Editorial

Dear Reader!
Esteemed Comrades!

Diseases originating from tropical and subtropical regions have long posed a significant challenge to military medicine. Throughout history, parasitic, viral, and bacterial infections have often caught deployment contingents unprepared, leading to morbidity and mortality rates that have frequently been decisive in determining victory or defeat. Even today, scientific expeditions, private travel, and commercial shipping remain affected. Consequently, it is only logical that maritime medicine, as well as travel and tropical medicine, are closely interconnected and play a crucial role in the Bundeswehr’s global operations. This applies to the prevention, diagnosis, and treatment of individual illnesses, as well as the management of disease outbreaks.

The foundation of today’s tropical medicine in the Bundeswehr was laid in the early 1990s by the team led by Dr. Gerhard Boecken at the Naval Institute of Maritime Medicine. Through professionalism, early expertise, and necessary persistence, this group paved the way for the sophisticated training of young medical officers in Germany and hospitals in the tropics. Brazil, Ghana, Tanzania, Thailand, and Senegal are just a few of the countries where the required training months are completed, ultimately leading to the “additional qualification in tropical medicine.”

Today, in 2026, tropical medicine in the Bundeswehr is characterised by clinical and scientific work in a civil-military collaboration. In Hamburg, the Bernhard Nocht Institute for Tropical Medicine, the University Medical Centre Hamburg-Eppendorf, and the Bundeswehr Hospital have been working successfully and efficiently together for 20 years. The Berlin Bundeswehr Hospital cooperates with the Charité University Medicine. It is, therefore, only logical that these two Bundeswehr hospitals take the lead in shaping infectious and tropical medicine across all Bundeswehr hospitals within the clinical military medicine network.

In the future, it will also be essential to consider the impact of climate change on the disease and pathogen spectrum in Germany. With the current spread of various vectors, the increased occurrence of “vector-borne diseases” in Central Europe is not a matter of “if,” but “when.” The COVID-19 pandemic has exemplarily demonstrated how inadequately prepared we are for such events clinically, diagnostically, from a public policy perspective, and in terms of communication. As many diseases can no longer be regionally contained, it is logical to continue developing tropical and infectious medicine together. This applies across all sectors, including inpatient and outpatient care, as well as public health responsibilities.

Insights from Ukraine also demonstrate that multi-resistant pathogens present health systems, particularly in crises and warfare, with highly complex challenges. Therefore, in military medicine, alongside trauma care topics, we must not lose sight of infectious and tropical diseases. Today, it is crucial to practice controlling these diseases by considering all aspects of prevention, diagnosis, and therapy, as well as outbreak management in civil-military partnerships, to prepare ourselves strategically.

Together with our civilian partners, we approach these tasks in an evidence-based, professional, and forward-thinking manner. I would like to take this opportunity to thank the Free and Hanseatic City of Hamburg, the Bernhard Nocht Institute for Tropical Medicine, and the University Medical Centre Hamburg-Eppendorf for 20 years of appreciative and fruitful cooperation. This explicitly includes our partners in the Global South, from whom we learn as equals. Together with the team of our Bundeswehr Hospital, I look forward to many more years of collaboration.

Dr. Thomas Harbaum
Brigadier General
Commander and Medical Director of the Bundeswehr Hospital Hamburg

20 Years of the Division of Tropical Medicine –

”You can do it... But Should You?”’

The Division of Tropical Medicine – Development, Tasks, and Focus Areas

Dorothea Wiemer^a

^a Division of Tropical Medicine and Infectiology, Department of Internal Medicine, Bundeswehr Hospital Hamburg, Branch at Bernhard Nocht Institute for Tropical Medicine

Summary

The Divsion of Tropical Medicine at the Bundeswehr Hospital in Hamburg was founded in 2005 and has been working in close cooperation with the Bernhard Nocht Institute and the University Medical Centre Hamburg-Eppendorf since January 2006. The department offers further training, research and clinical care relating to tropical diseases such as malaria, dengue fever and leishmaniasis, as well as travel advice, vaccinations and prophylaxis. Despite its rarity, the field remains relevant, as global mobility and climate change favour the spread of pathogens. Within the Bundeswehr Medical Service, tropical medicine, as an extension of infectious diseases, contributes to ensuring operational readiness and resilience. It encompasses specific preventive measures such as vector detection and control, early clinical diagnosis, and expertise in managing highly dangerous infections.

Keywords: tropical medicine; civil-military cooperation; operational capability; prevention; resilience

Introduction and Historical Overview

The Division of Tropical Medicine (DivTropMed) at the Bundeswehr Hospital Hamburg/Bernhard Nocht Institute (BNI) was established on the basis of a cooperation agreement between the BNI and the Bundeswehr Medical Service and has been working in cooperation with its partners for 20 years. Upon its establishment, the University Medical Centre Eppendorf (UKE) took on the role of second partner, assuming responsibility for clinical patient care – including outpatient and inpatient services.

The roots of the Department of Tropical Medicine (FbTropMed) lie in a department of the Naval Institute of Maritime Medicine, which had previously been intensively engaged with issues relating to tropical medicine. The focus was in particular on so-called ‘barrier nursing’, a method of infection control involving targeted isolation measures.

Since 2006, the Division of Tropical Medicine has been working closely with the BNI and the UKE. Its remit includes further training in the field of tropical medicine, the delivery of relevant teaching content across all sub-disciplines, research into the diagnosis of tropical pathogens, and the clinical care of patients with potential tropical medical conditions.

This article aims to describe the development of expertise in tropical medicine within the Bundeswehr Medical Service, as well as its continuing significance, particularly regarding national and alliance defence.

Brief Historical Overview

Tropical medicine developed in the 19th century in response to the increasing number of colonists and missionaries in tropical regions. In this early phase, the main focus was on safeguarding the health of European travellers as well as local labourers and slaves, particularly to secure economic and military interests in the colonies. Modern tropical medicine also engages critically and across professional boundaries with this part of its own history in order to ensure that its further development is clearly value-based [1].

Nowadays, outside the traditional tropical and subtropical zones, tropical medicine primarily assumes the role of so-called ‘post-travel medicine’. The focus here is on the medical care of individuals following stays in tropical regions. Furthermore, expertise in tropical medicine is also applied to a limited extent in the field of ‘Migrant medicine’ is used to specifically address the health needs of immigrants from tropical countries. Most travellers returning from abroad are rarely affected by typical tropical diseases. This is largely since most are short-term travellers who receive the appropriate vaccinations before departure and are given comprehensive advice on preventive measures such as malaria prophylaxis. This provides effective protection against the most common tropical infectious diseases.

Nowadays, tropical medicine primarily takes on the role of “travel returnee medicine” outside the classic tropical and subtropical zones. The focus here is on the medical care of individuals after stays in tropical regions. Additionally, tropical medical expertise is applied to a limited extent in “migrant medicine” to address the health needs of immigrants from tropical countries specifically.

Most travel returnees are rarely affected by typical tropical diseases. This is mainly because they are usually short-term travellers who receive appropriate vaccinations before travelling and are extensively advised on preventive measures such as malaria prophylaxis. Thus, there is effective protection against the most common tropical infectious diseases.

However, the scope of tropical medicine extends beyond the mere care of travellers returning from abroad and encompasses a wide range of aspects that are of considerable importance in the context of global healthcare and prevention.

Tropical Medicine in the Context of Climate Change and Global Mobility

In the 21st century, tropical medicine is an interdisciplinary and cross-cutting field. Its focus lies on the diagnosis, prevention and control of diseases whose occurrence is influenced by geographical, social, ecological and economic conditions in tropical and subtropical regions. The global significance of tropical medicine is continually increasing.

The ‘One Health’ approach highlights the complex interconnections between various health risks, including zoonotic diseases, antibiotic resistance, food safety, environmental pollution and the consequences of climate change. This holistic perspective is becoming increasingly relevant in tropical medicine and will shape its future development [2].

Progressing climate change is leading to an expansion of the ranges of numerous vectors. A prime example is the Asian tiger mosquito (Aedes albopictus), which has now also been detected in Germany (Figure 1). As a result, disease patterns that previously occurred predominantly in tropical regions are now increasingly being observed or re-emerging in temperate latitudes.

Another contributing factor is global mobility. This leads to the introduction of chikungunya and dengue viruses (Figure 2) into areas with susceptible mosquito populations, such as Italy, France and Spain. During the summer months, local transmission occurs in these areas, including at Lake Garda and in Alsace; malaria has also been imported into Italy, leading to short-lived autochthonous transmission chains.

Fig. 2: Typical dengue rash with positive dermographism (Image rights: Dorothea Wiemer)

The introduction and establishment of pathogens are not limited to viruses: Schistosoma haematobium was presumably introduced into Corsica from Senegal. There, it hybridised with the native species S. bovis, giving rise to a form of human-pathogenic schistosomiasis that has already caused numerous cases of the disease (Figure 3) [3].

Fig. 3: Left: Region of the Cavu River in Corsica; infections with schistosomes occurred here (Image source: Adobe)
Right: Adult form of the so-called blood flukes (Schistosoma spp.) (Image source: AI, Adobe)

Climate change is creating more favourable conditions overall for the survival and spread of pathogens. The Crimean-Congo haemorrhagic fever virus is now established in Spain. Further relevant examples of the spread of tropical diseases include the Europe-wide increase in babesiosis and the frequent occurrence of the West Nile virus in Germany (Figure 4).

Fig. 4: Left: Babesia in blood smear (Image source: Wagelöhner)
Right: Dermacentor reticulatus, marsh tick, carrier of babesiosis (Image source: Adobe)

Travel Clinics

Experiences in the Post-Travel and Tropical Dermatology Clinics

Experiences in the post-travel and tropical dermatology clinics Ongoing involvement in the post-travel consultation has given the colleagues involved a deep understanding of the diverse clinical presentations and varying prevalence of diseases acquired in the tropics.

The routine use of common diagnostic and treatment protocols and careful differential diagnosis are key components of high-quality care.

Particularly challenging and instructive cases, such as severe malaria in patients with asplenia, clinical manifestations of chikungunya fever, visceral leishmaniasis, tapeworm infections or muscular sarcocystosis, enrich everyday clinical practice. Now that more common conditions such as malaria, dengue fever, schistosomiasis, African tick-borne fever and giardiasis have become routine, these specific diagnoses regularly lead to a lively exchange of knowledge within the team.

In the tropical dermatology consultation, certain diagnoses are an integrated part of day-to-day practice. Cutaneous leishmaniasis is part of the ‘common business for treating doctors. Although rare, leprosy also regularly features as a diagnosis, rounding off the broad spectrum of tropical dermatological diseases.

Current Vaccination and Prophylaxis Measures in Travel Clinic

In the travel clinic, the latest recommendations on vaccination and prophylaxis measures are applied in a practical manner to a wide range of different patients. Individual advice is always provided in line with the latest scientific findings and guidelines.

Direct and ongoing consultation with tropical medicine specialists at the UKE is a key component of this work. Here, relevant data on vaccination recommendations and indications are discussed to ensure the best possible preventive medical care. New vaccines are introduced whilst carefully monitoring their side-effect profiles, acceptance and tolerability, ensuring that our knowledge of vaccinations and preventive measures remains up to date and that patients can be offered the best possible care.

Over the past 20 years, tens of thousands of patients have been treated and over a hundred thousand travel consultations and vaccinations have been carried out. A small but highly effective pool of experts has been established, comprising doctors and non-medical support staff. This group of experts ensures that advice and treatment are always up to date and that all relevant aspects are covered.

Nevertheless, the question arises time and again as to whether the effort involved in providing this expertise is justified, given that it primarily concerns rare and exotic diseases which play a supposedly minor role within the broad spectrum of military medical challenges.

Tropical Medicine Remains Relevant for Military Medicine

If tropical medicine is described as a specialised, globally and ecologically expanded form of infectious diseases medicine, these descriptions of changes in vector and pathogen landscapes demonstrate how important tropical medicine is even outside the tropics. Given the Bundeswehr’s current shift in focus from international crisis management (IKM) towards national and alliance defence (LV/BV), one might initially assume that diseases typically occurring in other climate zones are becoming less significant for the medical care of service personnel. However, this impression is misleading. The question of the necessity of specialist expertise in tropical medicine within military medicine can be traced back to various factors. Expertise in tropical medicine contributes significantly to ensuring the operational readiness of soldiers by minimising absences due to infection and planning preventive protective measures. Furthermore, it prepares personnel for global and regional health threats, supports humanitarian missions and even fulfils tasks relating to security resilience.

These tasks are carried out as part of the Force Health Protection concept. This involves collaboration between various disciplines, such as public health, hygiene, microbiology, veterinary medicine, human medicine, entomology and epidemiology. Through the joint collection and evaluation of data, measures are developed to ensure the combat and operational readiness of the troops. The success of this strategy is evident in the comparatively low incidence of illness among soldiers, relative to their numbers and the cumulative duration of exposure [5]. From this perspective, clinical, individualised tropical medicine expertise does not appear to be strictly necessary at first glance.

Importance of Early Detection

It should be noted, however, that the necessary data can only be collected if it is recognised as such and classified as relevant. Every public health approach begins with the individual who is unwell and with the realisation that a health problem or risk exists. If tropical medicine is limited solely to theoretical aspects and diagnostics, a capability gap arises in the recognition and treatment of specific cases. It is therefore necessary to ensure clinical assessment, targeted and cost-effective diagnostics, the monitoring of epidemiological links and, above all, the care and treatment of patients [6].

Trained tropical medicine specialists bring experience to the table. They contribute to the provision of medical care under resource-constrained conditions, across diverse social settings and cultures. They are familiar with severe forms of HIV and tuberculosis and understand the serious consequences of diarrhoeal disease outbreaks in the context of poverty, war and malnutrition.

Resilience in the Event of Conflict

As the intensity of a conflict increases, preventive measures cannot always be implemented consistently due to limited resources. Support in the form of personnel and supplies from other sources, including civilian ones, will diminish, meaning that, in addition to caring for the wounded, a growing proportion of individual patients with infectious diseases must also be anticipated. Disease outbreaks and the provision of medical care to the civilian population also play a role in this context [4].

Early recognition and assessment of symptoms, as well as an awareness of when medical treatment or protective measures are required, are crucial to the course and extent of the damage.

These capabilities have a direct impact on resilience in the event of a conflict. In contrast to the trauma care chain, soldiers with infectious diseases can be rapidly returned to duty following prompt diagnosis and treatment; repatriation is often unnecessary. Numerous situations can be envisaged in which additional expertise in tropical medicine is required:

individual context:

• Severe cases of infectious diseases requiring intensive care, such as malaria, typhoid, plague and all forms of viral haemorrhagic fevers.

in the context of both the individual and public health:

• Outbreaks resulting from inadequate hygiene measures or increased vector presence,
• the occurrence of highly contagious infectious diseases (HCIDs) requiring barrier nursing, as well as
• unusual clusters of cases caused by the deliberate release of biological agents, such as smallpox or anthrax.

Outlook

The Division of Tropical Medicine will continue to fulfil its remit in the future and provide the necessary expertise in tropical medicine in close collaboration with civilian partners. This collaboration ensures that every soldier is optimally protected and, in the event of illness, receives adequate and effective medical treatment. The expertise gained over two decades, including in dealing with so-called highly dangerous infectious diseases such as Ebola, is of particular importance in this regard. This knowledge and practical experience will continue to be specifically applied to the management of CBRN situations (chemical, biological, radiological and nuclear threats) in order to strengthen the operational readiness and safety of soldiers in the long term.

Key Statements

• The Division of Tropical Medicine has existed for 20 years and cooperates in a civil-military manner with the Bernhard Nocht Institute and the UKE.
• It´s remit includes training and continuing professional development, research and clinical care relating to tropical diseases, as well as travel advice and vaccinations.
• Through the post-travel and tropical dermatology clinics, extensive experience and expertise regarding rare tropical diseases have been gained.
• Tropical medicine, as a cross-cutting and interdisciplinary field, remains relevant even outside the tropics due to global mobility and climate change.
• Tropical medicine, in the form of a specialised field of infectious diseases that incorporates global and ecological aspects, is indispensable in military medicine for ensuring and maintaining operational readiness.

References

1. Bernhard Nocht Institute für Tropical Medicine. [Overview of the history of the Institute] [Internet]. BNITM 2026;[Last accessed: June 14, 2026]; available at https://www.bnitm.de/en/institute/about-the-institute/history read more
2. Brattig NW, Graf A, Konou A, et al.: More than seven decades of Acta Tropica: Looking back to move into the future. Acta Trop. 2022 Feb;226:106155. read more
3. Holtfreter MC, Moné H, Müller-Stöver I, Mouahid G, Richter J. Schistosoma haematobium infections acquired in Corsica, France, August 2013. Euro Surveill. 2014 Jun 5;19(22):20821. read more
4. Izaguirre MK, Cox E, Lodi PC, et al. To conserve fighting strengths in large-scale combat operations. Military Review [Internet]. Army University Press 2026; [Last accessed June 13, 2026]; available at https://www.armyupress.army.mil/journals/military-review/online-exclusive/2025-ole/conserve-fighting-strength-in-lsco/ read more
5. Schawaller M, Wiemer D, Hagen RM, Frickmann H.: Infectious diseases in German military personnel after predominantly tropical deployments: a retrospective assessment over 13 years. BMJ Mil Health. 2023 Apr;169(2):146-151. read more
6. Wiemer D, Frickmann H, Savini H. “Infectious Epidemic Diseases on the Battlefield” in: Hoitz,J., Bricknell M. and Smiljanic, A. 2025. Handbook of military Medicine for the Battlefield. Meckenhaim 2025: CPM Verlag.

Manuscript Data

Citation

Wiemer D: 20 Years of the Division of Tropical Medicine – ‘You can do it... But Should You?’ The Division of Tropical Medicine – Development, Tasks, and Focus Areas. WMM 2026;70(9E):2.

DOI: https://doi.org/10.48701/opus4-962

Author

Lieutenant Colonel (MC) Dr. Dorothea Wiemer, MD

Division of Tropical Medicine and Infectiology

Department of Internal Medicine

Bundeswehr Hospital Hamburg

Branch at Bernhard Nocht Institute for Tropical Medicine

Bernhard-Nocht Str. 74, D-20359 Hamburg

E-Mail: dorotheafranziskawiemer@bundeswehr.org