Table 8

A summary of risk factors associated with ARinf in athletes with prevention measures that can be considered

Risk categorySpecific risk factorPrevention measure
Individual athlete (internal risk factors)Older age

  • Age is a non-modifiable risk factor but be aware that older athletes and staff are more susceptible to ARinf

Existing chronic respiratory conditions for example, allergies/asthma

  • Screening for respiratory conditions (eg, at preseason, preparticipation, ‘training camp’ setting before competitions)

  • Optimise treatment including medication

  • Implement monitoring

Existing other chronic diseases (eg, diabetes mellitus, obesity, hypertension, cardiovascular disease, chronic disease in other organ system)

  • In general, these conditions are uncommon in younger athletes but if present they are associated with increased risk of ARinf or more severe ARinf

  • Screening for chronic conditions (eg, at preseason, preparticipation, or at ‘training camp’ setting before competitions)

  • Optimise treatment including medication

  • Implement monitoring

Health conditions that reduce immune function (immunocompromised athlete for example, organ transplant, athletes with negative energy balance)

  • Increased awareness of risk

  • Optimise other modifiable risk factors

  • Consider probiotics, vitamin D, and vitamin C on an individual basis

Para athlete

  • Increased susceptibility to infection in sub-groups

  • Be aware of increased risk of transmission through use of adaptive equipment, low vision, or intellectual impairment (eg, ability to social distance)

Medications that negatively affect immune function (eg, systemic corticosteroids)

  • Increased awareness of risk following systemic corticosteroid injections or oral corticosteroid use

Confirmed recent exposure to athlete/staff/friend/family with ARinf

  • Increased risk of ARinf

  • Consider isolation

  • Consider vitamin C and Zinc supplementation to reduce duration

  • If pathogen is confirmed as influenza, consider anti-viral agents as prophylaxis

Reduced sleep (quantity and quality) and recovery

  • Adopt strategies that facilitate good quality sleep and correct sleep hygiene practices at night

General nutrition

  • Assess general nutritional status and implement personalised nutrition programmes

  • Consider probiotics, vitamin D, and vitamin C on an individual basis

Personal hygiene measures*

  • Educate athletes on personal hygiene measures (maintain physical distance when in contact with potential infected individual, be aware of and avoid high touch surfaces, regular hand washing/hand sanitiser use, wearing of appropriate face masks)

Home environmentIncreased risk to pathogen exposure in the social context

  • Increased awareness of risk in household/family setting (especially young children)

  • Consider isolation – as required

Sport typeEndurance sports

  • Increased awareness of risk

  • Consider periodic training load adjustments and increased monitoring

  • Optimise other modifiable risk factors

  • Consider probiotics, vitamin D, and vitamin C on an individual basis

Winter sports

  • Increased awareness of risk - greater monitoring

  • Optimise other modifiable risk factors

  • Consider probiotics, vitamin D, and vitamin C on an individual basis

Training/competition factorsIncreased training load

  • Increased awareness of risk

  • Consider periodic training load adjustments and increased monitoring

  • Consider probiotics, vitamin D, and vitamin C on an individual basis

Inadequate recovery

  • Diet, sleep education and monitoring, including personalised nutrition programmes

Increased exposure to a wider sport team and support staff

  • Reinforcing lifestyle and behavioural strategies.

  • Develop team ethos to minimising infection

Risk of transmission at the time of return-to-training and competition

  • Consider transmission risk mitigation strategies as athletes return-to-training following an ARinf for example, avoiding in-person team meetings and team dining, using face masks, and making use of outdoor training venues

  • Consider isolation of minimum of 3–4 days after symptom onset before return-to-training in a team setting

SeasonWinter season

  • Increased awareness of risk during winter seasons

  • Consider training load adjustment and increased monitoring

  • Optimise other modifiable risk factors

  • Consider probiotics, vitamin D, and vitamin C on an individual basis

VaccinationInfluenza, SARS-CoV-2 vaccination, pneumococcus

  • Encourage vaccination

  • Adhere to local, regional, national and international health and vaccination regulations

International travelIncreased risk of pathogen exposure (on flight during travel, at the destination, using public transport)

  • Encourage strict personal hygiene measures during long-haul and international travel

  • Encourage appropriate mask wearing

  • Be aware of higher risk seating positions on aircraft

  • Encourage limitation of movement around the cabin during flight

  • Consider probiotics, vitamin D, and vitamin C on an individual basis

Training and competition venuesIncreased risk of pathogen exposure - team and support staff

  • Increased awareness of risk transmission

  • Consider higher risk environments such as accommodation, venue, dining, transport, media, exposure to the public

  • Encourage personal hygiene measures and appropriate mask wearing

Epidemics/pandemicsBe aware of local and regional infectious disease patterns

  • Conduct a full risk assessment of the risk status in a geographical area

  • Plan and implement transmission risk mitigation strategies (eg, comply with full SARS-CoV-2 measures during the pandemic)

Poor ventilationPoor ventilation in indoor sports venues

  • Consider assessment and monitoring to ensure good ventilation at indoor sports venues

  • *Personal hygiene measures can be applied widely as a transmission risk mitigation strategy.