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Incidence of acute respiratory illnesses in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’
  1. Wayne Derman1,2,
  2. Marelise Badenhorst1,3,
  3. Maaike Maria Eken1,
  4. Josu Ezeiza-Gomez1,2,
  5. Jane Fitzpatrick4,
  6. Maree Gleeson5,
  7. Lovemore Kunorozva1,
  8. Katja Mjosund6,
  9. Margo Mountjoy7,
  10. Nicola Sewry2,8,
  11. Martin Schwellnus2,8
  1. 1 Institute of Sport and Exercise Medicine, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
  2. 2 International Olympic Committee Research Centre, Pretoria, South Africa
  3. 3 Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
  4. 4 Centre for Health and Exercise Sports Medicine, Faculty of Medicine Dentistry and Health Science, University of Melbourne, Parkville, Victoria, Australia
  5. 5 School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
  6. 6 Paavo Nurmi Centre, Sport and Exercise Medicine Unit, University of Turku, Turku, Finland
  7. 7 Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
  8. 8 Sport, Exercise Medicine and Lifestyle Institute, University of Pretoria, Faculty of Health Sciences, Pretoria, South Africa
  1. Correspondence to Professor Wayne Derman, Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa; ewderman{at}


Objective To determine the incidence of acute respiratory illness (ARill) in athletes and by method of diagnosis, anatomical classification, ages, levels of performance and seasons.

Design Systematic review and meta-analysis.

Data sources Electronic databases: PubMed-Medline, EbscoHost and Web of Science.

Eligibility criteria Original research articles published between January 1990 and July 2020 in English reporting the incidence of ARill in athletes, at any level of performance (elite/non-elite), aged 15–65 years.

Results Across all 124 studies (n=1 28 360 athletes), the incidence of ARill, estimated by dividing the number of cases by the total number of athlete days, was 4.7 (95% CI 3.9 to 5.7) per 1000 athlete days. In studies reporting acute respiratory infections (ARinf; suspected and confirmed) the incidence was 4.9 (95% CI 4.0 to 6.0), which was similar in studies reporting undiagnosed ARill (3.7; 95% CI 2.1 to 6.7). Incidences of 5.9 (95% CI 4.8 to 7.2) and 2.8 (95% CI 1.8 to 4.5) were found for studies reporting upper ARinf and general ARinf (upper or lower), respectively. The incidence of ARinf was similar across the different methods to diagnose ARinf. A higher incidence of ARinf was found in non-elite (8.7; 95% CI 6.1 to 12.5) vs elite athletes (4.2; 95% CI 3.3 to 5.3).

Summary/conclusions These findings suggest: (1) the incidence of ARill equates to approximately 4.7 per athlete per year; (2) the incidence of upper ARinf was significantly higher than general (upper/lower) ARinf; (3) elite athletes have a lower incidence of ARinf than non-elite athletes; (4) if pathogen identification is not available, physicians can confidently use validated questionnaires and checklists to screen athletes for suspected ARinf. For future studies, we recommend that a clear diagnosis of ARill is reported.

PROSPERO registration number CRD42020160472.

  • respiratory system
  • athletes
  • sports
  • exercise
  • epidemiology

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  • Twitter @wderman, @goipergormance, @sportsdocaus, @margo.mountjoy

  • Contributors WD, NS and MS conceived the study idea. MB, ME and LK completed the search. WD, MB, ME, JF, MG, LK, KM, MM and NS extracted and reviewed data from the studies included in the meta-analysis. NS performed the data analysis and data visualisation. All authors interpreted the data analysis, contributed to writing of the draft of the manuscript and approved the submitted version.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.