Sewry, Nicola AnnSchwellnus, Martin PeterReadhead, ClintSwanevelder, SonjaJordaan, Esme2023-02-172022-08Sewry, N., Schwellnus, M., Readhead, C. et al. 2022, 'The incidence and transmission of SARS-CoV-2 infection in South African professional rugby players - AWARE II', Journal of Science and Medicine in Sport, vol. 25, no. 8, pp. 639-643, doi : 10.1016/j.jsams.2022.06.004.1440-2440 (print)1878-1861 (online)10.1016/j.jsams.2022.06.004https://repository.up.ac.za/handle/2263/89647OBJECTIVES : To describe the incidence and transmission of SARS-CoV-2 infections in South African professional rugby union players in different phases of return-to-competition during a pandemic. DESIGN : Prospective cohort study. METHODS : Players reported their history of SARS-CoV-2 infection before/during a national competition, using an online questionnaire (physician verified). Three periods of return to training/competition after a nation-wide complete lockdown during a pandemic were studied: 1) non-contact training, 2) contact training, 3) competition. The total period was 184 days (20/07/2020–20/01/2021) including 45 matches. Outcomes were: 1) incidence of SARS-CoV-2 infection (I: per 1000 player days; 95%CI) in each period (calculated using a Poisson distribution), 2) player symptoms, 3) median days to return-to-training following SARS-CoV-2 infection, 4) method of transmission, and 5) percentage matches cancelled due to SARS-CoV-2 infections. RESULTS : 185 players had 42 physician verified positive SARS-CoV-2 infections (I = 1.23; 95%CI: 0.86–1.61). Incidences during the three periods were: non-contact training = 0, contact training (I = 1.04; 0.36–1.71; mostly forwards), and competition (I = 1.54; 1.00–2.10). 83 % of the infected players were symptomatic and 52 % of the 42 positive players had systemic symptoms. Median return-to-training was 14 days. 22 (52 %) SARS-CoV-2 infections were rugby-related: 13 off-field (31 %), 9 on-field (21 %). 11 % of matches were cancelled due to SARS-CoV-2 infections. CONCLUSIONS : As contact in rugby was introduced back into the game following lockdowns there was an increasing incidence of SARS-CoV-2 infection. On-field rugby activities were responsible for 21 % of SARS-CoV-2 infections and 11 % of matches had to be cancelled, indicating the need for risk mitigation strategies.en© 2022 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved. Notice : this is the author’s version of a work that was accepted for publication in Journal of Science and Medicine in Sport. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. A definitive version was subsequently published in Journal of Science and Medicine in Sport, vol. 25, no. 8, pp. 639-643, 2022, doi : 10.1016/j.jsams.2022.06.004.Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)RugbyAWARETransmissionPostprint Article