Vaccination in elite athletes

Infectious risks associated with outdoor sports activities

In France, outdoor sports and activities account for 36% of sports engagement, making outdoor venues the most popular settings for sports participation. Discussing the links between sports and health almost always highlights the beneficial impact of engaging in sports. However, due to a lack of specific notifications, infectious risks are not subject to epidemiological monitoring, and need to be better understood. Since the practice of outdoor sports has become part and parcel of many individuals' daily routines, it is essential to more accurately characterize the knowledge we have gained about the risks associated with exposure. However, directly associating the practice of a sport with an elevated risk of infectious diseases is a challenging endeavor. Sociological factors based on risk awareness and adoption of protective behaviors in response to the risk are crucial to the orientation of prevention efforts. This review deals with several (bacteriological, viral, parasitic, and mycological) infectious risks related to outdoor activities practiced in a natural field via contamination routes such as tick-bite, enteric pathogen, skin, and aerosol transmission. We have also detailed a number of preventive measures taking into account the outdoor setting (e.g., vaccination).

Common Sports Infectious Disease

There is growing concern about the impact of infectious diseases in athletes, especially as they relate to exposures in athletic training facilities. This article reviews common pathogens encountered in athletic training facilities, while offering an evidence-based overview of practical preventative measures that can be implemented to reduce the incidence of infectious diseases in close-contact sports such as American football and wrestling.

Self-reported side effects following COVID-19 vaccination in athletes: A retrospective study

Billions of coronavirus disease 19 (COVID-19) vaccines have been administered worldwide. However, limited data on side effects have been reported in athletes. This study aimed to describe the incidence of side effects following COVID-19 vaccination in athletes and to identify the factors associated with the main side effects in this population. Information on COVID-19 vaccination, side effects, and overall symptom duration was retrospectively collected from recreational and competitive athletes. A total of 460 participants were included in this study. Fever and arm pain were more frequently reported after the first-dose vaccination, 9.6% vs 4.6%, p = .007 and 81.3% vs 24.9%, p ≤ .001. Myalgia was more common after the second-dose vaccination, 0.65% vs. 7.1% p ≤ .001. Males were more likely to present with arm pain after the first and second vaccinations. Those with SARS-CoV-2 infection before vaccination were less likely to present with arm pain after the first dose of vaccination (OR: 0.162, p ≤ .001) and more likely to present with fever after the second dose of vaccination (OR: 3.442, p = .046). First-dose vaccination with the BNT162b2 vaccine compared to other brands was characterized by lower odds of fever (OR: 0.394, p = .017). Our results indicated mild adverse effects and a short duration of symptoms in athletes following COVID-19 vaccination.

Sports Elite Means Vaccine Elite? Concerns and Beliefs Related to COVID-19 Vaccines among Olympians and Elite Athletes

(1) Background: The purpose of this study was to investigate the concerns and beliefs of Olympians and elite athletes toward COVID-19 vaccination. (2) Methods: The study was framed by a quantitative method and was conducted using the PAPI (pen and paper interview) technique among 895 Polish elite athletes representing 34 sports. (3) Results: Three-quarters (76.3%) of the athletes were vaccinated against COVID-19; statistically participants were more likely to be women, and athletes who participated in the Olympic Games. Four in ten (39.2%) were in favor of vaccination. Athletes were mainly concerned that COVID-19 would exclude them from training/competition (19.3%) and could have a long-term impact on their health (17.2%). Athletes who were vaccinated reported much higher confidence in the composition of the vaccine and the doctors who recommended vaccination than unvaccinated athletes. Athletes who competed at the Olympic level were more likely than others to disbelieve that vaccines were produced too quickly and were not well tested. National-level athletes showed the highest degree of distrust in the government regarding COVID-19 vaccination, with one in six respondents distrusting doctors with respect to COVID-19 vaccination. Four in ten respondents said they were in favor of vaccination. (4) Conclusions: Athletes' attitudes toward COVID-19 vaccination were significantly influenced by their environment-especially coaches and relatives. The power of social norms with respect to the decision to vaccinate against COVID-19 was very strong. Therefore, it is essential to build awareness about preventive policies among athletes and their social environment.

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 1: acute respiratory infections

Acute illnesses affecting the respiratory tract are common and form a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. Acute respiratory illness (ARill) can broadly be classified as non-infective ARill and acute respiratory infections (ARinf). The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to ARinf in athletes. The International Olympic Committee (IOC) Medical and Scientific Commission appointed an international consensus group to review ARill (non-infective ARill and ARinf) in athletes. Six subgroups of the IOC Consensus group were initially established to review the following key areas of ARill in athletes: (1) epidemiology/risk factors for ARill, (2) ARinf, (3) non-infective ARill including ARill due to environmental exposure, (4) acute asthma and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport and (6) acute nasal/vocal cord dysfunction presenting as ARill. Several systematic and narrative reviews were conducted by IOC consensus subgroups, and these then formed the basis of sections in the consensus documents. Drafting and internal review of sections were allocated to 'core' members of the consensus group, and an advanced draft of the consensus document was discussed during a meeting of the main consensus core group in Lausanne, Switzerland on 11 to 12 October 2021. Final edits were completed after the meeting. This consensus document (part 1) focusses on ARinf, which accounts for the majority of ARill in athletes. The first section of this consensus proposes a set of definitions and classifications of ARinf in athletes to standardise future data collection and reporting. The remainder of the consensus paper examines a wide range of clinical considerations related to ARinf in athletes: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations, risks of infection during exercise, effects of infection on exercise/sports performance and return-to-sport guidelines.

A Guide to Different Intensities of Exercise, Vaccination, and Sports Nutrition in the Course of Preparing Elite Athletes for the Management of Upper Respiratory Infections during the COVID-19 Pandemic: A Narrative Review

Elite athletes use high-intensity training to maintain their fitness level. However, intense training can harm the immune system, making athletes suspectable to COVID-19 and negatively affecting their performance. In addition, the diet of athletes should be appreciated more as it is another influencer of the immune system, especially during the COVID 19 pandemic. The other important issue elite athletes face currently is vaccination and its possible intervention with their training. The present study attempts to discuss the impact of different training intensities, nutritional strategies, and vaccination on the immune system function in elite athletes. To this end, Scopus, ISC, PubMed, Web of Science, and Google Scholar databases were searched from 1988 to 2021 using the related keywords. The results of our review showed that although high-intensity exercise can suppress the immune system, elite athletes should not stop training in the time of infection but use low- and moderate-intensity training. Moderate-intensity exercise can improve immune function and maintain physical fitness. In addition, it is also better for athletes not to undertake high-intensity training at the time of vaccination, but instead perform moderate to low-intensity training. Furthermore, nutritional strategies can be employed to improve immune function during high-intensity training periods.

Recent COVID-19 vaccination has minimal effects on the physiological responses to graded exercise in physically active healthy people

Athletes are advised to receive the COVID-19 vaccination to protect themselves from SARS-CoV-2 infection during major competitions. Despite this, many athletes are reluctant to get the COVID-19 vaccine due to concerns that symptoms of vaccinosis may impair athletic performance. This study aimed to determine the effects of COVID-19 vaccination on the physiological responses to graded exercise. Healthy physically active participants completed a 20-min bout of graded cycling exercise at intensities corresponding to 50%, 60%, 70%, and 80% of the predetermined V̇O2max before and ∼21 days after receiving the COVID-19 vaccine (2-dose Pfizer mRNA or 1-dose Johnson & Johnson). Vaccination had no effect on a large number of physiological responses to exercise measured in blood (e.g., lactate, epinephrine, and cortisol) and by respiratory gas exchange (e.g., oxygen uptake, CO2 production, ventilation, respiratory exchange ratio, predicted V̇O2max, and ventilatory threshold) (P > 0.05). We did, however, find significant elevations in heart rate (∼5 beats/min) and norepinephrine (P = 0.006 and 0.04, respectively) in response to vigorous (i.e., 70%-80% V̇O2max) intensity exercise after vaccination, particularly in those who received the two-shot Pfizer mRNA vaccine regimen. These findings held true when compared with demographically matched controls who completed identical bouts of exercise several weeks apart without receiving a vaccine; delta values for heart rate (P = 0.03) and norepinephrine (P = 0.01) were elevated in the second trial for those who received the Pfizer mRNA vaccine compared with the controls at the 70% and 80% V̇O2max stages, respectively. Recent COVID-19 vaccination has minimal effects on the physiological responses to graded exercise in physically active healthy people. The small elevations in cardiovascular and neuroendocrine responses to exercise after the Pfizer mRNA vaccine regimen could have implications for athletes at the elite level and warrants investigation.NEW & NOTEWORTHY Recent COVID-19 vaccination does not affect a large number of physiological responses to graded exercise, indicating that vaccination is unlikely to impair exercise capacity in normal healthy people. Heart rate and norepinephrine levels were elevated in response to exercise after the two-dose Pfizer mRNA vaccination compared to controls. Small elevations in cardiovascular and neuroendocrine responses to exercise after recent COVID-19 vaccination could have implications for exercise performance in elite athletes and warrants investigation.

Safety and Impact on Training of the Influenza Vaccines in Elite Athletes Participating in the Rio 2016 Olympics

OBJECTIVE

The aim of the study was to evaluate the safety and tolerance of influenza vaccines for the northern and southern hemispheres in Polish elite athletes participating in the Rio 2016 Olympics.

DESIGN

Prospective, observational, cohort study.

SETTING

Institutional level.

PARTICIPANTS

Ninety-seven athletes vaccinated only with the northern hemisphere vaccine; 98 athletes received the southern hemisphere vaccine alone, whereas 39 athletes were vaccinated with both vaccines.

INTERVENTIONS

The athletes were vaccinated with a trivalent, inactivated influenza vaccine recommended for the northern hemisphere 2015/2016 and then with the vaccine recommended for the southern hemisphere 2016. Athletes kept a diary of adverse events and effects (if any) on training for 6 days after vaccination.

MAIN OUTCOME MEASURES

The percentage of general and local adverse events, number of lost or modified training sessions.

RESULTS

Significantly more local adverse events (pain and redness) were found in the group immunized with the vaccine for the northern hemisphere. There were no differences in the frequency of general adverse events and influence on training between groups. Of total 273 athletes who had 1911 training days during 6 days after vaccination, 6 athletes (2.2%) lost 13 training days (0.7%) and 16 athletes (5.9%) had to modify 34 (1.7%) training days within first 2 days after vaccination.

CONCLUSIONS

Athletes tolerated influenza immunization well. If they are going to travel to the other hemisphere during the influenza season, the use of the second influenza vaccine should be advised. Athletes should anticipate modification of trainings for 2 days after vaccination.

Time Out of Play Due to Illness in Major and Minor League Baseball

OBJECTIVE

To generate a summative report on the most commonly diagnosed illnesses in Major League Baseball (MLB) and Minor League Baseball (MiLB) athletes with specific attention to their impact based on time out of play.

DESIGN

Retrospective analysis.

SETTING

Injury and illness data from the MLB Health and Injury Tracking System.

PARTICIPANTS

All MLB and MiLB athletes active between 2011 and 2016.

ASSESSMENT OF RISK FACTORS

Illnesses were defined as atraumatic medical diagnoses that occurred during the MLB or MiLB season and resulted in at least 1 day out of play.

MAIN OUTCOME MEASURES

Incidence of illness diagnoses and resulting time out play.

RESULTS

Eight thousand eight hundred thirty-four illnesses were reported, representing 14.7% of all diagnoses resulting in time out of play. Total days missed (DM) due to illness were 39 614, with a mean of 4.6 (SD 9.9 days) and median 2 DM per diagnosis. The annual incidence of illness per season was 20.3 per 100 athletes. The most common diagnosis was nonspecific viral illness (15.3%), followed by gastroenteritis (13.6%), other gastrointestinal illness (8.3%), influenza (7.0%), and upper respiratory infection (6.2%). Appendicitis (15.2%) and Epstein-Barr virus/cytomegalovirus (9.1%) were the most common season-ending diagnoses.

CONCLUSIONS

Illnesses represent a significant cause of time out of play in MLB and MiLB. Prevention efforts should focus on limiting the spread of communicable viral, respiratory, and gastrointestinal disease among players, as the majority of diagnoses fell into these categories. This work may be used to guide future research into illness treatment and prevention in professional baseball.

Timing of Vaccination after Training: Immune Response and Side Effects in Athletes

OBJECTIVES

Influenza vaccination was used to assess whether induction of immunity or side effects are influenced by the timing of the last training session before vaccination.

METHODS

Forty-five healthy athletes (36 male, 23 ± 8 yr, ≥5 training sessions per week, predominantly national competition level) were vaccinated with the tetravalent influenza vaccine; blood samples were collected immediately before and 1, 2, and 26 wk after vaccination. Athletes were randomly assigned to vaccination within 2 h after the last training session versus after 24-26 h. Influenza-specific T cells were quantified after stimulation with the vaccine based on intracellular cytokine staining. Antibodies (IgA, IgG, IgM) were quantified by enzyme-linked immunosorbent assay and neutralization assay. Participants documented resulting side effects and training restrictions using a standardized diary.

RESULTS

Both groups showed an increase in influenza-reactive CD4 T-cell levels, which peaked 1 wk after vaccination (fold changes to baseline; median (interquartile range), 3.7 (3.0-5.4; P < 0.001) in the 2-h group; 4.6 (2.8-7.4; P < 0.001) in the 26-h group) with no difference between groups (P = 0.52). Influenza-specific antibodies showed a significant increase after vaccination in both groups (at least 1.4-fold, each P < 0.001, no group differences; P = 0.24-0.97 for different antibody types). Only antibodies toward the Brisbane strain showed a trend toward significant differences in neutralization titers between groups (4-fold (2-17.8) in the 2-h group, 16-fold (4-32.9) in the 26-h group; P = 0.06), whereas other specificities did not differ (P = 0.16-0.72). No intergroup differences were found for side effects; no athlete reported a loss of training time due to the vaccination or its side effects.

CONCLUSION

Infection prophylaxis in elite athletes by influenza vaccination seems to be effective and safe. Timing of vaccination after prior training does not seem to require specific constraints.

Attitudes of elite athletes and their support staff to the influenza vaccine

BACKGROUND

Influenza is an important public health issue, even amongst healthy adults. Uptake rates of the influenza vaccine amongst elite athletes vary and can depend on the attitudes of their coaches, fellow athletes and support staff. International studies have documented a fear amongst elite athletes to the potential side effects of the vaccine.

AIMS

Determine the influenza vaccine uptake rates in elite Irish athletes and their support staff along with attitudes, fears and barriers to receiving it.

METHODS

A cross-sectional survey was performed in the Sport Ireland Institute. Elite athletes and support staff from the 2019 database were invited to participate via an anonymous online survey. The database included a variety of sports, e.g. athletics, boxing, cycling, rowing, swimming and para-athletics.

RESULTS

From 218 athletes and staff invited, 39% (n = 87 [43 male, 44 female]) responded to the online survey. Fifty-nine percent (n = 51) of participants received the influenza vaccine during the 2018/2019 season. Forty-six percent (n = 40) completely agree that the influenza vaccine is safe. Fourteen percent (n = 12) of participants believe the vaccine causes influenza. "Getting sick" from the vaccine was the biggest fear for participants. Athletes were least likely to recommend the influenza vaccine to others and most likely to fear missing time from training or work as a result of it.

CONCLUSIONS

Elite Irish athletes are vulnerable to contracting influenza annually, despite free access to immunisation. Barriers to receiving the vaccine include location access, education and fear of side effects.

Response of Sport Horses to Different Formulations of Equine Influenza Vaccine

The international governing body of equestrian sports requires that horses be vaccinated against equine influenza within 6 months and 21 days of competing. The aim of this study was to compare the antibody response of young sport horses to six-monthly booster vaccination with equine influenza vaccines of different formulations. An inactivated vaccine was allocated to 35 horses and subunit and recombinant vaccines were allocated to 34 horses each. After vaccination, all horses were monitored for evidence of adverse reactions. Whole blood samples were collected at the time of vaccination and on nine occasions up to six months and 21 days post vaccination. Antibodies against equine influenza were measured by single radial haemolysis. Transient fever and injection site reactions were observed in several horses vaccinated with each vaccine. Only two horses failed to seroconvert post booster vaccination but there was a delayed response to the recombinant vaccine. The antibody response to the recombinant vaccine was lower than that induced by the whole-inactivated and subunit vaccines up to three months post vaccination. Thereafter, there was no significant difference. By six months post vaccination, the majority of horses in all three groups were clinically but not virologically protected. There was minimal decline in antibody titres within the 21-day grace period.

Vaccination practices and influenza in professional football players in Greece

BACKGROUND

There is limited data on vaccination practices for professional footballers globally.

AIMS

To record vaccination practices employed by medical staff of individual football teams of the Super League Greece, and absenteeism of footballers related to influenza illness.

METHODS

A brief questionnaire was distributed to chief medical officers (CMOs) of the sixteen teams of the Super League Greece. Participants were asked to report vaccines they recommended for footballers. In addition, the questionnaire included questions on new cases of influenza and absenteeism due to influenza. Descriptive statistics (absolute and relative frequencies) were used for the presentation of the results.

RESULTS

Overall, 87% of the CMOs recommended seasonal influenza vaccine, 62% hepatitis B vaccine and 50% pneumococcal vaccine. Fourteen CMOs (87%) reported that the occurrence of seasonal influenza in the 2016-17 northern hemisphere season ranged from one to five cases, while two medical officers (12%) reported zero workdays lost due to influenza.

CONCLUSIONS

Our survey shows considerable variation in vaccination practices of CMOs of the Super League Greece. The results of this survey should stimulate further evaluation of vaccination policy and influenza-related absenteeism in footballers.

Elite athletes on regular training show more pronounced induction of vaccine-specific T-cells and antibodies after tetravalent influenza vaccination than controls

Compliance of elite athletes with vaccination recommendations is low mainly based on concerns about side-effects and perceived poor vaccine efficacy due to continued physical training. We therefore employed seasonal influenza vaccination to investigate the effect of regular physical training on vaccine-induced cellular and humoral immunity in elite athletes and controls. Lymphocyte subpopulations and vaccine-specific T-cells were quantified and functionally characterized from 45 athletes and 25 controls before, and 1, 2 and 26 weeks after vaccination. Moreover, influenza-specific antibodies and their neutralizing function were quantified. Both groups showed a significant increase in vaccine-reactive CD4 T-cell levels which peaked one week after vaccination (p < 0.0001). The increase was significantly more pronounced in athletes (4.1-fold) compared to controls (2.3-fold; p = 0.0007). The cytokine profile changed from multifunctional T-cells co-producing IFNγ, IL-2 and TNFα to cells with restricted cytokine expression. This change in functionality was associated with a significant increase in CTLA-4 expression (p < 0.0001), which again was more pronounced in athletes. Likewise, the increase in neutralizing antibodies was stronger in athletes (p = 0.004 for H1N1; p = 0.032 for H3N2). In conclusion, both groups mounted a strong vaccine-specific cellular and humoral immunity after standard vaccination. The more pronounced increase in specific T-cells and neutralizing antibodies indicates that high frequency and intensity of training enhance vaccine-responses in elite athletes.

PyeongChang 2018 Winter Olympic Games and athletes' usage of 'polyclinic' medical services

Objective

This paper aims to describe the medical service of two polyclinics of the PyeongChang Winter Olympic Games and to analyse the injury and illness of athletes who visited the polyclinics during the oilympic period in order to provide some insight with respect to the future construction and operation of polyclinics in mass gathering events such as the Olympic Games.

Methods

The PyeongChang Olympic Village was located near the Olympic Stadium for snow sports athletes and the Gangneung Olympic Village was located near the ice venues for ice sports athletes. During the Olympic Games, polyclinics were consisted of emergency service and outpatient clinics. We retrospectively analysed the electronic medical record data of athletes who visiting polyclinics between 9 February 2018 and 25 February 2018.

Results

During the Olympics, there were 1639 athlete encounters in both polyclinics. Among those, injuries of athletes were 237 (14% of all athlete encounters) in total, and the most common injured site was knee joint. Upper respiratory infection was the most frequent case in diseases of athlete encounters. Total 223 cases of image study were done, MRI was 44 cases.

Conclusion

The PyeongChang Winter Olympic Games had the highest number of participants in the history of Winter Olympic Games. Overall 48% of athletes encountered polyclinics due to disease during the Games period. Upper respiratory infection and other seasonal diseases were more frequent this Olympic Games than before. Polyclinics were managed healthcare of athletes as well as injury and illness of athletes. In winter sports, a polyclinic and similar medical facilities should be prepare for diseases considering geography, weather as well as injuries and endemic diseases when planning future mass gathering events.

Immunizations in Athletes

Context:

Immunizations are a cornerstone of preventive care and an important consideration for team physicians caring for athletes.

Evidence Acquisition:

A PubMed search was performed from August 2016 through May 2017 as well as a website review of the Centers for Disease Control and Prevention, World Health Organization, and Immunization Action Coalition.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

By keeping abreast of diseases endemic to nations to which athletes may be traveling as well as the vaccination status of the athletes, team physicians can provide appropriate advice regarding immunization and prevention of disease.

Conclusion:

There are a host of regularly updated reliable websites to assist the team physician in these recommendations.

Antibody Response to Trivalent Influenza Vaccine in the Northern and the Southern Hemisphere in Elite Athletes

Being frequent travelers, the elite athletes are advised to undergo an influenza vaccination. The aim of the study was to describe the antibody response to repeated trivalent, inactivated, split influenza vaccine, of different antigenic content, recommended for the Northern and the Southern Hemisphere, administered to sportsmen before the Olympic Games in Brasil in 2016. Fourteen athletes were included in the study. For both A/California/7/209/pdm09 A/H1N1/ antigen and A/Switzerland/971593/2013/A/H3N2/ antigen, higher seroconversion rates were obtained after the first than the second vaccination (10.2 vs. 1.5 and 10.6 vs. 3.0, respectively; p < 0.05 both). Conversion rates for B/Phuket/3073/2013, B/Brisbane/60/2008, and A/HongKong/4801/2014/A/H3N2/ antigens were lower. Nonetheless, the protection rate was greater than 70% for all antigens contained in both vaccines. The proportion of individuals demonstrating a high level of both protection rate and response rate was greater after the first than the second vaccination. We conclude that the immunological response after influenza vaccination is good in elite athletes and remains so after a second influenza vaccination required due to a different vaccine composition recommended for different hemispheres.

Prevalence of Inadequate Immunity to Measles, Mumps, Rubella, and Varicella in MLB and NBA Athletes

BACKGROUND

Multiple outbreaks of vaccine-preventable viral diseases have occurred in professional sports in recent years. Currently, there is no established protocol for vaccination or immunity screening for professional athletes.

HYPOTHESIS

There are significant differences in the prevalence of inadequate immunity dependent on age, sport, country of birth, and participation in collegiate sports.

STUDY DESIGN

Cross-sectional cohort study.

LEVEL OF EVIDENCE

Level 4.

METHODS

A sample of Major League Baseball (MLB) and National Basketball Association (NBA) players were screened for serologic evidence of immunity to measles, mumps, rubella, and varicella prior to the 2015 and 2016 seasons. The results were designated as adequate (immune) or inadequate (equivocal or nonimmune) based on laboratory criteria. Comparison with an age-matched control group was performed using data from the National Health and Nutrition Examination Survey (NHANES).

RESULTS

A total of 98 athletes (62 MLB, 36 NBA) were screened. The prevalence of inadequate immunity for any virus was 35.5% in MLB players and 33.3% in NBA players. There was a significantly greater risk of inadequate immunity to rubella (risk ratio, 6.38; P < 0.01) and varicella (risk ratio, 4.21; P < 0.01) in athletes compared with the age-matched NHANES population. Our analysis did not reveal differences in rates of immunity based on sport, country of birth (US born vs international), or participation in college athletics. There was a lower rate of inadequate immunity to varicella with increasing age (odds ratio, 0.72; P = 0.05).

CONCLUSION

One-third of athletes studied had inadequate immunity to 1 of the 4 viruses tested. Younger players had a significantly greater risk of inadequate immunity to varicella. Birth outside the US and lack of participation in college athletics were not found to influence immunity rates.

CLINICAL RELEVANCE

These results can inform the development of future screening programs to prevent outbreaks of viral infections in professional athletes.

Pertussis outbreak in Polish shooters with adverse event analysis

In addition to different injuries, infections are the most common reason for giving up training altogether or reducing its volume and intensity, as well as a lack of opportunities to participate in sports competitions. Nowadays, a slow but constant re-emergence of pertussis, especially among teenagers and young adults, including athletes, can be observed. This paper describes an outbreak of pertussis among professional Polish shooters, focusing on the transmission of Bordetella pertussis infection between members of the national team, its influence on performance capacity and adverse event analysis. From 9 June, 2015 to 31 July, 2015, a total of 4 confirmed and suspected cases of pertussis were reported among members of the Polish Sport Shooting National Team, their relatives and acquaintances. Pertussis significantly decreased exercise performance of the first athlete, a 35-year-old woman, interrupted her training, and finally resulted in failure to win a medal or quota place. Pertussis also significantly decreased performance of the second athlete, a 25-year-old shooter. The other cases emerged in their families. Whooping cough is a real threat to athletes and should be prevented. Preventive measures include appropriate immunization, constant medical supervision, as well as early isolation, diagnostic tests and treatment of all infected sport team members. Regular administration of booster doses of the acellular pertussis vaccine (Tdpa) every 5 years seems reasonable.

Sports: The Infectious Hazards

Although the medical complications of sports are usually traumatic in nature, infectious hazards also arise. While blood-borne pathogens such as HIV, hepatitis B, and hepatitis C, cause significant illness, the risk of acquiring these agents during sporting activities is minimal. Skin infections are more commonplace, arising from a variety of microbial agents including bacterial, fungal, and viral pathogens. Sports involving water contact can lead to enteric infections, eye infections, or disseminated infections such as leptospirosis. Mumps, measles, and influenza are vaccine-preventable diseases that have been transmitted during sporting events, both in players and in spectators. Prevention is the key to many of these infections. Players should be vaccinated and should not participate in sports if their infection can be spread by contact, airborne, or droplet transmission.