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Adequate prophylaxis should always be the order of the day if anyone plans to visit a foreign country where he may be at risk of being exposed to infectious diseases. Numerous protective vaccinations are available for this purpose in Germany. Basing on the incidence of recorded damage caused by such vaccinations 1971-1990 we must conclude that the risk of damage to health as a result of such vaccinations is very remote. Hence, the protective vaccinations carried out in Germany are of vital importance in respect of keeping down the number of infections.

Hospital-acquired infections are a worldwide problem especially in hospitals for the treatment of acute cases. These infections are among the leading causes of death. Certificates of death of 4656 patients who died in hospitals were analysed. Of these, 564 deaths were caused by nosocomial infections (12.1%). It was estimated that annually around 40,000 deaths in the Federal Republic of Germany are attributable to infections acquired in the hospital.

Malaria was in 1989/90 the most important imported disease in Germany. Most of all cases were imported by German tourists (about 75%). Africa was the most prominently represented geographic region (about 75%). Kenia and Ghana represented there the biggest share. About 33% of all patients had not done a sufficient prophylaxis against malaria. An adequate prophylaxis against malaria taking into consideration the recommendations for medicaments for different geographical areas is imperative before the number of importations of malaria into Germany can be reduced.

73 cases of leprosy were imported into the Federal Republic of Germany between 1981 and 1992. A large number of imported cases came from Asian countries (32 cases). 61 patients were male, 12 female. 30 patients had the tuberculoid type of leprosy, 29 the lepromatous. From the total of 73 leprosy patients 7 were German nationals. Early diagnosis and efficient treatment play an important role in ensuring a good prognosis.

The results of an inquiry about the personnel and organisation of the hospital hygiene in 657 German rehabilitation centres and psychiatric hospitals demonstrate that 24% of these hospitals have a hospital epidemiologist, 44% have infection control nurses and 74% infection control physicians. Infection control committees are present in 64% of these hospitals. 78% of the hospitals use the guideline of the Federal Public Health Office "On the Identification, Prevention and Control of Hospital Infections" as a basis for all decisions on hospital hygiene.

Analysis of the outbreaks of food-borne infections and intoxications with a total of 2,610 patients in 1991 demonstrates that these cases were caused in 67.4% by Salmonella species. Eggs were mainly responsible for the outbreaks, whereas poor kitchen hygiene played also a main part in promoting disease.

An outbreak of septicaemia caused by Acinetobacter involved eight patients of an ICU within a period of 6 days. All patients were treated with heparin infusions. We isolated Acinetobacter from the blood of all these patients and from a mixture of heparin and isotonic saline solution. As underlying causal event a combination of risk factors and mistakes is suggested. These may include the multiple reuse of infusion bottles by different users, the reuse of perfusor injectors, and underscores the necessity of strict hygienic precautions. This event points to a disseminated risk factor that should be considered within the frame of control systems for hospitals.

Malaria continues to be an important travellers' disease in Germany. In 1988 885 cases of malaria were imported into the Federal Republic of Germany. German tourists to far-away countries represented the biggest share (about 80%). Africa was the most prominently represented continent with 76%. Differentiation according to species of pathogens showed that 68% of the diseases were caused by Plasmodium falciparum. 11 patients died of malaria in 1988, in all cases due to P. falciparum infection. The mortality of the patients increases with age. Only in 5 of 11 persons who died there had been a sufficient prophylaxis against malaria, at least as far as the anamnesis revealed. Careful planning of sufficient prophylaxis taking into consideration the partly very marked resistance to a multitude of drugs, as well as competent medical advice to would-be travellers, are imperative before the number of malaria imports into Germany can be reduced.

The results of an inquiry about the hospital hygiene in 2034 German hospitals demonstrate, that 35% of all hospitals have a hospital epidemiologist, 66% have infection control nurses and 86% infection control physicians. Infection control committees are present in 81% of German hospitals. 88% of all hospitals use the guideline of the Federal Public Health Office "On the Identification, Prevention and Control of Hospital Infections" as a basis for all decisions on hospital hygiene.

1976 the Federal health Office published the guideline "Erkennung, Verhütung und Bekämpfung von Krankenhausinfektionen". The guideline defines the levels of hospital hygiene and gives important directions to physicians and nursing staff. The guideline has been increasingly incorporated in regulations.