Effectiveness of public health measures and strategies to reduce risk of spread of respiratory pathogens at sporting mass gatherings: systematic literature review.

OBJECTIVES

To determine the type and effectiveness of public health interventions implemented at sporting mass gatherings to mitigate respiratory infectious disease spread and understand how feasible and acceptable the interventions were to implement.

DESIGN

Systematic review.

DATA SOURCES: Medline, EMBASE, Cochrane Library, Scopus, Web of Science, Global Health, Epistemonikos, Global Index Medicus, WHO Library, WHO IRIS, IOC and FIFA were search in June 2023 and July 2025.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies that assessed public health strategies for sporting mass gatherings aiming to reduced respiratory infections were included. Publications prior to 2000, predictive modeling studies, commentaries, editorials, literature reviews, pre-prints and studies that did not retrospectively discuss official sporting events were excluded.

RESULTS

Thirty-four articles assessing 37 sporting MGs were included. The most common MGs assessed were the Olympic Games (n = 10). Almost all articles described multi-layered intervention packages including bubble approaches, routine testing, country entry screening, masking, physical distancing and/or isolation and quarantine. Based on an effectiveness framework developed for this study, 23 articles described effective intervention packages, three described non-effective packages and six were indeterminate. Feasibility concerns appeared a challenge for MGs with many spectators and linked to scalability issues. Acceptability factors were likely influenced by perceptions of increased work burden, compliance levels and stakeholder engagement.

CONCLUSION

This systematic review provides the first opportunity to comprehensively map pre-pandemic and pandemic-era planning for sporting MGs and underscores the importance of multilayered, context-specific intervention packages which may meaningfully reduce the risk of respiratory disease spread.

SYSTEMATIC REVIEW REGISTRATION: CRD42023433619.