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World Cup 2010: Anticipated Infections in Travelers to South Africa
Abstract & Commentary
By Stan Deresinski, MD, FACP, Clinical Professor of Medicine, Stanford, Associate Chief of Infectious Diseases, Santa Clara Valley Medical Center, is Editor for Infectious Disease Alert.
Synopsis: Travelers who restrict themselves to World Cup venues in South Africa are not at an unusual risk of infectious diseases, but this may not be the case for those who add on travel to national parks or neighboring countries.
Source: Mendelson M, et al. Health risks in travelers to South Africa: The GeoSentinel experience and implications for the 2010 FIFA World Cup. Am J Trop Med Hyg. 2010;82:991-995.
Before the 2010 FIFA World Cup competition began, it was anticipated that more than 350,000 visitors, including many from the United States, would descend upon South Africa.1 It was further anticipated that almost one-third would extend their trip to visit other tourist sites within South Africa and other African countries, most often nearby countries such as Zambia. Unfortunately, some of these travelers will acquire an illness. Mendelson and colleagues have examined the GeoSentinel database to determine the pattern of illnesses in individuals returning from South Africa, and other countries on the continent, from 1997 through 2009, who were evaluated at one of 50 GeoSentinel sites in 23 countries.
The most frequently encountered clinical presentations of illness acquired in South Africa, as well as in countries of sub-Saharan Africa, were, in descending order, systemic febrile illness, dermatologic problems, and acute diarrhea. For South Africa-only travelers, 39% of presentations to GeoSentinel clinic sites were because of systemic febrile illness and, in contrast to visitors to other African countries, the predominant cause was spotted fever-group rickettsiosis, presumably due to Rickettsia africae. In contrast, only six of the 327 ill South Africa-only travelers (19 per 1,000 travelers) had confirmed malaria, and only one of these plasmodial infections was acquired during the winter months (June, July, August). Only one case each of hepatitis A and of typhoid fever was identified among South Africa-only travelers during the 13-year period that was examined, while there were 11 cases of influenza. The World Cup is, of course, occurring during the southern hemisphere's winter influenza season.
Respiratory illnesses were the fourth most common presentation in South Africa-only travelers, among whom 11 had influenza and one had measles.2 Nine were given post-exposure prophylaxis for possible rabies exposure.
Sexually transmitted diseases were infrequently detected, but the extraordinarily high incidence of HIV infection (29.3% of pregnant women) must be kept in mind.
Additional infections not reported by Mendelson et al, which may be acquired by travelers to affected areas of South Africa and neighboring countries, may include dengue, filariasis, onchocerciasis, schistosomiasis, and trypanosomiasis. South Africa also has been experiencing an outbreak of Rift-Valley fever, with 186 human cases with 18 deaths identified as of May 10, 2010.3 The risk to travelers is minimal, except for those coming in contact with farm animals or sleeping outdoors in affected areas. While these infections are not only of concern to visitors to sites of football competition, others may be acquired in the absence of additional travel. Thus, South Africa has had an ongoing outbreak of measles, a highly contagious disease, and has reported more than 9,000 confirmed cases during January 1, 2009 through March 12, 2010.4 Also to be considered is the potential for exposure to tuberculosis, a disease with a high prevalence in South Africa, as well as HIV.