Travelling to China for the Beijing 2008 Olympic Games

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1 1 Anglesea Clini, Hamilton, New Zealand; 2 Worldwise Travellers Health, Hamilton and Aukland Clinis, New Zealand Correspondene to: Dr C J Milne, Anglesea Clini, PO Box 228, Hamilton, 3240 New Zealand; hris@ angleseaphysioandsports.o.nz Aepted 6 Marh 2008 Published Online First 1 April 2008 Travelling to China for the Beijing 2008 Olympi Games C J Milne, 1 M T M Shaw 2 ABSTRACT The Beijing Olympis will be the world s premier sporting event in Countries should begin planning for appropriate support for their Olympi athletes. Experiened medial staff should be appointed early and beome familiar with the major medial or injury onerns of athletes and offiials. Teams should assemble a omprehensive medial kit. Appropriate medial advie an ensure that athletes will arrive in Beijing in optimal ondition. Medial issues partiularly relevant to ompetitors at the Beijing Olympis inlude heat and humidity, waterborne diseases and air pollution. However, the air pollution probably represents less of a threat than previous media reports would indiate. The Olympi village and venues an be thought of as small enlaves loated within a rapidly developing ountry. The 26th modern Olympi Summer Games, onduted only one every 4 years sine 1896, will be held in Beijing, China on 8 24 August There will be approximately 28 major and 302 minor events in 37 venues in Beijing, Hong Kong, Qingdao, Qinhuangdao, Shanghai, Shenyang and Tianjin. The Games in Beijing will play host to the 28 summer sports urrently on the Olympi programme. Approximately athletes are expeted to partiipate in the Games, with around aredited media bringing the Games to the world and up to several hundred thousand spetators at any one time. 1 A piture of the main stadium, dubbed the bird s nest, under onstrution is shown in fig 1. This paper fouses on relevant health and safety issues for athletes and team staff who will be travelling to the Games. It is based on the best available published evidene from the sports mediine and travel medial literature and the personal experienes of the authors, eah of whom has travelled to Beijing in the past 12 months. It needs to be remembered that irumstanes an hange and that travellers should seek up-to-date travel health advie for China at least 1 month before their departure. PREPARATORY PHASE Although most Olympi teams will develop their own medial plans for their sports men and women, it is important that this inludes information on travel health issues. An exellent review for the travelling athlete has been published elsewhere, 2 although it should be borne in mind that this was speifially written for the 1998 Commonwealth Games in Kuala Lumpur, Malaysia. Areas whih need to be overed inlude personal health issues (inluding sexual health), a Original artile dental assessment, immunisations, advie on inset avoidane and malaria prevention, jet lag, ulture shok and alimatisation. In addition, managing personal stress, personal and team medial kits, female health issues, managing finanes and personal seurity are important issues. Dietary advie for travellers, inluding travelling athletes, has been disussed elsewhere. 3 Immunisations All those travelling to China for the Games need to ensure that their routine immunisations are up to date. While there are no legally required vainations for travel to the ountry, 4 all travellers need to be offered vaination against ommon foodborne and/or water-borne illnesses suh as typhoid and hepatitis A virus, partiularly if they are travelling to other less developed ountries in the region. In addition, serious onsideration needs to be given to four other vaines: Influenza Japanese B enephalitis Rabies Hepatitis B Influenza is a disease that remains the most vaine-preventable on the globe. Athletes, like other travellers, tend to be prone to respiratory trat infetion during travel, training and in the Olympi Village. This vaination would be partiularly useful for athletes from ountries in the southern hemisphere who have to return to old wintery onditions. Vaination against Japanese B enephalitis should be onsidered for those going to Shunyi Olympi rowing-anoeing park, an area near to agriultural land and pig farms where mosquitoes remain a onern. Reent advie from the Communiable Diseases Centre (CDC) in Atlanta, USA is that the threat is not suffiient to onsider routine vaination for all rowing and anoe/kayak ompetitors and offiials (E Walkley, personal ommuniation). The experiene of one author (CM) at the World Rowing Junior Championships held at the Shunyi ourse would tend to bear this out. The third vaine to be onsidered, partiularly in the Beijing region, is rabies. This disease was the leading ause of death due to infetious diseases in China from May 2006 to Marh Whether the vaine is used or not, all travellers should be advised about what they are to do if bitten by any suspet mammal. This is overed below. Finally, athletes in partiular ontat sports suh as boxing may be required to have vaination against hepatitis B virus. Br J Sports Med: first published as /bjsm on 1 April Downloaded from on 13 June 2018 by guest. Proteted by opyright. Br J Sports Med 2008;42: doi: /bjsm

2 Original artile Figure 1 National stadium ( bird s nest ), Olympi Green, Beijing: venue for trak and field events, football and the opening and losing eremonies. Other important seasonal and speifi disease information for travellers There are a number of diseases speifi to the region of whih travellers need to be aware. 5 Although the risk for them may be low, preautions and preventive measures are advised at all times. AIDS/HIV China s overall burden of HIV and AIDS is low. 6 An estimated people in China (less than 0.05% of the total population) were living with HIV at the end of Heterosexual transmission is overtaking injetion drug use as the dominant mode of HIV transmission. Avian flu Sine Deember 2003 there have been instanes of avian flu among poultry in south-east Asia. While it is unusual for humans to get influenza virus infetions diretly from poultry or birds, there have been 25 human ases of the disease with 16 deaths. 7 Travellers are thus advised to avoid plaes suh as poultry farms and bird markets where live poultry are raised or kept, and to avoid ontat with sik or dead poultry. Cholera Immunisation is not internationally required by the World Health Organization. The risk to travellers attending venues of the Olympi Games is negligible and therefore the vaine is not routinely reommended. Dengue fever Dengue ours as frequent, often widespread, outbreaks. The inidene is highest in south-eastern China. There is an inreased risk in oastal urban areas below 1500 metres elevation. Most disease transmission ours during the summer months. Prevention of dengue fever onsists of taking protetive measures against mosquito bites. Food and water Outside the Games venues, awareness of water-borne and foodborne problems is advisable. It is our reommendation that all drinking water should be onsidered a potential health risk and sterilisation is advisable. Bottled water will be available at all venues and at stores throughout China. All meat, poultry and seafood must be well ooked and served while hot. Vegetables should be well ooked and served hot. Salads and mayonnaise are best avoided. The experiene among three teams at the World Rowing Junior Championships in August 2007 in Shunyi was favourable. Among three teams of rowers totalling over 100 athletes who ate at the designated hotel and venue exlusively, there were only two ases of gastrointestinal upset in a 2-week period (C J Milne, unpublished data). Influenza Influenza is highly seasonal and in Beijing the epidemi season ranges from Otober to Marh. The flu vaine is advised for travellers aged.50 years, those with hroni disease or a weakened immune system and those ompetitors who wish to have it. Japanese enephalitis The risk of Japanese enephalitis is greatest in rural pig-breeding agriultural areas of the entral and eastern provines, espeially during the warm rainy months from May to September. There is a low risk of transmission in urban areas due to the relative absene of mosquitoes, but the area of Shunyi is an at-risk region for the disease and vaination against Japanese enephalitis has been reommended for travellers who will be attending the water sports in the region. 8 However, reent CDC advie is that routine immunisation for travellers to the Shunyi venue may not be required (E Walkley, personal ommuniation). Leishmaniasis Viseral leishmaniasis (kala azar) ours in the temperate entral and north-eastern provines. Most ases have bee reported from Gansu Provine; utaneous leishmaniasis has been reported from the Xinjiang autonomous region. All travellers to these areas should avoid being bitten by sand flies. Malaria The risk of malaria for travellers to the sports venues during the Olympi Games will be negligible. 4 For those travelling to other regions of the ountry, malaria ours in Hainan, Yunnan, Anhui, Henan, Hubei and Jiangsu. There is no malaria risk in urban areas, in the densely populated plain areas or at altitudes above 1500 metres. 4 9 If travellers are planning side trips to risky areas, they need to be advised to adhere to appropriate malaria hemoprophylaxis and areful personal protetive measures. 10 Rabies The inidene of rabies in China is seond in the world after India. In 2006 there were 3200 ases of rabies were reported, with people in Beijing having sustained animal bites. From May 2006 through to Marh 2007, rabies was the number one ause of death due to infetious diseases. 8 All animal bites or srathes, espeially from a dog, should be taken seriously and immediate medial attention sought. Aess to rabies vaine or Br J Sports Med: first published as /bjsm on 1 April Downloaded from on 13 June 2018 by guest. Proteted by opyright. 322 Br J Sports Med 2008;42: doi: /bjsm

3 Original artile rabies immune globulin may require emergeny evauation to another ountry. Rabies is rare among tourists. Sudden aute respiratory syndrome (SARS) The sudden aute respiratory syndrome (SARS) is not urrently onsidered to be a risk for travellers to the ountry. Shistosomiasis There is a risk of shistosomiasis throughout the year in southern tropial areas and from June through August in temperate areas. Major endemi areas inlude the Yangtze River Valley, inluding tributaries and adjaent lakes. In 2003 alone, Chinese were infeted, most of them living in frequently flooded areas along the Yangtze River where the arrier snail has an ideal habitat, aording to reports. 5 All travellers should avoid swimming, wading or bathing in freshwater lakes, ponds or streams. Travellers diarrhoea All travellers are advised to ensure strit food and water hygiene. Tap water is not reommended, even in the resort hotel regions. Bottled water, whih is readily available, should be used. If travellers diarrhoea ours, a high intake of nonaloholi fluids suh as sports drinks should be maintained and dairy produe avoided. Diarrhoea not responding to treatment with an antibioti or hroni diarrhoea may be due to a parasiti disease suh as giardiasis, amoebiasis or ryptosporidiosis. TRAVEL PHASE Jet lag and sleep pattern Jet lag ours when there is desynhrony between normal daily rhythms and the loal environment. As the natural daily rhythm is about 25 h, travel in an easterly diretion tends to produe greater jet lag as it ompresses a 24 h day. Medial publiations on travel offer varying advie on the use of mediation to minimise the effets of time zone hange. Yung et al 11 reommend that melatonin 3 5 mg should be taken at Box 1 General travel guidelines Plan to travel to the venue at least 1 week before ompetition begins. Take books, magazines and your own preferred musi in your arry-on bag. Be aware that reently introdued regulations severely limit the ability of travellers to take extra fluids on international flights. Generally, these must be purhased air-side at the airport from whih you depart. Exerise during the flight. Streth in your seat and get up and walk down the aisle of the airraft every few hours. Adjust your wath to the time of your destination during the flight at a time when you are devoid of environmental ues. Eye shields, ear plugs or relaxing musi played over the airraft or one s own personal sound system are all useful adjunts to promoting sleep. Try to arrive at the destination during daylight hours as natural light an help in resetting the body lok to loal Beijing time. If there is suffiient time after areditation has been ompleted, try to omplete an easy training session. bedtime (loal time) starting the first evening after arrival and ontinuing for the next 5 days. In ontrast, the World Health Organization does not reommend melatonin but suggests that short-ating sedatives may be used. 12 These are used routinely by members of teams ompeting in the Super 14 international rugby ompetition. 13 Arguably, this annual ompetition involves travel over the most time zones of any in world sport. Elite athletes an perform with distintion, even after roundthe-world travel. 14 Venous thromboembolism Previous experiene with teams travelling long distanes to the Sydney Olympis in 2000 has shown an inidene of deep vein thrombosis (DVT) of about 1% (R Budgett, personal ommuniation). Findings of the reent WRIGHT epidemiologial studies indiate that the risk of venous thromboembolism (VTE) approximately doubles after a long-haul flight (.4 h) and also with other forms of travel where travellers are exposed to prolonged seated immobility. The risk inreases with the duration of the travel and with multiple flights within a short period. 15 Other risk fators identified were obesity, extremes of height, use of oral ontraeptives and the presene of prothromboti blood abnormalities. Nevertheless, the absolute risk of VTE per.4 h flight in a ohort of healthy individuals was relatively low (1 in 6000). For those people at high risk of DVT, a preventive strategy therefore needs to be in plae well in advane of travel to China. We advise use of pressure stokings plus low moleular weight heparin in seleted ases. General guidelines for travel to and from the venue are listed in box 1. VILLAGE PHASE Arrival Team members arriving in Beijing after long flights an be expeted to be tired and fratious. However, all team personnel must first go through the proess of areditation. Although this proess has been progressively streamlined, there may still be a delay of several hours before they arrive at the Olympi Village. To smooth the areditation proess it is imperative that all athletes and offiials aurately omplete doumentation for their National Olympi Committee (NOC) in good time for it to be forwarded to the Beijing Organising Committee for the Olympi Games (BOCOG). Beijing International Airport is approximately 20 km from the Olympi Village. Team members an expet the trip to take up to 2 h, espeially at peak times. Beijing, like other Olympi host ities, will be making strenuous attempts to failitate travel for members of the Olympi Family, but delays are inevitable in a ity of 15 million people. On arrival at the Olympi Village it is suggested that all teams adjust to loal time as quikly as possible. Avoid the temptation to sleep during the day as this will delay the establishment of a normal sleep/wake yle at the Village and prolong any symptoms of jet lag. The Olympi Village experiene For any athlete, partiularly the first-time Olympian, living in the Olympi Village an be an intimidating prospet. An exellent analysis by Miller was published in Gold Minds. 16 Steve Sott, Amerian middle distane runner said: The pressure at the Games is onstant day after day. It s like a tourniquet. The loser it got, the harder it was to relax. Surviving and indeed maximising the Village experiene is of Br J Sports Med: first published as /bjsm on 1 April Downloaded from on 13 June 2018 by guest. Proteted by opyright. Br J Sports Med 2008;42: doi: /bjsm

4 Original artile vital importane if one is to ompete well. Teams should make an effort to make their quarters a small part of home as this is appreiated by athletes and helps to build team unity. Food Athletes and offiials an be assured that the food on offer at the Olympi Village will be of high quality and, as far as is pratiable, tailored to their speifi dietary preferenes. Different ultural needs (eg, Halal ooking) will be generally well atered for and exating hygiene standards ensure that the inidene of food-borne illness is low. 3 The major hallenge is to avoid eating too muh the so-alled dining hall syndrome. Athletes need to adopt a disiplined approah to eating to avoid gaining weight. Food intake should be timed to allow for absorption well before training and ompetition. The dining hall is open 24 h a day so there is ample opportunity to replenish glyogen stores even after a late evening ompetition. Athletes with signifiant food allergies (eg, peanuts, gluten) should inform the dotor performing their pre-games assessment of these partiular issues. Sleeping Teams at the Beijing Olympis will be aommodated in newly built tower bloks adjaent to the main Games venue. Athletes from different ountries will be housed in lose proximity to one another, so Village residents will need to show onsideration for their ompatriots. In partiular, those who have already finished their ompetition need to be reminded about partying late into the night in the Olympi Village. Earplugs are therefore well worth paking. Transport Transport an be a major problem at the Olympi Games beause many of the venues are some distane away. In Beijing most venues will be within a 60 min bus ride from the Olympi Village. Nevertheless, traffi jams our so it is suggested that teams leave for any venue min before the time they are expeted there. Table 1 Seurity Over the past 25 years there has been an esalating emphasis on seurity at the Olympi Games. This has intensified sine the events of 11 September 2001 when hijaked airraft were able to rash into and destroy the Twin Towers in New York City. Seurity at the Olympi Village and all venues will be at a high level and athletes must learn to get on with their daily routines in spite of this seurity. The areditation pass must be taken everywhere; at an Olympi Games it is more important than your passport. Safety Do not neglet basi safety proedures. Traffi aidents are a partiular onern: the ountry had traffi aidents in 2006 with road traffi deaths. 8 In China vehiles drive on the right hand (European/Amerian) side of the road. Competitors from the UK, Australasia, Japan, Southern Afria and the other few ountries that drive on the left therefore need to be partiularly areful with road safety. Sexual health is a partiular onern. Athletes need to be aware that the inidene of sexually transmitted disease is rising, and even elite sports ompetitors an be HIV positive. Condoms, whih will be freely available at the polylini at the Olympi Village, should therefore be used and high-risk sexual enounters avoided. AT THE VENUE Heat, humidity and dehydration The average daytime temperature in Beijing in August will be about 28uC. There will be about 75% humidity and air pollution and rain storms are to be expeted. At those venues in ities further south (eg, Hong Kong, Shanghai) the temperature may be signifiantly warmer. Average daytime temperatures in Hong Kong, for example, are likely to reah 30 32uC with a high relative humidity of 80%. By night there will be only partial relief as the temperature drops to around 22uC. Advie regarding optimal hydration strategies has undergone a profound sea hange in the past deade. Hitherto, athletes were advised to drink to a predetermined shedule of ml per hour of exerise. However, a spate of ases of Weather foreasts at the Shunyi venue during the 2007 World Rowing Junior Championships August 9 August h h h h h h h h h Weather Sunny Sunny Cloudy Overast Overast Overast Cloudy Cloudy Cloudy Temperature (uc/f) 34/93 35/95 32/90 29/84 28/82 25/77 25/77 27/81 30/86 RH (%) Body temperature (uc/f) 39/102 38/100 38/100 34/93 33/91 27/81 27/81 31/88 36/97 Wind diretion N SW SW S N NE NE NE SW Wind speed (m/s) Rainfall (mm) August 10 August h h h h h h h h h Weather Cloudy Thunder shower Overast Overast Overast Overast Shower Shower Shower Temperature (uc/f) 33/91 24/75 22/72 22/72 24/75 27/81 31/88 30/86 28/82 RH (%) Body temperature (uc/f) 40/104 38/100 22/72 22/72 25/77 31/88 41/106 38/100 35/95 Wind diretion SW N NE NE NE SW SW S S Wind speed (m/s) Rainfall (mm) RH, relative humidity. Br J Sports Med: first published as /bjsm on 1 April Downloaded from on 13 June 2018 by guest. Proteted by opyright. 324 Br J Sports Med 2008;42: doi: /bjsm

5 Original artile Box 2 Summary of reommendations (A) Preparatory phase Personal health issues: remember dental hek-up Immunisations: Routine: update these Influenza: for at-risk individuals Rabies: possible role Typhoid: possible role Hepatitis A: if travelling to less developed areas Hepatitis B: ontat sports (eg, boxing, wrestling) Speifi disease information: AIDS/HIV: inreasing heterosexual transmission Avian flu: avoid bird markets and poultry farms Cholera: negligible risk Dengue fever: avoid mosquito bites in daytime Gastroenteritis: avoid risky food, eat at the Village Influenza: elderly, unwell at greater risk of ompliations Japanese enephalitis: theoretial risk at Shunyi venue but immunisation not universally required Leishmaniasis: avoid sandfly bites Malaria: no risk in urban areas Rabies: seek immediate medial attention after any animal bite SARS: not a urrent risk Shistosomiasis: mainly in Yangtze River Valley (B) Travel phase Jet lag: short-ating sedatives melatonin Venous thromboembolism: variable risk, preventive strategy (C) Village phase Arrival: get aredited, establish normal sleep-wake yle Olympi Village experiene: provide some reminders of home ountry Food: avoid overeating Sleeping: show onsideration for fellow residents Transport: expet delays and allow for them Seurity: don t let it oppress you Safety: are with rossing the road (D) At the venue Heat and humidity: drink aording to thirst, daily weigh-in Pollution: less of a onern than previous media reports indiate Alimatisation: arrive early in Beijing Food: may need a paked lunh at the venue (E) After the event Written reports and debriefing session hyponatraemia in endurane events has prompted a radial rethink in reent years. The best available evidene suggests that athletes should start the day well hydrated and drink aording to thirst as eah day progresses. A set of sales bak at the Village an ensure that athletes know their wet weight. Athletes need to take their own bottles of sports drink along to training and ompetition venues and ensure that these are not tampered with. At the venue they should stay out of the sun before ompetition to minimise insensible fluid loss. Cooling jakets worn before the event an also ensure that athletes reah the start line in optimal ondition. What is known about this topi The Olympi Games is the world s premier sporting festival and medial support of athletes has beome inreasingly sophistiated. Competitions staged in hot environments pose an additional hallenge for athletes. This is the first summer Olympi Games to be held in Asia sine the Seoul Olympis in What this study adds Speifi knowledge of the environment in Beijing and other major Chinese ities an be of assistane to athletes preparing for the 2008 Beijing Olympi Games. Reent experiene with teams ompeting at the World Rowing Junior Championships indiates that heat and humidity are likely to represent signifiant hallenges, but that air pollution should be less of a problem than previous media reports have indiated. Pollution Signifiant air pollution has been reported from a variety of sites in China. Athletes with respiratory disorders suh as asthma are likely to be more signifiantly affeted by air pollution and need to take this into aount when planning their training. At the 2007 World Rowing Junior Championships held at the Olympi rowing and anoeing venue at Shunyi, signifiant air pollution was evident on most ompetition days. Visibility was redued to 1000 metres and low flying airraft on their final approah to nearby Beijing Airport were often barely visible. However, the firing of rokets leared the air in the immediate viinity within hours. Spirometri tests performed on elite New Zealand rowers ompeting at the World Rowing Junior Championships in August 2007 showed no fall in fored expiratory volume in 1 s or vital apaity from baseline data obtained in New Zealand 2 months before travel (J C Milne, unpublished data). Paradoxially, on days when the pollution had been dispersed for example, on Finals day of the Championships the air temperature in the sun rose to 36uC with 41% humidity (J C Milne, unpublished data). The Chinese authorities are making strenuous attempts to minimise air pollution around the time of the 2008 Olympi Games. Two of the proposed measures inlude temporary losure of fatories near to major ompetition venues and some form of loud seeding to ause rain and help lear the lower atmosphere. Alimatisation For most athletes arriving from most northern hemisphere ountries, Beijing will also be in late summer during the time of the Olympi Games so there is no major environmental hallenge. By ontrast, athletes arriving from the extreme north of Europe or Ameria or temperate ountries in the southern hemisphere will need to invoke an alimatisation strategy. Usually this involves exerising in the heat, possibly at some intermediate loation en route to Beijing. Ordinarily, a 1- to 2-week period of progressively inreasing exerise intensity is suffiient to improve heat tolerane. Beijing is at an altitude of Br J Sports Med: first published as /bjsm on 1 April Downloaded from on 13 June 2018 by guest. Proteted by opyright. Br J Sports Med 2008;42: doi: /bjsm

6 Original artile only 60 metres so separate alimatisation for this is not required. Weather foreasts at the Shunyi venue during the 2007 World Rowing Junior Championships are shown in table 1 and give an indiation of the range of onditions that ould be expeted in August Food In most ases the pre-ompetition meal an be onsumed at the Olympi Village before departure for the ompetition venue. In some ases (eg, yahting, rowing) prolonged travel times may neessitate taking paked food to the venue. In most irumstanes this an be arranged in onjuntion with the BOCOG provided suffiient notie is given. Management for the affeted teams should larify this issue before arrival at the Olympi Village. Athletes with speial dietary needs (eg, those with diabetes) need to plan their ompetition nutrition metiulously in onjuntion with a dietiian, develop a system that works well in the preeding months and stik to it. 19 AFTER THE EVENT On return from Beijing there should be a formal debriefing session. Before the session all setion managers should prepare a written report. From the medial team, signifiant medial issues should be highlighted. The written reports provide a basis for disussion at the debriefing session and sentinel events should be examined in detail. Any lessons learned an then be passed onto the NOC and enable a ontinuous improvement in the servies to athletes. A summary of these reommendations is shown in box 2. CONCLUSION In the lead-up to the Olympi Games, athletes devote many of their waking hours to optimal preparation for their event. Team support staff need to be equally well prepared. The injured or unwell athlete should find the medial room to be an open weloming plae, and reeive prompt appropriate treatment. As we wrote in our onlusion to the paper published in the lead-up to the Sydney 2000 Olympi Games: Early aess to well qualified, experiened sports mediine experts is something that elite athletes have ome to expet. At the Olympi Games, they deserve nothing less. 20 Competing interests: None. The authors do not neessarily represent the views of the Beijing Olympi Games Organizing Committee or of any other ageny onneted with the Beijing Olympi Games of REFERENCES 1. Anon. Offiial site of the Beijing 2008 Olympi Games. (aessed 6 July 2007). 2. Young M, Friker P, Maughan R, et al. The traveling athlete: issues relating to the Commonwealth Games, Malaysia, Br J Sports Med 1998;32: Leggat PA, Nowak M. Dietary advie for airline travel. J Travel Med 1997;4: World Health Organization. International travel and health: China. ith/ountries/hn/en/ (aessed 9 July 2007). 5. Anon. Worldwise ountry travel health reports. ountry-reports.asp#asia (aessed 10 July 2007). 6. World Health Organization. HIV/AIDS situation in China. sites/hsi/overview.htm (aessed 10 July 2007). 7. Anon. Cumulative number of onfirmed human ases of avian influenza A/(H5N1). Reported to the World Health Organization. avian_influenza/ountry/ases_table_2007_06_29/en/index. html (aessed 10 July 2007). 8. MaDonald S. Beijing 2008 Olympis: preparations for medial emergenies. Vitoria, Canada: GeoSentinel Annual Site Diretors Meeting, International Assoiation for Medial Assistane to Travellers. World malaria risk hart. (aessed 15 July 2007). 10. Shaw M, Leggat PA. Travelling to Australia for the Sydney 2000 Olympi and Paralympi Games. J Travel Med 2000;7: Yung A, Ruff T, Torres T, et al. Manual of travel mediine. 2nd ed. Melbourne: IP Communiations; 2004: World Health Organization. International travel and health. Geneva: WHO, (aessed 6 July 2007). 13. Cook J, Harourt P, Milne C. Providing team are. In: Brukner P, Khan K, eds. Clinial sports mediine. 3rd ed. Sydney: MGraw-Hill, Milne C, Fuard MH. Beating jet lag. Br J Sports Med 2007;41: World Health Organization. WHO researh into global hazards of travel (WRIGHT) projet en/index.html (aessed 9 July 2007). 16. Miller B. Gold minds. Ramsbury: The Crowood Press, Hew-Butler TD, Verbalis JG, Noakes TD. Updated fluid reommendation: position statement from the International Marathon Medial Diretors Assoiation (IMMDA). Clin J Sport Med 2006;16: Noakes TD. Hydration in the marathon. Sports Med 2007;37: Burke L, Deakin V. Clinial sports nutrition. 2nd ed. Sydney: MGraw-Hill, Milne C, Shaw M, Steinweg J. Medial issues relating to the Sydney Olympi Games. Sports Med 1999;28: Br J Sports Med: first published as /bjsm on 1 April Downloaded from on 13 June 2018 by guest. Proteted by opyright. 326 Br J Sports Med 2008;42: doi: /bjsm