Chapter 10 Popular Itineraries Africa & the Middle East
East Africa: Safaris
Arguably the ultimate in adventure travel, an African safari is the experience of a lifetime. There are safaris for families, honeymooners, and people with similar interests (serious photographers, for example). Many safaris accept young children as participants and have special age-appropriate programs for children and adolescents aged 6–16 years. While the centerpiece of safari-going remains viewing majestic animals in their natural habitat, many tour operators now include programs on local culture, history, geology, and ecosystems, encouraging travelers to get to know the local people not merely as subjects of photos. Topography, vegetation, and bird life in the region also help differentiate safari types.
Animals can be viewed from open trucks, air-conditioned vans, private aircraft, or hot air balloons. Hiking with trained, licensed guides in well-scouted settings offers another opportunity to see wildlife up close. Safari accommodations can range from crawl-in tents to air-conditioned, walk-in canopy tents with full bathrooms. Luxurious 5-star lodges with floodlit water holes enable patrons to view animals at night. Dining in the wilderness varies from eating prepackaged sandwiches while seated on a tree stump to formally served 3-course meals on tables with linen cloths and matching napkins. Some safaris include side trips to exotic places—to see or climb Mount Kilimanjaro, or to visit Zanzibar or Lake Victoria, for example.
Travelers often choose an East African game park in Kenya or Tanzania for their first safari. The most famous game park in Kenya is the Masai Mara National Reserve, the northern continuation of the Serengeti National Park game reserve in Tanzania. Together these parks are home to perhaps the grandest and most complete collection of the large wild animals for which Africa is famous. The Serengeti is the starting point of the annual migration of more than a million wildebeest and several hundred thousand zebras searching for pasture and water. Tanzania also has the Ngorongoro Crater, a 100-square-mile depression (caldera) formed when a giant volcano, perhaps the size of Mount Kilimanjaro, exploded and collapsed on itself millions of years ago. The major East African game parks are shown on Map 10-01.
Travelers should research the optimum time of the year for their safari. The wildebeest migration in the Serengeti is a seasonal event, for example, although the precise time of the migration may vary from year to year. Some parks have a dry season, offering better views of the animals as the vegetation is sparser, and animals gather where water is present, but roads are dustier. And many areas of Africa have times of the year that are more comfortable for visitors, with cooler weather, lower humidity, and less chance of rain.
Map 10-01. East Africa destination map
Health and safety issues that safari-goers are likely to encounter are mostly predictable and largely avoidable. A pretravel consultation with a travel health care provider is essential. Multiple vaccinations as well as malaria prophylaxis may be required. Health advice must be specific to each itinerary and game park visited. Immunizations and preventive medications necessary for one park may not be so for others. Parks may be long distances apart and located in countries with different health standards and dissimilar climates. Some parks are located at higher elevations and close to the equator, making proper sun precautions imperative, including seeking shade when possible and avoiding the sun during midday hours. Significant sunburn can occur in less than an hour. Sunglasses are essential, in addition to protective clothing, hats, and use of a broad-spectrum sunscreen with SPF ≥15 that protects against both UVA and UVB (see Chapter 3, Sun Exposure).
Travelers should choose an experienced and sophisticated tour operator and take along a small, personal medical kit (see Chapter 6, Travel Health Kits). Experienced tour operators generally provide clients with ample literature describing local conditions and require that clients purchase medical evacuation insurance policies. In addition, they employ knowledgeable guides who carry first-aid kits and communication equipment to summon help, if necessary (see Chapter 6, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance).
Generally, proper preparations, commonsense precautions, experienced guides and drivers, and the short duration of most trips (usually <2 weeks), make safaris relatively low-risk undertakings for travelers of all ages.
Food and Water
Travelers’ diarrhea appears to be the most common ailment on safari, and most cases are mild (see Chapter 2, Travelers’ Diarrhea). Sensible food and water selections may reduce the incidence (see Chapter 2, Food & Water Precautions). Illness may occur even on deluxe trips; self-treatment is recommended. Active cholera transmission has been reported in Kenya and Tanzania in recent years. Check the destination page at www.cdc.gov/travel for current recommendations.
Wild animals are unpredictable. Travelers should follow verbal and written instructions provided by safari operators. Animal-related injuries are extremely uncommon and usually result when travelers disregard rules, for example, when they approach animals too closely to feed or photograph them (see Chapter 3, Animal Bites & Stings).
Rabies exists throughout Africa; dogs and bats are the primary animal reservoirs (see Chapter 4, Rabies). Bats transmit other infections to humans, such as viral hemorrhagic fevers. Warn travelers not to enter caves where bats roost and shelter; several cases of Marburg hemorrhagic fever have occurred in travelers visiting bat caves in Uganda.
Malaria transmission occurs in most game parks. Most infections are caused by Plasmodium falciparum, and all P. falciparum in sub-Saharan Africa should be considered chloroquine-resistant. Safari activities often include sleeping in tents and observing animals at dusk or after dark, sometimes near water holes, all increasing the risk of being bitten by malaria-carrying mosquitoes. Preventive medication and personal protection—wearing long-sleeved shirts and pants, using insect repellents, and sleeping under permethrin-impregnated mosquito netting—are essential. Observing recommendations to prevent malaria helps minimize the risk of a host of other diseases spread by insects (see Chapter 2, Yellow Fever Vaccine & Malaria Prophylaxis Information, by Country, and Chapter 4, Malaria).
Travelers going on an African safari should consult a travel medicine professional for the very latest information regarding yellow fever at their destination. The World Health Organization (WHO) and CDC update yellow fever activity and vaccination recommendations regularly. Currently, WHO and CDC recommend yellow fever vaccination for much of sub-Saharan Africa (see Chapter 2, Yellow Fever Vaccine & Malaria Prophylaxis Information, by Country).
In 2010, WHO and CDC reclassified a portion of East Africa as “low potential for exposure” to yellow fever virus and consequently downgraded the vaccination recommendation for these areas to “generally not recommended.” This recommendation now limits vaccination to a small subset of travelers at increased risk for exposure to yellow fever virus (prolonged travel, heavy exposure to mosquitoes, and/or inability to avoid mosquito bites). Areas where vaccine is no longer generally recommended include (but are not limited to) eastern Kenya, the cities of Nairobi and Mombasa, and all of Tanzania.
Some countries require proof of yellow fever vaccination in the form of a valid International Certificate of Vaccination or Prophylaxis (ICVP) as a condition of entry. Moreover, some safaris cross international borders to include more than one country. Travelers must check the requirements of each country on their itinerary, including countries they only transit through on the way to their destination. Some countries may require a valid ICVP even if there is no yellow fever in the country they are leaving or entering.
Other Health Risks
Day-biting tsetse flies (Glossina) transmit African trypanosomiasis (sleeping sickness), a disease only rarely seen in travelers (see Chapter 4, African Trypanosomiasis). Light-colored clothing (and not wearing blue) seems to deter the flies, whereas insect repellents are only partially effective. Symptoms include fever, eschar at the site of the bite, and headache. There may be signs of central nervous system involvement. Several reports document recent cases of trypanosomiasis (rhodesiense) in European tourists visiting the Masai Mara National Reserve in Kenya and wildlife reserves in Tanzania.
Zika virus, dengue, filariasis, leishmaniasis, and onchocerciasis (river blindness) are other diseases carried by insects found in East Africa. Entering freshwater ponds, lakes, and rivers can expose travelers to Schistosoma spp., a parasite found in freshwater snails (see Chapter 4, Schistosomiasis). Travelers should consider all freshwater sources to be contaminated. Swimming in the ocean or well-chlorinated pools is not a risk for schistosomiasis (bilharzia).
Myiasis and tungiasis are rare skin diseases among travelers. Caused by fly larvae penetrating the skin, myiasis is characterized by boil-like lesions with a central aperture. Adult flies lay eggs on clothing left to dry outdoors; when the traveler puts on the clothing, the larvae can enter the wearer’s skin. Instruct travelers to dry their clothing indoors or press with a hot iron before wearing. Tungiasis, small, painful nodules, often on the foot adjacent to toenails, is caused by direct penetration of skin by sand fleas. Prevention includes wearing closed-toed footwear, not walking barefoot.
Symptoms of many diseases acquired in Africa may surface weeks and occasionally months after exposure, sometimes long after the traveler has returned home. Obtain a travel history from all patients presenting for care.
Within the game parks themselves, crime is unusual. Robberies and carjackings are more common in urban areas (see Chapter 3, Safety & Security Overseas). Street muggings occur during the day and night. In sub-Saharan African countries, the rates of fatal motor vehicle crashes are among the highest in the world. Travelers should fasten seat belts when riding in cars, and wear a helmet when riding bicycles or motorbikes (see Chapter 8, Road & Traffic Safety). Within game parks, serious motor vehicle crashes are rare, as the poor roads discourage speeding. However, travel in rural areas between parks is high risk, especially after dark. If possible, travelers should avoid nighttime driving in sub-Saharan Africa, and pedestrians should take extra care for speeding vehicles. Travelers should also avoid boarding overcrowded buses.
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- Schlagenhauf P, Weld L, Goorhuis A, Gautret P, Weber R, von Sonnenburg F, et al. Travel-associated infection presenting in Europe (2008–12): an analysis of EuroTravNet longitudinal, surveillance data, and evaluation of the effect of the pre-travel consultation. Lancet Infect Dis. 2015 Jan;15(1):55–64.
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