Vaccination in Elite Athletes

Abstract

Public health vaccination guidelines cannot be easily transferred to elite athletes. An enhanced benefit from preventing even mild diseases is obvious but stronger interference from otherwise minor side effects has to be considered as well. Thus, special vaccination guidelines for adult elite athletes are required. In most of them, protection should be strived for against tetanus, diphtheria, pertussis, influenza, hepatitis A, hepatitis B, measles, mumps and varicella. When living or traveling to endemic areas, the athletes should be immune against tick-borne encephalitis, yellow fever, Japanese encephalitis, poliomyelitis, typhoid fever, and meningococcal disease. Vaccination against pneumococci and Haemophilus influenzae type b is only relevant in athletes with certain underlying disorders. Rubella and papillomavirus vaccination might be considered after an individual risk–benefit analysis. Other vaccinations such as cholera, rabies, herpes zoster, and Bacille Calmette–Guérin (BCG) cannot be universally recommended for athletes at present. Only for a very few diseases, a determination of antibody titers is reasonable to avoid unnecessary vaccinations or to control efficacy of an individual’s vaccination (especially for measles, mumps, rubella, varicella, hepatitis B and, partly, hepatitis A). Vaccinations should be scheduled in a way that possible side effects are least likely to occur in periods of competition. Typically, vaccinations are well tolerated by elite athletes, and resulting antibody titers are not different from the general population. Side effects might be reduced by an optimal selection of vaccines and an appropriate technique of administration. Very few discipline-specific considerations apply to an athlete’s vaccination schedule mainly from the competition and training pattern as well as from the typical geographical distribution of competitive sites.

Vaccinations among athletes: evidence and recommendations

“…In scientific literature the theme of vaccinations of athletes is not largely studied and over the last 30 years only 18 papers are available in PubMed using the following key words: 'vaccine and athletes', 'vaccine and sport', 'vaccination and athletes', 'vaccination and sport' [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. We considered only articles in English in which the main topic (or the only topic) was related to immunization strategies or concerns for athletes.…”

“…Moreover, infections have a different significance in competitive sports. For elite athletes even mild diseases, that would never cause absenteeism in the general population, are relevant for their individual performance and because team coaches tend to leave them on the bench in case of infection [4]. A diarrhea or an upper respiratory infection is not a serious problem for a healthy young adult, but it can be very serious for an international athlete the day before the World Cup Final: due to this apparently mild disease, he could miss or fail the most important appointment in his life, e.g.…”

“…Strong and particular recommendations have been formulated for tetanus, in particular for athletes who have potential contacts with soils contaminated with C. tetani and who are at risks of lesions (e.g. horse racing, cross-country) and hepatitis B, above all in sports with possible contact to blood and body fluid such as football, boxing and hockey [3,4]. In addition, athletes should be the of annual influenza immunization campaigns because of the sharing of overcrowded environments and the advantages of a healthy status for their performances; it is favorable to clarify that in several countries, annual flu vaccination is recommended only for oldest persons or subjects affected by chronic diseases and not for young adults, such as athletes [3].…”

“…Gärtner and Meyer [4] underlined that the risks of adverse events following immunization are aggravated in athletes for immunological factors as it is for the risk due to infection, and they recommended several risk-benefits evaluations before the vaccination, but their observations did not seem to be based on rigorous data.…”

Yellow Fever and Traveling Athletes: Is Competing in Brazil Safe?

“…The risk of infectious diseases can be even higher in elite athletes due to their intense travel routine (Gärtner and Meyer, 2014) added to the exposure to different types of the environment where these athletes train (Turbeville et al, 2006). …”