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Germany



Capital: Berlin

Time Zone: +1 hour. (GMT +2 between the last Sunday in March and the last Sunday in October).
Tel. Country Code: 49
USADirect Tel.: 0
Electrical Standards: Electrical current is 230/50 (volts/hz). European-style two-pin plugs are standard. Grounding Adaptor Plug D.


Travel Advisory - Germany

Europe, Russia and former the Soviet Union countries vary widely in travel risks and adequacy of health care delivery. Water- and food-borne illnesses such as travelers' diarrhea, typhoid and Giardia are threats outside of Western Europe. Insect-transmitted diseases, such as Lyme disease and tick-borne encephalitis are common in wooded, rural areas in most countries, including Western Europe.

Dr. Rose Recommends for Travel to Germany


Resource Links

NaTHNaC
World Health Organization
CDC
Travel Health Services
Country Insights
Travel Warnings
Consular Information
Foreign Commonweatlh Office

Embassies

• U.S. Embassy
Neustaedtische Kirchstrasse 4-5
Berlin
Tel: [49] (30) 238-5174, 8305
Website: http://germany.usembassy.gov/

• U.S. Consulates:
Duesseldorf
Tel: 49-211-788-8927; Fax: 211-788-8938
Frankfurt
Tel: 69-75350; Fax: 49-69-7535-2304
Hamburg
Tel: 40-4117-1351; Fax: 49-40-44-30-04
Leipzig
Tel: 341-213-8418; Fax: 341-21384-17
Munich
Tel: 89-288-8722; Fax: 49-89-280-9998

• Embassy of Canada
Leipziger Platz 17
Berlin
Tel: [49] (30) 20 31 20
Emergency toll-free to Ottawa: 00-800-2326-6831
Fax: 49 (30) 20 31 24 57
E-Mail: brlin-cs@international.gc.ca
Website: http://www.berlin.gc.ca

• British Embassy
Wilhelmstrasse 70
Berlin
Tel: [49] (30) 20457-0
Website: http://www.britischebotschaft.de/

Entry Requirements

HIV Test: Testing is required for those applying for residence permits (Bavaria only).

Required Vaccinations: None required.

Passport Information

Passport/Visa: Germany is a modern and stable democracy. Tourist facilities are highly developed. In larger towns, many people can communicate in English. 

ENTRY REQUIREMENTS: A passport is required. U.S. citizens can stay without a visa for a tourist/business stay of up to 90 days. That period begins when you enter any of the Schengen countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain and Sweden. Further information on entry, visa and passport requirements may be obtained from the German Embassy at 4645 Reservoir Road NW, Washington, DC 20007, telephone (202) 298-4000.
Web site: http://www.germany.info/relaunch/index.html
or the German Consulates in Atlanta, Boston, Chicago, Houston, Los Angeles, Miami, New York, or San Francisco.

Vaccinations: Recommended and Routine

Hepatitis A: Recommended for all travelers not previously immunized against hepatitis A who wish extra protection.

Hepatitis B: Recommended for all travelers who might be exposed to blood or body fluids from unsafe/unprotected sexual contact; from injecting drug use; from medical treatment with non-sterile (re-used) needles and syringes; from contact with open skin sores of an infected person. Recommended for any traveler requesting protection against hepatitis B.

Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.

Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.

NOTE: There has been a significant number of cases of measles reported in Bavaria and Hesse since January 2007. Measles is a potentially serious infectious disease, particularly for children, and the Department of Health and Ageing advises that travellers to Switzerland should ensure they are protected against measles prior to travel and should consult their doctor.

Who should receive the MMR vaccine?
• All infants 12 months of age or older
• Susceptible adults who do not have documented evidence of measles immunity, such as a physician-diagnosed case of measles, a blood test showing the presence of measles antibody, or proof of receiving measles vaccine.

Immunity against measles is particularly important for adults at high risk for measles exposure, including college students and health care workers. People born before 1957 who are not in one of these high-risk categories are generally considered immune to measles through environmental exposure.



Hospitals / Doctors

Medical care in Germany is of a high standard. All travelers to should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea (low risk) or other infections (e.g., urinary tract infection). Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage. Policies should cover: ground and air ambulance transport, including evacuation to home country; payment of hospital bills; 24-hour telephone assistance.

Travel Medicine and Infectious Disease specialists:

• Luise Prufer-Kramer, MD
Travel Clinic
Furtwänglerstr. 9
Bielefeld
Telephone: [49] (521) 521-3530
Fax: [49] (521) 521-2404
E-mail: pruefer-kraemer@gmx.de;
Website: http://www.tropenmedizin-bielefeld.de
Pre-Travel Vaccination, Official Yellow Fever Vaccine Center, Post-Travel Medical Consultation, On-Site Diagnostic Laboratory.

• Thomas Schmidt, MD
MediScon Worldwide
Kaulbachstr, 25
Hannover
Telephone: [49] (511) 2283885; Fax: [+49] (511) 2283884
E-mail: info@mediscon.com
Website: http://www.mediscon.com
Pre-Travel Vaccination, Post-Travel Medical Consultation.

• Gerhard Boecken, MD
German Naval Medical Institute
Division for Applied Tropical Medicine
and Infectious Diseases Epidemiology
120 Kopperpahler Allee
Kronshagen-Kiel
Kronshagen-Kiel
Tel: [49] (431) 5409-1707; Fax: [49] (431) 5409-1533
E-mail: tropmed.marine@t-online.de
Pre-Travel Vaccination, Official Yellow Fever Vaccine Center, Post-Travel Medical Consultation, On-Site Diagnostic Laboratory.

• Peter Hartmann, MD
Tropenmedizinische Praxis
Schellingstrasse 153 b
Munich
Germany
Tel: [49] (89) 1296344; Fax: [49] (89) 1296317
E-mail: dr-hartmann@online.de
Website: http://www.dr-hartmann-web.de
Pre-Travel Vaccination, Official Yellow Fever Vaccine Center, Post-Travel Medical Consultation, On-Site Diagnostic Laboratory.

• Thomas Loscher, MD
Department of Infectious Diseases and Tropical Medicine
University of Munich
Leopoldstrasse 5
Munich
Tel: [49] (89) 21803517; Fax: [49] (89) 336112
E-mail: loescher@lrz.uni-muenchen.de
Website: http://www.tropinst.med.uni-muenchen.de
Pre-Travel Vaccination, Official Yellow Fever Vaccine Center, Post-Travel Medical Consultation, On-Site Diagnostic Laboratory.

• Frank von Sonnenburg, MD
Department of Infectious Diseases and Tropical Medicine
Leopoldstr, 5
Munich
Tel: [49] (89) 398844; Fax: [49] (89) 336112
E-mail: tropinst@lrz.uni-muenchen.de
Website: http://www.tropinst.med.uni-muenchen.de
Pre-Travel Vaccination, Official Yellow Fever Vaccine Center, Post-Travel Medical Consultation, On-Site Diagnostic Laboratory.

• Michael von Zielonka, MD
Center International Medicine
Isabellastrasse 20
Munich
Tel: [49] (89) 2716700; Fax: [49] (89) 27373101
E-mail: zielonka@lrz.uni-muenchen.de

• Jargen Knobloch, MD
Institute of Tropical Medicine
University of Tubingen
Keplerstr. 15
Tubingen
Telephone: [49] (49) 7071-2982365; Fax: [49] (49) 7071-295267
E-mail: reisemedizin@med.uni-tuebingen.de
Website: http://www.medizin.uni-tuebingen.de/~webitm/
Pre-Travel Vaccination, Official Yellow Fever Vaccine Center, Post-Travel Medical Consultation, On-Site Diagnostic Laboratory.

Destination Health Info for Travelers

AIDS/HIV: Primary risk groups include men having sex with men (MSM) and intravenous drug users. Adult HIV prevalence in Germany is 0.1%. According to estimates, the largest numbers of people living with HIV in Western Europe in 2006 were in France (prevalence 0.4%) and Italy (prevalence 0.5%). Source: www.Avert.org
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with the body fluids of another person or their blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.

Accidents & Medical Insurance:
Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes. Important safety rules to follow are 1) Do not drive at night, 2) Do not rent a motorcycle, moped, bicycle, or motorbike, even if you are experienced, and 3) Don't swim alone, at night, or if intoxicated.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.

Avian Influenza (Bird Flu): The Friedrich-Loeffler-Insitute / Federal Research Institute for animal health has confirmed outbreaks of avian Influenza (Bird Flu) in wild birds throughout Germany. Following outbreaks in Bavaria, Saxony, Thuringia and Eastern France (close to the German border) in June 2007 the national crisis team for Avian Influenza raised the risk level for farmed poultry to high. No human infections or deaths have been reported.
• H5N1 avian influenza is predominantly a disease of birds. The virus does not pass easily from birds to people and does not to pass from person to person (except in very rare cases of close contact with an infected blood relative). The risk to humans from avian influenza is believed to be very low and no travel restrictions are advised, except travelers should avoid visiting animal markets, poultry farms and other places where they may come into close contact with live or dead poultry, or domestic, caged or wild birds and their excretions. In addition, travelers are advised to:
1. Cook poultry and egg dishes thoroughly. (Well-cooked poultry is safe to eat.)
2. Wash hands frequently with soap and water if around poultry.

The World Health Organization (WHO) does not recommend travel restrictions to countries experiencing outbreaks of H5N1 avian influenza in birds, including those countries which have reported associated cases of human infection.

The usual vaccines against influenza are not protective against “bird flu.”
Oseltamivir (Tamiflu) is somewhat effective in the treatment of H5N1 avian influenza. It seems to be effective in some cases, but may fail in others. Recently, resistant strains have been reported. In addition, the dosage and duration of treatment appear to be different in severe H5N1 cases.

• Updated information here: http://content.nejm.org/cgi/content/full/358/3/261

• The World Organisation for Animal Health (OIE) has confirmed cases of avian influenza in birds in a number of countries throughout the world. For a list of these countries, visit the OIE website: http://www.oie.int/downld/avian%20influenza/A_AI-Asia.htm

Hantavirus Pulmonary Syndrome: From January to April 2010, 396 hantavirus infections were reprted, a considerable increase compared with previous years, (including the record-setting year, 2007). Most patients resided in known Puumala virus endemic areas in southern Germany. The recent increase in notified hantavirus infections is probably due to an increased population density of the main animal reservoir, the bank vole (Myodes glareolus).
Hantavirus is transmitted by rodents and, although risk to the typical traveler is minimal, contact with rodent droppings and rodent urine should be avoided. Travelers are at low risk of infection. There is a principal role for respiratory infection from aerosols of infectious virus from rodent urine, feces and saliva. (In 1993, in the southwestern United States, an outbreak of respiratory illness caused by the Sin Nombre virus, which belongs to the genus Hantavirus, occurred and was described as the Hantavirus pulmonary syndrome.) Person-to-person spread of infection does not occur.

Hepatitis: There is a low risk of hepatitis A in Western Europe, especially in Germany, but the hepatitis A vaccine should be considered for maximum protection. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is endemic at a low level. Seroepidemiological investigations show a prevalence of hepatitis E antibodies of 1% in the general population.
(Eurosurveillance: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=1398)
Sporadic cases may occur but be underdiagnosed or underreported. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at <1%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic at a low level with a prevalence of 0.1% in the general population. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C, an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.

Influenza: Influenza is transmitted from November through March. The flu vaccine is recommended for all travelers over age 6 months.

Legionnaires' Disease: Currently an investigation is ongoing to explore and control an outbreak of Legionnaires’ disease, affecting 65 people as of 22 January 2010, in the cities of Ulm and Neu-Ulm, south-west Germany. A hitherto unidentified wet cooling system in these twin cities is considered as the most likely source of infection.
• On 5 January 2010, Ulm University Hospital informed the local health office of a cluster of hospitalisations due to community acquired pneumonia caused by Legionella pneumophila serogroup (sg) 1. As of Friday 22 January 2010, 65 cases including five deaths were under investigation by the local and regional health authorities. With only a few exceptions all cases were living or working in Ulm or Neu-Ulm in south-west Germany. All cases are German residents aged between 27 and 96 years (median age 67 years).

Lyme Disease: This disease is reported countrywide, but most cases are reported in the south, primarily in Bavaria, mostly in the spring and summer. Up to 34% of ticks in some endemic areas are infected. The ticks that transmit Lyme disease are found in brushy, wooded areas and broadleaf (mostly oak) forests under 1,000 meters elevation.
Travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease if taken within 72 hours of being bitten by an infected tick. (Reference: http://content.nejm.org/cgi/content/abstract/345/2/79).
Source: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19472

Other Diseases/Hazards: Brucellosis
• Boutonneuse fever (vert rare; reported from a region SE of Frankfurt in the 1980s)
• Echinococcosis (risk greatest in Swabbian uplands of central Wurttemberg State; E multilocularis eggs, which are the infectious agents for humans, are dispersed in the environment via the feces of carnivores. The eggs may contaminate various types of food, including fruits and vegetables collected from gardens or infected meadows, and drinking water) • Legionellosis (See Legionnaire's Disease, above)
• Leptospirosis (risk may be elevated in the northeast; related to direct contact with infected rats and dogs)
• Q fever (outbreak reported in 1996 in Rollshausen and vicinity; some cases had breathed infectious aerosols when walking near sheep farms that had infected animals)
• Tularemia (rare; outbreak reported in November 2005 among hare hunters in the Darmstadt-Dieburg district)

Rabies: Germany is reported to be free of canine rabies. All wild animal bites, however, especially from a racoon dog or fox, should be vigorously cleansed with soap and water and medically evaluated for possible post-exposure treatment.
Rabies is still present in Europe. Its incidence in humans remains limited (fewer than 5 human cases per year) through the application of strict prophylactic measures (anti-rabies treatment) and by means of veterinary rabies control measures in the domesticated and wild animal populations. The main indigenous animal reservoirs are: the dog in eastern European countries and on the borders with the Middle East; the fox in central and eastern Europe; the racoon dog in northeastern Europe; and the insectivorous bat throughout the entire territory.
Eurosurveillance: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=575

Tick-Borne Encephalitis (TBE): Most cases reported from the southern lowland forested and wooded areas of Bayern and Baden-Wurttemburg. Cases are reported from Baden-Wurttemburg (Black forest, upper Rhine valley) region. The valleys of Kinzig, Elz, and Dreisam as well as the regions around Freiburg and Pforzheim are endemic areas. Upated risk areas are here:
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19236
• Vaccination against TBE should be considered by those camping near forests, for extended hiking and camping in rural endemic areas, and for forest workers. The standard vaccination schedule consists of 3 doses given at 0, 1-3 months, and at 9-12 months. An 2-dose accelerated schedule is possible (0, 21 days), with 85% protection resulting. The European vaccine (FSME-IMMUN-Baxter) is available in health clinics in Germany, Austria, Slovakia, Czech Republic and Poland, as well as Canada, but the traveler would have to initiate the vaccine after arriving in the area and hiking/camping delayed for 3 weeks before adequate protection to kick in. This makes administration of vaccine generally impractical for the average traveler. Tick-bite protection is therefore essential.
• Travelers, especially those engaging in outdoor activities in rural areas, are advised to take measures to prevent tick bites during the peak transmission season, March to November. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A map showing the distribution of TBE is here: http://www.nathnac.org/includes/contents/documents/TBEmap.gif

Other known tick-borne diseases in Germany include Lyme borreliosis, Q-fever, babesiosis and presumably ehrlichiosis.
• Human granulocytic ehrlichiosis is now called human granulocytic anaplasmosis.
• Babesiosis: The majority of babesia infections in Europe are life-threatening and caused by Babesia divergens and B. bovis
• Mediterranean spotted fever (southern Europe; caused by Rickettsia conorii)
• Tularemia (also transmitted to humans by direct handling of infectious carcasses, ingestion of contaminated food or water, and inhalation of infectious dusts or aerosols)

Travelers' Diarrhea: In western Germany, drinking water in urban areas is safe, but well water in rural areas may be contaminated. In the new states of the former East Germany, advanced water treatment systems that reduce contamination from industrial solvents, pesticides, heavy metals, and other pollutants may be lacking. Water there is safe to drink only in major cities and at the better hotels and restaurants. Travelers to eastern Germany should drink only commercially bottled water or other safe beverages.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%.
• A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.

Typhoid Fever: In June 2004, six confirmed cases of typhoid fever were reported to the health authorities in Leipzig, Germany. The illness was locally acquired; none of the patients had traveled to endemic countries. Although there is a very low risk of acquiring typhoid in Europe, this diagnosis should be consider in illness with unexplained fever.
• The reservoir for Salmonella typhi is strictly human. Most restaurant outbreaks that have been described in the literature are due to the consumption of raw or not reheated food contaminated by an infected foodhandler. Handwashing before any handling of food, and after each visit to the toilet, is an indispensible hygiene measure for the prevention of transmission of this disease.