Tennis Pros and Yellow Fever: Is Competing in Brazil Safe?

Is the ATP World Tour unintentionally exposing elite athletes to infectious diseases?

As the men’s tennis tour completes its Brazilian swing, pro players may not know the consequences of a Yellow Fever infection.

The risk of catching Yellow Fever in Brazil is substantial, as it became an epidemic during 2017, according to the World Health Organization.

In the current outbreak in Brazil, all human cases of yellow fever have been linked to Haemagogus and Sabethes mosquitoes.

São Paulo and Rio de Janeiro are 2018 tennis tournament locations and are now considered endemic areas for the Yellow Fever virus.

Which means, tennis athletes, tourists, and spectators traveling to Brazil should be aware of vaccination recommendations and prevention suggestions.

The tennis community is at an increased risk…. Because they are outside, along with the Haemagogus and Sabethes mosquitoes, which are vectors for Yellow Fever.

As of February 16, 2018, Brazil's yellow fever vaccination campaign has vaccinated 4.3 million persons (3.9 million persons with fractional doses and 379 900 persons with standard doses). This figure represents 21% of the planned 20 million persons targeted for vaccination within the two states.

"Both the ATP and ITF make frequent recommendations regarding player safety when traveling, but country-specific immunization decisions are left up to the individual', said Josh Hagar, current pro tennis player, former Captain of Notre Dame University's tennis team, and a graduate of the Austin Tennis Academy.

"The only time pro tennis players would be required to get a vaccine is when it's integral to the visa process to enter a country. In the case of Brazil and Yellow Fever, it's only recommended that individuals should get the vaccine, not required.”

“Therefore, a lot of players probably enter the country without proper precautionary immunizations," said Hagar.

Both the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), have issued travel alerts for Brazil.

And some countries are requiring proof of immunization before entering the country.

Yellow Fever is a single-stranded RNA virus that belongs to the genus Flavivirus. 

Humans infected with this virus experience the highest levels of viremia after exposure, and there is an incubation period of 3 to 6 days.

The infection can occur in two phases, with the following signs and symptoms:

• First (acute): fever, muscle pain, headache, shivers, appetite loss, nausea, and vomiting. In this case, most people get better after 3 to 4 days;
• Second (15% of the cases, more toxic phase, fast progression, and approximately 24 hours of remission): high fever,  jaundice, abdominal pain, vomiting, bleeding mouth, nose and eyes, presence of blood in the vomit and feces, and kidney function deterioration. People who enter this phase (50%) may die within 10 to 14 days.

Although there is no specific treatment for yellow fever, the disease can be prevented with a vaccination, at least 10 days before visiting an endemic area.

In the USA, Sanofi Pasteur received FDA approval to distribute the STAMARIL® Yellow Fever Vaccine through an Expanded Access Investigational New Drug Program during the YF-VAX vaccine shortage, which may end in late 2018.

Considering how easy pro tennis athletes can travel internationally, the dissemination of accurate information about yellow fever is necessary to help prevent infections among athletes if they decide to compete in a country with endemic yellow fever areas, such as Brazil, reported Dr. Tim Wood, Glenferrie Private Hospital, Australia.

Various pharmacies offer the STAMARIL and YF-VAX vaccines, as well as other travel vaccines.

Over 200 national tennis federations are affiliated with the International Tennis Federation, the governing body for tennis. The standard of medical care provided by each national federation to its tennis players various enormously.

Pro players should prepare for future tennis tournaments located in infectious disease hot-spots, such as:

• Hepatitis A:  Southern California
• Zika:  Miami
• Measles: Italy

The CDC Vaccine Price List provides the private sector prices and general information, and discounts can be found here.