Sports and Young Athletes with Hepatitis B and Sickle Cell Trait

For most youngsters, sports competition is safe and rewarding. But occasionally, injury can cause a young athlete to come into contact with another child's blood, which poses a special problem if the blood contains hepatitis B, hepatitis C, or other infectious agents.

Boy being examined by nurse

Other blood conditions, like sickle cell disease, are inherited and not contagious, but can limit a young person's physical activities. Although youngsters with sickle cell disease may participate in sports for fun, they are unlikely to play competitive sports like basketball or football because they need to avoid sports that involve overexertion, overheating, dehydration, or chilling—these conditions could set off a life-threatening crisis.

Youngsters with sickle cell trait, meaning that they have one normal gene and one sickle cell gene—often participate in competitive sports. They do not usually show symptoms and may not even know they have the condition. Although they do not have the actual disease and can play on sports teams, young athletes with sickle cell trait do need to take certain precautions.

What to know about HBV and HCV

To prevent the spread of hepatitis B, hepatitis C, and other diseases that can be acquired through contact with blood and other body fluids:

  • Check that sores and cuts are properly covered or that a youngster sits out until a wound has healed sufficiently and can be covered. Youngsters whose bleeding cannot be halted should not play sports.

  • Make sure that you are working with your child's health care provider to treat any symptoms and get the necessary tests, such as liver enzyme tests, that track chronic hepatitis infection. All kids should get an annual sports physical to determine if they are healthy enough to participate.

  • Use universal precautions when treating any injury or when cleaning up blood and other bodily fluids. Use proper first aid to treat bleeding immediately and the appropriate germicide to clean equipment, mats, and other surfaces that athletes touch.

  • All players should be up to date on all vaccinations, especially HBV. (There is no vaccine for HCV.) Hepatitis is rarely spread during sports events, but it helps to be on the safe side. Coaches, referees, volunteers, and others who might come in contact with blood should get HBV vaccinations as well.

  • Educate all young athletes on the risks of unprotected sex and of sharing needles, a practice common among athletes who inject illegal drugs, such as anabolic steroids. Sharing needles is also common among youths who do body piercings or tattooing at home. Hepatitis is often spread in these ways.

  • Encourage young athletes who engage in risky behaviors, such as injection drug use or body art to be tested for hepatitis. The test results and an athlete's medical status are confidential information that should be shared only with the athlete's permission.

  • Any youngster who is experiencing acute hepatitis symptoms should not participate in contact sports or competitions, such as wrestling, until blood tests confirm that he or she can no longer spread the disease. Athletes with chronic infection should not be playing close contact sports.

Tips for young athletes with sickle cell trait

Because sickle cell trait is inherited, it can't be spread to another young athlete by contact with blood or other bodily fluids. However, sickle cell trait can make it difficult for kids to participate in some sports under certain conditions. If you do not know whether your child has sickle cell disease or carries the gene for sickle cell (sickle cell trait), consider having him or her tested. Youngsters at higher risk for sickle cell trait are those with ancestors from Africa, Central and South America, the Mediterranean, the Caribbean, Saudi Arabia, and India.

Even youngsters who have sickle cell trait and usually don't show symptoms of sickle cell disease can have pain crises during extremely vigorous exercise. When competition and physical activity are intense, the round red blood cells of a child with sickle cell trait can take on a half moon or sickle shape, causing intense pain and interfering with blood flow. Some college athletes who were not aware they had sickle cell trait, particularly football players, have collapsed and even died during competitions. The National Collegiate Athletic Association (NCAA) recommends screening all college athletes for sickle cell trait.

To avoid pain and other complications during sports, the NCAA also recommends that young athletes:

  • Build up their endurance gradually through a training program.

  • Don't go all out for more than two or three minutes without taking a breather.

  • Avoid becoming overly tired, out of breath, or chilled.

  • Stop playing immediately if experiencing symptoms like muscle pain, intense fatigue, weakness, or breathlessness. Notify the coach right away when experiencing any or all of these symptoms. 

  • Manage any asthma well. Asthma can worsen symptoms of sickle cell trait.

  • Drink plenty of water. Dehydration makes sickle cell symptoms worse. Avoid energy drinks with caffeine and other stimulants because these can contribute to dehydration.

  • If competing at a high altitude, take time to get used to the elevation before playing. Even moving up 2,000 feet can affect performance. Young athletes should talk with their health care provider to find out how long they should be at a higher altitude before competitive play and ask that supplemental oxygen be available at high altitudes.

  • Don't practice or compete when sick or feverish. 

  • Seek medical attention right away if they feel unusually ill.