Health Precautions for Travel to Southern Africa
Travelers to southern Africa should take comprehensive malaria prophylaxis, use mosquito bite prevention measures, receive appropriate vaccinations, and practice food/water safety precautions to reduce health risks during their visit. 1
Malaria Prevention
Malaria represents the most significant infectious disease risk for travelers to southern Africa, with chloroquine-resistant Plasmodium falciparum being common throughout the region.
Chemoprophylaxis Options:
- First-line option: Mefloquine 250mg once weekly, starting 1 week before travel, continuing during travel, and for 4 weeks after leaving 1, 2
- Alternative options:
Special Considerations:
- Renal impairment: Adjust proguanil dosing based on creatinine clearance:
60 ml/min: 200mg daily
- 20-60 ml/min: 150mg daily
- 10-20 ml/min: 100mg daily
- <10 ml/min: 50mg alternate days 1
- Pregnancy: Chloroquine and proguanil have a long history of safe use; mefloquine can be used in second and third trimesters 1
- Asplenic travelers: At particular risk for severe malaria and need meticulous precautions 1
Mosquito Bite Prevention 1, 5
- Apply EPA-registered insect repellents containing DEET (concentration <50%) to exposed skin
- Wear long-sleeved shirts and long pants, especially from dusk to dawn
- Use permethrin-treated clothing for additional protection
- Sleep under insecticide-treated bed nets in accommodations without screens or air conditioning
- Use pyrethrum-containing flying-insect spray in living and sleeping areas during evening hours
- Avoid outdoor activities during peak mosquito feeding times (dusk to dawn)
Required and Recommended Vaccinations 1
Essential vaccines:
- COVID-19 vaccine
- Influenza vaccine
- Pneumococcal vaccine (for those with heart failure or other chronic conditions)
- Hepatitis A vaccine (South Africa is an endemic area)
- Yellow fever vaccine (for travelers visiting certain countries in Africa) 6
Consider based on specific itinerary:
- Hepatitis B vaccine (for longer stays or potential exposure to blood/body fluids)
- Typhoid vaccine (for travelers to certain areas with poor sanitation)
- Rabies vaccine (for travelers to high-risk areas including KwaZulu-Natal, eastern Cape, and Mpumalanga provinces) 7
Additional Health Precautions
Water and food safety: While water sanitation is excellent in most large cities and towns, travelers to rural areas should exercise caution 7
- Drink only bottled or treated water
- Avoid raw or undercooked foods
- Wash hands frequently or use alcohol-based hand sanitizers
Schistosomiasis prevention: Avoid freshwater swimming or wading in endemic areas 7
STI prevention: Practice safe sex due to high HIV prevalence in the region 7
Post-Travel Vigilance
- Investigate all fevers and flu-like illnesses occurring within a year of visiting Africa as a matter of emergency 1
- Breakthroughs of malaria can occur despite proper prophylaxis
- Inform healthcare providers about travel history if illness develops after return
Common Pitfalls to Avoid
Inadequate malaria prophylaxis: Many travelers fail to adhere to their planned use of antimalarials, particularly VFR travelers (Visiting Friends and Relatives) 8
Delayed medical care: Failing to seek prompt medical attention for fever after return from travel can lead to severe complications from malaria
Overconfidence in urban areas: While risk is lower in urban centers, travelers should maintain precautions throughout their stay
Inadequate bite prevention: Many travelers neglect proper mosquito avoidance measures, especially during evening hours 5
Focusing only on malaria: While malaria is the most common specific diagnosis among ill returned travelers (40.3%), other diseases like acute diarrhea (12.3%) also pose significant risks 9