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