Disease Risks and Precautions
in North Africa
The material
provided below is for informational purposes only.
It may not be current, and it should not be considered definitive.
All travelers
should check the Center for Disease Control (CDC) website
for the most current disease risk and disease prevention information.
DISEASES TRANSMITTED BY INSECTS
DISEASES TRANSMITTED THROUGH
FOOD AND WATER
DISEASES TRANSMITTED THROUGH
INTIMATE CONTACT
OTHER DISEASES
SUMMARY OF RECOMMENDATIONS
FOR NORTH AFRICA
COUNTRIES IN REGION
Algeria, Canary Islands, Egypt, Libyan Arab Jamahiriya, Morocco,
Tunisia
GENERAL PRECAUTIONS
Travelers to North Afica may be exposed to potential diseases
from a number of sources. The most frequently reported illness
is traveler's diarrhea, but there are other diseases which are
unique to Africa or the tropics. The East Africa contains a variety
of diseases transmitted by insects, contaminated food and water,
or close contact with infected people. Specific diseases are discussed
under each of these topical headings.
In order to reduce the risk of infection travelers must (1) protect
themselves from insects, (2) ensure the quality of their food
and drinking water, and (3) be knowledgeable about potential diseases
in the region to be visited. Finally, diseases are not restricted
to cleanly defined geographical areas, i.e. mosquitoes can fly
over city or country borders, therefore, all travelers should
protect themselves by taking the basic preventive precautions.
DISEASES TRANSMITTED BY INSECTS
Many diseases are transmitted through the bite of infected insects
such as mosquitoes, flies, fleas, ticks, and lice. In general
travelers must protect themselves from insect bites by wearing
proper clothing, using bednets, applying an insect repellent to
exposed skin and clothing, and if possible, avoiding high risk
situations, i.e. outdoor activities during night time hours from
dusk to dawn when mosquitoes bite, unscreened living accommodations,
etc. If a mosquito net is unlikely to be available, consideration
should be given to purchasing a portable mosquito net.
MALARIA
Risk: In Algeria, Egypt, Libyan Arab Jamahiriya, Western Sahara,
and Morocco there is a very limited risk of malaria. Travelers
following the usual tourist itineraries do not need drugs for
malaria prevention. Canary Islands and Tunisia: no risk. Only
travelers to Egypt who will spend the night in rural areas of
the Nile Delta, the El Faiyum area, the oases, and southern Egypt
near the Sudan border need to take a weekly chloroquine tablet.
The dominant form is P. vivax which has not been reported to be
resistant to the drug CHLOROQUINE.
Prevention: Travelers at risk for malaria should take CHLOROQUINE
to prevent malaria. The weekly dosage for an adult is 500 mg once
a week. This drug should be taken one week before entering a malarious
area, weekly while there, and weekly for 4 weeks after leaving
the malarious area. No other anti-malarial drugs are needed.
In addition to using drugs to prevent malaria and treat a possible
malaria attack, travelers should use measures to reduce exposure
to malaria-carrying mosquitoes, and protect themselves from mosquito
bites. These mosquitoes bite mainly during the evening and night,
from dusk to dawn.
YELLOW FEVER
Risk: There is little or no risk of yellow fever infection in
North Africa. However, some countries Algeria, Egypt, Libyan Arab
Jamahiriya, and Tunisia may require a yellow fever vaccination
and certificate for entry. Morocco does not require a yellow fever
vaccination.
Prevention: NOTE: SOME COUNTRIES REQUIRE YELLOW FEVER VACCINATION
FOR ENTRY.In general, CDC does not recommend a yellow fever vaccination
when traveling to a North African country from countries not infected
with yellow fever. However, some countries require a yellow fever
vaccination when travelers arrive from certain African and South
American countries. Therefore, sometimes the easiest and safestthing
to do is to get a yellow fever vaccination and a signed certificate.
Yellow fever vaccination, a one dose shot, may be administered
to adults and children over 9 months of age. This vaccine is only
administered at designated yellow fever centers, usually your
local health department. If at continued risk a booster is needed
every 10 years. Infants under 4 months MUST NOT be immunized.
Also, persons severely allergic to eggs should not be given the
vaccine. Generally, persons able to eat eggs or egg products can
safely receive the vaccine. The vaccine is not recommended for
persons who are pregnant or whose immune systems are not functioning
normally. In addition to the vaccine travelers should use measures
to reduce exposure
to mosquitoes and protect themselves from mosquito bites. These
mosquitoes bite mainly during the evening hours.
REQUIREMENTS: If you are traveling to a country in North Africa,
CDC generally does not recommend a yellow fever vaccination. (However,
since yellow fever vaccine is the ONLY vaccine that may be officially
required for entry into certain countries, please check the following
information.) Algeria, Egypt, Libyan Arab Jamahiriya, and Tunisia
have conditional requirements. Canary Islands and Morocco have
no yellow fever vaccination entry requirements.
In addition if you are traveling TO / FROM a country listed below
you are required to have a yellow fever vaccination.
TRAVELING FROM "ENDEMIC" YELLOW FEVER INFECTED COUNTRIES
BELOW:
Africa:
Angola
Benin
Burundi
Burkina Faso
Cameroon
Central African
Republic
Chad
Congo
Cote d'Ivoire,
(Ivory Coast)
Equatorial Guinea
Ethiopia
Gabon
Gambia
Ghana
Guinea
Guinea Bissau
Kenya
Liberia
Mali
Mauritania
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Sierra Leone
Somalia
Sudan
Tanzania
Togo
Uganda
Zaire
South America:
Bolivia
Brazil
Colombia
Ecuador
French Guiana
Guyana
Panama
Peru
Suriname
Venezuela
TRAVELING TO NORTH AFRICAN COUNTRIES BELOW:
Algeria
Egypt, (for Egypt add Botswana, Malawi, and Zambia to the list
of "FROM" )
Libyan Arab Jamahiriya
Tunisia
Yellow Fever Certificate:
After immunization an International Certificate of Vaccination
is issued and is valid 10 days after vaccination to meet entry
and exit requirements for all countries. The Certificate is good
for 10 years. You must take the certificate with you. Travelers
who have a medical reason not to receive the yellow fever vaccine
should obtain a medical waiver. Most countries will accept a medical
waiver for persons with a medical reason not to receive the vaccine
(e.g. infants less than 4 months old, pregnant women, persons
hypersensitive to eggs, or those with an immunosuppressed condition.)
DENGUE FEVER
Risk: Dengue fever occurs sporadically in Egypt. The risk of infection
is small for most travelers except during periods of epidemic
transmission.
Prevention: There is no vaccine for dengue fever therefore the
traveler should avoid mosquito bites. These mosquitoes bite mainly
in the daytime.
OTHER INSECT DISEASES
Risks: Other diseases spread by mosquitoes, sand flies, black
flies, or other insects are prevalent, especially in rural areas.
These diseases include: Filariasis and Chikungunya (mosquito),
leishmaniasis (sandfly), Onchocerciasis (blackflies), Trypanosomiasis
(flies), typhus (lice), and Plague (fleas).
PREVENTING INSECT BITES
To reduce mosquito bites travelers should remain in well-screened
areas, use mosquito nets, and wear clothes that cover most of
the body. Travelers should also take insect repellent with them
to use on any exposed areas of the skin. The most effective repellent
is DEET (N,N-diethyl meta-toluamide) an ingredient in most insect
repellents. Travelers should also purchase a flying insect-killing
spray to use in living and sleeping areas during the evening and
night. For greater protection clothing and bednets can be soaked
in or sprayed with PERMETHRIN, which is an insect repellent licensed
for use on clothing. If applied according to the directions, permethrin
will repel insects from clothing for several weeks.
DISEASES TRANSMITTED THROUGH FOOD AND
WATER
Food and waterborne diseases are the number one cause of illness
to travelers and are very common in the Indian Subcontinent. Traveler's
diarrhea is the most frequent health problem for travelers. It
can be caused by viruses, bacteria, or parasites which are found
universally throughout the region. Transmission is most often
through contaminated food or water. Infections cause diarrhea
and vomiting (typhoid fever, cholera, and parasites), liver damage
(hepatitis), or muscle paralysis (polio).
TYPHOID FEVER
Risk: Travelers to the North Africa are at risk for typhoid fever,
especially when traveling to smaller cities, villages, or rural
areas.
Prevention: By drinking only bottled or boiled water and eating
only thoroughly cooked food, a traveler lowers the risk of infection.
Currently available vaccines have been shown to protect 70- 90%
of the recipients. Therefore, even vaccinated travelers should
be cautious in selecting their food and water. Two available vaccines
provide equivalent protection against typhoid fever -- oral and
injectable.
Recommendations: CDC recommends a typhoid vaccination for those
travelers who are going off the usual tourist itineraries, traveling
to smaller cities and rural areas, or staying long term, that
is, a traveler for six weeks or more. Typhoid vaccination is not
required for international travel.
CHOLERA
Risk: Cholera cases have been reported from most of the countries
of North Africa. The risk of infection to the U. S. traveler is
low, especially those that are following the usual tourist itineraries
and staying in standard accommodations. Travelers should consider
the vaccine if they have stomach ulcers, use anti-acid therapy,
or if they will be living in less than sanitary conditions in
areas of high cholera activity.
Prevention: Travelers to cholera infected areas should follow
the standard food and water precautions of eating only thoroughly
cooked food, peeling their own fruit, and drinking either boiled
water, bottled carbonated water, or bottled carbonated soft drinks.
Persons with severe cases respond well to simple fluid and electrolyte-replacement
therapy, but medical attention must be sought quickly when cholera
is suspected. The available vaccine is only 50% effective in reducing
the illness, and is not recommended routinely for travelers.
HEPATITIS A
Risk: Travelers are at high risk for Hepatitis A, especially if
travel plans include visiting rural areas and extensive travel
in the countryside, frequent close contact with local persons,
or eating in settings of poor sanitation. A study has shown that
many cases of travel-related hepatitis A occur in travelers to
developing countries with "standard" itineraries, accommodations,
and food consumption behaviors.
Prevention: The virus is inactivated by boiling or cooking to
85 degrees centigrade for one minute, therefore eating thoroughly
cooked foods and drinking only treated water serve as general
precautions. Havrix, the hepatitis A vaccine currently licensed
for use in the U.S., or immune globulin (IG) is recommended before
travel for persons 2 years of age or older. Hepatitis A vaccine
is preferred for persons who plan to travel repeatedly or reside
for long periods of time in intermediate or high risk areas. Immune
globulin is recommended for travelers < 2 years of age. Immune
globulin is recommended for persons of all ages who desire only
short term protection.
Recommendations: CDC recommends hepatitis A vaccine or IG for
protection against hepatitis A. For travelers over 18 years of
age, hepatitis A vaccine should be given in a two dose series
with the second dose administered 6-12 months after the first.
.
Immune globulin should be used for travelers < 2 years of age.
Immune globulin is recommended for persons of all ages who desire
only short term protection.
PARASITES
Risk: Travelers to North Africa are at risk of parasitic infections.
There are many types of parasites and infection may occur in several
ways: by eating undercooked meats infected with parasites or their
larva; by eating food or drinking water contaminated with parasites
or their eggs; by contact with soil or water infected with parasites;
or through insect bites. Several types of parasites can penetrate
intact skin and travelers are advised to wear shoes.
Prevention: Travelers should eat only thoroughly cooked food,
drink safe water, wear shoes, refrain from swimming in fresh water,
and avoid contact with insects, particularly mosquitoes, biting
flies, gnats, and midges.
DISEASES TRANSMITTED THROUGH INTIMATE
CONTACT
AIDS / HIV
Risk: AIDS is found throughout the region. However, little information
is available regarding the rates of infection, or the extent of
risk behaviors. The risk to a traveler depends on whether the
traveler will be involved in sexual or needle-sharing contact
with a person who is infected with HIV. Receipt of unscreened
blood for transfusion poses a risk for HIV infection.
Prevention: No effective vaccine has been developed for HIV. Travelers
should avoid sexual or needle-sharing contact with a person who
is infected with HIV. If a blood transfusion is necessary, screened
blood should be from an HIV-negative blood donor.
Recommendations: Travelers should avoid activities known to carry
risks for infection with HIV.
HEPATITIS B
Risk: The risk of Hepatitis B virus infection is high for North
Africa. The risk to the individual international traveler is determined
by the extent of: (1) direct contact with blood or other body
fluids, etc.; (2) intimate sexual contact with an infected person;
(3) the duration of travel.
Prevention: The primary prevention consists of either vaccination
and/or reducing intimate contact with those suspected of being
infected. For those travelers expecting to reside in countries
of high risk, as well as all health workers, vaccination is strongly
recommended. Vaccination should ideally begin 6 months before
travel, in order to complete the full series.
Recommendations: CDC recommends vaccination for any of the following
people: any health care worker (medical, dental, or laboratory)
whose activities might result in blood exposure; any traveler
who may have intimate sexual contact with the local population;
any long-term (6 months or more) traveler, e.g. teachers, who
will reside in rural areas or have daily physical contact with
the local population; or any traveler who is likely to seek either
medical, dental, or other treatment in local facilities during
their stay. Hepatitis B vaccination is not required for travel
to any country.
MENINGOCOCCAL DISEASE
Risk: There is seasonal risk of meningococcal disease in parts
of North Africa, primarily during the dry season from December
through June. When a traveler lives and works around the local
population, the risk increases.
Prevention: A one dose vaccine called Menomune is available.
Recommendations: Vaccination is not required for entry into any
country in this region. CDC recommends vaccination with meningococcal
vaccine for travelers going to Mali and all countries directly
eastward, including Burkina Faso, Niger, Benin, Nigeria, Chad,
and Sudan, when travel occurs between December and June.
OTHER DISEASES
SCHISTOSOMIASIS
Risk: The main risk of schistosomiasis is in the Nile River delta
and valley region of Egypt. Schistosomiasis infection also can
be found in the North African countries of Algeria, Libya, and
Tunisia. The risk is a function of the frequency and degree of
contact with contaminated fresh water for bathing, wading, or
swimming.
Prevention: The traveler cannot distinguish between infested and
non-infested water. Therefore, swimming in fresh water in rural
areas should be avoided. Bath water should either be heated to
50 degrees C (122 degrees F) for five minutes or treated with
chlorine or iodine as done for drinking water. If exposed, immediate
and vigorous towel drying or application of rubbing alcohol to
the exposed areas may reduce the risk of infection. Screening
procedures are available for those who suspect infection, and
schistosomiasis is treatable with drugs.
Recommendations: Avoid contact with potentially contaminated water.
RABIES
Risk: For countries in North Africa, there is a risk of rabies
infection particularly in rural areas, or in areas where large
numbers of dogs are found.
Prevention: Do not handle any animals! Any animal bite should
receive prompt attention. When wounds are thoroughly cleaned with
large amounts of soap and water, the risk of rabies infection
is reduced. Exposed individuals should receive prompt medical
attention and advice on post-exposure preventive treatment.
Recommendations: There are no requirements for vaccination, but
pre-exposure vaccination is recommended for:
- travelers visiting, for more than 30 days, foreign areas where
rabies is known to exist;
- veterinarians and animal handlers;
- spelunkers; and
- certain laboratory workers.
Pre-exposure vaccination does not nullify the need for post exposure
vaccine, but reduces the number of injections.
Summary of Recommendations for North AFRICA
Travelers should (1) take the appropriate country specific malaria
prevention measures, (chloroquine, Egypt only), (2) follow precautions
to prevent insect bites, (3) pay attention to the quality of their
drinking water and food, (4) have a dose of Immune Globulin (IG)
or the Hepatitis A vaccine, and (5) consider booster doses of
tetanus (Td) and polio (eIPV) vaccines. (6) Depending on the locations
to be visited, planned activities, and health of the traveler,
the following vaccines should be considered: Hepatitis B, Japanese
Encephalitis, Typhoid, Meningococcal, Rabies (pre-exposure), and
Cholera. Details for these recommendations are found in this document.
(7) Finally, the normal "childhood" vaccines should
be up-to-date: Measles, Mumps, Rubella (MMR Vaccine); Diphtheria,Tetanus,
Pertussis (DTP Vaccine) [ < 7 years of age]; and Polio vaccine.
Disease risks and precautions