Systematic review of public health interventions to curb respiratory infections at sporting mass gatherings

This systematic review evaluated the type and effectiveness of public health interventions implemented at sporting mass gatherings (MGs) to mitigate respiratory infectious disease spread, alongside feasibility and acceptability of implementation. Searches spanned Medline, EMBASE, Cochrane Library, Scopus, Web of Science, Global Health, Epistemonikos, Global Index Medicus, WHO Library, WHO IRIS, IOC and FIFA in June 2023 and July 2025. Publications before 2000, predictive modeling studies, commentaries, editorials, literature reviews, pre-prints, and studies not retrospectively discussing official sporting events were excluded.

Thirty-four articles assessing 37 sporting MGs were included, with the Olympic Games (n = 10) being the most frequently represented. Almost all articles described multi-layered intervention packages that combined bubble approaches, routine testing, country entry screening, masking, physical distancing, and/or isolation and quarantine. Applying an effectiveness framework developed for this review, 23 articles described effective intervention packages, three described non-effective packages, and six were indeterminate.

Feasibility concerns were prominent for MGs with many spectators and were linked to scalability issues. Acceptability was likely shaped by perceptions of increased work burden, compliance levels, and stakeholder engagement. The abstract does not report effect sizes, transmission rates, or safety outcomes, and findings reflect heterogeneous event contexts rather than controlled comparisons.

Clinical and public health relevance is restrained: the review offers the first comprehensive mapping of pre-pandemic and pandemic-era planning for sporting MGs, supporting multilayered, context-specific intervention packages as a plausible way to meaningfully reduce respiratory disease spread. Conclusions rest on retrospective event reports, and the included evidence base was not designed to quantify comparative effectiveness.