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Infectious diseases in German military personnel after predominantly tropical deployments: a retrospective assessment over 13 years
  1. Marius Schawaller1,
  2. D Wiemer1,
  3. R M Hagen2 and
  4. H Frickmann3,4
  1. 1Department of Tropical Medicine and Infectious Diseases, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
  2. 2Department of Microbiology and Hospital Hygiene, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
  3. 3Department of Microbiology and Hospital Hygiene, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
  4. 4Institute for Medical Microbiology, Virology and Hygiene, Universitätsmedizin Rostock, Rostock, Germany
  1. Correspondence to H Frickmann, Department of Microbiology and Hospital Hygiene, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany; Frickmann{at}


Objectives Military deployments to the tropics are associated with specific infection risks. To add to the available epidemiological information, infectious disease risks in German military personnel returning from predominantly tropical deployments were assessed.

Methods Since 2006, German soldiers returning from predominantly tropical deployments have been offered the opportunity of returnee screenings at the Department of Tropical Medicine and Infectious Diseases of the Bundeswehr Hospital Hamburg. Case files and diagnostic results recorded between 2006 and 2018 were retrospectively assessed to identify deployment-associated infectious disease risks.

Results Along with high enteric colonisation rates with apathogenic protozoa and resistant Enterobacteriaceae, direct or indirect proof of infections among the 764 assessed cases comprised Plasmodium spp (n=37), Giardia duodenalis (n=21), Schistosoma spp (n=14), Yersinia enterocolitica (n=5), Strongyloides stercoralis (n=3), Campylobacter jejuni (n=1), Leishmania spp (n=1) and Salmonella enterica (n=1), as well as latent infections with Mycobacterium tuberculosis complex (n=8). The infections were mainly imported from the African region and Eastern Mediterranean region and high proportions of cases lacked typical symptoms. Reported side effect rates of antimalarial chemoprophylaxis for mefloquine (n=121), atovaquone/proguanil (n=49) and doxycycline (n=6) were 36.3%, 19.3% and 11.8%, respectively, while non-compliance rates were 12.9%, 13.0% and 5.9%, respectively.

Conclusions Considerable rates of infections with sometimes atypical or absent symptoms confirm a need for returnee screenings after tropical deployments. High reported side effect rates for mefloquine support its replacement by atovaquone/proguanil or doxycycline for antimalarial chemoprophylaxis.

  • epidemiology
  • gastrointestinal infections
  • infectious diseases
  • diagnostic microbiology
  • molecular diagnostics
  • tropical medicine

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  • Contributors MS, DW, RMH and HF jointly planned the study. MS assessed the data and prepared the manuscript. All authors have jointly optimised and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical clearance (WF-019/17) for anonymous retrospective assessment without informed consent was obtained from the Ethics Committee of the Medical Association of Hamburg, Germany, in line with German national laws.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Data are available on reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.