Malaria is endemic in the Lowveld of Mpumalanga and in Limpopo (including the Kruger Park and private game reserves which make these provinces so popular with travellers). In KwaZulu Natal malaria is endemic on the Maputaland coast. So if you are travelling to the far north of South Africa, please consult a heath-care professional for the latest advice on malaria prophylaxis as it changes regularly. City centres like Johannesburg, Durban and Cape Town are free from malaria and safe for travellers of all ages.

In low risk areas no anti-malaria drugs are necessary. In the North West Province and the Northern Cape along the Molopo and Orange Rivers, including the Augrabies Falls and the Kgalagadi Transfrontier Park, malaria is only occasionally locally transmitted. It is not necessary to take anti-malaria drugs when visiting these areas, but precautionary measures to prevent mosquito bites should be taken.

Visitors to high risk Malaria areas should personally take precautions between dawn and dusk.

• apply insect repellent to exposed skin
• if possible remain indoors
• close windows and doors at night unless they are screened
• spray an aerosol insecticide inside the sleeping area
• burn mosquito coils and mosquito mats in sleeping areas
• sleep under a mosquito-proof bed-net
• wear long-sleeved clothing, trousers and socks if outdoors during this time
• in high-risk areas (Kruger Park, northern parts of Limpopo and northern parts of KwaZulu Natal) the use of anti-malaria drugs is recommended from October to May.

People at particular risk who should take extra precautions are:

• children under 5
• adults over 65
• pregnant women
• people on long term steroids
• people receiving chemotherapy
• people with Aids / HIV, porphyria or epilepsy
• people who have had their spleens removed
• chronically ill patients

If you do decide to take malaria prophylaxis, it is essential to take the drugs according to the directions on the package insert. You need to start a week or two before entering the malaria-endemic area and it is also essential that you continue to take the drugs for four weeks after leaving the malaria risk area. Please consult your physician or a registered health-care professional about the possible side-effects of the drugs.

Some medical conditions are contra-indications for malaria prophylactic drugs, so consult your regular doctor if you have any pre-existing conditions. If you are pregnant it is advisable to avoid malaria areas but you can still have a great holiday (including some excellent game viewing) without setting a foot in a malaria-endemic area.

It is important to note that a person may still contract malaria even though all precautionary measures have been taken. If any flu-like symptoms namely, headache, fever, muscular and joint pains, sweating, shivering attacks, nausea, diarrhoea and fatigue occur after a visit to a malaria risk area (and for up to six months there-after) consult a doctor immediately and advise the doctor of your visit to the malaria area in order to ensure that malaria is diagnosed and treated in time. Malaria attacks can occur up to six months after leaving a malaria area.

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Ticks are most prevalent in South Africa during the warmer months of the year. Netcare Travel Clinics urges travellers, hikers, campers and farmers to be vigilant of potentially debilitating and serious tick-borne diseases at this time of the year.

Dr Pete Vincent of the Netcare Travel Clinics and Medicross Family Medical and Dental Centres, Tokai, warns that tick-borne diseases, such as spotted fever rickettsiosis, commonly known as tick-bite fever, and the more dangerous Crimean-Congo Haemorrhagic Fever (CCHF), occur more commonly on the southern African sub-continent between November and April every year.

“Taking precautions, including checking yourself for, and removing, ticks daily after having been potentially exposed to them, greatly decreases the chances of becoming infected with such tick-borne diseases,” he adds.

“While the occurrence of CCHF in South Africa is rare, the same can unfortunately not be said of common African tick-bite fever,” states Dr Vincent. “African tick-bite fever can occur around the country and sub-continent, but in SA it is endemic in areas such as the Free State, Northern Cape, Eastern Cape and the Kruger National Park. It is, in addition, found on the east coast of South Africa throughout the year, and is one of the most commonly reported infections among international visitors.”

“The National Institute of Communicable Diseases [NICD] has reported that a number of Johannesburg residents have presented with mild febrile illness with rash in recent weeks, which may be as a result of tick-bite fever, although the cause of these infections is currently being investigated.”

According to Dr Vincent, the severity of tick-bite fever can vary widely, and if it is not treated promptly with antibiotics can be a most unpleasant illness, causing high fevers, muscle pain and severe headaches, and can lay a sufferer low for two weeks or more.

“It is essential to see your doctor if you have been bitten by a tick and start developing symptoms such as fever, headache and rash. Early treatment with a tetracycline antibiotic should resolve the illness early and prevent further possible complications.

“In January, the NICD has confirmed two cases of CCHF, which is usually tick-borne and can be life-threatening, in farmers from the Western- and Northern Cape,” adds Dr Vincent. “The risk of travellers getting the CCHF infection is extremely low, however. CCHF is generally seen in people who come into regular contact with livestock in endemic areas such as the Free State and Northern Cape.”

“People who walk through long grass or come in close contact with cattle should be particularly vigilant of ticks that may be carrying infection, and take steps to avoid being bitten by them. It should be noted that ticks on dogs and other mammals in urban and peri-urban areas may also potentially carry tick-bite fever.

“With tick bite fever there is usually an eight-day incubation period. The bite site will develop black scabs, known as eschars, which can result in open wounds and swelling of lymph glands close to the bite site. At day eight, one usually gets onset fever, muscle pain and a headache. Three days later patients can present a macular or skin rash that appears as small, flat red spots,” says Dr Vincent.

“The onset of CCHF, on the other hand, is sudden. Patients may have a range of flu-like symptoms including headaches, high fever, muscle pain, lower back pain, cold shivers and hot sweats. As the illness progresses, severe bruising and nosebleeds could occur.”

Dr Vincent recommends the following precautionary measures to protect against tick-borne diseases:

• Check whether the area and place you are visiting has a high prevalence of tick-bite diseases.
• Wear long trousers that can be tucked into long socks and boots or closed shoes.
• A DEET based mosquito repellent can be used on your lower legs.
• For added protection spray fabric insecticides, such as Permethrin, onto your clothing and leggings.
• Inspect your clothes and body for ticks immediately after potential exposure particularly along the legs, groin and hair line. This should be done at the end of each day while in a potential exposed area.
• Extract any ticks as soon as possible using tweezers. The tweezers should be placed as close as possible to the skin, over the tick’s mouthparts. The tick should be pulled slowly, straight up and out, with care taken not to squeeze its stomach contents into the bite site.

“Should you be bitten by a tick, the affected area can be washed with soap and water, and an antihistamine ointment or mild cortisone cream applied. You can also take an oral antihistamine. Ticks should be removed before the affected area is cleaned. It is not advisable to try to burn the tick or use kerosene, turpentine or petroleum jelly to remove it,” concludes Dr Vincent.

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