more common infectious diseases such as colds and the flu may
be spread during the close contact of sport and while not usually as serious, these
illnesses will reduce your competitiveness and enjoyment of the game.
“It doesn’t matter if you are an elite athlete or if its the local footy game just down the
street, you’ll have to know how to deal with the Blood Rule because you never know what
viruses people have.”
Dr. Ron McCoy
HIV & Hepatitis Specialist
Blood Rules, OK Video
Individuals and sporting clubs have the responsibility of playing their part in preventing the
spread of infection through participation in sport. Players, officials, coaches, sports trainers
and first aiders can be blood aware by following some simple guidelines and encouraging
each other to do likewise. Clubs can be blood aware by adopting an infectious disease
policy, providing information such as the pamphlet in the Blood Rules, OK kit to players,
and maintaining a safe and clean environment for players and spectators alike.
In the light of HIV and other blood-borne viruses, attitudes to blood on the field or court
have changed considerably in the past ten to twenty years. This booklet has been
written to help people understand blood-borne viruses and other infectious diseases,
how they are transmitted and what actions can be taken to prevent their spread
through participation in sport.
We’re not a contact sport!
Most people associate ‘blood rules’ with contact sports where the risk of collision and
injury, and therefore blood spills, are greatest. However, all sports from time to time
involve injury, and the playing field is only one area in which the risk of infection needs
to be reduced.
“It’s not the sport, it’s the blood we should be concerned about.”
Dr. Ron McCoy
HIV & Hepatitis Specialist
Blood Rules, OK Video
The social aspect of people’s involvement in a sporting club may also expose them to
infectious diseases that can be passed on through sexual activity and injecting drug use.
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We don’t attract people like that!
With the number of people who attend on match days - players, officials and spectators -
or other events run by your club, it’s possible that someone has a blood-borne virus.
With some blood-borne viruses, a person with the virus may show few, if any, signs of
infection for many years. Indeed, many people don’t even know they have the sorts of
viruses we’re going to discuss in this booklet.
However, not knowing doesn’t mean that the virus can’t be transmitted. The best way
to deal with the risks involved is to simply adopt preventative measures many of which
are described later in this booklet.
We only have juniors!
Sure, some blood-borne viruses are more common in adults than children, but that
doesn’t make it impossible for children to be infected. Babies and children who are
infected with hepatitis B, for example, can have the virus and show no symptoms.
We only have older players!
It’s true that some sports mostly attract older adults, but being older is no guarantee of
being free of the risk of infection.
How do I use this booklet?
You can use this book on its own or as an extra source of information when presenting or
watching the video “Blood Rules, OK”. The booklet follows a similar format to the video.
If you are responsible for presenting the video to others, you may like to pause the video at
key points (times from beginning of opening scene are given) and discuss these with the
group referring to the relevant chapters, one to five in the booklet. Information about how
to obtain a copy of the video is contained on page 26 of this booklet.
There are eight chapters in this booklet…
Chapter 1 [1min:44sec]
Infections and How They’re Transmitted, describes the most significant infectious
diseases, blood-borne viruses, and how they are transmitted from person to person.
Other infectious diseases that can be transmitted through close personal contact
including sexual contact are briefly listed, with full descriptions contained in the Fact
Sheets in Chapter 7.
Chapter 2 [5min:22sec]
Prevention on the Field outlines the ways in which people can best prevent the
spread of blood-borne viruses and other infections on the playing field and in club
facilities.
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Chapter 3 [11min:48sec]
Discrimination and Exclusion of Players gives information to assist sporting clubs
and associations an understanding of their rights and responsibilities in the event of it
becoming known that a player or member is infected with a blood-borne virus. It also
describes the rights of people who have a blood-borne virus in the context of their
participation in sport.
Chapter 4 [14min:37sec & 20min:40sec]
Risk of Infection Through Sport provides information about the risk of infection by a
blood-borne virus through participation in sport.
Chapter 5 [17min:30sec]
Prevention off the Field describes the steps people can take to reduce the risk of
transmission of blood-borne viruses through sexual activity and use of injecting
equipment. While these behaviours do not necessarily occur within the sporting
context, they present the greatest risk of infection through the social side of your club
or association.
Chapter 6
Becoming a “Blood Aware” Club has been written to encourage and guide sporting
organisations to adopt policies and practices which protect the health of all
participants.
Chapter 7
Fact Sheets provides more detailed information about the infectious diseases mentioned
only briefly in the first chapter of the booklet. If you are worried about your health we
strongly recommend you contact your doctor or local community health centre.
Chapter 8
Where to Go for Further Information lists some useful sources of information if you
want to find out more about a particular topic, if you have concerns which you would
like to discuss confidentially, or where to obtain copies of the educational resource kit
Blood Rules, OK.
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INFECTIONS AND HOW THEY’RE TRANSMITTED
Blood-Borne Viruses
Viruses, like other microscopic organisms, live in, on and around us all the time. When
they (a) exist in sufficient quantities, (b) are able to spread from someone or something
(like food or animals) and (c) enter your body, they can cause disease. When our
bodies are under stress, for example during periods of intensive training for
competition, we are more susceptible to illness caused by these tiny germs.
Blood-borne viruses are those which are transmitted from one person’s blood to
another person’s blood stream.
Hepatitis
Hepatitis means inflammation of the liver. The liver is responsible for filtering the blood
and breaking down food and poisons in the body. Viral hepatitis (often simply called
hepatitis) refers to a number of different viruses which affect the liver and can
potentially cause fever, vomiting, jaundice (where the eyes and skin go yellow) or
sometimes permanent liver damage, even cancer. Sometimes people with hepatitis
have no obvious symptoms but may still be able to infect others. The most significant
types of hepatitis are A, B & C and these are described below.
Several new types of hepatitis have been discovered in recent years (hepatitis D, E, &
G), and it is possible that more strains will be identified in the future. Other forms of
hepatitis (non-viral) can be caused by alcohol or drug abuse (including steroids).
Hepatitis A
Hepatitis A is passed on through contaminated food or water, or through oral contact
indirectly with infected faeces (poo). This is why it’s important to always wash your
hands after going to the toilet and immediately prior to handling food.
In older children and adults the symptoms include fever, nausea, abdominal discomfort,
dark urine, and yellow skin and eyes (called jaundice). Many people with hepatitis A
show few or no symptoms, particularly children less than three years old.
Hepatitis A is not a chronic (prolonged) infection and people who’ve had hepatitis A
cannot be reinfected. An effective vaccine is available.
Recommended fact sheets
http://www.health.gov.au/hfs/pubhth/strateg/hiv_hepc/hepc/index.htm
http://www.hepatitisaustralia.com
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Hepatitis B
Hepatitis B is highly infectious - about 100 times more infectious than HIV. In Australia,
most hepatitis B infections occur in adolescents and young adults. It is transmitted via
body fluids (blood, semen, vaginal fluid, saliva or breast milk) from one person into
another. Hepatitis B can be passed on during vaginal or anal sex, through sharing
injecting equipment or body piercing and tattooing with improperly cleaned and
sterilised equipment. Even sharing toothbrushes, razors, nail files, nail scissors or other
personal equipment where small traces of blood may be present can be risky.
Symptoms of hepatitis B include loss of appetite, nausea, vomiting, pain in the
abdomen and/or joints, fever and jaundice. Normally these symptoms disappear in a
few weeks.
Some people who are infected with hepatitis B do not get ill and some show no
symptoms at all. A small number, about 10% who look and feel well, will still be able
to transmit the virus to others. Babies and children with hepatitis B are more likely than
adults to be able to do this. An effective vaccine is available.
There have been a number of reported cases of hepatitis B being spread through
sporting activities. These were mainly due to poor infection control measures in the
past when the risks of infection through blood contact were not widely known. An
increasing number of sports are encouraging players, coaches, officials, trainers, and
first-aiders to be vaccinated against hepatitis B.
Hepatitis C
Hepatitis C is a blood-borne virus and is the most commonly reported notifiable
infectious disease in Australia, with an estimated one in a hundred people infected.
(Notifiable diseases are those that doctors must report to State or Territory Health
Departments). In Australia, hepatitis C is most commonly transmitted through the
sharing of contaminated needles, syringes and other injecting equipment by people
who inject drugs.
Hepatitis C can also be spread by using body piercing and tattooing equipment which
has not been properly cleaned and sterilised, as well as by sharing toothbrushes,
razors, nail files, nail scissors or other personal equipment where small traces of blood
may be present. Sexual transmission of hepatitis C is unlikely.
People with hepatitis C may initially show only mild, flu-like symptoms, or no
symptoms at all. Symptoms that do appear include dark urine, signs of jaundice,
nausea and tiredness.
Once infected with hepatitis C, over 70% of people will not clear the virus from their
bodies, and as a result may be capable of transmitting the virus to others. No vaccine
is available.
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Human Immunodeficiency Virus (HIV)
Human immunodeficiency virus (HIV) is the blood-borne virus that can lead to AIDS
(Acquired Immune Deficiency Syndrome). HIV can be passed on through anal or vaginal
sex without a condom, through sharing equipment used for injecting drugs, from an
infected mother to her baby during pregnancy, birth or breast feeding, and much less
commonly, through oral sex where a person has cuts or sores in their mouth.
Some years after an HIV infection, a person’s immune system can become so weak
that it can no longer fight off infections, and this is when the person is said to have
developed AIDS. A person with HIV gradually loses immune function along with certain
immune cells, called CD4 T-lymphocytes.
HIV infection is detected by a blood test to see whether there are HIV antibodies
present in the bloodstream (the body develops antibodies to fight HIV). In most
people, if antibodies are present they can be detected within three months of infection.
Some of the common symptoms and physical signs of AIDS are also common to a
number of other illnesses, and can include: recurrent fevers, chills and night sweats;
extreme and constant tiredness; a persistent or dry cough; diarrhoea; decreased appetite;
rapid weight loss, swollen lymph glands, white spots or unusual marks in the mouth, and
purplish raised or flat marks or bumps on the skin.
About 50% of people with HIV will develop AIDS within 10 years, and close to 70% within
15 years. No vaccine is available for HIV and there is no cure for AIDS. There are a
number of drug therapies that can delay the progression of HIV infection to AIDS.
Recommended fact sheets
http://www.health.gov.au/hfs/pubhth/strateg/hiv_hepc/hepc/index.htm
http://www.hepatitisaustralia.com
Other Infections
There are a number of other infectious diseases, caused by viruses, bacteria, fungi and
tiny parasites that can have an effect on the health and performance of people
participating in sport. Some may be transmitted during play, some through social
activities after the game. The way in which they are passed on from person to person
varies and some are more serious than others, particularly if left untreated. The fact
sheets in the last chapter provides information about each of the following:
Bacterial Infections
• Chlamydia, Pelvic Inflammatory Disease (PID)
and Non-specific urethritis (NSU)
• Gonorrhoea
• Scrumpox
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Viral Infections
• Influenza
• Genital Warts (HPV)
• Genital Herpes (HSV-1 and HSV-2)
Fungal Infections
• Tinea
• Thrush
Parasitic Infections
• Pubic Lice
• Scabies
How infections can spread through sport
People can be exposed to infection through participation in sport in a variety of ways:
• Through blood to blood contact via broken skin and open wounds. Of most concern
are the serious blood-borne viruses such as HIV and hepatitis C.
• Through contact between a person’s broken skin, mouth, eyes and other mucous
membranes with another person’s infected body fluid (blood, saliva, semen and
vaginal fluids). A number of serious infections are possible, including those which are
sexually transmitted.
• Through exposure of the skin to another person’s infected skin or body fluids. This may
be via direct body to body contact or indirectly through the use of shared equipment (eg
wrestling mats), clothing (eg jumpers, socks) and other surfaces that remain moist for a
period of time (shower floors, rub down benches). These usually involve fungal skin
infections such as tinea, viral infections such as warts, or parasites such as scabies.
• Through ingestion of contaminated food and drinks. If people handling food don’t
wash their hands properly, hepatitis A or a number of other infectious diseases, such
as those which cause gastroenteritis, can be passed on.
• By breathing in airborne droplets of saliva or sputum when an infectious person
coughs, sneezes or spits. The common cold and the flu are easily passed on from
person to person in this way.
Further useful information about a range of infectious diseases can be found at the
Department of Human Services Victoria public health website, including some multi-
language information:
http://www.dhs.vic.gov.au/phb
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