Flu Nipped in the Bud at the Olympics

A system for early detection and treatment of upper respiratory infections at the 2002 Winter Olympics in Salt Lake City likely preserved some medals for at least one flu-ridden team. The system also has implications for quick, effective treatment of influenza in the general population, suggests a study being presented at the 40th Annual Meeting of the Infectious Diseases Society of America (IDSA).

"It was a beautiful example of really modern medicine -- we were able to diagnose and treat athletes and Olympics workers promptly, as well as prevent flu from infecting lots of folks who certainly would have gotten it," said Merle Sande, M.D., director of the internal medicine training program, professor of internal medicine at the University of Utah School of Medicine, Salt Lake City

and past president of the IDSA, who was involved with setting up the medical clinic at the Olympics. "I'm absolutely sure we salvaged some medals with this approach."

Taking advantage of two fairly recent developments -- rapid flu tests and anti-viral medications -- the strategy also has implications for decreasing the inappropriate use of antibiotics, he said. Over the years, athletes in the midst of competition and people in general often have been given antibiotics for cold or flu-like symptoms, often for lack of anything else to prescribe. Although some wintertime illnesses are caused by bacteria, the most common are viral, and antibiotics are ineffective because they attack bacteria, not viruses."With this strategy, we not only could prove to people that they had a viral rather than a bacterial infection, but we also could offer them the correct therapy quickly," said Adi V. Gundlapalli, M.D., Ph.D., adjunct assistant professor of infectious diseases at the University of Utah School of Medicine and principal investigator for the study. "Among people in close quarters -- such as those residing in the Olympic Village and in college dormitories -- the flu spreads like wildfire, so it's important to diagnose it early and nip it in the bud. Early treatment shortens and lessens the suffering for those who come down with the flu and also prevents others from getting it. Once people are treated, they're less likely to be contagious."

When athletes and other workers came to the Salt Lake Olympic Village Polyclinic complaining of flu-like symptoms -- including fever, chills, sore throat and body aches -- they were given two diagnostic tests for the flu, one ready in 20 to 30 minutes, the other in about six hours. If the physician's suspicion of influenza was high and/or either test was positive, the patient was prescribed oral oseltamivir, an anti-viral medication approved three years ago by the Food and Drug Administration (FDA). The polyclinic operated during the February Olympics and March Paralympics, for athletes with physical disabilities.

During the Olympics and Paralympics, the Polyclinic logged 729 primary care visits from athletes, coaches, security workers, employees and volunteers. Of these, 188 had significant upper respiratory system symptoms and were evaluated with the viral diagnostic tests. Tests confirmed influenza in 36 patients. Three athletic teams and one security team experienced flu outbreaks during the Olympics. Due to the confidentiality of the research, the specific teams treated cannot be named.

In a particularly dramatic example, a member of one Olympic team came to the clinic with typical symptoms during the games. The athlete was tested, found to have the flu and treated with oseltamivir. Four days later, three teammates came to the clinic with the same symptoms and were treated with oseltamivir, based on the physician's observations. As one-third of the team had flu symptoms, the rest of the team was started on oseltamivir to prevent flu infection. No one else on the team got sick; they went on to compete, and several medals were won.

"Quick effective treatment can really make the difference for elite athletes during major competitions," said Dr. Gundlapalli, who is also medical director of Wasatch Homeless Health Care, Inc., in Salt Lake City. "It's bad news if you get influenza two days before the competition. You've trained for four years and this could significantly affect your performance."

Although it's less dramatic, the same applies to the general population, said Dr. Gundlapalli. As patients with flu symptoms start seeing physicians, they can be given rapid tests to confirm the virus and then given an anti-viral medication. As others with the same symptoms visit their local physicians, diagnosis can be made without the test -- since flu has now been confirmed in the area and is quite contagious -- and medication started. Further, family members of those who are sick can be given the anti-viral medication to prevent them from getting the flu.

"If we use this system in the community, antibiotic resistance might almost disappear," said Dr. Sande. "In the Olympic clinic, only 15 percent of patients received antibiotics and most of these were prescribed for streptococcal pharyngitis, which is an appropriate use of these drugs. Nationally, more than half of patients going to the doctor for upper respiratory symptoms receive antibiotics."

The 2002 Winter Olympics strategy evolved from lessons learned during the previous winter games. In preparation for the 2002 games, Dr. Sande and Dr. Mark Elstad, medical director of the Olympic Polyclinic, visited Nagano, Japan, site of the 1998 Winter Olympics. Doctors there commonly prescribed antibiotics to athletes sick with cold- and flu-like symptoms. Although most of the doctors there were aware that most of the illnesses the athletes had likely were caused by viruses, the desperate athletes often demanded antibiotics in the hope that the medicine could help them.

"All we heard about at Nagano was that everyone's got the flu, everyone's sick," said Dr. Sande. "With the new advances, we thought we could bring all the technology to bear and treat them appropriately."

"This system could easily be applied to other major sporting events," said Dr. Gundlapalli. "Somewhere or other in the world, it's flu season."

In addition to Drs. Sande and Gundlapalli, co-authors of a paper on the topic being presented at IDSA are Michael Rubin, Bert Lopansri, Timothy Lahey, Heather Mcguire, Laura Davies, James Dunn, Kevin Winthrop, Stuart Willick, Randy Vosters, Joseph Waeckerle, Karen Carroll, Matthew Samore and Mark Elstad.IDSA is an organization of physicians, scientists and other health care professionals dedicated to promoting human health through excellence in infectious diseases research,

education, prevention and patient care. Major programs of IDSA include publication of two journals, The Journal of Infectious Diseases and Clinical Infectious Diseases, an Annual Meeting, awards and fellowships, public policy and advocacy, clinical affairs and other membership services. The Society, which has nearly 7,000 members, was founded in 1963 and is headquartered in Alexandria, Va.

Editor's note: Study numbers are current as of Oct. 14 and may change upon presentation at the IDSA Annual Meeting.