Disease Risks and Precautions
in Southern Africa
The material
provided below is for informational purposes only.
It may not be current, and it should not be considered definitive.
All travelers
should check the Center for Disease Control (CDC) website
for the most current disease risk and disease prevention information.
DISEASES TRANSMITTED BY INSECTS
DISEASES TRANSMITTED THROUGH
FOOD AND WATER
DISEASES TRANSMITTED THROUGH
INTIMATE CONTACT
OTHER DISEASES
SUMMARY OF RECOMMENDATIONS
FOR SOUTHERN AFRICA
COUNTRIES IN REGION
Botswana, Lesotho, Namibia, South Africa, St.Helena (an island
in the South Atlantic), Swaziland, and Zimbabwe
GENERAL PRECAUTIONS
Travelers to Southern Afica may be exposed to potential diseases
from a number of sources. The most frequently reported illness
is traveler's diarrhea, but there are other diseases which are
unique to Africa or the tropics. These diseases are transmitted
by insects, contaminated food and water, or close contact with
infected people. Specific diseases are discussed under each of
these topical headings.
In order to reduce the risk of infection travelers must (1) protect
themselves from insects, (2) ensure the quality of their food
and drinking water, and (3) be knowledgeable about potential diseases
in the region to be visited. Finally, diseases are not restricted
to cleanly defined geographical areas, i.e. mosquitoes can fly
over city or country borders, therefore, all travelers should
protect themselves by taking the basic preventive precautions.
DISEASES TRANSMITTED BY INSECTS
Many diseases are transmitted through the bite of infected insects
such as mosquitoes, flies, fleas, ticks, and lice. In general
travelers must protect themselves from insect bites by wearing
proper clothing, using bednets, applying an insect repellent to
exposed skin and clothing, and if possible, avoiding high risk
situations, i.e. outdoor activities during night time hours from
dusk to dawn when mosquitoes bite, unscreened living accommodations,
etc. If a mosquito net is unlikely to be available, consideration
should be given to purchasing a portable mosquito net.
MALARIA
Risk: Malaria risk areas include: Botswana: northern part of the
country (North of 21oS); Namibia: all areas of Ovamboland and
Caprivi Strip; South Africa: rural areas (including the game parks)
in the north, east, and western low altitude areas of Transvaal
and in the Natal coastal areas north of 28oS; Swaziland: all lowland
areas; Zimbabwe: a HIGH RISK exists throughout the year. In Lesotho
and St. Helena, there is no risk.
Prevention: Travelers at risk for malaria
should take MEFLOQUINE to prevent malaria. This drug is marketed
in the United States under the name Lariam . The adult dosage
is 250 mg (one tablet) once a week. MEFLOQUINE should be taken
one week before leaving, weekly while in the malarious area, and
weekly for 4 weeks after leaving the malarious area.
In addition to using drugs to prevent
malaria and treat a possible malaria attack, travelers should
use measures to reduce exposure to malaria-carrying mosquitoes,
and protect themselves from mosquito bites. These mosquitoes bite
mainly during the evening and night, from dusk to dawn. See the
section "Preventing Insect Bites" below.
YELLOW FEVER
Risk: There is little or no risk of yellow fever infection in
Southern Africa. However, some countries Lesotho, Namibia, South
Africa, and Swaziland require a yellow fever vaccination and certificate
for entry. Botswana, and St. Helena do not require a yellow fever
vaccination.
Prevention: NOTE: SOME COUNTRIES REQUIRE
YELLOW FEVER VACCINATION FOR ENTRY. (See "REQUIREMENTS"
below.) In general, if you are traveling to a Central African
country, the easiest and safest thing to do is to get a yellow
fever vaccination and a signed certificate. Yellow fever vaccination,
a one dose shot, may be administered to adults and children over
9 months of age. This vaccine is only administered at designated
yellow fever centers, usually your local health department. If
at continued risk a booster is needed every 10 years. Infants
under 4 months MUST NOT be immunized. Also, persons severely allergic
to eggs should not be given the vaccine. Generally, persons able
to eat eggs or egg products can safely receive the vaccine. The
vaccine is not recommended for persons who are pregnant or whose
immune systems are not functioning normally. In addition to the
vaccine travelers should use measures to reduce exposure to mosquitoes
and protect themselves from mosquito bites. These mosquitoes bite
mainly during the evening hours.
REQUIREMENTS: PLEASE NOTE: If you are traveling to most countries
in Southern Africa, CDC RECOMMENDS AND MANY COUNTRIES REQUIRE
A YELLOW FEVER VACCINATION. (Yellow fever vaccine is the ONLY
vaccine that may be officially required for entry into certain
countries.)
Botswana, and St. Helena have no yellow fever entry requirements.
However, if you are traveling from a country
in the left two columns of the following table to a Southern African
country in the right hand column, you are required to have a yellow
fever vaccination and certificate.
TRAVELING FROM "ENDEMIC" TRAVELING TO
YELLOW FEVER SOUTHERN
INFECTED COUNTRIES: AFRICAN COUNTRIES:
Africa: South America: Lesotho
Angola Bolivia Namibia
Benin Brazil South Africa
Burundi Colombia Swaziland
Burkina Faso Ecuador Zimbabwe
Cameroon French Guiana
Central African Guyana
Republic Panama
Chad Peru
Congo Suriname
Cote d'Ivoire, Venezuela
(Ivory Coast)
Equatorial Guinea
Ethiopia
Gabon
Gambia
Ghana
Guinea
Guinea Bissau
Kenya
Liberia
Mali
Mauritania
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Sierra Leone
Somalia
Sudan
Tanzania
Togo
Uganda
Zaire
Yellow Fever Certificate:
After immunization an International Certificate of Vaccination
is issued and is valid 10 days after vaccination to meet entry
and exit requirements for all countries. The Certificate is good
for 10 years. You must take the certificate with you. Travelers
who have a medical reason not to receive the yellow fever vaccine
should obtain a medical waiver. Most countries will accept a medical
waiver for persons with a medical reason not to receive the vaccine
(e.g. infants less than 4 months old, pregnant women, persons
hypersensitive to eggs, or those with an immunosuppressed condition.)
DENGUE FEVER
Risk: Dengue fever occurs occasionally in South Africa, Swaziland,
and Zimbabwe. The risk of infection is small for most travelers
except during periods of epidemic transmission.
Prevention: There is no vaccine for dengue
fever therefore the traveler should avoid mosquito bites. These
mosquitoes bite mainly in the daytime.
OTHER INSECT DISEASES
Risks: Other diseases spread by mosquitoes, sand flies, black
flies, or other insects are prevalent, especially in rural areas.
These diseases include: Filariasis and Chikungunya (mosquito),
leishmaniasis (sandfly), Onchocerciasis (blackflies), Trypanosomiasis
(flies), Congo-Crimean Hemorrhagic Fever (ticks), typhus (lice),
and Plague (fleas).
PREVENTING INSECT BITES
To reduce mosquito bites travelers should remain in well-screened
areas, use mosquito nets, and wear clothes that cover most of
the body. Travelers should also take insect repellent with them
to use on any exposed areas of the skin. The most effective repellent
is DEET (N,N-diethyl meta-toluamide) an ingredient in most insect
repellents. Travelers should also purchase a flying insect-killing
spray to use in living and sleeping areas during the evening and
night. For greater protection clothing and bednets can be soaked
in or sprayed with PERMETHRIN, which is an insect repellent licensed
for use on clothing. If applied according to the directions, permethrin
will repel insects from clothing for several weeks.
DISEASES TRANSMITTED THROUGH FOOD AND
WATER
Food and waterborne diseases are the number one cause of illness
to travelers and are very common in Southern Africa. Traveler's
diarrhea is the most frequent health problem for travelers. It
can be caused by viruses, bacteria, or parasites which are found
universally throughout the region. Transmission is most often
through contaminated food or water. Infections cause diarrhea
and vomiting (typhoid fever, cholera, and parasites), liver damage
(hepatitis), or muscle paralysis (polio).
TYPHOID FEVER
Risk: Travelers to Southern Africa are at risk for typhoid fever,
especially when traveling to smaller cities, villages, or rural
areas.
Prevention: By drinking only bottled or
boiled water and eating only thoroughly cooked food, a traveler
lowers the risk of infection. Currently available vaccines have
been shown to protect 70- 90% of the recipients. Therefore, even
vaccinated travelers should be cautious in selecting their food
and water. Two available vaccines provide equivalent protection
against typhoid fever. The oral vaccine consists of 4 capsules
taken every other day over a seven day period. The other vaccine
consists of a primary series of two injections, spaced at least
4 weeks apart.
Recommendations: CDC recommends a typhoid
vaccination for those travelers who are going off the usual tourist
itineraries, traveling to smaller cities and rural areas, or staying
long term, that is, a traveler for six weeks or more. Typhoid
vaccination is not required for international travel.
CHOLERA
Risk: Cholera cases have been reported from most of the countries
of Southern Africa. The risk of infection to the U. S. traveler
is low, especially those that are following the usual tourist
itineraries and staying in standard accommodations. Travelers
should consider the vaccine if they have stomach ulcers, use anti-acid
therapy, or if they will be living in less than sanitary conditions
in areas of high cholera activity.
Prevention: Travelers to cholera infected
areas should follow the standard food and water precautions of
eating only thoroughly cooked food, peeling their own fruit, and
drinking either boiled water, bottled carbonated water, or bottled
carbonated soft drinks. Persons with severe cases respond well
to simple fluid and electrolyte-replacement therapy, but medical
attention must be sought quickly when cholera is suspected. The
available vaccine is only 50% effective in reducing the illness,
and is not recommended routinely for travelers. The primary series
is normally two injections with booster doses given every 6 months
for persons who remain at high risk. Cholera vaccine is not recommended
for infants under 6 months old, or for pregnant women.
HEPATITIS A
Risk: Travelers are at high risk for Hepatitis A, especially if
travel plans include visiting rural areas and extensive travel
in the countryside, frequent close contact with local persons,
or eating in settings of poor sanitation. A study has shown that
many cases of travel-related hepatitis A occur in travelers to
developing countries with "standard" itineraries, accommodations,
and food consumption behaviors.
Prevention: The virus is inactivated by boiling or cooking to
85 degrees centigrade for one minute, therefore eating thoroughly
cooked foods and drinking only treated water serve as general
precautions. Havrix, the hepatitis A vaccine currently licensed
for use in the U.S., or immune globulin (IG) is recommended before
travel for persons 2 years of age or older. Hepatitis A vaccine
is preferred for persons who plan to travel repeatedly or reside
for long periods of time in intermediate or high risk areas. Immune
globulin is recommended for travelers < 2 years of age. Immune
globulin is recommended for persons of all ages who desire only
short term protection.
Recommendations: CDC recommends hepatitis A vaccine or IG for
protection against hepatitis A. For travelers over 18 years of
age, hepatitis A vaccine should be given in a two dose series
with the second dose administered 6-12 months after the first.
.
Immune globulin should be used for travelers < 2 years of age.
Immune globulin is recommended for persons of all ages who desire
only short term protection.
PARASITES
Risk: Travelers to the Southern African region are at risk of
parasitic infections. There are many types of parasites and infection
may occur in several ways: by eating undercooked meats infected
with parasites or their larva; by eating food or drinking water
contaminated with parasites or their eggs; by contact with soil
or water infected with parasites; or through insect bites. Several
types of parasites can penetrate intact skin and travelers are
advised to wear shoes and avoid swimming, wading, or washing in
fresh water .
Prevention: Travelers should eat only thoroughly cooked food,
drink safe water, wear shoes, refrain from swimming in fresh water,
and avoid contact with insects, particularly mosquitoes, biting
flies, gnats, and midges.
DISEASES TRANSMITTED THROUGH INTIMATE
CONTACT
AIDS / HIV
Risk: AIDS is found throughout the Southern African region. However,
little information is available regarding the rates of infection
or the extent of risk behaviors. The risk to a traveler depends
on whether the traveler will be involved in sexual or needle-sharing
contact with a person who is infected with HIV. Receipt of unscreened
blood for transfusion poses a risk for HIV infection.
Prevention: No effective vaccine has been developed for HIV. Travelers
should avoid sexual or needle-sharing contact with a person who
is infected with HIV. If a blood transfusion is necessary, screened
blood should be from an HIV-negative blood donor.
Recommendations: Travelers should avoid activities known to carry
risks for infection with HIV.
HEPATITIS B
Risk: The risk of Hepatitis B virus infection is high for Southern
Africa. The risk to the individual international traveler is determined
by the extent of: (1) direct contact with blood or other body
fluids, etc.; (2) intimate sexual contact with an infected person;
(3) the duration of travel.
Prevention: The primary prevention consists of either vaccination
and/or reducing intimate contact with those suspected of being
infected. For those travelers expecting to reside in countries
of high risk, as well as all health workers, vaccination is strongly
recommended. Vaccination should ideally begin 6 months before
travel, in order to complete the full series.
Recommendations: CDC recommends vaccination for any of the following
people: any health care worker (medical, dental, or laboratory)
whose activities might result in blood exposure; any traveler
who may have intimate sexual contact with the local population;
any long-term (6 months or more) traveler, e.g. teachers, who
will reside in rural areas or have daily physical contact with
the local population; or any traveler who is likely to seek either
medical, dental, or other treatment in local facilities during
their stay. Hepatitis B vaccination is not required for travel
to any country.
OTHER DISEASES
SCHISTOSOMIASIS
Risk: Schistosomiasis infection can be found in the Southern African
countries of Botswana, Namibia, South Africa, Swaziland, and Zimbabwe.
The risk is a function of the frequency and degree of contact
with contaminated fresh water for bathing, wading, or swimming.
Prevention: The traveler cannot distinguish between infested and
non-infested water. Therefore, swimming in fresh water in rural
areas should be avoided. Bath water should either be heated to
50 degrees C (122 degrees F) for five minutes or treated with
chlorine or iodine as done for drinking water. If exposed, immediate
and vigorous towel drying or application of rubbing alcohol to
the exposed areas may reduce the risk of infection. Screening
procedures are available for those who suspect infection, and
schistosomiasis is treatable with drugs.
Recommendations: Avoid contact with potentially contaminated water.
RABIES
Risk: For all countries in the Southern African Region, there
is a risk of rabies infection particularly in rural areas or in
areas where large numbers of dogs are found.
Prevention: Do not handle any animals! Any animal bite should
receive prompt attention. When wounds are thoroughly cleaned with
large amounts of soap and water, the risk of rabies infection
is reduced. Exposed individuals should receive prompt medical
attention and advice on post-exposure preventive treatment.
Recommendations: There are no requirements for vaccination, but
pre-exposure vaccination is recommended for:
- travelers visiting, for more than 30 days, foreign areas where
rabies is known to exist;
- veterinarians and animal handlers;
- spelunkers; and
- certain laboratory workers.
Pre-exposure vaccination does not nullify the need for post exposure
vaccine, but reduces the number of injections.
Summary of Recommendations for SOUTHERN AFRICA
Travelers should (1) take Mefloquine (or equivalent) for malaria
prevention, (2) follow precautions to prevent insect bites, (3)
pay attention to the quality of their drinking water and food,
(4) have a dose of Immune Globulin (IG) or the Hepatitis A vaccine,
and (5) consider booster doses of tetanus (Td) and polio (eIPV)
vaccines. (6) Depending on the locations to be visited, planned
activities, and health of the traveler, the following vaccines
should be considered: Hepatitis B, Yellow Fever, Typhoid, Rabies
(pre-exposure), and Cholera. (7) Finally, the normal "childhood"
vaccines should be up-to-date: Measles, Mumps, Rubella (MMR Vaccine);
Diphtheria, Tetanus, Pertussis (DTP Vaccine) [ <7 years of
age], and Polio vaccine.
Disease risks and precautions