Surveillance of Physician-Diagnosed Skin and Soft Tissue Infections Consistent With Methicillin-Resistant Staphylococcus Aureus (MRSA) Among Nebraska High School Athletes, 2008–2012

BACKGROUND: Though historically confined to hospital settings, methicillin-resistant Staphylococcus aureus (MRSA) has received increasing attention in the wider community, particularly among athletes. A 2007–08 investigation in Nebraska concluded that MRSA skin infections were an emerging problem among the state’s student athletes with estimated infection rates as high as 25.1 per 10,000 football players and 60.1 per 10,000 wrestlers. To estimate incidence of skin and soft tissue infections consistent with MRSA among student athletes, we conducted biannual surveillance during each school year from 2008–2012 at all public and private member high schools of the Nebraska School Activities Association (NSAA).

METHODS: Statewide surveillance was conducted by inviting high school athletic officials at each NSAA member school to complete an Internet-based survey following the fall and winter sport seasons during each of the four school years. Each responder provided personal contact information, sport program participation numbers, and the number, sport, and grade of athletes with physician-diagnosed skin and soft tissue infections consistent with MRSA during the respective school years and seasons. Total numbers of infections and participants in each sport were used to estimate incidence per 10,000 athletes.

RESULTS: Over the four year period, 310 of 312 (99.4%) invited Nebraska high schools responded to at least one of the eight surveys. Median response rates for the four fall and four winter surveys were 77.9% (range, 75.0–80.4%) and 73.6% (56.7–80.4%), respectively. Overall from 2008–12, 30.0% (93/310) of responding Nebraska high schools reported ≥1 infection consistent with MRSA among athletes. Median proportions of responding teams reportedly affected by such infections during the four football and four wrestling seasons were 5.4% (range, 3.6–6.8%) and 6.2% (range, 5.2–7.4%), respectively. Incidence estimates per 10,000 athletes decreased substantially from 20.9 (2008–09) to 11.3 (2010–11) among football players and from 60.8 (2008–09) to 28.1 (2010–11) among wrestlers. During 2011–12 sport seasons, incidence estimates increased to 16.6 per 10,000 football players and 43.3 per 10,000 wrestlers.

CONCLUSIONS: Following steady declines in estimated physician-diagnosed MRSA-consistent infection incidence among Nebraska football players and wrestlers during the first three years of surveillance, increases were demonstrated during the 2011–12 school year. This finding demonstrates that infections consistent with MRSA remain a concern among Nebraska high school athletes. High school athletic departments should remain vigilant for skin and soft tissue infections among athletes, including MRSA, and continue to prioritize prevention and control efforts.