Stress induced immunomodulation and the risk of infections during major sporting events: Implications for the FIFA World Cup 2022

The FIFA World Cup 2022 which was hosted in Qatar in November, was the most highly anticipated sporting event of that year. It is established in the literature that spectators and football players can experience a great deal of stress during major sporting events. This is supported by the findings of some studies that reported elevated cortisol levels among spectators and players during important matches. Cortisol plays a critical role in regulating physical and mental stress by hyperactivating the hypothalamic-pituitary-adrenocortical axis and the sympathetic-adrenal-medullary system. Evidence has shown that psychological stress can modulate the immune system as the neurotransmitters released by the sympathetic fibers descending from the brain to the lymphoid tissues bind some receptors on the surface of white blood cells and alter their function, hence, resulting in immunosuppression and subsequently increasing the susceptibility to infections. However, a major interindividual variability in stress-mediated immune responses exist particularly due to variability in stress-induced sympathetic nervous system activation among different people. Moreover, the engagement in certain high-risk behaviors as stress coping strategies to escape stress such as excessive alcohol drinking, high-risk sexual behaviors can also modify immune processes and impact vulnerability to infections. Identity fusion and the extent to which football fans are deeply connected to their team can also modify the stress response system activation and cortisol hormone release as one study showed higher cortisol levels over the course of a World Cup match among the most fused. The evolving literature is highlighting the negative repercussions of the COVID-19 related containment measures and restrictions on the lifestyle of people and the implications on those with chronic diseases like diabetes mellites, and cancer among others. Having such chronic diseases with immunosuppressing characteristics might further increase the susceptibility of patients to stress induced immunosuppression. The FIFA world cup is a mass gathering event as millions of people are expected to come from all parts of the world to attend this major event. Mass gathering events can pose public health risks and strain the public health resources and the health system of the hosting country. The migration of people from different areas of the world with diverse profiles of susceptibility and health behaviors to attend such events can be an opportunity to spread infectious diseases. The emotional stress-induced immune modulations and immunosuppression experienced by football fans and players therefore can potentially pave the way towards enhancing the dissemination of infectious agents during major sporting events like the FIFA world cup. Strategies to control stress and its related consequences should be part of preparedness plans for major mass gathering events. Qatar has launched a three-year joint project titled "Healthy 2022 World Cup - Creating Legacy for Sport and Health" in collaboration with the World Health Organization to place health promotion and mental wellbeing at the heart of the FIFA World Cup . This event can be an opportunity for people to meet, celebrate and connect after long periods of movement and travel restrictions imposed during the COVID-19 pandemic that adversely affected the lifestyle of people worldwide. In light of the unprecedented crises of COVID-19 and its negative psychological consequences, countries need to pay a great deal of attention to the mental health of people. This should extend beyond the hosting country to involve all countries worldwide. The FIFA world cup is an opportunity for all countries to advance health awareness messages with a focus on optimizing mental health and controlling stress with appropriate coping strategies to their people as a way to prevent and mitigate stress induced infectious diseases.

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Published in: Journal of Infection and Public Health
License: http://creativecommons.org/licenses/by/4.0/
See article on publisher's website: https://dx.doi.org/10.1016/j.jiph.2023.03.024