South AfricaClinician View
COVID-19 Travel Information
Travel Health Notices
Stay aware of current health issues in South Africa in order to advise your patients on additional steps they may need to take to protect themselves.
The following diseases are possible risks your patients may face when traveling in South Africa. This list is based on our best available surveillance data and risk assessment information at the time of posting. It is not a complete list of diseases that may be present in a destination. Risks may vary within different areas of a destination.
|African Tick-Bite Fever||
Mosquitoes carrying chikungunya bite during the day and night, both indoors and outdoors, and often live around buildings
Bloodborne & Direct Physical Contact
Airborne & Droplet
|H5N1 Avian Influenza||
Counsel your patients on actions they can take on their trip to stay healthy and safe.
Counsel travelers to be diligent about food and water precautions:
- Avoid cooked food served at room temperature.
- Avoid raw food, including raw vegetables unless they can be washed thoroughly.
- Drink only beverages from sealed bottles or cans.
- Water is safe if it has been boiled or chemically treated.
- Avoid ice unless made from bottled/disinfected water.
Consider prescribing an antibiotic for self-treatment of travelers’ diarrhea, factoring in resistance issues at the destination.
Foodborne and waterborne illness (toxoplasmosis, listeriosis, hepatitis E) may have serious sequelae in pregnant women, so urge adherence with food and water precautions.
Treating Travelers’ Diarrhea
- Compounds containing bismuth subsalicylate (including Pepto-Bismol and Kaopectate) are contraindicated in pregnant women.
- Oral rehydration is the mainstay of therapy. Loperamide should be used only when necessary.
- Antibiotic treatment of travelers’ diarrhea during pregnancy can be complicated. Azithromycin or an oral third-generation cephalosporin may be the best options, if an antibiotic is needed.
Pregnant Travelers (YB)Hide
Counsel travelers to be diligent in insect precautions:
- Cover exposed skin.
- Use an appropriate insect repellent. (see below)
- Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). Travelers can buy pre-treated clothing and gear or treat them at home. Treated clothing remains protective after multiple washings. Permethrin should NOT be used directly on skin.
- Stay and sleep under in air-conditioned or screened rooms.
- Use a bed net if sleeping area is exposed to the outdoors.
More Information on Insect Repellents
DEET (concentration of 20% or more) is the only insect repellent shown to be effective against ticks. However, several EPA-registered active ingredients provide reasonably long-lasting protection against mosquitoes:
- DEET (chemical name: N,N-diethyl-m-toluamide or N,N-diethyl-3-methyl-benzamide): Concentrations above 50% show no additional protective benefit.
- Picaridin (KBR 3023 [Bayrepel] and icaridin outside the United States; chemical name: 2-(2-hydroxyethyl)-1-piperidinecarboxylic acid 1-methylpropyl ester): Must be reapplied more often than DEET.
- Oil of lemon eucalyptus (OLE) or PMD (chemical name: para-menthane-3,8-diol), the synthesized version of OLE. “Pure” oil of lemon eucalyptus (essential oil) is not the same product; it has not undergone similar testing for safety and efficacy, is not registered with EPA as an insect repellent, and is not covered by this recommendation.
- IR3535 (chemical name: 3-[N-butyl-N-acetyl]-aminopropionic acid, ethyl ester).
Products with <10% active ingredient may offer only limited protection (1–2 hours).
Encourage patients to use repellents and reapply only as instructed. If sunscreen is also needed, they should apply sunscreen first and repellent second. Encourage them to follow package directions for using repellent on children and avoid applying to their hands, eyes, and mouth.
For more detailed information, visit the Yellow Book: Protection against Mosquitoes, Ticks, & Other Insects & Arthropods
- Using Insect Repellents Safely (EPA)
- Insect Repellent Use and Safety (CDC)
- National Pesticide Information Center
EPA does not recommend any additional precautions for using registered repellents on pregnant or lactating women.
Counsel pregnant travelers to observe routine precautions while using insect repellents.Hide
Advise travelers to exercise caution during outdoor activities. Important tips include dressing appropriately for the climate (such as loose, lightweight clothing in hot climates and warm layers in cold climates), staying hydrated, avoiding overexposure to the sun, and practicing safe swimming habits. To avoid infection while swimming, travelers should not swallow water when swimming and avoid contact with water that may be contaminated from poor sanitation.
Encourage travelers to learn basic first aid and CPR before travel, especially if they will be traveling to remote areas where medical assistance may not be accessible. Help them assemble a travel health kit.
Schistosomiasis is endemic in South Africa. Travelers should avoid swimming in fresh, unchlorinated water, such as lakes, ponds, or rivers.
Counsel travelers to be cautious around all animals.
- Travelers should avoid touching, petting, handling, or feeding animals, including pets.
- Arthropods such as spiders and scorpions can pose a stinging risk, and travelers should exercise care in environments where these creatures are likely to be present.
- Stress the urgency of treating suspected and probable rabies infection by:
- Washing the wound immediately with soap and clean water.
- Seeking medical attention as soon as possible.
- Travelers at risk for rabies should consider medical evacuation insurance, since postexposure prophylaxis may not be available at the destination.
If needed, preexposure and postexposure prophylaxis for rabies are not altered by pregnancy.Hide
People who are ill should not travel. Urge travelers to practice hand hygiene and sneeze into a tissue or their sleeve.Hide
Counsel travelers on the risks of diseases associated with the exchange of saliva, blood, vomit, semen, urine, and feces.
- Use a latex condom correctly every time they engage in sex (vaginal, anal, and oral-genital).
- Not inject drugs.
- Limit alcohol consumption.
- Not have tattoos, piercings, or other procedures that use needles (acupuncture) unless the needles are packaged new or sterilized.
- Ensure that medical and dental equipment is sterile or disinfected if seeking care.
Additional Resources:HIV & AIDS (YB)
Hepatitis B (YB)
Hepatitis C (YB)
Medical Tourism (YB) Hide
Travelers should plan for how to obtain health care during their trip, should the need arise.
Discuss supplemental travel health insurance and medical evacuation insurance, and consider helping the traveler obtain an extra month of prescriptions for any needed medications.
Travelers may think they can find cheaper antimalarial drugs at their destination. To ensure medication quality, urge them to have their prescriptions filled in the United States.
Counsel pregnant travelers on the following:
- Determine beforehand whether blood is routinely screened for HIV and hepatitis B and C at their destination.
- Pregnant travelers should consider the safety of blood transfusions, if needed, when making plans for international travel.
- The pregnant traveler should also be advised to know her blood type.
- Research the prevalence of tuberculosis (TB) at the patient’s destination, along with her planned itinerary. If exposure to TB will be a risk, she should receive skin testing before and after travel.
Motor vehicle crashes are the #1 killer of healthy US citizens in foreign countries.
Most recommendations for safe transportation are basic and could be considered common sense. However, travelers often do not think about the importance of being aware and careful when walking, riding, driving, or flying.
In many places cars, buses, large trucks, rickshaws, bikes, pedestrians, and even animals share the same lanes of traffic, increasing the risk for crashes.
Counsel travelers to think about transportation options before they arrive, especially if they will be driving in South Africa.
Medical Evacuation Insurance
If your patient is seriously injured, emergency care may not be available or may not meet US standards. Trauma care centers are uncommon outside urban areas. Encourage patients to purchase medical evacuation insurance.
Some basic reminders to review with your patients:
- Choose safe vehicles and avoid motorbikes when possible.
- Wear a seatbelt or a helmet at all times.
- Do not drive after drinking alcohol or ride with someone who has been drinking.
- Avoid driving at night; street lighting in certain parts of South Africa may be poor.
- If they will be driving, remind them to get any driving permits and insurance they may need. It is recommended to get an International Driving Permit (IDP).
- Avoid using local, unscheduled aircraft, and fly on larger planes (more than 30 seats) when possible.
Road Safety Overseas (Information from the US Department of State): Includes tips on driving in other countries, International Driving Permits, Auto Insurance, and other resources.
Encourage your patients to look up the information provided under Travel and Transportation on US Department of State's country-specific information for South Africa.
Remind your patients that traffic flows on the left side of the road in South Africa. Encourage them to pay close attention to the flow of traffic, especially when crossing the street.
If your pregnant patient has any placental abnormalities or risks for premature labor, you should recommend that she avoid any air travel.
Review the following general transportation tips with your pregnant patient for her safety and comfort.
- She should fasten seatbelts at the pelvic area, not across the lower abdomen. Lap and shoulder restraints are best.
- If she is in a crash, even a minor one, recommend that she consult a physician to determine that the fetus has not been injured.
- Recommend that she check with her airline about their policies and any paperwork they require for traveling while pregnant.
- Recommend she walk every half hour during a smooth flight and flex and extend ankles frequently to prevent swelling.
- Encourage her to drink plenty of fluids during flights.
Travelers should be reminded on how to protect their personal safety during travel, regardless of their destination.
The US Department of State has an extensive website with safety information for international travelers, travel alerts and warnings, and country-specific information. Travelers should be directed to the Department of State resources for information and tips on safe travel.
Stay abreast of current events, particularly those that could pose a safety or health problem for travelers. You can also receive updates on new travel alerts and warnings from the US Department of State by subscribing to their RSS feeds.Hide
Healthy Travel Packing List
Remind your patients to pack health and safety items. Use the Healthy Travel Packing List for South Africa for a list of health-related items they should consider packing.
Advising Returning Travelers
Although some illnesses may begin during travel, others may occur weeks, months, or even years after return. A history of travel, particularly within the previous 6 months, should be part of the routine medical history for every ill patient. A newly returned, ill international traveler should be preferentially evaluated by a physician versed in travel-related illness.
Here are two professional medical organizations that provide directories of travel clinics throughout the United States:
- American Society of Tropical Medicine and Hygiene (ASTMH)
- International Society of Travel Medicine (ISTM)
Malaria is always a serious disease and may be a deadly illness. Any patient presenting with a fever after traveling in a malaria-risk area during the last year should be evaluated immediately using the appropriate diagnostic tests for malaria. Malaria, especially P. falciparum, requires urgent intervention as clinical deterioration can occur rapidly and unpredictably.
For more information on advising patients after international travel, see Yellow Book Chapter 5: Post-Travel Evaluation.
Map Disclaimer - The boundaries and names shown and the designations used on maps do not imply the expression of any opinion whatsoever on the part of the Centers for Disease Control and Prevention concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Approximate border lines for which there may not yet be full agreement are generally marked.