A hospital disease spreads to schoolchildren

Marinating in sweat after gym class is not only unclean, it’s also making students vulnerable to a persistent and potentially deadly bacterial infection, known as community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). This mutation of MRSA has turned a hospital-based infection into a public problem.

The problem is that many students don’t shower after exercise during the school day. Combine the skin-to-skin contact and abrasions implicit in playing sports with the sweat-laden surfaces of gym equipment and you set the stage for exposure to the infection.

When people say “MRSA” they are usually referring to healthcare-associated MRSA (HA-MRSA). CA-MRSA is caused by three specific strains of staph infection that, unlike the healthcare strains, affect people who are otherwise healthy. Research has found that CA-MRSA is less resistant to antibiotics and more infectious. Rates of the disease have also increased in the last decade, according to the U.S. Centers for Disease Control and Prevention. A recent study in the journal Emerging Infectious Diseases found that the number of CA-MRSA infections has risen more than 33 percent each year from 1999 to 2006.

The infection, which is highly resistant to antibiotics regardless of strain, usually shows up on the skin as a painful bump but can progress to a larger wound. In severe cases, treatment can last years and require surgery. At its worst, MRSA also makes people vulnerable to other fatal infections.
Various strains of MRSA have already struck athletic teams in several high-profile cases. An NFL physician’s survey of its 32 clubs determined there were 33 MRSA infections league-wide from 2006 to 2008.

Children in a physical education class are exposed to the same bacteria-friendly environment as any other athlete and face the same risks, according to Frank DeLeo, a researcher with the National Institute of Allergy and Infectious Diseases. Even adults who use community gyms face exposure to the pathogen if they don’t practice proper hygiene.

So far, few cases of non-athlete infections have been widely publicized, but research has shown the bacteria to be the number one cause of skin infections brought into emergency rooms. That kind of statistical impact is not created by athletes alone.

Science writer Maryn McKenna, author of the prize-winning book Superbug: The Fatal Menace of MRSA, sees reasons why non-athlete students would be overlooked. Athletes receive attention from their teams, fans and the media, she says. “A kid in high school only has his or her mom. Sometimes, not even that.”

Scientists don’t know for sure why rates have gone up. But New York University researcher Barry Kreiswirth thinks it’s because infection rates were so high in hospitals that the disease simply spilled over into the community. With so many people affected, it just took the right strain infecting the right person for HA-MRSA to become CA-MRSA and move from patients to the public.

If mandatory showers would help protect students from this spillover, why have so many schools stopped requiring them? It may simply stem from tighter schedules in many modern schooldays; students are forced to choose between cleanliness and tardiness. Funding is also tight, and soap and towels may not be top priorities, McKenna says. “Also, the attitudes toward getting naked in front of other students have changed,” she emphasizes. For example, in 1994 the American Civil Liberties Union sued the school district of Hollidaysburg, Pennsylvania, arguing that its communal shower rule was a violation of privacy. In response, the school district dropped its shower requirement.

So what can parents and children do to reduce the chance of a CA-MRSA infection? “Send kids to school with wet wipes,” McKenna says. “Make sure they shower and change after sports and don’t just go straight to a friend’s house.” DeLeo also recommends using alcohol wipes for cleaning gym equipment and educating children to make sure they understand the risk. In the end, a little soap could go a long way.