Glossary

Air travel

Air travel is becoming increasingly popular. To ensure that you get through these trips without any discomfort, we will be happy to advise you on topics such as thrombosis prophylaxis, nicotine patches, long-term medication and time-shifting.

Altitude fitness test

The altitude fitness test is used to * Assess hypoxia tolerance * Assess altitude fitness * Evaluate training results Individual altitude fitness is largely determined by genetic factors. The occurrence of altitude sickness is not related to age, gender or physical fitness. The altitude test determines the individual altitude tolerance (based on the hypoxia = reduced oxygen content of the blood at altitude) and the associated stress on the cardiovascular system. The test is carried out under medical supervision. After an appropriate preliminary examination, a dosed oxygen-reduced air mixture is breathed in for a defined period of time via a breathing mask. A pulse oximeter (finger clip) is used to measure the extent and speed of the changes in blood oxygen saturation. The changes in oxygen saturation and pulse rate provide information about possible problems and reactions at altitude. The speed at which oxygen saturation returns to baseline after the test is completed also provides important information about individual hypoxia tolerance (= suitability for altitude). An ECG (electrocardiogram) taken at the end of the test shows whether the heart rhythm has been changed by the hypoxia. The altitude fitness test can be used to assess whether the altitude tolerance is average, above average or below average. This is very important information for a planned mountain or trekking tour. You can have an altitude tolerance test carried out by us in Berlin and Munich. Appointments can be made via our central hotline 030/ 960 609 40.

Altitude sickness

Even completely healthy people can develop symptoms of altitude sickness during a rapid ascent to altitudes above 2,000m. More serious symptoms can occur at altitudes above 2,500 m. This is caused by a lack of oxygen. Lack of fluids or a reduced heart-time volume result in reduced blood flow. Symptoms of the mildest form of acute mountain sickness (AMS) are a mild “hangover”: headache, fatigue, nausea and loss of appetite as well as mild shortness of breath. Symptoms generally begin 4 to 12 hours after the ascent and reach their maximum within the first 1 to 2 days. After 2 to 3 days they decrease as a sign of acclimatisation. Treatment is to stop ascending and to descend if symptoms persist during the resting phase. Severe acute altitude sickness is manifested by worsening symptoms despite rest, with increasing breathlessness and coughing, which may gradually develop into pulmonary oedema. This condition is observed at altitudes as low as 2,500 m and occurs in about 1 to 2% of cases when ascending above 4,000 m. Cerebral oedema occurs either simultaneously or alone. Symptoms here are slowly increasing headaches, confusion, sluggishness. Very characteristic are disturbances of balance, gushing vomiting and clouding of consciousness. Treatment consists of immediate descent. If oxygen is available, 4 to 5 l/min should be given. How well individuals adapt to altitude is genetically predetermined. This ability can be determined by the so-called altitude fitness test.

Altitude training

Altitude training is the attempt to achieve a training effect through natural or simulated altitude. Since acclimatisation to the lack of oxygen (hypoxia) is the most important factor in this form of training due to the decrease in air pressure at high altitude, it is often referred to as hypoxia training. The effectiveness of altitude adaptation training is well proven, especially for endurance sports. Especially when training at natural altitude, the Live High-Train High (LHTH) concept is usually used. This means that the athlete lives at high altitude for a certain time and also trains there. However, due to the easier accessibility of altitude training centres and the availability of altitude chambers, alternative methods have been developed in recent years, as this allows a quick change between different altitudes. In particular, the Living Low-Training High (LLTH) concept, whereby the athlete lives in the lowlands but visits the altitude for training, is currently becoming increasingly popular. Which type of altitude training is best suited as a training method and at what intensity depends strongly on the planned activity or the sport in question, but also on the individual athlete, as differences are seen in the individual suitability for altitude training. Choice of altitude level for altitude training |altitude|adaptation| |sea level – 2,000m|problem-free| |2,000m|reaction threshold| |2,000m – 3,000m|full compensation| |3,000m – 4,000m|disturbance threshold| |4,000m – 6. 000m|insufficient compensation| |approx. 6,000m|critical threshold| |6,000m – 8,000m|critical zone| |approx. 8,000m|death threshold| In sports training, training is usually done at relatively low altitudes, often in the range between 1,900m and 2,500m. In alpinism, on the other hand, especially in high-altitude mountaineering, acclimatisation at much higher altitudes can be useful and necessary, since lower load intensities usually occur here and acclimatisation to altitudes that never occur in competitive sports is necessary. When choosing the right altitude, individual characteristics of the athlete such as previous hypoxia experience are also taken into account. Frequency and duration Usually, periods of several weeks, but at least 2 weeks, are recommended for sensible altitude training. Repetitions of hypoxia training are often considered beneficial. Active and passive training Studies have shown that the main effect of the “live low-train high” concept is to accustom the body to oxygen deprivation. The metabolism adapts and the muscles learn to work with less oxygen. Here, a training load during the hypoxia phase is obviously only of minor relevance. The same effects as under load can also be observed during passive altitude training, i.e. purely breathing the altitude air without physical exercise. In our Centre in Berlin you can have both a Altitude fitness test and altitude training. Please make an appointment by calling: 030/ 960 609 40. In our travel practice in Munich we offer a height fitness test, which is necessary, among other things, to carry out altitude training in the altitude chamber of Globetrotter Ausrüstung Munich. Appointments can also be made here via our central telephone number: 030/ 960 609 40 Vouchers You can purchase vouchers for travel advice, altitude training or an altitude fitness test from us at any time. You can also get vouchers for all our other services.

Appointment

In principle, it is not necessary to register for our travel practices. You can drop in spontaneously at any time during opening hours at our individual travel practices. In our head office in Berlin-Mitte we offer the service of a fixed appointment for the Reisepraxis Berlin-Mitte under 030- 960 609 40. Appointments for Tropical fitness examinations according to G35 or tropical return examinations are offered very promptly at our centre in Berlin- Mitte under 030-960 609 40 or anmeldung@bcrt.de. Appointments for consultations within the framework of the Lyme disease & tick consultation hour must also be arranged via our registration desk. Appointments for altitude fitness tests and altitude training are made centrally via the hotline: 030- 960 609 40

Bilharzia / Schistosomiasis

Bilharzia is a worm infection with acute and chronic phases. It is endemic in Africa, Asia, South America and some Caribbean islands. Water snails are the intermediate host of transmission when their freshwater habitat is contaminated by the excreta of infected persons. The WHO estimates that about 200 million people in 74 tropical and subtropical countries are infected with schistosomiasis and that 20,000 deaths occur annually. This makes it the second most common parasitic tropical disease after malaria. Through human excretions, the egg enters the water, where it matures and releases a larva. These infect specific snails that live in stagnant water. In the snail, they develop into cercariae. These are released into the water in large numbers. At a size of less than one millimetre, cercariae are not visible to the naked eye. They are able to penetrate intact skin and mucous membranes after a short period of exposure. After penetrating the human body, cercariae develop into schistosomes, which migrate through human tissue to the liver and portal vein. The worms start producing eggs 3-7 weeks after invasion of the human body and continue for 3-8 years. These eggs lead to tissue changes and chronic disease. The incubation period of chronic manifestation may extend over several years. It is not uncommon for oesophageal variceal bleeding to appear as the first symptom 10-15 years after the initial infection. Clinical manifestations # Cercarial dermatitis: The itchy skin irritation is triggered a few minutes to 24 hours after exposure to cercariae. # Acute schistosomiasis: Also called catayama fever. This is a reaction that occurs between 4 and 87 days after infection. Katayama fever is acute with fever, chills, nausea, headache and diarrhoea. # Chronic schistosomiasis: Refers to a condition of chronic inflammatory changes with tissue scarring caused by schistosomes. Often progresses without symptoms. However, fever, fatigue, abdominal pain and diarrhoea may occur. In the long term, severe damage can occur to the liver, lungs, heart, intestines and brain. Treatment Praziquantel (Biltricide® Tbl. à 600 mg) 40 mg/kgKG as a single dose or distributed in intervals of 4-6 hours. The success rate is 80%. Therefore, it is advantageous to repeat the treatment after 3-6 months.

Cholera

Cholera is a bacterial diarrhoeal disease. As a rule, the traveller is spared from it. However, the oral vaccination available is often used as a travel vaccination against “travellers’ diarrhoea”.

Dengue fever

Dengue fever is an arbovirus infection that, like yellow fever, is transmitted by Aedes mosquitoes. The female mosquito bites mainly in the early morning and late afternoon hours just before sunset, but is also active during the rest of the day and night. The bite is painless but often itchy, unlike the bite of the malaria mosquito (Anopheles). There are four serotypes of the dengue virus: dengue 1, 2, 3 and 4, all of which cause the same clinical picture. The virus belongs to the flavivirus group. It is closely related to the yellow fever virus and the Japanese encephalitis virus. The dengue virus causes dengue fever and dengue haemorrhagic fever (DHF). The origin of DHF is not fully understood. Apart from a certain accumulation of serotype 2, the process of “immune enhancement” seems to play a role. The initial infection with any serotype is initially uncomplicated and leaves behind a lifelong, mainly humoral immunity. However, in the case of an infection with another serotype, the IgG antibodies already present form immune complexes with the new viruses. This promotes the progression of the infection and can ultimately lead to haemorrhagic complications and even dengue shock syndrome.

Diphtheria

Diphtheria is an infectious disease of the upper respiratory tract caused by the bacterium Corynebacterium diphtheriae. The bacterium is transmitted by droplet infection, usually affecting the tonsils or throat. The toxin secreted by these pathogens is feared and can lead to life-threatening complications and late effects, e.g. it can affect the heart, kidneys or liver. The pathogen is widespread worldwide, especially in the countries of the former Soviet Union. Basic immunisation consists of 3 vaccinations and usually takes place in infancy. An active booster vaccination is required every 10 years, regardless of long-distance travel.

Diving fitness

Every reputable diving school will require you to have a diving fitness certificate before diving. In principle, any general practitioner can issue such a certificate, but it is advisable to see a specially trained doctor, as he or she will be familiar with the particular problems of fitness for diving. What examinations will be carried out? The doctor will take your personal medical history and carry out a physical examination. In particular, this should include: * Examination of nose and ears * ECG (electrocardiogram) * Pulmonary function test * Blood sample if necessary Further examinations depend on any previous illnesses. Possibly clarification of a persistent foramen ovale by heart ultrasound (open connection between the left and right atrium of the heart, which can be detected in up to 30% of the population) In our Head Office in Berlin we offer you the possibility of having a diving fitness test carried out. You can make an appointment at short notice by calling 030 / 960 609 40.

First-aid kit

A well-stocked first-aid kit can be very important, especially when travelling to remote areas. In order to be able to correctly assess previously unknown medicines, it is at least essential to read the package leaflet carefully; medical advice is better. Previously used or incompatible medicines should be remembered before compiling the first-aid kit. Chronically ill persons must take their tablets with them and take into account any additional requirements. It should be noted that in hot climates the expiry time can be shortened, medicines in liquid form dry out more quickly, active ingredients evaporate, suppositories become soft. Taking sterile disposable syringes and needles with you can be beneficial, as there is often a shortage of them in remote hospitals or sterilisation is insufficient. As a rule of thumb, two needles (needles for intramuscular injection are the most versatile) per syringe should be taken along, as one needle is needed to draw up the medication. It should be noted, however, that customs authorities, especially in the Southeast Asian region, now have extensive experience with Central European drug addicts. Any suspicions that may arise during the search of luggage can be extremely unpleasant. The BCRT has developed a modular first-aid kit to meet the requirements of most activities during long-distance travel. The modules can be prescribed accordingly in our travel practices. The compilation is, of course, only intended as a suggestion. It is essential to consult the package leaflet before taking the medication.

Hepatitis A

Hepatitis A is an inflammation of the liver that can be contracted through contaminated food and drinking water. There is a very well-tolerated vaccination for prevention. The hepatitis A vaccination is recommended for all travellers, regardless of the duration of the trip or the destination outside Europe, North America, Australia, New Zealand and Japan. In Europe, vaccination is recommended for travel to Albania, Romania, Bulgaria and the former Yugoslavia, for longer stays in the Baltic countries, Poland, Hungary, the Czech Republic and Slovakia. The hepatitis A vaccination can also be given immediately before departure. A booster after 6-12 months guarantees a vaccination protection of approx. 25-30 years. The hepatitis A vaccine is always available in our travel practices. Come and see us!

Hepatitis B

Like hepatitis A, hepatitis B is also widespread worldwide. However, it is much rarer than the former. The disease is transmitted via all body fluids, but especially blood and semen. It is not absorbed through food and is therefore not a typical travel disease. Special risk groups are recipients of untested blood and other plasma products, medical personnel, homosexuals, drug addicts, prostitutes and their clients. Travellers belonging to a relevant risk group should seriously consider appropriate precautions and vaccination, as infection with hepatitis B virus can be chronic and lead to cirrhosis of the liver. In addition, all tropical travellers should avoid any procedure that results in injury to the skin (tattooing, ear piercing, acupuncture, injections) under dubious hygienic conditions. Hepatitis B is hyperendemic in large parts of Africa, Southeast Asia and South America. In case of a longer stay in these areas, vaccination is recommended for children and adults who are in close contact with the local population, e.g. medical staff. Since 1995, hepatitis B vaccination has been part of the basic childhood immunisation in Germany, as recommended by the WHO. In our travel practices the vaccine against hepatitis B is always available.

Herpes zoster/ shingles

Herpes zoster, colloquially known as shingles, is a viral disease that mainly appears as a painful, stripe-like skin rash with blisters on one side of the body. This is caused by the inflammation spreading from a nerve to the surrounding skin area. The disease is caused by the herpes virus varicella-zoster in adults and usually occurs in older people or those with a weakened immune system. The initial infection with the varicella-zoster virus usually occurs in childhood and manifests as intensely itchy chickenpox. As these viruses are very infectious, the rate of infection is also very high: after the age of 11, >90 percent of the population have experienced this infection. However, chickenpox does not completely disappear from the body after the disease has been overcome. Some remain – “dormant”, so to speak, and kept in check by the immune system – in the ganglion cells of the nerve tracts for life. Under certain conditions, the viruses can be reactivated and lead to the unpleasant and dangerous herpes zoster. Depending on which nerve tracts are affected, the zoster infection spreads halfway around the body from the spine, hence the name shingles. The cause of a reactivation of the viruses is usually unknown. However, it is known that the immune status is reduced with increasing age or, for example, during severe stress – the virus can then migrate back along the nerve pathways into the skin. There, the infection first makes itself felt as burning, itching or stabbing pain. The typical skin rash only appears later – about 1 to 3 days after the virus has reached the skin. This rash consists of red spots on the skin and small blisters that contain a virus-laden, infectious fluid. After another 3 to 5 days, the blisters break open and gradually form crusts that fall off after 2 to 3 weeks. Most often, zoster occurs in the area of the chest. Occasionally, the back, arms or legs can also be affected. Zoster ophthalmicus affects the face and eyes and can result in partial or complete blindness due to corneal scarring. If the facial nerves are affected, there may be temporary signs of paralysis, loss of the sense of taste or infestation of the auditory canal. In addition to the severe pain typical of zoster, possible consequences include hearing loss and disturbances of the sense of balance. If left untreated, permanent hearing impairment or deafness can be the result. Since 2018, an inactivated vaccine for protection against herpes zoster has been approved in Europe for people >50 years of age, which is applied twice to the upper arm muscle at a minimum interval of 8 weeks. In a large-scale study involving more than 16,000 people, it was shown that vaccination reduces the incidence of shingles by 94-98% (depending on the age group). After vaccination, local reactions may occur for a few days (pain at the vaccination site), otherwise the vaccine is generally very well tolerated. This finally provides effective protection against this common and dangerous disease. The vaccination is available in all BCRT travel practices.

HIV

The human immunodeficiency virus (HIV) attacks the central part of the immune system, the CD4 helper cells. Over a period of 5-10 years, this leads to a severe defect of the immune system, the acquired immune deficiency syndrome (AIDS), which manifests itself with the occurrence of a multitude of opportunistic infections. Since 1980, an HIV pandemic has developed, the effects of which hit developing countries particularly hard. There is almost no country left on earth that is not affected by the disease. The greatest impact can be found in southern Africa. Risk for travellers HIV is transmitted neither through normal social contacts nor through insects! The virus has low environmental stability and is therefore almost exclusively infectious through the passing on of body fluids by means of sex, needle sticks or the transfer of blood and blood products. The most important risk when travelling is sexual contact. This includes heterosexual, homosexual, anal, vaginal and oral intercourse. In large cities like Nairobi or Bangkok, well over 50% of prostitutes are infected. Similarly, the number of HIV-positive prostitutes in Eastern Europe has increased significantly. Various studies show that casual sexual contact outside of committed partnerships occurs in up to 60% of western travellers, regardless of gender!

Hotline

The BCRT has a hotline that is switched to our Head Office in Berlin. Here, all questions can be answered and appointments can be made. The hotline is available daily from 9 am – 7 pm and on Saturdays from 12 pm – 5 pm. Telephone number: 030/ 960 609 40

Influenza

Influenza epidemics occur annually from December-April in the northern hemisphere and from April to October in the southern hemisphere. In tropical regions, influenza can occur all year round. Virus: Influenza illnesses can be caused in humans by 2 types: Type A and Type B. Both human-pathogenic influenza types have their reservoir in animals (poultry, pigs). As with other RNA viruses, influenza A has a high mutation rate. It is not only the emergence of new influenza strains that poses a risk of disease. It is also necessary to be vaccinated again every year in September/October due to the loss of type-specific immunity in patients within years and in vaccinated patients within months in order to have a high antibody titre during the influenza season. Cross-immunity between similar strains reduces the severity of the disease, but often cannot prevent it completely. During an epidemic, the risk of contracting the disease is higher in children than in adults, but the severity of the course and the frequency of complications increases significantly with age. The protective effect of vaccination depends primarily on the age and immunocompetence of the vaccinated person, but also on the antigenicity of the virus. In persons under 60 years of age, 70-90% protection can be expected from the vaccination; in older persons, the general protection provided by the vaccination drops to 30-70%. However, 80% protection can be expected against severe courses with fatal consequences. Immunity exists 14 days after vaccination. As it takes more than 6 months to produce a new vaccine, the new virus variants of the other hemisphere cannot be considered in the production of the new vaccine. Vaccination indication * Persons aged 65 years and older * Residents of care facilities * Persons with chronic pulmonary or cardiovascular diseases * Persons with chronic metabolic diseases (e.g. diabetes mellitus), renal insufficiency or immunosuppression * All persons in professions with a lot of customer traffic * Medical personnel (to prevent infection of high-risk groups) * Pregnant women Vaccines: There is no such thing as a “general flu vaccination”! Very different vaccines are produced. Relevant differences are: * Subunit or split vaccines with no other special features: Protects against the 3 most common, currently circulating influenza strains Especially useful for children and healthy adults up to the age of 60. * Split vaccine from cell culture (free of chicken egg protein): Especially useful in cases of allergy to chicken egg protein, but also offers somewhat broader protection against other influenza strains * Adjuvanted split vaccine: Has been used successfully for more than 10 years, leads to significantly improved protection. Especially useful for chronically ill patients and adults over 60 years of age. * Virosomal vaccine, without adjuvant: leads to significantly improved protection, comparable to adjuvanted vaccine. Particularly useful in chronically ill patients and adults aged 60 and over. In the travel practices of the BCRT all essential vaccine types are available for selection. Travellers: The risk of exposure to influenza during travel depends very much on the time of year and the location. In the tropics, influenza can occur throughout the year. Although influenza is much more significant in temperate climates during the winter months, a number of influenza outbreaks have been reported, particularly among group travellers. These were caused by one or more people from parts of the world where the influenza virus was circulating. Central air-conditioning systems in hotels, buses, trains, planes and ships lead to the spread of the disease. Influenza vaccination should therefore be considered for the following travellers: * Travellers to the tropics regardless of the time of year * Travellers to the southern hemisphere during the months of April-September * Group travellers travelling together with people from epidemic areas. In our travel practices we have various flu vaccinations that we can offer you depending on age & indication.

Japanese encephalitis

Japanese encephalitis is a mosquito-borne viral infection that occurs exclusively in Asia. Encephalitis is an inflammation of the brain. It is the most common viral encephalitis in Asia. The natural reservoir of the Japanese encephalitis virus is birds, especially waterfowl, and pigs. Transmission occurs through Culex mosquitoes, which are mainly nocturnal and breed in stables and near human dwellings in rural areas. In Asia, rice fields are also relevant for mosquito reproduction. Some Asian countries (e.g. China, Vietnam) have introduced compulsory vaccinations for the population in order to reduce the number of cases. Overall, the disease is a rare complication following a trip abroad. However, it must be clearly emphasised that Japanese encephalitis is one of the most serious forms of encephalitis, with a lethality rate of about one third of those who contract the disease. Another third of patients retain lifelong sequelae. A specific therapy is currently not available, so treatment is purely symptomatic and intensive care. Since 2009, Ixiaro®, an inactivated vaccine produced in Europe, has been approved and offers very good protection. Relevant side effects are not to be expected, in contrast to the vaccines used in Asia: in the approval studies, the side effect rate and severity was the same as in the placebo group. A further important measure is protection against mosquito bites through the use of mosquito nets and repellents. Vaccination indication: When staying in rural areas of Asia, regardless of the duration. Dose: 0.5ml intramuscularly, repeated after 4 weeks. A third dose should be given after 1-2 years. The duration of long-term protection is probably in the order of 10 years.

Leishmaniasis

Disease and route of infection* Leishmania are protozoa that can cause a wide range of diseases in humans. Two important forms are cutaneous leishmaniasis and mucocutaneous leishmaniasis. While the former leads to the so-called Oriental bump, a chronic ulcer of the skin, the latter form can lead to severe, sometimes mutilating ulcers of the face (e.g. so-called Chiclero ulcer, Espundia, etc.). Infection occurs through the bite of infected butterfly mosquitoes (phlebotomines, sandflies), which are mainly active outdoors at dusk. Rodents, dogs and in some areas (India) also humans serve as reservoirs for the disease. Occurrence/frequency Leishmaniasis is widespread worldwide in tropical and subtropical climatic zones (except Australia), with the Mediterranean region being the most important source of infection for German travellers. The WHO estimates that there are 11 million new cases of cutaneous and mucocutaneous leishmaniasis worldwide each year. In cutaneous leishmaniasis, the incubation period, i.e. the time from infection to the outbreak of the disease, is 1-2 months. As a result, skin nodules initially form at the injection site, which turn into skin ulcers with a tendency to bleed and local lymph node swelling. Spontaneous healing is possible after a few months, but chronic ulcers with disfiguring scarring can also occur. Relapses occur in 5-10% of patients, especially on the face. Mucocutaneous leishmaniasis is often found after cutaneous leishmaniasis caused by South American species (Leishmania braziliensis). It is most notable for nosebleeds, swelling of the nose and lips, and disfiguring scarring or destructive ulcers between the upper lip and nose or in the nasopharynx. In addition to the resulting cosmetic problems, bacterial infections of the ulcer areas are particularly dangerous. *Diagnosis The diagnosis is usually made by microscopic detection of Leishmania from marginal areas of the skin ulcer. Treatment As with diagnosis, treatment of leishmaniasis should always be carried out by a doctor experienced in the disease. Substances used for treatment include: Pentostam, Glucantim, Pentamidine, Amphotericin B (preferably liposomal), Fluconazole (Diflucan®) 200 mg daily for 6 weeks (seems to be equally effective in the treatment of L. major) and Miltefosine . Prophylaxis * Suitable clothing (long sleeves!) * Mosquito repellent * Use of fine-mesh protective nets impregnated with permethrin© can provide some protection against the bite of butterfly mosquitoes.

Lyme disease

Lyme disease is a bacterial infection transmitted by ticks. It can be treated. In our Centre in Berlin we offer a special consultation by our infectiologists for the diagnosis & therapy of Lyme disease. You can get information & appointments for this at anmeldung@bcrt.de or 030/ 960 609 40.

Lyme disease vaccination

A vaccine against Lyme disease is currently still being researched. The most effective protection until approval is therefore long clothing and appropriate insect protection.

Malaria

Malaria is one of the most common and significant tropical diseases. It is caused by single-celled parasites (plasmodia), which are transmitted by the bite of the Anopheles mosquito. This mosquito species is mainly active at dusk and at night. The leading symptom of malaria is fever, accompanied by headache and pain in the limbs with a strong feeling of illness, chills and sweating. There are different forms of malaria, the most dangerous form, malaria tropica, is caused by Plasmodium falciparum. Symptoms appear after an incubation period of at least 7 days. Life-threatening conditions with coma and multi-organ failure can quickly occur. Especially cerebral malaria, i.e. when the parasites infect the brain, can lead to death within a few days. Adequate treatment as early as possible is necessary to cure the infection. If left untreated, more than 20% die; with treatment, this rate can be reduced to about 1%. The rarely life-threatening forms, malaria tertiana and quartana, are caused by Plasmodium vivax, P. ovale and P. malariae. They have longer incubation periods. An occurrence of fever even weeks after returning from a trip from a risk area can therefore still be malaria. Later relapses of the disease also occur with these forms if they were not treated appropriately at the beginning. A typical fever rhythm does not necessarily have to be present; irregular courses of fever are also possible and are therefore not a criterion for ruling out the disease. In recent years, malaria in humans has also been increasingly caused by Plasmodium knowlesi in South-East Asia. This type of plasmodia usually mainly affects animals. The severity of the disease is similar to that of malaria tropica. The diagnosis is confirmed during the acute illness by microscopic parasite detection in the blood; it can also be confirmed later by special antibody tests. You can get detailed advice on malaria prophylaxis and the most suitable medication for you in our travel practice. We can also issue the corresponding prescription.

Malaria "stand-by therapy"

Chemoprophylaxis is generally recommended when travelling to malaria areas with a high transmission potential and can still significantly reduce the risk even in regions with multi-resistant malaria tropica pathogens. If regular chemoprophylaxis is not given in areas with a low risk of malaria, the therapeutic dose of a reserve drug should be carried along to be taken in case of symptoms suspicious of malaria and if medical help cannot be reached (emergency self-treatment or “standby”). However, this should only be an emergency measure until medical help is reached.

Malaria prophylaxis in children

Children are susceptible to malaria and require special prevention from birth. Mother’s milk does not transmit enough of the active ingredient to ensure adequate protection. Symptoms of malaria are often less pronounced in children because they have a lower fever response in the first six months of life. Malaria can often start with symptoms such as coughing or diarrhoea due to blocked microcirculation in the lungs and intestines. Parents should be informed that very young children should only be taken on a holiday trip to malaria areas in exceptional cases. It is difficult to protect young children. Clinical diagnosis and treatment options are limited. Special care should therefore be taken to protect them from mosquitoes! You can get detailed recommendations from us in the Travel Practices!

Malaria prophylaxis in pregnant women

Pregnant women run a special risk when they expose themselves to the risk of malaria infection. This is probably due to a certain degree of immunosuppression during pregnancy as well as a preference of the malaria pathogens for the placental circulation. Malaria in pregnancy has a particularly serious prognosis for the mother and unborn child. Primary protection against the bite of the Anopheles mosquito by means of an impregnated mosquito net and application of repellents to the skin is therefore particularly important. Malaria drugs in pregnancy Chloroquine and proguanil can be taken throughout pregnancy (for malaria prophylaxis and therapy). Folic acid should probably be taken additionally when using proguanil over a longer period. However, the combination no longer offers effective protection in most risk areas, as countless resistances have emerged. * Pregnancy should be avoided for up to 3 months after use of Mefloquine (Lariam ®). Mefloquine should also not be given in the first trimester of pregnancy. However, according to WHO information, no embryotoxic or teratogenic side effects have been proven with mefloquine so far. The substance can therefore be used as a malaria prophylaxis after the first trimester (also during the entire pregnancy in the case of travel to high-endemic areas and strict risk assessment). Pregnancy occurring during or within three months of treatment with mefloquine is not an indication for termination of pregnancy. * Doxycycline is contraindicated throughout pregnancy. Doxycycline must be discontinued one week before a possible pregnancy. * Malarone© is contraindicated throughout pregnancy. *Breastfeeding period * The concentration of mefloquine, chloroquine and proguanil in breast milk is so low that it is considered harmless to the baby. However, it can also be concluded from this that no effective prophylaxis is given via breast milk. * According to the WHO and CDC, doxycycline is contraindicated during breastfeeding. In contrast, some national authorities, e.g. in Sweden, do not see any problems with doxycycline intake by breastfeeding mothers. * Due to the uncertain data situation, Malarone is currently still contraindicated. Conclusions Travelling to areas with a high prevalence of malaria tropica is not a good idea during pregnancy! If travel is unavoidable, it is imperative that the traveller consistently protects herself from mosquito bites and seeks medical attention immediately if malaria is suspected.

Malaria rapid test

Rapid tests have been developed for the detection of malaria tropica, which now have a fairly high detection accuracy. With appropriate preparation, these can also be taken along on a trip. You can obtain information on this in our travel practices.

Meningococci

Meningococci are capsule-bearing bacteria and are transmitted by healthy carriers via droplets or contact. The clinical picture is meningitis with or without sepsis. In Germany, the disease often occurs in young people under 20 years of age and is fatal in about 5%, mostly because the diagnosis is made too late. The disease is considered very contagious. The general risk for travellers to contract meningococcal infection is not known. It is estimated to be very low at 0.4/100,000/month of stay. In Europe and North America, 40-70% of the disease is caused by group B meningococci and 20-40% by group C meningococci. In the tropics, the risk of infection comes from serogroups A and C, and less frequently from serogroups Y or W135. Vaccination against meningococci is recommended when staying in these endemic areas. Vaccination is especially important when in contact with many locals, staying overnight in dormitories or in simple conditions and travelling to areas with a current meningitis outbreak. We have the vaccine against meningococcal menigitis in stock in our travel practices. The vaccination is given once and has a vaccine protection of 5-10 years.

Mosquito repellent

When staying in malaria areas, it is increasingly important to protect oneself from the bite of the Anopheles mosquito. The mosquito bites predominantly after dusk until dawn or in dark rooms. The risk of malaria is often assessed by the presence of mosquitoes. This, in turn, is judged by the audible buzz of mosquitoes and the amount of bites felt. In contrast to many native mosquitoes, vectors of malaria (Anopheles mosquitoes) hardly fly audibly. Moreover, their bite elicits no or only a minimal reaction. Thus, the risk of transmission is often underestimated. Apart from malaria, a whole range of other tropical-specific infectious diseases (e.g. dengue, Japanese encephalitis, sleeping sickness, etc.) are transmitted by insects. Therefore, a consistent insect protection is absolutely recommended for every tropical trip. We will be happy to provide you with detailed information during your travel medicine consultation.

Post-/Long-COVID-19 consultation

After a Covid-19 infection, a certain proportion of sufferers can develop post-viral symptoms (post-Covid syndrome). As early as 2020, it became apparent in Wuhan (China) that some patients who had been infected with the novel corona virus showed an unusual course after having passed through the infection. Various symptoms, especially shortness of breath, muscle weakness, fatigue or unusual exhaustion – the so-called fatigue syndrome – as well as concentration problems can be the consequences of a COVID-19 infection. These leading symptoms can persist or reappear during the infection, immediately after the disease or even months later, even after a mild course of the disease. Usually, these symptoms are only present for a few weeks. However, in some people they can last for months. The clinical picture is then also called “long CVID syndrome”. The German Society for Pneumology and Respiratory Medicine (DGP) estimates that about 10% of all people with the disease have to deal with long-term consequences of this kind.

The long-term consequences vary depending on the course of the COVID-19 disease. In a severe course, the consequences are more serious. According to one study, it is assumed that 50-70 percent of the patients will suffer from the consequences for a long time. It is now also known that Long Covid occurs more often in women than men and is strongly age-dependent. Since the exact causes are not yet well understood and have hardly been researched in German-speaking countries, medical care after a Covid-19 infection is important.

Post-COVID-19 or Long-COVID-19: What does that mean in detail?
In addition to the disease itself, the sometimes very invasive therapy, such as treatment in intensive care for several days or prolonged ventilation, can also put a strain on the body and the psyche. Even after the disease has been overcome, some patients may continue to suffer from a wide range of symptoms. This situation is called post-COVID-19 or long-COVID-19.
COVID-19: Not only the lungs but also other organs and organ systems can be affected
COVID-19 is a disease that can affect a number of organs and organ systems other than the lungs. These include the cardiovascular system, the kidneys, the liver and the central nervous system.

What symptoms and complaints can occur and when should I see a doctor?
The causes, the spectrum of the disease and its course are not yet fully known. Those affected suffer from symptoms such as fatigue, persistent breathing difficulties, lack of resilience in everyday life and cardiovascular problems. Psychological symptoms such as increased anxiety or depressed mood play an important role. Often, those affected are no longer able to cope with their daily lives to the extent they are used to. Even in the case of initially uncomplicated and mild courses of COVID-19, such symptoms can occur after the infection has been overcome.

Your contact point in Berlin for a post/long COVID-19 consultation
In our consultation in the centre of Berlin, with our comprehensive expertise in the fields of internal medicine, general medicine, neurology/psychiatry, infectious diseases and tropical medicine, we would like to offer those affected a first point of contact in order to record the symptoms and stresses, to carry out the first important steps in clarification and, if necessary, to plan the further course of action together, e.g. by presenting to other specialists. For this purpose, we have created a network of medical specialists who support us in this task.

Pulse oximetry

Pulse oximetry or pulse oximetry is a procedure for the non-invasive determination of arterial oxygen saturation. A pulse oximeter is a medical device used to measure pulse rate and oxygen saturation in capillary blood. Pulse rate and oxygen saturation are two important parameters that are monitored during ambulance or emergency medical service missions and in critical situations in intensive care medicine or also for safety during outpatient internal surgery. Continuous and simple monitoring is possible with the pulse oximeter. Pulse oximeters are also increasingly used in high-altitude mountaineering to provide early indications of impending altitude sickness. The pulse oximeter is a small device in the form of a clip that is attached to a finger (other easily accessible parts of the body such as the earlobe, toes or, in the case of newborns, heel etc. can also be used). Attaching and wearing the clip is painless and completely harmless for the patient. The clip of a pulse oximeter essentially consists of two parts: A light source on one side and a light sensor on the other. The light source emits infrared light waves that penetrate the finger. On the opposite side, the sensor measures which light components have been absorbed. The different colouring of the haemoglobin, which is saturated with oxygen, results in different absorption for the red light that shines through, which is measured by the photo sensor. In addition to the saturation, the pulse in the smallest blood vessels (capillaries) is also recorded via the clip or adhesive sensor. The measurement records the pulsating blood flowing through and not the tissue and vessels. Pulse oximetry is only an indirect method and therefore potentially prone to error. The procedure is relatively accurate in the usual measurement range (saturation between 80 and 100%), but can be falsified by: * light reflection on painted or artificial fingernails or in the case of nail fungus * insufficient capillary perfusion in shock patients or hypothermic patients with insufficient peripheral perfusion * in the case of carbon monoxide poisoning (here the Hb is 100% saturated – but not with oxygen!) * in the case of mechanical shock, e.g. when driving over uneven terrain, errors occur due to changes in the measuring arrangement. Normal oxygen saturation is no guarantee of undisturbed ventilation. However, direct determination of the O2 saturation in the blood can only be done with a blood gas analysis from a blood sample. Therefore, pulse oximetry offers a good and, above all, simple way to detect early disturbances in the oxygen supply. During activities at very high altitudes, taking a pulse oximeter with you offers the possibility of closely monitoring the adaptation to the lowered oxygen partial pressure. Here, individual readings are never decisive. What is important is the course of the values and the adjustment over several hours, e.g. overnight. An altitude fitness test before the journey can give you an indication of this.

Seaworthiness

In order to obtain the seaman’s book, the examination for seaworthiness is mandatory. This “seaworthiness examination” is mandatory for all seafarers before each change of flag. This examination can take place at the BCRT by appointment. Seafarers who sign on on German seagoing vessels must also prove their fitness for sea service before changing flag in accordance with the requirements of the German Ordinance on Fitness for Sea Service. These sea service fitness examinations are carried out by doctors authorised by the Maritime Medical Service. A preliminary medical examination is permissible for changes of flag: If a fitness for sea duty examination cannot be carried out by an authorised doctor, a preliminary examination may be carried out by other doctors. This is carried out at the BCRT according to the “Standards for the qualification for Maritime Service in Germany” (by appointment).

Sleeping sickness

Disease and route of infection* Sleeping sickness is caused by infection with the protozoan Trypanosoma brucei gambiense (West African form) or Trypanosoma brucei rhodesiense (East African form). Transmission occurs through the bite of an infected tse tse fly. Occurrence/frequency WHO estimates put the number of deaths at 50,000 and the number of infected people at about ten times that number per year. In recent years, outbreaks of sleeping sickness have occurred in Uganda, the Democratic Republic of Congo, Angola, Sudan and the Central African Republic. Sleeping sickness has become a serious health problem in some African countries. As the outbreaks are mainly concentrated in remote parts of the country and refugee camps, tourists are only very rarely affected. However, in recent years, infections have been observed in some tourists who had previously visited the Serengeti in East Africa. This resulted in one death due to treatment failure. Hunters are at particularly high risk in East Africa. Pattern of symptoms West African form: In the first stage, 2 to 3 weeks after the bite, in 5-20% inflammatory swelling with central, non-ulcerating vesicles at the site of the bite (so-called trypanosome chancre). This is followed by an acute general infection with fever and chills and swelling of the lymph nodes, typically mainly in the neck (so-called Winterbottom’s sign). After a largely symptom-free phase, which can last weeks to months, headache, fever, water retention, sensory disturbances and palpitations occur. This stage progresses into a slowly progressive inflammation of the brain, manifested by apathy and eventually coma and death. East African form: In this form of sleeping sickness, the time between infection and onset of the disease is generally shorter, and can be as short as a few days. In 50% of those infected, a so-called “trypanosome chancre” occurs as a direct reaction to the bite of the tse-tse fly. This is a painless, reddened bump on the skin that contains infectious fluid. This is often followed by acute fevers, chills, marked water retention in the tissues and cardiac arrhythmias. Acute heart failure is a common cause of death, otherwise the disease progresses rapidly with the development of increasing apathy and eventually coma and death. Prophylaxis * The best protection is to strictly avoid areas with a high incidence of tsetse flies. Such foci are usually well known locally. * Vaccination is not available. Drug prophylaxis with the substance pentamidine or suramin is possible in principle, but is not recommended due to potential drug side effects and a complicated intake regimen. * Applying repellents to the skin has no protective effect against tsetse flies. * Travellers to risk areas should protect themselves with light-coloured clothing, which should also be impregnated with Permethrin ®. * Tsetse flies seek out dark objects (e.g. cars). Huts and vehicles should be searched regularly * Bites from tsetse flies are painful – they are almost always well remembered. Travellers with a history of such bites and fever or other symptoms of trypanosomiasis should seek medical attention immediately.

Sun protection

Ultraviolet radiation from the sun can cause severe burns to the skin, frequent and excessive exposure can cause skin ageing and even malignant degeneration, such as melanoma or basalioma. The effect of UV radiation and the effects it causes are not only dose-dependent, but also conditioned by skin type (e.g. fair-skinned people are more sensitive than dark-skinned people) and pre-tanning (pre-tanned people are better protected from unwanted UV effects). The amount of radiation dose per unit of time depends on the location, time of day and season. Solar radiation is most intense in the summer months around midday, on tropical beaches, at high altitudes (especially in snow-covered landscapes), at sea and in desert areas. Today, a sun protection factor of at least 25 should be used in the Mediterranean, and a sun protection factor of at least 30 in the tropics and high mountains. Cooling winds or light cloud cover do not reduce the effect of radiation. In heavier cloud cover or in the shade, UV radiation is reduced by 50-70%. However, with the considerable UV exposure in the tropics, this means that fair-skinned Europeans can quickly get sunburned even with closed cloud cover! To avoid sunburn, direct exposure of the skin to the sun should not exceed 15-20 minutes. In addition, a sunscreen cream (at least sun protection factor 10, depending on skin type) should be applied several times a day. Children especially infants and toddlers need a sunscreen with a higher sun protection factor (at least 18-20) at the beginning of UV exposure. The duration of exposure should be reduced to a minimum, as sunburns, especially in children and adolescents up to the age of 15, increase the risk of skin cancer many times over. The sun protection factor is always valid for the whole day. Repeated application does not extend the tanning time – but it is useful to maintain the effect, as sweat, water, sand, textiles or drying off reduce the effect. Important: When applying sun creams, it should be noted that the full development of the sun protection factor is only reached after approx. 60 minutes. Sunbathing should not take place until then. IMPORTANT: Any necessary repellents for insect protection should always be applied after the sunscreen!

TBE- tick-borne encephalitis

TBE- tick-borne encephalitis is the abbreviation for “early summer meningoencephalitis”. This is a viral disease that is transmitted by ticks. TBE is spreading more and more. There is a very reliable vaccination against TBE, which must be administered 3 times at a certain interval. You can get more information and the vaccination without an appointment in our travel practices.

Tetanus

Tetanus, also known as lockjaw, is an infectious disease that is often fatal and is triggered by the bacterium Clostridium tetani. The bacterium is found worldwide and almost everywhere, even in road dust or garden soil. Infection occurs when the spores penetrate wounds, where the bacterium multiplies and secretes toxins. This toxin damages the muscle-controlling nerve cells, causing the typical paralysis and muscle cramps. People can become infected through almost any kind of injury – even through small wounds and scratches, such as those that often occur during gardening. Basic immunisation consists of 3 vaccinations and usually takes place in infancy. Every 10 years, regardless of long-distance travel, an active booster vaccination is required. After an injury, if there is no or insufficient vaccination protection, both active and passive, i.e. simultaneous immunisation, is necessary.

Travel clinic

Travel medicine advice centre of the BCRT – Berliner Centrum für Reise- und Tropenmedizin, staffed by experienced travel medicine specialists. You can find travel clinics in Berlin, Dresden, Frankfurt, Hamburg, Cologne, Munich, Stuttgart and Wiesbaden. You can also get more information from our central hotline: 030-96060940

Travel return check

After a longer stay in the tropics/subtropics as well as during particularly high-risk shorter stays, it is advantageous to carry out a screening for the infectious diseases commonly found in the tropics. In case of symptoms of one or more organ systems, the examination should be adapted accordingly in addition to the usual screening. We offer the possibility of a tropical return examination at our Head Office in Berlin. Please call 030 / 960 609 40 to make an appointment.

Travellers' diarrhoea

Travellers’ diarrhoea is a clinical picture of sudden, non-bloody, often thin, watery diarrhoea in travellers. Travellers’ diarrhoea typically starts very suddenly after an incubation period of 4 to 8 days and lasts on average 3 to 4 days. In 10% of cases, the condition lasts no longer than a week. More serious infections with bloody diarrhoea, a duration of more than 14 days or with a temperature increase of more than 38.5°C should be clarified by a doctor. You can get further advice and tips on the prevention and treatment of travellers’ diarrhoea in our Travel practices. See also Cholera

Typhus abdominalis

Typhus abdominalis is a salmonella infection caused by Salmonella typhi. It is acquired through the consumption of infected food, but also through smear infections in people in the acute stage of the disease. Vaccination indications: * Travelling for a long time in endemic areas and/or staying in villages with the risk of ingesting contaminated water or food. * Travellers who are deficient in gastric acid due to illness or treatment. Oral vaccination: 1 capsule on day 1, 3 and 5 achieves immunity after 10 days. For booster after one year, take 3 capsules again. Contraindications: Oral typhoid vaccine should not be used in persons with immunodeficiencies, children under 3 years of age and pregnant women. Parenteral vaccine should be used instead. Injection: 0.5 ml into the upper arm muscle The injection can be used as a good alternative to oral vaccination. This vaccination protects for up to three years. It can be used in pregnant women, children under 3 years of age and people with immunodeficiencies, including AIDS patients. This vaccine has a longer protective effect and fewer unwanted side effects. We are happy to advise and vaccinate you on typhoid vaccination in our travel practices.

vaccination certificate

The international vaccination certificate is a multilingual document in which all vaccinations received should be entered. This makes it easy to see which vaccinations are available, which need to be refreshed and which should still be carried out. There are special pages in the vaccination certificate for mandatory vaccinations. For example, the yellow fever vaccination also requires a special seal for documentation. This is only available at yellow fever vaccination centres. The vaccination certificate is a document and should be carried when travelling. If you do not have a vaccination certificate, you will be issued a new one at our travel practices.

Vaccination schedule

During every travel medicine consultation, the traveller receives an individual vaccination schedule from our doctors. This schedule lists the existing vaccinations as well as all vaccinations recommended by us and their required intervals. The traveller should bring this vaccination schedule back to the travel clinic for all vaccinations.

Vaccinations for immunodeficiency

Severe immunodeficiencies can be congenital. Advanced HIV infection (AIDS), leukaemia, lymphoma, generalised cancer and treatment with high doses of corticosteroids ( >20 mg / day), cytostatics, radiotherapy also lead to immunodeficiencies. Persons with immunodeficiencies should not be vaccinated with live vaccines. This also applies to persons living together with immunodeficient persons, since vaccinated persons often excrete large amounts of virus and can infect immunodeficient persons. It can be assumed that HIV-infected persons who have a CD4 count of more than 200 cells/microlitre, with or without treatment, can be vaccinated with live vaccines without major risk. However, there is hardly any experience available so far. Therefore, it is still advisable to replace live vaccines with inactivated vaccines as far as possible. In our opinion, MMR vaccinations do not pose a greater risk. The same vaccination programme is recommended for HIV-infected children as for other children. Inactivated vaccine can equally be used in immunodeficient individuals.

Vaccinations in children

The basic rule is: children need the same vaccinations as adults! From the age of 12-15 months, when the protection provided by maternal antibodies against some infectious diseases such as measles, mumps and rubella wears off, children have at least the same risk of infection as adults. For some diseases, such as TBE, polio, typhoid fever, meningitis and hepatitis B, the risk of contracting the disease in older children even appears to be significantly higher than in adults. This is especially true for those children who visit their grandparents in their home country or stay abroad for a longer period of time. These children have a significantly increased risk of contracting water-associated infections such as hepatitis A / E, typhoid or rotavirus. Close contact with local children increases the risk of meningitis, hepatitis B, tuberculosis and diphtheria. Travelling children also expect very high exposure to pathogens of the classic childhood diseases, especially measles, and makes early vaccination advisable, deviating from the vaccination calendar. We have special vaccines for children in our travel practices.

Vaccinations in pregnant women

In general, if you are pregnant, you should consider postponing your trip to the tropics until after the end of your pregnancy. Vaccines containing live, attenuated microorganisms (yellow fever, BCG, oral typhoid vaccine, oral polio, oral cholera (CVD 103), or MMR) should not be given to pregnant women at all or only after strict consideration of the risks. However, if these vaccines are given when pregnancy is undiagnosed, abortion is not necessary for this reason. Vaccinating a pregnant woman may be necessary, for example, if she is staying in areas with a high risk of yellow fever transmission. Inactivated vaccines can be given during the journey after weighing up the risks of infection. When travelling to the tropics/sub-tropics, the risk should be minimised by choosing suitable accommodation, using a mosquito net and taking appropriate precautions when eating. A change of destination should be considered if there is a high risk of infection, e.g. malaria. In some situations it may be necessary to vaccinate pregnant women against hepatitis A, hepatitis B, diphtheria and “tetanus” before travelling abroad: #tetanus (if they have not received the primary vaccination), Japanese encephalitis, typhoid (parenteral vaccine), meningococcal, poliomyelitis, and yellow fever. The majority of product information for vaccines in Germany states that there is insufficient experience during breastfeeding. Even if there is no evidence that vaccination during this time is harmful, an individual risk assessment should be made. The WHO and the CDC do not have any contraindications for the administration of vaccinations during the breastfeeding period.

Vaccines

Live vaccines such as yellow fever vaccine and oral typhoid and polio vaccines should not be used in immunodeficient persons (including AIDS patients) beyond the contraindications listed in the schedules. For vaccination of persons with immunodeficiency, live vaccines should be replaced by inactivated vaccines, e.g. inactivated polio and typhoid Vi. * All vaccines can be given at the same time, but as separate injections. There is now a whole range of combination vaccines on the market that make administration much easier, especially in children. * If vaccinations are not given at the same time, subsequent vaccination with an inactivated vaccine, such as diphtheria, tetanus, parenteral polio (IPV), haemophilius influenza (Hib), Japanese encephalitis (JE), hepatitis A (HAV), hepatitis B (HBV), cholera, oral cholera WC/rBS, meningococcal A + C, rabies, parenteral typhoid, pneumococcal or influenza can be administered at any time without disturbing the immune response or increasing possible vaccine reactions. * Vaccinations with live vaccines (yellow fever, MMR) should be given at the earliest 4 weeks after vaccination with other live vaccines. When vaccinated with live vaccines, the body produces natural interferons which make it more difficult for the virus to multiply in the following 3 to 4 weeks. * In addition to the contraindications mentioned for each individual vaccination, live vaccines such as those against yellow fever or measles are contraindicated for travellers with manifest immune deficiency. For this group, only inactivated vaccines should be used if possible. * As a rule, intervals between vaccinations should not be shortened. On the other hand, an extension of vaccination intervals is possible without any problems. It is therefore not necessary to start again from the beginning with a once interrupted basic immunisation. * The mode of application is of paramount importance. In particular, vaccines for which a strictly intramuscular application is recommended, such as Hepatits A, B, A+B, Typhoid, Rabies, the upper arm muscle should always be chosen. * Vaccinations should not be administered in acute, especially febrile, illnesses, as on the one hand the immune response may be weakened, and on the other hand symptoms of illness may be misinterpreted as vaccination reactions. * Components of vaccines can trigger allergic reactions in sensitive individuals. Animal proteins (e.g. chicken egg white in yellow fever and influenza vaccines), preservatives (thiomersal in hepatitis A, B or A+B vaccines), neomycin (MMR) or stabilisers (gelatine) may be responsible. * All vaccines can trigger vaccination reactions. Mostly, these manifest themselves as mild flu-like symptoms with or without fever, which occur within 24h after vaccination. This in no way excludes further vaccinations. * If a vaccination against Japanese encephalitis or hepatitis B is part of the vaccination schedule, it should be started at least 3 weeks, better 4 weeks before departure. Otherwise, short-term appointments are also possible.

Vouchers

Vouchers for travel consultations, altitude training lessons or other services of our BCRT can be obtained at any time from our Head Office in Berlin. anmeldung@bcrt.de or 030/ 960 609 40

Yellow fever

Yellow fever is a viral disease transmitted by mosquitoes. The mosquitoes are diurnal and the virus is found especially in South America and Africa. The incubation period is 3-6 days, the mortality rate is 30-50%. Effective protection is a vaccination with the live vaccine, which provides lifelong protection. Many countries require proof of a yellow fever vaccination upon entry. This must be documented in the vaccination card with a separate seal. In our Reisepraxen you will be informed in detail if necessary. The yellow fever vaccination can be carried out at our travel practices.

Zostervax

vaccine against shingles / herpes zoster. See also Herpes zoster

BCRT - Berliner Centrum für Reise- und Tropenmedizin ist eine Firmierung der Praxis Prof. Dr. Jelinek an den jeweiligen Standorten der Reisepraxen. Der Behandlungsvertrag kommt ausschliesslich mit Prof. Dr. Jelinek zustande.