North Africa
Travel To North Africa
* Algeria * Canary Islands * Egypt * Libya * Madeira Islands * Morocco * Tunisia * Western Sahara
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, and diphtheria persist in the region. More common infections in returned travellers are gastrointestinal: diarrhoea (acute and chronic) and occasionally typhoid fever, amoebiasis, and brucellosis. Chronic and latent infections in immigrants (and long-term residents) from this region include tuberculosis, schistosomiasis, fascioliasis, hepatitis B and C, intestinal parasites, and echinococcosis.
Vector-borne infections: Many have focal distributions or seasonal patterns. Risk to the usual traveller is low. Vector-borne infections in parts of the region include dengue fever, lymphatic filariasis (especially in the Nile Delta), leishmaniasis (cutaneous and visceral), malaria (risk limited to a few areas), relapsing fever, Rift Valley fever,* sand fly fever, Sindbis virus infection, West Nile fever (especially in Egypt), Crimean-Congo haemorrhagic fever, spotted fever due to Rickettsia conorii, and murine typhus.
Food- and water-borne infections: These infections, which are common in travellers to this region, include dysentery and diarrhoea caused by bacteria, viruses, and parasites. Risk for hepatitis A is high throughout the region. Hepatitis E and cholera have caused focal outbreaks, and indigenous wild polio was still present in Egypt in 2003. Other risks include typhoid fever, brucellosis, amoebiasis, and fascioliasis (rare in visitors to the area). Intestinal helminths are common in some local populations but rare in short-term travellers.
Airborne and person-to-person transmission: The annual incidence of tuberculosis is estimated to be 50-100/100,000. Q fever is widespread in livestock-raising areas.
Sexually transmitted and blood-borne infections: HIV prevalence (in adults 15-49 years) is estimated to be <1%. Chancroid is a common cause of genital ulcers. Prevalence of chronic hepatitis B carriage is estimated to be 2%-7% in the region; hepatitis C prevalence exceeds 15% in Egypt.
Zoonotic infections: Rabies is endemic in the region. Sporadic cases of human plague* are reported, and an outbreak occurred in Algeria in 2003. Sporadic cases and outbreaks of anthrax* occur in the region.
Soil- and water-associated infections: Schistosomiasis is present, especially in the Nile Delta and Valley; it is found focally in other countries. Other risks include leptospirosis.*
Other hazards for travellers include scorpion stings, snake bites, and a high rate of motor-vehicle accidents and violent injuries. Screening of blood before transfusion is inadequate in many hospitals.
