Health, vaccinations and medical care in South Africa

Malaria, which is the real question

• Most of South Africa has no malaria at all. Cape Town, the Garden Route, the Winelands, Johannesburg and Durban are risk-free.
• The risk areas are the low-lying northeast: the Kruger lowveld, northeastern KwaZulu-Natal and the borders with Mozambique and Zimbabwe.
• Risk is highest in the rainy season, September to May. South African guidance recommends prophylaxis for that window; the US CDC recommends it year round.
• The parasite here is chloroquine-resistant. Atovaquone-proguanil, doxycycline or mefloquine are the options; talk to a travel clinic six weeks out.
• Bite avoidance is half the job. DEET at dusk, long sleeves, and a fan or air conditioning in the room.

Vaccinations

• Hepatitis A and typhoid are the standard recommendations, plus routine boosters.
• Yellow fever certificate is required only if you arrive from a yellow fever country, which includes much of central Africa. Check if you are combining South Africa with Kenya, Tanzania or Zambia.
• Rabies exists. Do not touch dogs, monkeys or bats, and treat any bite as urgent.

Healthcare

• Private hospitals are world class: Netcare, Mediclinic and Life Healthcare are the three big groups and are used to treating foreigners.
• They will want payment or an insurer guarantee up front. Comprehensive travel insurance is not optional here.
• Public hospitals are free at the point of care and heavily overstretched. Go private if you have the choice.
• Pharmacies are excellent. Clicks and Dis-Chem are everywhere and pharmacists advise well.

Everyday

• Tap water in the cities is treated and safe, including Cape Town and Johannesburg. In rural areas, game reserves and small towns, drink bottled or filtered.
• The sun is severe. South Africa sits under a thin ozone layer and burns happen in 20 minutes in summer.
• Bilharzia is present in still fresh water in the north and east. Do not swim in dams or slow rivers in Limpopo or Mpumalanga.
• Altitude in Johannesburg is 1,750 m, which is enough to leave you short of breath and dehydrated on the first day.
• HIV prevalence is high. The ordinary precautions apply.