Central, East, and West Africa
Travel To Central Africa
* Angola * Cameroon * Central African Republic * Chad * Congo * Democratic Republic of Congo (Zaire) * Equatorial Guinea * Gabon * Sudan * Zambia
Travel To East Africa
* Burundi * Comoros * Djibouti * Eritrea * Ethiopia * Kenya * Madagascar * Malawi * Mauritius * Mayotte * Mozambique * Réunion * Rwanda * Seychelles * Somalia * Tanzania * Uganda
Travel To West Africa
* Benin * Burkina Faso * Côte d'Ivoire (Ivory Coast) * The Gambia * Ghana * Guinea * Guinea-Bissau * Liberia * Mali * Mauritania * Niger * Nigeria * Saint Helena * São tomé and Principe * Senegal * Sierra Leone * Togo
Vector-borne infections are common and widespread and pose a major risk to local residents and travellers. Access to clean water and sanitary disposal of waste are limited in many areas, so infections related to faecal contamination of food and water remain common and widespread. Vaccine-preventable diseases such as measles, mumps, rubella, poliomyelitis, and diphtheria persist in the region.
The most common cause of systemic febrile illness in travellers to this region is malaria caused by Plasmodium falciparum. Subacute or chronic infections in immigrants (and long-term residents) from the area include tuberculosis, hepatitis B, HIV, lymphatic filariasis, onchocerciasis, loiasis, schistosomiasis, echinococcosis, leprosy, and intestinal parasites.
Vector-borne infections: Malaria transmission is intense in many parts of the region, including urban areas, where falciparum malaria, much of it resistant to chloroquine, predominates. Sporadic cases and outbreaks of yellow fever have occurred in at least 14 of the countries (especially in West Africa) in the past 10 years, with the largest number of cases being reported from Nigeria, Guinea, the Sudan, Côte d'Ivoire, Liberia, Senegal, and Sierra Leone. All countries in the region are considered to be in the endemic zone, and unvaccinated travellers are at risk for infection. Official reports of yellow fever reflect only a small percentage of all infections. African trypanosomiasis has increased in Africa (it is epidemic in Angola, Democratic Republic of Congo, and the Sudan; highly endemic in Cameroon, Central African Republic, Chad, Congo, Côte d'Ivoire, Guinea, Mozambique, Uganda, and Tanzania; and low levels are found in most of the other countries), and an increase in travellers has been noted since 2000. Most had exposures in Tanzania and Kenya, reflecting common tourist routes. Trypanosoma brucei gambiense is found in focal areas of western and central Africa; T. b. rhodesiense, which causes more acute illness, is found in east Africa. Vector-borne viral infections include dengue fever, Crimean-Congo haemorrhagic fever,* Rift Valley fever,* West Nile fever, and O'nyong nyong fever. Lymphatic filariasis is present in many areas; onchocerciasis is widely distributed around river systems, especially in West and Central Africa and as far west as east as Ethiopia. Another filarial infection, loiasis, is widely distributed in the tropical rain forest, especially in Central and West Africa. Filarial infections are rare in short-term travellers. The rickettsial infections murine typhus, louse-borne typhus, and African tick bite fever (due to Rickettsia africae) occur in the region. African tick-bite fever has been increasingly recognised in travellers to rural areas. Murine typhus is more common in coastal areas. Tungiasis (penetration of the skin by sand fleas) is widespread in tropical Africa, especially West Africa, including Madagascar.
Tick-borne relapsing fever is widespread in eastern and central Africa and sporadic elsewhere. Epidemics of louse-borne relapsing fever have occurred in the past but pose little risk to usual travellers. Visceral leishmaniasis is endemic in Ethiopia, Kenya, and Sudan (and has caused large epidemics); it is found in the savanna parts of the region. Cutaneous leishmaniasis is also found in the savanna and in Sudan, Ethiopia and Kenya. Myiasis transmitted by the tumbu fly can affect travellers.
Food- and water-borne infections: Dysentery and diarrhoea are common in local populations; diarrhoea in travellers may be caused by bacteria, viruses, and parasites (especially Giardia, Cryptosporidium, Entamoeba histolytica). Cholera is sporadic and epidemic. Risk of hepatitis A is widespread; sporadic cases and outbreaks of hepatitis E occur. Polio persists in Nigeria and has recently spread to 12 other countries in West and Central Africa. Other risks to travellers include typhoid and paratyphoid fever, amoebiasis, and brucellosis. Dracunculiasis remains endemic in 12 countries, with the highest number of cases in Sudan, Nigeria, and Ghana, but it is rare in travellers. Intestinal parasites are common in residents in many parts of region but are rare in short-term travellers.
Airborne and person-to-person transmission: The estimated annual incidence rates of tuberculosis (per 100,000) are >100 in all countries and >300 in much of region. Frequent epidemics of serogroup A meningococcal disease occur during the dry season (December through June) in a band of countries from Senegal to Ethiopia. Severe outbreaks have occurred in Burkina Faso, Chad, Mali, Niger, Nigeria, Ethiopia, and the Sudan. Serogroup W135 emerged in Burkina Faso in 2002, causing a large epidemic (13,000 cases). Nosocomial and intrafamilial spread of Ebola* occurs in outbreaks (Sudan, Democratic Republic of the Congo, Côte d'Ivoire, Gabon). Nosocomial spread of Lassa fever virus* has also occurred.
Sexually transmitted and blood-borne infections: Estimated prevalence of HIV in adults (15-49 years) ranges from 1% to 15% in most countries. In most of the region, prevalence of chronic infection with hepatitis B virus exceeds 8%. HTLV-1 is endemic in West Africa. Common causes of genital ulcer disease include chancroid, syphilis, and herpes simplex.
Zoonotic infections: Dogs are the most important source of rabies, which is found throughout the region. A wild rodent is the reservoir host for Lassa fever virus*, which is endemic in West Africa; cases have also been documented in the Central African Republic. Echinococcosis* is widespread in animal breeding areas. Sporadic cases and outbreaks of anthrax* occur in the region (it is hyperendemic in Zambia, Ethiopia, Niger, and Chad and in several countries along the western coast). Monkeypox* is found in West and Central Africa, primarily in remote villages in rain forest areas. Plague* is enzootic, and sporadic cases and outbreaks occur in humans. (Outbreaks have occurred since 2000 in Madagascar, Malawi, Mozambique, Uganda, and Tanzania). Q fever* (airborne spread) is found, especially in West Africa, where stock breeding is common.
Soil- and water-associated infections: Schistosomiasis due to Schistosoma mansoni and S. haematobium is widespread; S. intercalatum has a more limited distribution (West Africa). Mycobacterium ulcerans (the cause of Buruli ulcer) is most concentrated in West Africa and is increasing in prevalence. Rare cases have occurred in travellers. Leptospirosis* (both sporadic cases and outbreaks) occurs in tropical areas. Other risks include mycetoma and histoplasmosis.
Other hazards for travellers include motor vehicle accidents and other injuries, including violent injury with assault rifles and other weapons, and sexual assaults. Aflatoxin contamination of grains and snake bites are common, especially in rural areas. Screening of blood before transfusion is inadequate in many hospitals.
