Not all areas of South Africa have safe drinking water, and levels of sanitation and hygiene can also vary widely from cities to rural areas, raising the risk of disease.
For those planning side trips to game parks, particularly Kruger National Park in South Africa’s north, there is also malaria to consider (see below).
Other concerns include rates of violent crime, traffic accidents and STDs that are among the highest in the world.
While there are no mandatory vaccinations required for travel to South Africa, several should be considered, including:

Hepatitis A is common in South Africa. The disease is a moderate to high risk to travellers of any age, regardless of their itinerary. Vaccination is recommended for even a short stay of two weeks, but would be even more strongly advised for longer stays – especially for destinations other than soccer stadiums.

Hepatitis B is also common. The vaccine can be administered singly or combined with Hep A vaccine. (Two to three shots are necessary before travel to have protection, so act early! ) The risk of Hep B lies in transmission through contaminated needles or syringes, during unprotected sex, tattooing, piercing, pedicures etc. as well as adventurous activities.

Typhoid is a low risk for those staying in cities and vaccination is not usually recommended, but should be discussed with your healthcare provider or at a Travelvax clinic. However, the risk increases to moderate with rural travel or stays (anywhere) of longer than two weeks. Like Hep A, typhoid is transmitted by contaminated food and water.

Meningitis is not typically a risk for South Africa. The airborne disease is normally associated with travel during the dry season (December – June) in North Africa’s sub-Saharan countries, where there are signs of major epidemics this year (see the report in this issue). Travelvax Australia feels that the presence of supporters, officials and players from those countries in the close confines of stadiums constitutes a low risk for fans from Australia and other developed nations. Vaccination should be considered, especially for certain travellers. They include those aged from late teens to early adulthood who have not had vaccinations for meningococcal meningitis in the past or who may have only received the meningococcal C strain vaccination. All other travellers should discuss the risk with their healthcare provider.

Influenza poses a seasonal travel risk through close contact with other fans and vaccination is recommended. This year’s seasonal flu will contain the strain for H1N1 (Swine flu). Minimise the risk of respiratory illnesses by avoiding people with a persistent cough, and through sound sanitation and hygiene practices. Wash your hands regularly before and after eating, particularly after visiting rest rooms, and after touching bus/train seats and stadium railings, door handles, ATMs etc.

Rabies vaccination is not recommended for short stays. However, the disease is present throughout Africa and travellers should avoid contact with animals. Urgent medical assistance is essential if you are bitten or scratched.

Yellow fever is not a risk in South Africa. However, Australians transiting any of the Yellow fever-endemic countries of North Africa (see list) on their way to the World Cup, or visiting them on their way home, should consider vaccination and may be required to show proof of vaccination in an internationally recognised record book.

Measles, mumps, whooping cough and polio make up the list of so-called childhood vaccinations and all travellers should update their protection through first-time vaccinations or boosters.
It should be noted that South Africa is currently experiencing a major, widespread epidemic of measles, which shows no signs of abating. There have been more than 7000 cases and the yearlong outbreak of the highly contagious disease is now affecting all nine provinces.

Other travel health issues for South Africa

Malaria: There is no risk in any of the cities where World Cup matches are scheduled. Malaria is present year-round in the low altitude areas of the Mpumalanga Province (including Kruger National Park), Northern Province, and northeastern KwaZulu-Natal, as far south as the Tugela River. The risk is highest from September to May, and lower (but not absent) during the winter months of the Cup.
Fans planning side-trips to malaria-infected areas within or outside South Africa should discuss their itinerary, the need (or not) for preventative medications, and the available options with their healthcare provider or at a Travelvax clinic.

STDs: There are high rates of sexually transmitted diseases in South Africa and unprotected sex carries a high risk of transmission.
Along with high rates of vaccine-preventable Hepatitis B, South Africa has one of the world’s highest rates of HIV. An estimated 5.7 million South Africans are living with the disease – one in every five adults. Every day, there are an estimated 1400 new HIV infections and nearly 1000 HIV-related deaths.

Travellers’ diarrhoea (TD): TD-causing gastro bugs are the main risk for World Cup travellers. Self-treatment medication is recommended and travellers prone to TD should consider the oral cholera vaccine Dukoral, which also offers good protection against a common cause of TD.
Taking simple precautions with food, beverages and personal hygiene is important. Here are the golden rules:
• Avoid buying food and beverages from street vendors and places where you suspect hygiene is lacking. Tap water, ice, unpasteurised milk, and dairy products are especially risky, while bottled carbonated beverages, hot tea or coffee, beer, wine, and water that has been boiled or treated are much safer.
• Do not eat raw or undercooked meat and seafood (purchased anywhere).
• Avoid raw fruit and vegetables unless you buy them whole and peel them yourself.
• If handled hygienically, well-cooked and packaged foods are safe.

Schistosomiasis (bilharzia) is a parasitic disease present in South Africa’s freshwater rivers, streams and lakes. Swimming or wading should be avoided, except in chlorinated or saltwater pools, or the ocean.

More advice for a wonderful World Cup

On the roads: South Africa’s traffic accident rates are also among the highest in the world. Avoid driving on unfamiliar rural roads, especially at night.

Health care: There is no reciprocal health care agreement between South Africa and Australia and travellers are strongly advised to obtain comprehensive medical insurance that includes cover for medical evacuation.
In urban areas, medical facilities usually meet international standards, but may be costly. In rural and remote areas, healthcare services may be basic.
Carry an advanced travel first-aid kit if you are planning extensive travel throughout Africa, including needles and syringes, as the standard of medical services may vary widely.

Before you go and while you are there …
The Australian Government warns of high levels of violent crime in South Africa and advises Australians to ensure their personal safety at all times. Its Smartraveller web site also recommends fans:
• Register their travel and contact details before departure, so they can be contacted in an emergency.
• Subscribe to emailed travel safety and security advisories for details of changing conditions.
• Take out comprehensive travel insurance.
• Know embassy contact details for assistance.
• Smartraveller offers its Top Ten Tips for World Cup fans too.