Mumps fosters cautious approach

NEW YORK -- The recent mumps outbreak in the NHL that led to emergency teamwide immunizations, occasional player quarantines, the cancellation of holiday hospital visits and a re-examination of the league's infectious disease prevention policies hasn't gone unnoticed by the NFL or NBA.

Awareness and action have been particularly heightened in cities where NHL and NBA clubs share the same arena or, in the case of the New York Rangers and New York Knicks, even the same practice facility.

So far, 18 NHL players -- including Rangers Derick Brassard and Tanner Glass -- have been diagnosed with mumps. On Thursday, the Rangers announced that forward Lee Stempniak and a minor league player and head coach for their American Hockey League affiliate in Hartford, Connecticut, had been put in isolation for five days and tested. Stempniak and Joey Crabb of AHL Hartford tested positive Monday. Also on Monday, the Pittsburgh Penguins sent home Steve Downie, Brandon Sutter and Thomas Greiss for testing.

The NHL outbreak has been sometimes called "mysterious" -- as if there is something endemic to hockey that caused it to roll on for two months (and counting) within the league.

Mumps, though highly contagious, was thought to be effectively managed once the MMR (measles, mumps, rubella) vaccine was introduced in the late 1960s. Only a couple hundred cases were reported the following year in the U.S., but that number ticked up to 584 in 2013 and 1,078 through Nov. 29 this year.

And so, while high-profile NHL cases such as that of Penguins superstar Sidney Crosby's diagnosis Dec. 12 have helped spotlight the issue, numerous public officials have said topics such as the efficacy of the MMR vaccine and reassessments of how often booster shots are needed were already being examined.

Merck, the pharmaceutical company that won the right to be the sole provider of the vaccine in the U.S., is facing at least two lawsuits alleging it hid or misrepresented facts about how well its vaccine lasts and performs.

Dr. Greg Wallace, who leads the domestic measles, mumps, rubella and polio team at the Centers for Disease Control and Prevention, hasn't ruled out new recommendations, like an increased frequency of booster shots.

Regardless of the infectious disease in question -- be it mumps or the NFL's much-publicized problems with MRSA (Methicillin-resistant Staphylococcus aureus, a potentially deadly staph infection) -- sports leagues have come to realize the importance of being proactive rather than reactive. They have also come to recognize the value of establishing standardized leaguewide protocols that step up prevention measures and informing players and staff how some diseases are transmitted through something as simple as sneezing, a shared water bottle or a handshake.

NBA spokesman Tim Frank said Sunday the league has no reported cases of mumps. But Frank added via email that the NBA moved quickly in the wake of the NHL's outbreak "to send a memo to our teams to convey information from the CDC with a reminder to review the immunization history of players and any other individuals under the care of the team medical staff."

But what has that meant in practice?

"[Knicks management] were a little scared for us," forward Jason Smith said Saturday. "They made us do a little bit of blood work just to see if anybody needed a booster shot. Most of the younger generation was fine with it. We were all immune to it and everything, but the older generation, I think there are maybe two or three guys [on the] coaching and training staff that needed to get a booster for it. They were definitely conscious about it."

Asked if the Knicks, whose practice gym is located in the same Greenburgh, New York, building as the Rangers' practice rink, were advised to avoid common areas the teams share, Smith said, "Not really. I think it was more of a natural 'be careful of where you touch and where you go' because we do share a practice facility and their locker room is right next to our locker room, so it's tough.

"But hey, we survived the mumps. Nobody got it."

The NFL has had no reported cases of mumps either. Over the past decade, however, the league's struggles to prevent MRSA prompted an overhaul of its procedures that predated the mumps outbreak in the NHL. The NFL's first reported MRSA cases involved the 2003 St. Louis Rams. Subsequent outbreaks occurred among the Washington Redskins and Cleveland Browns.

From 2006 to 2008, 33 cases were reported leaguewide. Then there was a gap before MRSA hit the Tampa Bay Buccaneers in 2013. Though Bucs cornerback Johnthan Banks returned to play two weeks after his diagnosis, Carl Nicks and Lawrence Tynes, who contracted MRSA two months before Banks during training camp, are both now out of the league. (Tynes and the NFL Players Association filed a grievance against the club.)

The Washington Post looked into why NFL teams are still struggling with how to combat MRSA 10 years after the fact. It published a report in August that the NFL allowed teams to set their own protocols for years, perhaps to their detriment. While the Redskins and Rams chose to respond hyperaggressively to their outbreaks, the Bucs faced pointed questioning (sometimes by their NFL peers) about whether they failed to take enough preventive measures.

Matthew Matava, the St. Louis Rams' team physician and current president of the NFL Physicians Society, told the Post that the Rams invited experts from the CDC to analyze their team facilities, review antibiotic records and examine the susceptibility for St. Louis' players. The locker rooms were fumigated, posters were hung to show players what a staph infection looks like, and, Matava added, for more than a decade the Rams have been infection-free.

Redskins team physician Anthony Casolaro told the Post that the Redskins went the extra mile when six to eight of their players contracted MRSA beginning in 2004. Casolaro said surfaces where players congregate at Redskins Park, such as the locker room, training room and training tables, were replaced with more sanitary surfaces. Benches that ran in front of the players' lockers were removed, and each player was given his own stool instead. The facilities were sprayed with anti-staph material, and showers and ultraviolet lights were installed next to therapy tubs. Redskins players were urged to take showers after practices and workouts and before using team whirlpools. Casolaro said an intern was even assigned to prevent players from using someone else's towel during games by scooping them up after they were used.

The Bucs' story was different.

After Tynes and Nicks were infected, Redskins officials asked Tampa Bay counterparts what they were doing to combat MRSA before they played during the 2013 preseason. Weeks later, the NFL considered postponing an Oct. 13 game between Tampa Bay and the Philadelphia Eagles when Banks became infected.

Although that game went on without incident, the Atlanta Falcons decided to take matters into their own hands. After the Bucs played an Oct. 20 game at the Georgia Dome, photos surfaced of the workers that the Falcons hired to disinfect the visitors' locker room in Hazmat suits just after the Bucs left. It was not a good optic for the NFL or the Bucs, especially with all the other safety issues swirling around the league at the time.

The NFL has since collaborated with the NFLPA and instituted a standardized infectious disease prevention program through a partnership with Duke University's infectious control outreach network.

The hard truth is that no league can really force a player to practice safer hygiene or get a vaccine. Minnesota Wild defenseman Ryan Suter underscored that when he chose to be the only player on the Wild to refuse a mumps booster shot -- then sheepishly acknowledged two weeks later that he came down with the disease.

But the NFL, NBA and NHL believe they now have improved, updated, systematic guidelines in place to at least address the prevention of infectious diseases. The NFL's program includes suggestions on how teams should educate players and their families on safety precautions, how to spot problems and leaguewide cleaning protocols.

Nowadays, if you happen to be in the New York Giants locker room, for example, it's not uncommon to see a team staffer wearing surgical gloves and spraying the undergarments that players wear beneath their shoulder pads with disinfectant or using the sort of mechanical grabber that highway crews use to pick up litter to collect the sweaty, dirty laundry in the room and drop it into a bin.

The bottom line is sports leagues are realizing, when it comes to players' health -- whether the concern is mumps or MRSA, a flu bug sweeping the team or diagnosing head trauma -- it's better to be smarter and safer. Not sorry later.