Prevention of infectious diseases in athletes

Epithelial barrier theory in the context of nutrition and environmental exposure in athletes

Exposure to toxic substances, introduced into our daily lives during industrialization and modernization, can disrupt the epithelial barriers in the skin, respiratory, and gastrointestinal systems, leading to microbial dysbiosis and inflammation. Athletes and physically active individuals are at increased risk of exposure to agents that damage the epithelial barriers and microbiome, and their extreme physical exercise exerts stress on many organs, resulting in tissue damage and inflammation. Epithelial barrier-damaging substances include surfactants and enzymes in cleaning products, laundry and dishwasher detergents, chlorine in swimming pools, microplastics, air pollutants such as ozone, particulate matter, and diesel exhaust. Athletes' high-calorie diet often relies on processed foods that may contain food emulsifiers and other additives that may cause epithelial barrier dysfunction and microbial dysbiosis. The type of the material used in the sport equipment and clothing and their extensive exposure may increase the inflammatory effects. Excessive travel-related stress, sleep disturbances and different food and microbe exposure may represent additional factors. Here, we review the detrimental impact of toxic agents on epithelial barriers and microbiome; bring a new perspective on the factors affecting the health and performance of athletes and physically active individuals.

Sports and Immunity, from the recreational to the elite athlete

The pivotal role of the immune system in physical activity is well-established. While interactions are complex, they tend to constitute discrete immune responses. Moderate intensity exercise causes leukocytosis with a mild anti-inflammatory cytokine profile and immunoenhancement. Above a threshold of intensity, lactate-mediated IL-6 release causes a proinflammatory state followed by a depressed inflammatory state, which stimulates immune adaptation and longer term cardiometabolic enhancement. Exercise-related immune responses are modulated by sex, age and immunonutrition. At all ability levels, these factors collectively affect the immune balance between enhancement or overload and dysfunction. Excessive training, mental stress or insufficient recovery risks immune cell exhaustion and hypothalamic pituitary axis (HPA) stress responses causing immunodepression with negative impacts on performance or general health. Participation in sport provides additional immune benefits in terms of ensuring regularity, social inclusion, mental well-being and healthier life choices in terms of diet and reduced smoking and alcohol, thereby consolidating healthy lifestyles and longer term health. Significant differences exist between recreational and professional athletes in terms of inherent characteristics, training resilience and additional stresses arising from competition schedules, travel-related infections and stress. Exercise immunology examines the central role of immunity in exercise physiology and straddles multiple disciplines ranging from neuroendocrinology to nutrition and genetics, with the aim of guiding athletes to train optimally and safely. This review provides a brief outline of the main interactions of immunity and exercise, some influencing factors, and current guidance on maintaining immune health.

Prevalence of Skin Injuries in Beach Volleyball Athletes in Greece

Background: Skin injuries often affect the sports community. Almost every type of athletic activity is associated with traumatic skin injuries, such as surface wounds, bruising, abrasions, subcutaneous hematomas, blunt trauma, nail injuries, friction burns, and blisters. Methods: The aim of this study was to assess the rates, location sites, and seasons of appearance of skin injuries in beach volleyball athletes in Greece. Seven hundred and eighty-five beach volleyball athletes participated in this study. The average age was 28.4 years. Skin injuries included superficial wounds (erosions, incisions, lacerations), deep wounds, hematomas, nail lacerations, friction burns, and friction blisters. The recorded variables encompassed gender, age, the time of year when athletes might be at higher risk of injuries, and the specific body regions affected. Additionally, data regarding training details such as years of practice, weekly training frequency, and daily training duration were also documented. Results: Incidence rates correlated to gender: (a) superficial wounds (p < 0.001), (b) years of training: hematomas (p < 0.001), and (c) average hours of daily training: superficial wounds (p < 0.001), deep wounds (p < 0.001), and friction blisters (p < 0.001). Conclusions: Although early detection, recognition, and treatment are essential, the prevention of skin injuries can also be linked to health and athletic performance.

Tetanus Vaccination Status and Vaccine Hesitancy in Amateur Basketball Players (Italy, 2020)

Basketball is among the third most popular team sport in Italy. Albeit not usually perceived as being at high risk for tetanus, the Italian legal framework (Law No. 292 of 1963; Presidential Decree 1301/1965) requires tetanus vaccination (TeV) even for amateur practice. Even though some previous reports have suggested a relatively low adherence towards vaccination practice among basketball player, corresponding knowledge, attitudes and practices towards TeV remain largely unknown. Our study specifically investigated such topics in a total of 270 amateur basketball players participating into an internet-based survey by completing a structured questionnaire. Of them, 73.0% had a proper vaccination status, but a third of respondents (33.3%) exhibited some degree of vaccine hesitancy. The average understanding of TeV and tetanus (79.8% with a potential range 0–100) as well as the risk perception for natural infection (63.9% ± 26.6) were quite good. Even though unmotivated fears towards TeV were more scarcely reported (14.0% ± 15.4), they still represented the main reasons for having missed vaccination shots (63.0%). Knowledge status and risk perception for natural infection and TeV were well correlated (R = 0.22 and R = −0.64, respectively). Appropriate TeV status was more likely in respondents not exhibiting vaccine hesitancy (Odds Ratio (OR) 0.114, 95% Confidence Interval (95%CI) 0.059–0.225). In turn, vaccine hesitancy was more frequently reported among individuals of male gender (OR 3.148, 95%CI 1.072–9.244), while better formal education (OR 0.065, 95%CI 0.013–0.319) and working in healthcare settings (OR 0.042, 95%CI 0.007–0.265) were characterized as negative effectors. Vaccinations in athletes represent an often overlooked issue, with a considerable lack of available evidence. The results stress the opportunity for appropriate TeV screening programs among amateur athletes and the potential relevance of interventions aimed at raising the perceived significance of TeV in order to cope with a significant share of vaccine-hesitant athletes.

Sports Injury and Illness Epidemiology: Thailand Team Surveillance During the 30th Southeast Asian Games

Background: Injury and illness surveillance in sports is the first step of the injury prevention model that generates effective injury prevention measures. Objectives: To identify the incidence, severity, and causes of injuries and illness in the Thailand national team during the 30th Southeast Asian (SEA) Games. Methods: All medical encounters were documented using the International Olympic Committee (IOC) injury and illness surveillance system for multi-sport events. We recorded the daily occurrence of injuries and illnesses reported by Thailand’s medical teams over the 12 days of the competition period. Results: Among 980 Thai athletes (568 male and 412 female), that participated in the 30th SEA Games, a total of 105 injuries and illnesses were reported. There were 84 injuries and 21 illnesses which equated to an incidence of 86 injuries and 21 illnesses per 1000 athletes. The most commonly injured body part was the lower leg (14% of all injuries), followed by the shoulder and clavicle. Ligament sprain or rupture and contusion (25% of all injuries) were reported as the most common type of injury. Of all injuries, 56 were classified as needing medical attention (only), 26 caused performance restriction, and two caused complete-time loss. The most common athlete illness was respiratory illness (48% of all illnesses) followed by gastrointestinal illness (19% of all illnesses). One-third (7 out of 21) of athlete illnesses restricted the athlete's performance, and the remaining 14 only required medical attention. Conclusions: Overall, 8% of athletes incurred at least one injury during the competition, and 2% suffered from an illness. Lower leg injury and respiratory illness were the most common, which is similar to other multi-sport events. Based on the research data, injury prevention, especially of ligamentous sprain and lower limb injuries, should be the focus in multi-sport events.

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.

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.

Methicillin-Resistant Staphylococcus aureus: Risk for General Infection and Endocarditis Among Athletes

The first studies on Staphylococcus aureus (SA) infections in athletes were conducted in the 1980s, and examined athletes that perform in close physical contact, with particular attention to damaged or infected skin. Recent studies have used molecular epidemiology to shed light on the transmission of SA in professional athletes. These studies have shown that contact between athletes is prolonged and constant, and that these factors influence the appearance of infections caused by SA. These results support the need to use sanitary measures designed to prevent the appearance of SA infections. The factors triggering the establishment of SA within professional sports groups are the nasal colonization of SA, contact between athletes and sweating. Hence, there is a need to use the most modern molecular typing methods to evaluate the appearance of cutaneous SA disease. This review aims to summarize both the current SA infections known in athletes and the diagnostic methods employed for recognition, pointing to possible preventive strategies and the factors that can act as a springboard for the appearance of SA and subsequent transmission between athletes.

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.

Medical assessment in athletes

Practicing sports at a professional level requires the body to be in good health. The fact of carrying out a continuous and high intensity physical activity in the presence of pathological conditions and/or a maladaptation of the body can be detrimental to the athletes' health and, therefore, to their performance. Many of the problems that arise in the sports field could be prevented with a periodic and well-structured medical assessment. In this review, we describe the protocol of the medical service of a high-level sports club for the assessment of its professional athletes.

Foodborne Illness Outbreak Investigation in a High-Profile Sports Club

A foodborne illness outbreak involving an elite sports team was investigated by a public health unit in Sydney, Australia. An epidemiological association was established between gastrointestinal illness and the consumption of food supplied by an external caterer, with a lamb meal most strongly associated with illness. Genetically identical Salmonella isolates were identified from clinical specimens, residual food items, and an environmental swab taken from the catering premises. The training schedule and other club operations were significantly affected by this outbreak. Increased susceptibility due to regular shared activities and the potential for significant impact upon performance indicates that sports clubs must ensure that food suppliers comply with the highest standards of hygiene. Collaboration with public health authorities assists in source identification and prevention of further transmission.

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.

Febrile illness in the athlete

CONTEXT

Acute febrile illnesses are common in athletes over the course of training and competition seasons. Complete recovery and rapid yet safe return to participation are critical for competitive athletes. Alterations in thermoregulation, metabolism, fluid homeostasis, muscle strength, and endurance, as well as potential complications for the athlete and others, must be considered.

EVIDENCE ACQUISITION

The PubMed database was searched (1970-2013) for all English-language articles related to febrile illness in sport, using the keywords fever, febrile, body temperature, thermoregulation, infection, illness, disease, exercise, athlete, sport, performance, return to play, metabolism, hydration, and dehydration.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 4.

RESULTS

Limited data confirm that febrile illness is correlated with alterations in the body's thermoregulatory system, with increases in metabolic rate, and with effects in fluid homeostasis. Human and animal studies demonstrate a decrease in muscle strength and endurance secondary to muscle catabolism in febrile illness. However, indirect evidence suggests that regular exercise enhances the immune response. No strong clinical research has been published on return to play during or following acute febrile illness, excluding mononucleosis and myocarditis.

CONCLUSION

Fever is correlated with an increase in insensible fluid losses, dehydration, metabolic demands, and dysregulation of body temperature. Fever can have detrimental effects on the musculoskeletal system, including decreasing strength and endurance, generalized muscle catabolism, and increase in perceived fatigue. Participating in strenuous exercise during febrile illness can worsen the illness and has demonstrated increased lethality in animal models. No consensus recommendations support return to activity before resolution of fever, and training should be resumed gradually once fever and dehydration have resolved.

National athletic trainers' association position statement: skin diseases

OBJECTIVE

To present recommendations for the prevention, education, and management of skin infections in athletes.

BACKGROUND

Trauma, environmental factors, and infectious agents act together to continually attack the integrity of the skin. Close quarters combined with general poor hygiene practices make athletes particularly vulnerable to contracting skin diseases. An understanding of basic prophylactic measures, clinical features, and swift management of common skin diseases is essential for certified athletic trainers to aid in preventing the spread of infectious agents.

RECOMMENDATIONS

These guidelines are intended to provide relevant information on skin infections and to give specific recommendations for certified athletic trainers and others participating in athletic health care.