Tanzania & Zanzibar
CDC Yellow Book 2024Popular Itineraries
Tanzania, land of the Serengeti and Zanzibar, can offer in a single destination what cannot be found anywhere in the world, either through tailored packages or independent visits. Boasting >32 national parks and reserves, each region of Tanzania offers a unique experience; the country is a top destination for travelers interested in aquatic recreation, mountaineering, or seeing wildlife.
In 2008, the New York Times named the snow and ice–capped Mount Kilimanjaro as a world “Place to Go” and a must-see destination. Climbing the tallest free-standing mountain in the world is like a virtual climatic world tour, hiking from the tropics through to the arctic. In addition to Mount Kilimanjaro, travelers can visit Serengeti National Park, one of the Seven Natural Wonders of Africa; Ngorongoro Conservation Area, a World Heritage Site; Mahale and Gombe National Parks on the shores of Lake Tanganyika, famous for their chimpanzees; and swim with the whale sharks in the Indian Ocean off Mafia Island (see Map 10-05).
Dar es Salaam is Tanzania’s most populous city and its former capital; it is also the country’s commercial center and home to its largest international airport. To get from Dar es Salaam (located on the Indian Ocean coast) to the islands of Zanzibar, one can take a 2-hour ferry ride or a 25-minute flight. Dodoma, designated Tanzania’s national capital in 1996, is ≈450 km (280 mi) inland, west of Dar es Salaam.
Travelers can visit Tanzania throughout the year. April is often the wettest month, and many popular resorts, guest houses, and tented camps close during this time. Tanzania can be safe and easy to navigate, but all travelers should plan in advance. Unprepared travelers can struggle with travelers’ diarrhea, vectorborne diseases, or altitude illness when attempting to summit Tanzania’s beautiful peaks. People traveling anywhere in Tanzania should be advised about the risk for vaccine-preventable diseases, foodborne and waterborne illnesses, malaria and other vectorborne diseases, and traffic injuries. With appropriate preparation, however, Tanzania is a rewarding and unforgettable destination.
Infectious Disease Risks
Travelers to Tanzania should be up to date on essential immunizations and carefully advised on recommendations for travel vaccines, including coronavirus disease 2019 (COVID-19), hepatitis A, polio, and tetanus. Proof of vaccination against yellow fever is required for travelers entering from yellow fever–endemic countries; carefully review each traveler’s full travel itinerary to determine whether they will need yellow fever vaccine.
Enteric Infections & Diseases
Caused by the bacterium Vibrio cholerae, cholera is characterized by abdominal cramps, profuse watery diarrhea, and vomiting (see Sec. 5, Part 1, Ch. 5, Cholera). In Tanzania, cholera outbreaks occur mostly during the rainy season and are due to poor sanitation and an inadequate supply of clean and safe drinking water. The last outbreak (2015–2019), totaling 33,702 cases and 556 deaths, affected all regions of the country.
Cholera can cause severe dehydration within a few hours; travelers should practice safe food and water precautions (see Sec. 2, Ch. 8, Food & Water Precautions) and careful hand hygiene. Travelers also should know the location of the nearest facility to seek medical care (see the US embassy in Tanzania website. The Advisory Committee on Immunization Practices recommends that adults traveling to areas with active cholera transmission be vaccinated with cholera vaccine. Because most travelers from the United States do not visit areas with active cholera transmission, they can avoid infection by adhering carefully to preventive measures (food and water precautions, scrupulous hand hygiene) without vaccination.
Giardiasis is endemic to Tanzania with high infection rates among young children. Giardia infection is acquired primarily by swallowing contaminated water, particularly untreated water from lakes, streams, and swimming pools; people also can get infected from eating contaminated food (see Sec. 5, Part 3, Ch. 12, Giardiasis). As with cholera, the best way to prevent giardiasis is to consume only safe food and water, and to practice good hygiene, including frequent handwashing.
Travelers’ diarrhea (TD) is the most common health complaint among travelers to Tanzania. Because TD commonly is due to consuming contaminated food or water, educate travelers on prevention measures and personal hygiene. Travelers should avoid consuming tap water in Tanzania. Travelers affected by TD should hydrate to replace lost body fluids and minerals. Most TD cases are mild and self-limiting, but travelers should still carry with them antimotility medications (e.g., Imodium or loperamide) to provide relief. Travelers also can carry antimicrobial drugs to treat moderate to severe TD (see Sec. 2, Ch. 6, Travelers’ Diarrhea, and Sec. 2, Ch. 8, Food & Water Precautions).
Typhoid fever (see Sec. 5, Part 1, Ch. 24, Typhoid & Paratyphoid Fever) is prevalent in Tanzania; the annual incidence rate between 2003 and 2007 was 580–1,400 cases/100,000 persons. Infected people can show symptoms 1–3 weeks after exposure. Travelers, especially long-term travelers, should get vaccinated; because the vaccine is not 100% effective, however, and because vaccine-induced immunity can be overwhelmed by a large bacterial inoculum, travelers should ensure they practice safe food precautions (e.g., eating foods that are well cooked and served hot, making sure fruits and vegetables are washed with clean water and cooked or peeled before consuming). Advise travelers to observe personal hygiene with regular and thorough handwashing or use of hand sanitizer with ≥60% alcohol when soap and safe water are unavailable.
Respiratory Infections & Diseases
Respiratory illnesses account for a high proportion of morbidity and mortality in Tanzania; >75% of hospital deaths are due to pneumonia and tuberculosis. Encourage travelers to Tanzania to take preventive measures against respiratory infections, including being vaccinated against COVID-19 and influenza, washing hands, avoiding sick people, and practicing respiratory etiquette.
Coronavirus Disease 2019
For current information on COVID-19 in Tanzania, consult the US Embassy in Tanzania website. See the US government’s COVID-19 international travel requirements and recommendations. All travelers going to Tanzania should be up to date with their COVID-19 vaccines.
Sexually Transmitted Infections & HIV
Over the past 10 years, Tanzania has implemented many measures to control its HIV epidemic. As of 2018, ≈1.6 million people were still living with HIV across Tanzania. In addition to HIV, prevalence of sexually transmitted infections is common, including chlamydia, gonorrhea, syphilis, and trichomoniasis. Educate travelers on the necessary precautions to prevent STIs, including HIV (see Sec. 5, Part 2, Ch. 11, Human Immunodeficiency Virus / HIV, and Sec. 9, Ch. 12, Sex & Travel).
Soil- & Waterborne Infections
Travelers who bathe, swim, or wade in unchlorinated freshwater sources in Tanzania, including Lake Tanganyika and Lake Victoria, are at risk for schistosomiasis (bilharzia).
In recent years, the incidence of dengue in Tanzania has increased, particularly along the coastal regions, including in Dar es Salaam and the islands of Zanzibar. As with other mosquito-borne diseases, travelers taking steps to prevent bites (including proper use of mosquito nets and insect repellent) is key to preventing infections (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods).
Chloroquine-resistant Plasmodium falciparum is endemic throughout Tanzania (see Sec. 2, Ch. 5, Yellow Fever Vaccine and Malaria Prevention Information, by Country). The islands of Zanzibar have been targeted for malaria elimination; although authorities have met with some success, malaria transmission still occurs on islands throughout the archipelago. In addition, climate change has expanded the range of suitable habitats for Anopheles spp. mosquitoes; thus, consider malaria prophylaxis for all travelers going to Tanzania, and educate all travelers, regardless of their itinerary, on mosquito avoidance techniques.
The tropical malaria-endemic location of Mount Kilimanjaro means that many trekkers will be taking malaria prophylaxis during their climb and will likely need to continue taking malaria prophylaxis after descent, particularly if they are visiting game parks or staying overnight at elevations below 1,800 m (≈5,900 ft).
Although cases of African trypanosomiasis are rare, they have been reported among travelers to Tanzanian national parks. Educate travelers on ways to reduce tsetse fly exposure (see Sec. 5, Part 3, Ch. 24, African Trypanosomiasis).
Yellow fever has never been reported from Tanzania. Due to the presence of the mosquito vector and the risk in neighboring countries, however, Tanzania has been designated low risk for yellow fever by the World Health Organization. Travelers ≥1 year of age arriving from a country with risk of yellow fever virus transmission, including transit >12 hours in an airport located in a country with risk of yellow fever virus transmission, are required to show proof of vaccination on an International Certificate of Vaccination or Prophylaxis to enter the country (see Sec. 2, Ch. 5, Yellow Fever Vaccine and Malaria Prevention Information, by Country).
Environmental Hazards & Risks
Altitude Illness & Acute Mountain Sickness
Many travelers visit Tanzania for the opportunity to summit Mount Meru (4,566 m; 14,980 ft) or Mount Kilimanjaro (5,895 m; 19,340 ft), both located in northern Tanzania. Mountain climbing is physically demanding, requiring a good fitness level and preparation for the elements. Weather in these locations is characterized by extremes; travelers should be prepared for tropical heat, heavy rains, and bitter cold, and they should store gear in waterproof bags.
Altitude illness is a major reason why only about half of those who attempt to summit Kilimanjaro reach the crater rim, Gilman’s Point at 5,685 m (18,651 ft), and ≤10% reach the top, Uhuru (Freedom) Peak at 5,895 m (19,340 ft). Travelers with signs and symptoms of altitude illness must stop their ascent. If symptoms worsen, descent is mandatory. Climbers should have a flexible itinerary and consider employing an extra guide who can accompany any members of the group down the mountain if they become ill.
Prevalence rates of acute mountain sickness (AMS) were 75%–77% in recent studies of 4- and 5-day ascents of Kilimanjaro. People using the carbonic anhydrase inhibitor acetazolamide were much less likely to develop AMS on 5-day ascents, but ≥40% of people taking this medication still reported AMS symptoms. For any traveler planning to ascend to elevations >8,000 ft, be sure to discuss the signs and symptoms of altitude illness and provide guidance on its prevention and treatment (for details, see Sec. 4, Ch. 5, High Elevation Travel & Altitude Illness). Climbers can prevent altitude illness and enhance their enjoyment of the experience by allowing more time to acclimatize (see Box 10-01).
Box 10-01 Acclimatization tips for high elevation hiking in Tanzania
Before attempting to climb Mt. Kilimanjaro (5,895 m, ≈19,340 ft), travelers can acclimatize by first hiking ≥1 of the following
- Ngorongoro crater (2,286 m; 7,500 ft); try to spend the last few nights here prior to climbing Mt. Kilimanjaro
- Mt. Meru (4,566 m; 14,980 ft); 70 km (≈43 miles) away from Mt. Kilimanjaro, Mt. Meru is considered a good “warm up” hike
- Point Lenana (4,895 m; 16,059 ft) on Mt. Kenya; combined Mt. Kenya and Mt. Kilimanjaro climbing trips are available
Add ≥1–2 days to the planned ascent of Mt. Kilimanjaro
- Taking additional time facilitates acclimatization, regardless of the route taken to the top
- Extra time for acclimatization is beneficial for travelers taking routes normally promoted as 4- to 6-day trips
People with some preexisting health conditions can be more susceptible to problems associated with travel to high elevations, or their medications can interact with those taken to prevent AMS. For travelers in higher risk categories, a pretravel consultation with a travel health provider who has specialized knowledge of altitude illness is critical.
Anyone with a history of AMS susceptibility, and for those in whom adequate acclimatization is not possible, use of medications to prevent altitude illness (e.g., acetazolamide) is recommended. Acetazolamide accelerates acclimatization and is effective in preventing AMS when started the day before ascent, and can also be used in treating AMS. Children can take it safely. Dexamethasone is an alternative for AMS prevention in people intolerant of or allergic to acetazolamide. Climbers also can use dexamethasone to prevent high-altitude pulmonary edema (HAPE) and to prevent and treat high-altitude cerebral edema (HACE).
Travel Health Kits & Travel Health Insurance
Advise travelers planning to climb the mountains in Tanzania to carry a personal first aid kit that includes, among other necessary items, altitude illness medication, analgesics, antibacterial and antifungal cream, antibiotics for travelers’ diarrhea, antiemetics, antihistamines, antimalarials, bandages and tape, a blister kit, oral rehydration salts, and throat lozenges (see Sec. 2, Ch. 10, Travel Health Kits). Include information on potential drug–drug interactions between medications used for altitude illness and routine or travel-related medications. In addition, discuss the need for adequate health insurance, including medical evacuation insurance, with travelers planning climbs (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance). Encourage travelers to confirm that their purchased policies cover the cost of evacuation or rescue from the top of a mountain and any associated care.
Animal Bites & Rabies
Canine rabies is prevalent throughout Tanzania, and travelers should avoid animal bites (see Sec. 5, Part 2, Ch. 18, Rabies). Advise travelers to avoid petting or handling wild animals and unfamiliar dogs, including puppies. Instruct travelers to seek care if bitten or scratched. Because both rabies vaccine and rabies immunoglobulin can be difficult to access, opportunities for postexposure prophylaxis might be limited. Depending on the itinerary and planned activities, discuss with travelers the merits of preexposure vaccination and purchasing medical evacuation insurance coverage (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance).
Sun Exposure & Ocean Sports
Snorkeling, scuba diving, and other ocean sports are popular among travelers to Tanzania. Include information on sun exposure (see Sec. 4, Ch. 1, Sun Exposure) and water safety (see Sec. 4, Ch. 4, Scuba Diving: Decompression Illness & Other Dive-Related Injuries) as part of the pretravel consultation. For less experienced scuba divers, be certain to discuss the risks of barotrauma and decompression illness. Inform travelers that broad-spectrum sunscreen (protects against both ultraviolet A and ultraviolet B) might not be readily available in country; advise that they carry an adequate supply from home.
Safety & Security
Crime in Tanzania is more common in urban settings, and tourists often can be targets for petty theft and scams. Common sense can prevent most crimes, but travelers should check with the US Department of State Bureau of Consular Affairs and Overseas Security Advisory Council ahead of time to learn more about safety and security risks at their destination.
Road traffic accidents occur often in Tanzania. Major contributors to risk include poor road quality, improperly maintained vehicles, and reckless driving habits. Counsel travelers to wear seat belts, use reputable transportation operators, and to avoid traveling at night. Pedestrians should have heightened awareness when crossing streets; traffic laws might be different from expected or disregarded by drivers.
Availability & Quality of Medical Care
Although health care can be accessed throughout the country, clinics and hospitals similar to those in high-income countries are found primarily in larger cities, and specialized care is limited (see Sec. 6, Ch. 2, Obtaining Health Care Abroad). Many medications are available over the counter, but quality might be unreliable (see Sec. 6, Ch. 3, . . . perspectives: Avoiding Poorly Regulated Medicines & Medical Products During Travel). Encourage travelers to carry with them any medications they anticipate needing, including malaria prophylaxis and prescription medications.
The following authors contributed to the previous version of this chapter: Kevin C. Kain
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