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Background: Analysis of injury and illness prevalence in elite sport provides the basis for the development of prevention programmes., Objectives: To analyse the frequency and characteristics of injuries and illnesses occurring during the 13th Federation Internationale de Natation (FINA) World Championships 2009., Design: Prospective recording of newly incurred injuries and illnesses., Methods: The 13th FINA World Championships hosted 2592 athletes from 172 countries in the disciplines of swimming, diving, synchronised swimming water polo and open water swimming. All team physicians or physiotherapists were asked to complete daily a standardised reporting form for all newly incurred injuries and illnesses for their teams. To cover teams without medical staff, the physicians of the Local Organizing Committee also submitted daily report forms., Results: 171 injuries were reported resulting in an incidence of 66.0 per 1000 registered athletes. The most affected body parts were the shoulder (n=25; 14.6%), and head (n=21; 12.3%). Half of the injuries occurred during training. The most common cause of injury was overuse (n=61; 37.5%). 184 illnesses were reported resulting in an incidence of 71.0 per 1000 registered athletes. The respiratory tract was most commonly affected (n=91; 50.3%) and the most frequently classified cause was infection (n=81; 49.2%). The incidence of injuries and illnesses varied substantially among the five disciplines, with the highest incidence of injury in diving and the lowest in swimming., Conclusions: As the risk of injury varied with the discipline, preventive measures should be discipline specific and focused on minimising the potential for overuse. As most of the illnesses were caused by infection of the respiratory and gastrointestinal tract, preventive interventions should focus on eliminating common modes of transmission.