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Sports Medicine Update IOC Advanced Team Physician Course 2017, Antalya, Turkey Medical challenges of travel - risk of illness / infections and injuries Prof. Martin Schwellnus Professor of Sport and Exercise Medicine, Faculty of Health Sciences, University of Pretoria, South Africa IOC Research Centre Travel medicine – sports medicine Medical hazards of travel 1. Does international travel increase the risk of injury? 2. Does international travel increase the risk of illness? 3. Are strategies to prevent illness during travel effective? IOC Research Centre Incidence of illness during the 2010 Super 14 Rugby tournament For a team physician taking care of a 30 player squad: 1. > 70% of players will report an illness during the 16 week tournament 2. A team physician will see 1 illness every 1.6 days 3. Respiratory, gastrointestinal and dermatological conditions are common 4. Infections are common 5. > 50% of illnesses were reported more than 24 hours after onset of symptoms (NB: preventing spread, early isolation) Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504 IOC Research Centre Travelling and the Super 14 Rugby tournament Super Rugby tournament: •259 elite rugby players from 8 teams •16-week competition period (22 676 player days) •Multiple travelDoes (east- westinternational and west-east) travel increase the incidence of injury and illness in Outcomes: 1. Incidencerugby of injury union(away and playershome) participating in 2. Incidence of illness in 3 time periods: •Baseline: Before travellinga 16-week tournament? •Travel: After travel > 5hrs time zone 11 hours difference •Return – After return to home country Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504 IOC Research Centre Is travelling related to an increased risk of injury? Super 14 Rugby tournament Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504 IOC Research Centre Travel and the incidence of time loss injuries during the 2012 Super Rugby tournament (per 1000 playing hours) No significant differences in injury risk between home and away location Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504 IOC Research Centre Travel and the incidence of injuries during the Sevens Rugby World Series There was no evidence to suggest that players were exposed to a greater risk of injury following extensive air travel and crossing multiple time zones Fuller, C et al, BJSM 2015; 49; 458-494 IOC Research Centre Is travelling related to an increased risk of illness / infections? Super 14 Rugby tournament Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504 IOC Research Centre Travel and all illness Baseline Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504 IOC Research Centre Travel and all illness Travel (> 5 time zones) incidence Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504 IOC Research Centre Travel and all illness Return to home country Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504 IOC Research Centre Travel and infective illness Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504 IOC Research Centre Travel and illness by systems Super 14 rugby tournament Respiratory tract Gastro-intestinal tract Schwellnus M, Derman W, et al, BJSM 2012; 46; 499-504 IOC Research Centre Air travel and risk of respiratory tract and GIT illness in elite cross-country skiers 37 elite cross-country skiers, 9 years, 7016 person–weeks Variables: training, competition, air travel, altitude, performance level, sex, season Air travel and competition were major risk factors for acute respiratory tract and gastrointestinal symtoms Svendsen I, et al, BJSM 2016; 50; 809-815 IOC Research Centre Illness at the London 2012 Paralympic Games and country clusters: Respiratory illness/1000 athlete days 3X 1,3 4,3 2,7 3,9 2X X 3X 3,2 3-6X 4,0 8,2 X IOC Research Centre Practical clinical advice to reduce illness in the travelling athlete 1. Be aware of the higher risk periods for illness (? It is the destination not the travel) 2. Knowledge of expected illness and types 3. Travelling: • Know the destination (altitude, pollution, allergens, food) • Medical screening of athletes (respiratory illness, allergies, past history of illness, dermatological screening) • Vaccinate / chemoprophylaxis • Hand sanitizers • Avoid handAre shaking these measures • Probiotics 4. Planning of medical support – medical kit, nutrition, fluids 5. Establish contact with medicaleffective? colleagues/services in destination countries 6. Educate athletes • Foods – e.g. bottled water, unpeeled fruits • Report symptoms early (isolation) • Personal hygiene (e.g. hand washing / sanitizers) IOC Research Centre Thank you for your attention IOC Research Centre.
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