Vector-borne
infections: Malaria is present in parts of all countries in the
region except Lesotho, although the risk is focal or seasonal in many
areas. African tick-bite fever (Rickettsia
africae) continues to be common in travelers to the region,
especially South Africa, Botswana, Swaziland, Lesotho, and Zimbabwe.
Other vector-borne infections include tick-borne relapsing fever, Rift
Valley fever,* dengue (focal outbreaks but larger areas infested with
Aedes aegypti), tick-borne
relapsing fever, murine typhus, West Nile fever, and Crimean-Congo
hemorrhagic fever.* African trypanosomiasis has been reported from
Botswana and Namibia in the past. Tungiasis is reported from South
Africa.
Food- and
water-borne infections: Risk for hepatitis A is high in
parts of the region and outbreaks of hepatitis E have been reported.
Risk for dysentery and diarrhea is highly variable within the region.
Diarrhea in travelers may be caused by bacteria, viruses, and parasites.
Other risks for travelers include typhoid and paratyphoid fever and
amebiasis. Cholera is sporadic and epidemic (outbreaks in 2004 in South
Africa, Swaziland, and Zimbabwe). Intestinal helminths, although common
in some local populations, are rare in short-term travelers.
Airborne and
person-to-person transmission: The estimated incidence rate of
tuberculosis is >300 per 100,000 population in the region. (Note
that the untreatable and frequently deadly XDR-TB is a problem)
Sexually transmitted
and blood-borne infections: HIV prevalence in antenatal clinics
exceeds 25% in many countries in the region; 15%-34% of adults aged
15-49 years are infected. Prevalence of chronic carriage of hepatitis B
virus exceeds 8%.
Zoonotic infections:
The mongoose is a source of rabies, in addition to domestic dogs and
other animals. Plague* is enzootic, and sporadic cases and outbreaks
have occurred in Botswana, Namibia, and Zimbabwe since 1990. Anthrax* is
hyperendemic in Zimbabwe, with recent outbreaks in animals and also
human cases. Sporadic cases of anthrax have been reported elsewhere in
the region.
Soil- and
water-associated infections: Focal active areas of
schistosomiasis persist (caused by
Schistosoma mansoni, S.
haematobium, and S. mattheei).
Cutaneous larva migrans can occur after exposures on beaches.
Leptospirosis* has caused outbreaks. Histoplasmosis has caused an
outbreak in South Africa.
Other hazards:
Motor vehicle accidents and violent injury, as
well as snake bites occur. Screening of blood before transfusion is
inadequate in many hospitals.