Enteroviral outbreaks involving athletic teams have been described although the mode of transmission has been unclear. In September 1991, an outbreak of pleurodynia among high school football players [in New York State, USA] provided an opportunity to identify possible modes of transmission. Illness was reported by 17 (20%) of the football players. Behaviours involving contact with common water containers were associated with illness, including eating ice cubes from the team ice chest (relative risk [RR], 9.2; 95% confidence interval [CI], 1.3 to 65.5) and drinking water from the team cooler (RR, 6.3; 95% CI, 1.5 to 25.7). Coxsackievirus B1 was isolated in four (50%) of the 8 stool specimens collected.
Contamination of common water containers by an infected player may have contributed to or initiated the outbreak. In addition to discouraging direct oral contact with common drinking containers, use of individual water containers and ice packs for injuries was recommended.
[This is a description of a classical outbreak of epidemic pleurodynia or Bornholm disease attributable to common use of a water container or ice cubes. A number of infections are known to be spread during contact sports or, as in this outbreak, by the use of communal facilities by sports teams. An interesting point raised in the Discussion section of this paper is the possible amplification of the illness, rendering it more likely to be symptomatic, by vigorous exercise. The suggestion for this, and the references quoted to support it, date from observations on the development of paralytic polio in the late 1940s. This highlights the need to educate young people to avoid excessive exercise if they have a febrile illness.]