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Infectious diseases in elite athletes
Introduction: As reported in literature, the most important infectious diseases affecting athletes are
gastroenteritis and upper airway infections.
It is well known that athletes are susceptible to infectious illnesses during intensive training and major
competition and recent epidemiological evidence is consistent with this perception.
There are many reasons explaining the observed increased incidence of infections in athletes.
First of all, reduced IgA concentrations and consequently decreasing anti-inflammatory activity.
Secondly the quick lymphocytopenia during the recovery phase of exercise; moreover it’s quite common
to observe, after training, an alteration of circulating leukocyte, cytokines, natural killer cell activity, and
neutrophil and macrophage phagocytic activity. We also know that overtraining syndrome is associated
with a general immunodepression. At last it is essential to underline the association between
psychological stress associated with major competition and infectious diseases susceptibility; this could
be an additive factor to the effects of intensive exercise on immune function.
Aim: The aim of the present research was to perform a surveillance on communicable disorders affecting
Italian top level athletes competing in International events, in order to collect valuable information on
diseases, eventual therapy and the post infection management.
First of all we wanted to understand if it is useful a surveillance system based on data collected by
medical staff during international competitions.
Secondly we wanted to detect the prevalence of communicable disorders among elite athletes, making a
comparison between prevalence of infectious diseases during competitions and during training camps in
order to comprehend the importance of psychological stress, jet lag etc. on immune system.
Moreover, another objective of our study was to comprehend the prevalence of not competing athletes
after infections.
At last we tried to observe if vaccination and prophylactic programmes adopted before arriving at the host
country are valid.
We sustain that all this information could be useful to give some suggestion and recommendations to
federal physician.
Material and methods: Medical Commissions of the involved Italian Sport Federations recruited in our
study were asked to join the project and were instructed about the standardized interviews required to
collect the data. The interview included accurate information concerning the competition, vaccination
protocol, the communicable disorders which affected the athletes, symptoms, diagnosis, therapies, post
infective management and isolation of patient and the impact on performance.
Our samples during competitions consisted in 412 male athletes (mean age 26 years old), 216 female
athletes (mean age 24 years old), 264 staff members (177 male mean age 32 years old and e 77 female
mean age 30 years old).
Our samples during training session consisted in 171 male athletes (mean age 24 years old), 40
female athletes (mean age 24 years old), 47 staff members (38 male mean age 30 years old and e 9
female mean age 31 years old).
Competitions (Olympic Games, Mediterranean Games, European and World Championships) took
place in Turkey, Russian Confederation, United Kingdom, France, Canada, United States of
America, Germany, China, France.
Principal sports disciplines that we included were: rowing, canoe, fencing, archery, alpine skiing,
modern pentathlon.
Results: A preliminary information from the interview of medical physicians was that athletes didn’t
received vaccination or any kind of prophylaxis before the competition.
Considering the whole sample, during competitions, upper airway infection showed a prevalence of
5% and were the most common infectious disease, gastroenteritis had a prevalence of 3,8% and
otitis of 1,4%.
We didn’t observe any cutaneous infections and lower airway infections.
The prevalence of infectious diseases in the male athletes was similar to the whole sample one.
Female athletes showed an higher prevalence of gastroenteritis (5%) followed by upper airway
infections (4,6%) and otitis (1,3%).
Prevalence of infectious diseases during training sessions was lower (3,5% of upper airway
infections in male athletes, 2,5% of upper airway infections in female athletes; 0,5% of otitis and
0,4% of other infections in male athletes; absence of gastroenteritis).
We didn’t find an higher prevalence of communicable disorders among aerobic sports
We didn’t find any staff members with infective pathologies either during competitions nor during
training sessions.
A relevant number of athletes couldn’t participate the competition:
- 28,1% and 40% of male and female athletes, respectively, who contracted upper airway infections
- 15,3% and 9,1% of male and female athletes, respectively, who contracted gastroenteritis
Moreover the two subjects with mononucleosis and abscess couldn’t participate the competition too.
We observed some possible cases of contagious during rowing World Championships in England ( 6
athletes with flu symptoms), then during European Championships of fencing in France (10 athletes with
gastroenteritis, 3 with flu) and at last during Alpine ski Championships (7 athletes with gastroenteritis and
4 with flu).
Discussion:
First of all it’s important to explain why Medical Physicians didn’t submit vaccination or any kind of
prophylaxis to the athletes before the competition, the reason was that probably most of events we took in
consideration took place in Europe, North America, Turkey and China (in safe areas) where the risk of
communicable disorders is similar to our country.
Results showed how the prevalence of infectious diseases among elite athletes was quite relevant.
In particular upper airways infections seemed to be the most frequent disease, followed by gastroenteritis,
confirming International Literature data.
Communicable disorders were more frequent in competition than throughout training session.
This findings could confirm the crucial role of immune system. In fact we know from Literature that
intensive exercise and psychological stress, especially in endurance, are associated with major infectious
diseases susceptibility. Moreover we also know how overtraining syndrome is associated with a general
immune depression.
We didn’t find any cutaneous infections, considered rather common among athletes in many literature
reviews; probably it occurred because we couldn’t receive data from contact sports.
One of the most interesting finding was that many athletes with infectious diseases, even if not serious,
suspended physical activity and took the risk of compromising their sports season and sometimes their
career, especially when the infections occurred during the most important competitions such as Olympic
Games or World Championships.
For all this reason we focalized our attention towards prevention and limitation of risks.
We suggested Federal Physician to take into account big and little details such as jet lag, immunization,
prevention of overtraining syndrome, prevention of psychological stress, hygienical and sanitary norms.
At this regard inspired by guidelines usually published before Olympic Games and by the results of our
study, we created the following Decalogue for Federal Physicians:
DECALOGO PER MEDICI FEDERALI IN TRASFERTA
VACCINAZIONI OBBLIGATORIE, CONSIGLIATE E DETTATE
DA EVENTUALI EPIDEMIE NEL PAESE DI PARTENZA
PRIMA DELLA PARTENZA
INFORMAZIONI SUL PAESE OSPITANTE
OVERTRAINING/STRESS PSICOLOGICO
(ESAMI EMATOCHIMICI E TEST/VIDEAT PSICOLOGICI)
PROBIOTICI E IMMUNOSTIMOLANTI
JET LAG (MELATONINA, BENZODIAZEPINE, ADATTAMENTO
GRADUALE) E PROBLEMATICHE INERENTI IL VIAGGIO
PREVENZIONE DURANTE LA
NORME IGIENICO SANITARIE IN TRASFERTA
COMPETIZIONE
NUTRIZIONE E INTEGRAZIONE
ANTIBIOTICI (SOLAMENTE IN CASI STRETTAMENTE
“MANAGMENT” POST INFETTIVO
NECESSARI)
ISOLAMENTO ATLETI MALATI
REPORT
PRIMA DEL RITORNO
.