Upper respiratory tract infections ("common cold") remain the commonest acute illnesses in elite athletes. Numerous studies on exercise immunology indicate that intense exercise may boost susceptibility to respiratory infections. However, there are limited Virological data to support that view, and several fundamental questions still need to be answered. 

Immunity to respiratory viral infections is highly complex, and no evidence exists that minor short- or long-term alterations in immunity in elite athletes have clinical implications. Moreover, the degree to which respiratory viruses infect athletes remains unclear. During major sports events, athletes possess an increased risk of symptomatic infections generated by the same viruses, similar to the general population. The symptoms usually remain mild and self-limiting. Although there are anecdotal reports that athletes exercise and compete with respiratory viral infections, no studies have been conducted to determine whether such activities would affect the illness or performance. There remains a risk of myocarditis. We still need to know about the simple mitigation procedures which are crucial for the effective control of seasonal respiratory viral infections.

Some Strategies have been recommended to prevent respiratory viral infections in athletes. To minimize viral transmission in everyday life, they must be aware of high-risk viral seasons, avoid interactions with individuals who have common colds, opt for a fist bump instead of a handshake and practice careful hand hygiene. Moreover, during traveling and competitions, they must follow universal masking, minimize shared housing and meal sharing, avoid close physical contact, crowds, and high-touch surfaces, use disinfection and isolate themselves if they have a common cold.

Furthermore, the athletes must also know how to keep up immunity. They must balance training load and recovery, avoid undernutrition and keep a relative energy balance, consume evidence-based supplements (vitamins D and C), get a regular sleep of 7–8 h per night, get professional guidance for maintaining a proper diet, manipulate gut microbiome with prebiotics, probiotics, and postbiotic and get vaccinated (e.g., pneumococcal, influenza, COVID-19).

Yet, there is a need to conduct high-quality research in collaboration with infectious diseases and sports medicine communities to improve the knowledge of respiratory infections in athletes.

Ruuskanen O, Luoto R, Valtonen M., et al. Respiratory Viral Infections in Athletes: Many Unanswered Questions. Sports Med. 2022;52:2013–2021. https://doi.org/10.1007/s40279-022-01660-9