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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 .