Expect the thrill of victory, the agony of bad air at the Olympics

With the 2008 Beijing Olympics around the corner, health experts warn that a once-in-a-lifetime trip to the games requires travelers to see beyond the excitement of the athletic contests to factors that could undermine their well-being.

In this context, the potential for rare infectious diseases is not the primary concern. Rather, the health problems that could be experienced by the 600,000 foreign visitors and athletes expected to travel to China next month are more likely to result from poor air quality, a common cold virus, inexperienced drivers and animal bites, according to a paper published this month and physicians advising Olympic guests.

"Using common sense while in Beijing can keep you healthy," said Nina Marano, DVM, MPH, chief of the Travelers' Health and Animal Importation Branch at the Centers for Disease Control and Prevention. "Wash your hands, watch your step and don't pet stray dogs."

The advice is based on findings published in the July American Journal of Tropical Medicine and Hygiene analyzing data from the GeoSentinel Surveillance Network run by the International Society of Travel Medicine and the CDC. This report documented that, over the past decade, travelers to China were far more likely than those going to India or Southeast Asia to experience respiratory issues. Sprains and strains along with bites from dogs, cats and monkeys were commonly reported. No cases of malaria, dengue, leishmaniasis or Japanese encephalitis were noted.

"We had thought we would find more exotic diseases. We need to tell people about dog bites. People need to consider respiratory illness and injuries," said Phyllis Kozarsky, MD, one of the paper's authors and a CDC expert consultant.

In addition, although the H5N1 avian influenza virus has long been problematic in the region's poultry, experts do not expect it to be an issue for these travelers.

"H5N1 is probably basically embedded in southern China. I'm not sure they're ever going to eliminate it," said Richard V. Lee, MD, professor of medicine at the State University of New York at Buffalo. "The advice there is don't go to wet markets and don't kiss chickens." Wet markets usually sell live animals along with fruits and vegetables.

But experts are particularly concerned about other respiratory illnesses, particularly those that are not infectious in origin. Many believe that, despite efforts made by officials to reduce pollution, anyone with asthma or other lung problems making this Olympic journey should be prepared for a flare-up. Additionally, indoor air quality is problematic because so much of the population smokes. In China, people can light up almost anywhere indoors.

"The air pollution can be just dreadful, and, oftentimes, it's not just in the ambient air. It's in the inside air as well," Dr. Lee said.

Look both ways

Physicians tracking the possible health risks associated with the games are eyeing certain other injuries and illnesses as reason for anxiety, too. New construction has been carried out rapidly but not necessarily to high safety standards. The city also has experienced a rapid increase in car ownership, meaning many drivers have not been on the road long.

"It seems that half the nation just recently traded in their bicycles for cars," said Gregory Juckett, MD, MPH, professor of family medicine and director of the West Virginia University International Travel Clinic in Morgantown. "I have been to China three times and have narrowly escaped rogue buses and other assorted vehicles each time. It's every man for himself." Dr. Juckett also is president of the West Virginia Academy of Family Physicians, although he was speaking personally.

Another threat is rabies. About 140,000 animal bites were reported in Beijing in 2006, and the country has the second-highest rate of human rabies in the world. Physicians are calling for extreme caution when dealing with any animal. But with the vaccine in short supply and lower rates of this disease in urban areas, pre-exposure immunization is not viewed as necessary, particularly for those not venturing far out of Beijing.

"People will see monkeys and think they are something they want to play with without realizing that it's a health danger," said Dr. Kozarsky, also a professor of medicine and infectious diseases at Emory University in Atlanta.

Physicians for the athletes, though, expect to be kept most busy with complaints that become more important in the midst of competition.

"Athletes think, 'This is my big chance.' That scratchy throat that they would not normally go to the doctor for turns into a great concern," said Kristine Karlson, MD, a physician for the U.S. Olympic team. Among the athletes she will be treating are those participating in rowing, kayaking and the triathlon. "We give out large doses of reassurance and do lots of cheerleading." She also is a family and sports medicine physician at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

In general, experts are advising that visitors avoid drinking the water, carry medications for travelers' diarrhea and be vaccinated against hepatitis A. Additional precautions are necessary if any part of the trip involves travel to a rural area.