South Africa is putting the final touches in place for hosting one of the largest sports tournaments in the world, the 2010 FIFA World Cup from 11 June to 11 July 2010. The official matches will take place in Bloemfontein, Cape Town, Durban, Johannesburg, Nelspruit, Polokwane, Port Elizabeth, Pretoria and Rustenburg. The National Institute for Communicable Diseases (NICD) is also gearing up to support public health services during this time. The NICD has a responsibility to make sure that the thousands of visitors coming from all over the world are adequately informed about which communicable diseases might pose a risk, and what actions visitors need to take to ensure they are safe for the duration of the World Cup. To this effect the NICD has put together “A Guide for 2010 FIFA World Cup Visitors to South Africa”, an easily accessed resource that will be updated as necessary.
- The 2010 FIFA World Cup will be staged during the winter influenza season in South Africa. Influenza A(H1N1), the pandemic strain (also called ‘swine flu’), is expected to cause the majority of infections in 2010. Travellers to South Africa should consult their travel-health practitioners with regards to the need for influenza vaccination. The southern hemisphere trivalent influenza vaccine will be available from March 2010 and will include the influenza A (H1N1) pandemic strain.
- There is an ongoing measles outbreak in all provinces in South Africa. A mass immunization campaign planned for April 2010 in South Africa is likely to reduce the numbers of cases. Pre- travel measles immunization should be considered for visitors not previously immunized or with no evidence of immunity from previous measles disease.
- Although there is no risk of contracting yellow fever in South Africa, according to the International Health Regulations, proof of vaccination in the past 10 years is mandatory for travellers visiting South Africa from countries affected by yellow fever. Yellow fever endemic countries are in Africa and South America; a full list of these can be accessed from www.sa2010.gov.za/en/confederations-cup/health-z.
- South Africa is considered polio-free and there have been no wild-type polio cases since 1989. However the country remains vulnerable to imported polio virus. Travellers less than 15 years of age from the following countries should also have a polio booster: Afghanistan, Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Guinea, India, Kenya, Liberia, Mali, Nepal, Niger, Nigeria, Sierra Leone, Somalia, Sudan, Pakistan, Togo and Uganda.
- Malaria occurs in the low lying areas of Limpopo, Mpumalanga and Kwazulu Natal Provinces in South Africa; however, transmission is uncommon in the winter months i.e. during the World Cup. In addition, malaria transmission does not occur in the cities where the matches will be staged. DEET-based insect repellents and protective clothing should always be used during visits to risk areas, including the Kruger National Park. See Figure1 for malaria risk areas in South Africa.
There should be a high index of suspicion for malaria in any person who develops a febrile illness post-travel to a malaria risk area. Plasmodium falciparum is the predominant species. Artemisinin combination therapy is indicated for treatment as chloroquine resistance is widespread. Visitors who plan on visiting certain neighbouring countries (e.g. Mozambique) need to consider chemoprophylaxis in addition to personal protective measures against mosquito bites. Malaria prophylaxis guidelines for 2009 from the National Department of Health can be accessed at www.doh.gov.za/docs/factsheets/guidelines/prevention_malaria09.pdf.
- There is a high prevalence of HIV and other sexually transmitted infections (STIs) in South Africa. It is advisable to practice safe sex and use condoms to reduce the risk of acquiring infections.
- Rabies is endemic to South Africa and is mainly related to contact with dogs. The mongoose, cats, cattle, and bat- eared foxes as well as other animals may also be infected. The risk to visitors is generally low and post-exposure prevention with vaccine and rabies immunoglobulin is available in the event of exposure.
- There is a seasonal increase in sporadic cases of meningococcal disease from May to October in South Africa, but pre- travel vaccination is not routinely recommended.
- Tick bite fever is a common disease in South Africa. It is transmitted by infected dog, cattle and game ticks. Your risk of being infected is low unless visiting rural or wilderness areas like game parks or farms. The use of protective clothing and DEET – containing insect repellent is recommended for prevention of bites by infected ticks. There is no vaccine against tick bite fever, and taking prophylactic antibiotics has not been shown to be effective. Tick bite fever treatment is available.
- South Africa has a high prevalence rate of tuberculosis (TB) and has been classified by the World Health Organization (WHO) as a high-burden country. The risk of contracting TB is highest in people with immunosuppressive conditions such as HIV/AIDS, and persons on corticosteroids or other immune-modulating drugs. Adequate ventilation (mechanical/natural) as well as sunlight reduce the risk of TB transmission. Therefore, the risk of contracting TB in stadia where matches will be staged is minimal. Bacille Calmette–Guérin (BCG) vaccine is used as a single dose at birth in most developing countries to reduce the severe consequences of TB in infants and children. BCG vaccine has variable efficacy in preventing the adult forms of TB and it is therefore not routinely recommended. More information can be accessed at www.cdc.gov/tb/publications/factsheets/general/tbtravelinfo.htm.
- Water from taps or faucets is considered safe in the larger centres, but is of variable quality in small towns. This water is treated so that it is free of harmful micro-organisms. In some areas, tap water is mildly discoloured due to the mineral content; please be assured that this is harmless and still of good quality. Drinking water directly from rivers and streams could put you at risk of waterborne diseases.
- Food sold from supermarkets, restaurants and fast food outlets is generally considered safe. Milk is pasteurised and dairy products are safe for consumption. Local meat, poultry, seafood, fruit and vegetables are generally considered safe to eat. You are advised as a traveller to be careful when eating food from street vendors or other informal outlets. Pre-accreditation of food providers at the official FIFA World Cup centres has been conducted.