1. Prevalence of Methicillin-Resistant Staphylococcus aureus in 4A and 5A High Schools in Texas UIL Region IV Fall 2004 By Carolina Espinoza Public Health Internship - Spring 2005

2. Objective Determine the prevalence of MRSA infections in Texas 4A and 5A UIL Region IV High Schools by surveying Licensed Athletic Trainers through mail and phone questionnaires. Investigate which athletic program sectors are affected.

3. Introduction

4. Important Facts Staphylococcus aureus (Staph) - Common bacteria - Acquired mainly through direct contact (individuals and objects) - Asymptomatic carriers - Found in nose, armpit, groin, and other similar areas - Causes soft tissue infections such as boils and impetigo - Can cause pneumonia and bloodstream infections - Treatable with antibiotics

5. Methicillin-resistant Staphylococcus aureus (MRSA) MRSA - Cannot be treated with common penicillin-like antibiotics - In the past confined to hospitals, nursing homes, long-term care facilities CA-MRSA = Community-Associated MRSA - Movement into the community - Affecting athletes

6. History of Staph & MRSA in Athletes 1984 - rugby team in London 1986 - outbreak of boils in football and basketball Kentucky 1993 - 1 st case of MRSA in a wrestling team in Vermont 2002 - 03 – MRSA boom!!! -Los Angeles county: athletes & county jail -Colorado, Indiana, and Pennsylvania – fencers, football, & wrestlers 2004 - 05 – high school, college, professional football and basketball

7. Methodology

8. Groups in the Study Athletic Program Sectors Athletes Football Volleyball Wrestling Cross Country Non-Athlete Students = student team managers and student athletic trainers Adults = coaches, athletic trainers, and other staff working closely with athletes

9. Questionnaire Sample

10. Results

15. Number of Skin, Staph, and MRSA Infections Reported in Texas 4A and 5A UIL Region IV High School According to Athletic Program Sector N = number of infections

17. Range of Skin, Staph, and MRSA Infections Reported in 4A and 5A Texas UIL Region IV High Schools According to Athletic Program Sector

18. Discussion

19. Football and Wrestling Most Affected Athletic Program Sectors - Football (more participants) - Wrestling (higher percentage) Most likely due to: - Contact sports (person to person transmission) - Increased risk of lesions as well as turf and mat burns - Sites of infections go unnoticed - Sharing of unclean equipment and/or personal items

20. Volleyball and Cross Country Emerging - Volleyball high number of reported infections - Cross country few reported infections Cause of concern - Volleyball: low contact sports - Cross country: non-contact sport - Possibly the first reported cases

21. Adults and Non-Athlete Students Emerging - Individuals not directly participating in competition being affected - Adults are being affected more than some sports sectors - Non-athlete students seem to be the least affected Most likely due to - Adults: fix, dress, and wrap athlete wounds - Non-athletes: clean up equipment and clean up after players

22. EDUCATION!!!

23. Recommendations to Prevent MRSA Infections For All Adults and Students - Stress the importance of HAND WASHING and hygiene - Keep wounds covered and dispose of bandages properly - Eliminate sharing of equipment and personal items - Stress clean facilities

24. Summary MRSA is prevalent in Texas 4A and 5A UIL Region IV High Schools throughout various athletic programs sectors except for non-athlete student. As expected based on previous reports Football and Wrestling are currently the greatest at risk!!!!

25. A Special Thanks to… My mentors Marilyn Felkner, DrPH and Jeff Taylor, MPH for all their constant advice and continual support. Hermia Brooks. All the 4A and 5A High School Athletic Trainers who responded to our questionnaire. The Texas Department of State Health Services. The Texas Health Foundation for providing funding.