Diseases potentially acquired by travel to North Africa
- David Murdoch, MD, MSc, DTM&H, FRACP, FRCPA, FFSc(RCPA)
David Murdoch, MD, MSc, DTM&H, FRACP, FRCPA, FFSc(RCPA)
- Clinical Microbiologist and Infectious Diseases Physician
- University of Otago, Christchurch
North Africa refers to the region of the African continent north of the Sahara Desert. For the purposes of this discussion, the countries within this region are Algeria, the Canary Islands (Spain), Egypt, Libya, Morocco, and Tunisia. This region is characterized by fertile coastal areas and a desert hinterland.
Malaria — Malaria is of very limited risk for most travelers to North Africa, with most areas being malaria free. In Algeria, there have been small foci of local transmission in the six southern and southeastern wilayas (Adrar, El Oued, Ghardaia, Illizi, Ouargla, and Tamanrasset). The malaria risk in Egypt is limited to the El Faiyum area only. There is no malaria risk in the Canary Islands, Libya, Morocco, or Tunisia. (See "Prevention of malaria infection in travelers".)
Yellow fever — There is no risk for yellow fever in North Africa. However, Algeria, Egypt, Libya, and Tunisia require travelers to have a yellow fever vaccination certificate if they are coming from specified areas in South America or sub-Saharan Africa. (See "Yellow fever".)
Leishmaniasis — Both cutaneous and visceral leishmaniasis occur in the Mediterranean littoral areas of Algeria, Egypt, Libya, Morocco, and Tunisia. Sand flies of the genus Phlebotomus are the vectors. The main reservoirs are dogs, foxes, and humans. In this region, Leishmania infantum is the principal cause of visceral leishmaniasis, and Leishmania tropica is the principal cause of cutaneous leishmaniasis. (See "Cutaneous leishmaniasis: Epidemiology and control" and "Visceral leishmaniasis: Epidemiology and control".)
Rickettsioses — Several rickettsial diseases are endemic in North Africa, including epidemic typhus (caused by Rickettsia prowazekii) [1,2], murine typhus (caused by Rickettsia typhi) , and Mediterranean spotted fever (caused by Rickettsia conorii) . Murine typhus has also been reported from the Canary Islands .
- Mokrani K, Fournier PE, Dalichaouche M, et al. Reemerging threat of epidemic typhus in Algeria. J Clin Microbiol 2004; 42:3898.
- Niang M, Brouqui P, Raoult D. Epidemic typhus imported from Algeria. Emerg Infect Dis 1999; 5:716.
- Letaïef AO, Kaabia N, Chakroun M, et al. Clinical and laboratory features of murine typhus in central Tunisia: a report of seven cases. Int J Infect Dis 2005; 9:331.
- Letaïef A, Souissi J, Trabelsi H, et al. Evaluation of clinical diagnosis scores for Boutonneuse fever. Ann N Y Acad Sci 2003; 990:327.
- Hernández Cabrera M, Angel-Moreno A, Santana E, et al. Murine typhus with renal involvement in Canary Islands, Spain. Emerg Infect Dis 2004; 10:740.
- Steffen R. Epidemiology of traveler's diarrhea. Clin Infect Dis 2005; 41 Suppl 8:S536.
- Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organ 2004; 82:346.
- Frank C, Walter J, Muehlen M, et al. Large outbreak of hepatitis A in tourists staying at a hotel in Hurghada, Egypt, 2004--orange juice implicated. Euro Surveill 2005; 10:E050609.2.
- Stoszek SK, Engle RE, Abdel-Hamid M, et al. Hepatitis E antibody seroconversion without disease in highly endemic rural Egyptian communities. Trans R Soc Trop Med Hyg 2006; 100:89.
- Benjelloun S, Bahbouhi B, Bouchrit N, et al. Seroepidemiological study of an acute hepatitis E outbreak in Morocco. Res Virol 1997; 148:279.
- Sadjjadi SM. Present situation of echinococcosis in the Middle East and Arabic North Africa. Parasitol Int 2006; 55 Suppl:S197.
- Cleaveland S. Royal Society of Tropical Medicine and Hygiene meeting at Manson House, London, 20 March 1997. Epidemiology and control of rabies. The growing problem of rabies in Africa. Trans R Soc Trop Med Hyg 1998; 92:131.
- ARTHROPOD-BORNE DISEASES
- Yellow fever
- Other arboviral infections
- FOODBORNE AND WATERBORNE DISEASES
- Travelers' diarrhea
- Hepatitis A and hepatitis E
- OTHER INFECTIONS
- HIV infection
- Hepatitis B and hepatitis C
- OTHER HAZARDS
- Snake bites
- Heat-associated illness
- High-altitude disease