Medical challenges of travel - risk of illness / infections and injuries

Transcription

1 IOC Advanced Team Physician Course 2018, Marrakech, Morocco 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 Director: Sport, Exercise Medicine and Lifestyle Institute (SEMLI) Director: of South Africa

2 Travel medicine sports medicine Medical hazards of travel 3 questions!! 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?

3 Is international travel related to an increased risk of injury? Super 14 Rugby tournament Sevens World Rugby Series Schwellnus M, Derman W, et al, BJSM 2012; 46; Fuller, C et al, BJSM 2015; 49;

4 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;

5 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;

6 Travel medicine sports medicine Medical hazards of travel 1. Does international travel increase the risk of injury? No Either no, or not enough data 2. Does international travel increase the risk of illness? 3. Are strategies to prevent illness during travel effective?

7 Is international travel related to an increased risk of illness / infections? Super 14 Rugby tournament Cross country skiing Paralympic Summer Games Schwellnus M, Derman W, et al, BJSM 2012; 46;

8 Is international travel related to an increased risk of illness / infections? March Super Rugby tournament

9 Super Rugby tournament: 259 elite rugby players from 8 teams 16-week competition period ( player days) Multiple travel (east-west and west-east) Outcomes: Travelling and the Super 14 Rugby tournament in 2010 Does international travel increase the incidence of illness in rugby union players participating in a 16-week tournament? 1. Incidence of injury (away and home) 2. Incidence of illness in 3 time periods: Baseline: Before travelling Travel: After travel > 5hrs time zone difference Return After return to home country Schwellnus M, Derman W, et al, BJSM 2012; 46;

10 International travel and all illness Super Rugby 2010 Schwellnus M, Derman W, et al, BJSM 2012; 46;

11 International travel and infective illness Schwellnus M, Derman W, et al, BJSM 2012; 46;

12 International travel and illness by systems Super 14 rugby tournament Respiratory tract Gastro-intestinal tract Schwellnus M, Derman W, et al, BJSM 2012; 46;

13 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 symptoms Svendsen I, et al, BJSM 2016; 50;

14 Illness at the London 2012 Paralympic Games and country clusters: Respiratory illness/1000 athlete days 2,7 2X 3X 1,3 3,2 3X 3,9 3-6X 4,3 X 4,0 8,2 X

15 Ongoing Super Rugby Illness Study (From 2010 to date) Preliminary data (Home and away: )

16 Travel medicine sports medicine Medical hazards of travel 1. Does international travel increase the risk of injury? No Either no, or not enough data 2. Does international travel increase the risk of illness? Yes 2-3 X higher risk 3. Are strategies to prevent illness during travel effective?

17 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 hand shaking Are these measures Probiotics 4. Planning of medical support effective? medical kit, nutrition, fluids 5. Establish contact with medical 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)

18 Super Rugby Illness Prevention Study: 2010 to date First results published in mid Now a 7-year prospective data (2010 to 2016) player days End of 2012 Consensus: Illness prevention program implemented o Pre intervention: o Post intervention:

19 Super Rugby Illness Prevention Study: Preliminary data Illness prevention > 50% reduction in incidence

20 Super Rugby Illness Prevention Study: Preliminary data Illness burden reduced by 36% following intervention

21 Super Rugby Illness Intervention ( ) Intervention strategies resulted in: 1. > 50% reduction in overall illness incidence ( ) Reduction in respiratory system, GIT and dermatological system illness Reduction in infective illness 2. Reduction of 36% in illness burden

22 Travel medicine sports medicine Medical hazards of travel 1. Does international travel increase the risk of injury? No Either no, or not enough data 2. Does international travel increase the risk of illness? Yes 2-3 X higher risk 3. Are strategies to prevent illness during travel effective? Yes requires confirmation in other settings / studies

23 Thank you for your attention