[Traveling with immunodeficiency-Problems and prevention]. / Reisen mit Immundefekt ­ Probleme und Prävention.

Advances in medical care have led to an increasing number of immunocompromised travellers. Travellers with immunodeficiencies have a higher risk of infections and can acquire infectious diseases that are rare in immunocompetent travellers. Of central interest are travellers' diarrhea, diseases of the respiratory tract, tuberculosis and inhalative mycoses as well as diseases transmitted by vectors such as malaria. For every such journey a timely consultation in travel medicine is indicated. First the individual risk must be assessed according to the degree of immunodeficiency. An individual counselling is then related to the itinerary, the travel destination and any activities planned. This information is the basis for an individual set of prophylactic measures with respect to infections and other risks through certain modes of behavior, medication, and vaccinations. Post-travel counselling and evaluation are equally important. This requires physicians experienced in both immunosuppression and travel medicine.

Health hazards and medical treatment of volunteers aged 18-30 years working in international social projects of non-governmental organizations (NGO).

The specific health risk profile and diversity of treatments sought by young volunteers participating in international social projects should differ from those of their older colleagues. In the absence of any data to identify whether this was correct, a retrospective analysis was performed using a standardized questionnaire. Questions included what diseases occurred, and details of the frequency and types of treatment sought during their stay - (e.g. self-treatment, medical/dental intervention, or local healer). The 153 participants were aged 18-30 years and worked in a non-governmental organization for >6 months. The participants were: 53% female, mean age 20 years, and mean duration of stay was 11.2 months. Their NGO placement abroad was in Latin America 65.4%, 14.4% in Africa, and 9.8% in Asia. 83% of the young volunteers had received some advice regarding travel medicine before their departure. However, they suffered from more injuries compared to private travellers, and febrile infections were more common when compared to older studies. 21.2% suffered from dental problems and 50% of them sought medical treatment. This study highlights a previously unreported higher risk profile of specific health problems occurring in young NGO volunteers, including some potentially life-threatening diagnoses that differed from their older colleagues and normal travellers. It is recommended that young volunteers should receive age specific, comprehensive pre-departure training in health and safety, first aid, and management of common health problems. A medical check-up upon returning home should be mandatory. The provision of a basic first aid kit to each volunteer before departure is also recommended.

Prophylactic immunisation against traveller's diarrhoea caused by enterotoxin-forming strains of Escherichia coli and against cholera: does it make sense and for whom?

Traveller's diarrhoea (TD) constitutes the most common disease relevant to travel medicine with ETEC as the leading causative pathogen. Cholera is the most serious, but very rare form of TD. ETEC and cholera share pathogenic mechanisms by producing a toxin that has an 80% amino acid homology. A consensus of German-speaking experts sees the indication to use the whole cell/B subunit oral cholera vaccine (WC--BS) if cholera is a risk for aid workers or travellers with an anticipated threat of cholera who stay under poor hygienic conditions. The use of the vaccine should be considered in the indication to avoid ETEC TD for travellers with predisposing illness or medication or for travellers at risk to develop a serious course.

[Chronic morbidity after travel in endemic malaria regions]. / Bleibende Gesundheitsschäden nach Aufenthalt in Malariaendemiegebieten.

Contracting malaria, especially Plasmodium falciparum infection, remains one of the main risks when non-immunes travel to the tropics. This contribution tries to describe qualitatively, and, wherever possible, quantitatively, the risk to suffer death or permanent incapacitation due to prophylaxis, disease or therapy of malaria. Roughly three million Germans annually go for a three to four weeks' trip to malaria-endemic areas. Around 700 to 1000 of them fall ill with malaria, two thirds infected with Pl. falciparum. Grossly 2% of patients expire. Lasting physical damage due to malaria (neurological sequelae after cerebral malaria, splenic rupture, impaired vision) due to therapy (cardiac side effects of chloroquine, quinine and mefloquine, acute psychoses) or due to prophylaxis (retinopathy after long-term chloroquine) are uncommon and hard to quantify. On the whole, however, well-tailored, correctly dosed prophylaxis, early diagnosis and circumspect therapy lower the risk of suffering grave health impairment due to malaria.