Purpose
Destination overview
Arguably the ultimate in adventure travel, an African safari is the experience of a lifetime. Safari-goers have options to view wildlife from different vantages: on land (e.g., traditional savannah sites and guided car safaris, open trucks, air-conditioned vans, personal vehicles), on the water (e.g., in a dugout canoe, boat), or from the air (e.g., private aircraft, hot air balloon). Hiking with trained, licensed guides in well-scouted settings offers another opportunity to see wildlife up close; treks to view chimpanzees or gorillas, for example, are highly popular.
With >150 game parks and reserves across the African continent, individual travelers, families, backpackers, and people with similar interests (e.g., serious photographers) have a range of choices and budget options. Some parks are remote and rustic, with long drives to see the animals but with fewer tourists. Other parks are easily accessible, with self-drive options. Many safaris accept young children and adolescent participants; gorilla trekking and other more strenuous activities require participants to be ≥15 years of age.
Map 11.1.1.1 and Map 11.1.1.2 show several major African game parks. In East Africa, the Maasai Mara National Reserve in Kenya is the northern extension of Tanzania's Serengeti National Park game reserve. Together these 2 parks are home to the complete collection of the so-called Big 5—Cape buffalo, elephants, leopards, lions, and rhinoceros—the large wild animals for which Africa is most famous. Other East African game parks that offer exceptional wildlife viewing include Tsavo National Park (Kenya); Amboseli National Park (Kenya); Akagera National Park (Rwanda); Ngorongoro Crater (Tanzania); and Ngamba Island Chimpanzee Sanctuary, Murchison Falls National Park, Kidepo National Park, Mt. Elgon National Park, Queen Elizabeth National Park, and Ziwa Rhino Sanctuary (Uganda). Travelers can trek to see gorillas at the Virunga National Park (the Democratic Republic of the Congo), Volcanoes National Park (Rwanda), and Bwindi Impenetrable National Park (Uganda); "impenetrable" refers to the challenging hiking required to go through the dense undergrowth, vines, and other vegetation in this park.
Map 11.1.1.1
Centers for Disease Control and Prevention
Map 11.1.1.2
Centers for Disease Control and Prevention
Game park destinations in Southern Africa include Moremi Game Reserve, Chobe National Park, and Kalahari Desert (Botswana); Etosha National Park (Namibia); Kruger National Park (South Africa); Kafue National Park, Lower Zambezi National Park, and South Luangwa National Park (Zambia); and Hwange National Park, Manu National Park, and Gonarezhou National Park (Zimbabwe).
Pendjari National Park in Benin, home to West African lions and elephants, is a major part of the largest intact ecosystem in West Africa, the transnational W-Arly-Pendjari (WAP) complex, which spans Benin, Burkina Faso, and Niger. Mole National Park (Ghana) boasts >93 mammal species, including elephants and hippos.
Although the centerpiece of safari-going remains viewing majestic animals in their natural habitat, many tour operators now also offer programs on local culture and history, ecosystems, and geology. Conservation-based tours promoting responsible tourism allow travelers to stay safe, help safeguard wildlife, protect vital habitats, and benefit local people.
Africa has a wide range of mountains that provide a perfect climbing experience for the adventurous. The East African region has some of the choicest of mountain ranges that provide unique trekking challenges to the mountain tops. The most popular mountains are Mount Kenya (approximately 5,200 m; 17,057 ft), in Kenya; Mount Kilimanjaro (approximately 5,900 m; 19,341 ft) and Mount Meru (approximately 4,560 m; 14,967 ft), in Tanzania; Mount Karisimbi (approximately 4,500 m; 14,790 ft) and Mount Bisoke (approximately 3,700 m; 12,180 ft) in Rwanda; and Mount Stanley (approximately 5,100 m; 16,763 ft) in the Rwenzori Mountain ranges, in Uganda and bordering the Democratic Republic of the Congo. Mount Bisoke, Mount Karisimbi, Mount Kenya, Mount Kilimanjaro, and Mount Meru are volcanic mountains, while the Rwenzori Mountain ranges are non-volcanic.
Each of these magnificent peaks provides a climatic range (i.e., from hot and humid temperatures to freezing temperatures) on the way to the top. Travelers should prepare for picturesque nature walks and mind-blowing landscapes that these respective majestic mountains have to offer. They also have an option of taking advantage of touring the nature and game reserves that lie below these majestic mountains as part of their experience in the respective countries. This will require the travelers to work with the respective country mountain tour operators for a detailed mountain excursion.
Kenya, Rwanda, Tanzania, and Uganda share the same weather patterns, with March–May and September–November known to be the rainy seasons (Kenya, Rwanda, and Uganda lie along the equator). Although the temperatures in the 4 East African countries are usually warm, travelers should expect cold temperatures at high altitudes (approximately 2,700 m; >9,000 ft) and should prepare warm clothing for these heights.
Infectious disease risks
Health, safety, and comfort issues that safari-goers are likely to encounter are mostly predictable and largely avoidable. A pre-travel consultation with a travel medicine specialist is essential (see The Pre-Travel Consultation chapter). Multiple vaccinations might be required for healthy safari travel. Provide advice specific to each traveler’s itinerary, country, and game park. Because vaccines take time to become effective, advise travelers to seek vaccination as early as possible prior to planned departure.
Enteric infections and diseases
Cholera
Cholera is an acute diarrheal infection caused by eating food or drinking water contaminated with Vibrio cholerae (see Cholera chapter). It spreads through fecal contamination or vomit of someone suffering from cholera. Cholera causes sudden and continuous passing of watery stool and sometimes vomiting. This leads to rapid loss of water and salts from the body, making the person generally weak. Cholera can lead to death within hours if a person is not treated quickly.
Cholera outbreaks have become common in recent years in East, Central, and Southern Africa and are often worse in the rainy season (August–November) but sometimes spill over into December. Uganda, Kenya, and Tanzania have had several outbreaks along Lake Victoria (in all 3 countries) and along the Nile River (in Uganda). These water bodies are near urban centers and are the locations of major tourism sites (e.g., hotels and beaches) and expeditions (rafting on the Nile).
If a traveler develops signs and symptoms of cholera, immediately advise them to start taking oral rehydration solution or other fluids at the earliest opportunity. Counsel travelers to follow proper fecal and other waste disposal guidelines as they travel, such as ensuring all feces, including those of children, are disposed of using a toilet. Reassure travelers that cholera rarely affects those on normal tourist itineraries.
Hepatitis A
Hepatitis A virus is transmitted through ingestion of contaminated food or water or through direct contact with an infectious person. Hepatitis A is among the most common vaccine-preventable infections acquired during travel. Risk is greatest for people who live in or visit rural areas, trek in backcountry areas, or eat or drink in settings of poor sanitation. Vaccination is recommended for travelers to Sub-Saharan Africa, including safari-goers (see Hepatitis A chapter).
Travelers' diarrhea
Travelers' diarrhea (TD) is the most common travel-related illness and is common on safaris. Prepare travelers by explaining the risks for TD and how best to prevent it through appropriate hand hygiene and careful selection of foods and beverages (see Travelers' Diarrhea and Food and Water Precautions for Travelers chapters). Infectious causes of TD include bacteria (e.g., Campylobacter jejuni, Escherichia coli, Salmonella spp., Shigella spp., Vibrio cholerae), viruses (e.g., norovirus, rotavirus), and protozoa (e.g., Cryptosporidium, Giardia; see Post-Travel Diarrhea chapter).
Most TD cases are mild and self-limiting. Advise travelers to carry antimotility medicine for symptomatic relief of mild TD. Consider prescribing antibiotic therapy to treat moderate to severe TD and providing travelers with clear written guidance about TD prevention and step-by-step instructions about how and when to use medications. Travelers should carry any medications with them on safari because access to authentic drugs is not guaranteed in remote locations. Travelers should consult a physician for moderate, severe, or persistent TD.
No vaccines are available for most pathogens that cause TD. Cholera vaccine is not needed for safari-goers unless they are planning a side trip to work in a refugee camp or do humanitarian aid work in an affected country. Advise travelers to carry alcohol-based hand sanitizer with ≥60% alcohol for use when water and soap are scarce or unsafe, or conditions are generally unhygienic. Travelers should avoid drinking tap water while on safari and only consume adequately disinfected (e.g., commercially bottled) water from an unopened, factory-sealed container (see Food and Water Precautions for Travelers chapter).
Typhoid fever
Typhoid fever is a bacterial disease caused by Salmonella typhi (see Typhoid and Paratyphoid Fever chapter). Typhoid fever vaccine generally is recommended for safari-goers. Because vaccination does not confer 100% protection, even vaccinated travelers should avoid consumption of potentially contaminated food and water.
Respiratory infections and diseases
Respiratory illnesses (e.g., COVID-19, influenza, tuberculosis [TB]) can spread between people and from people to the wildlife they encounter.
Coronavirus disease 2019
In zoos and animal sanctuaries, big cats (e.g., cougars, lions, pumas, tigers, snow leopards) and mountain gorillas have tested positive for SARS-CoV-2, the virus that causes COVID-19 (see COVID-19 chapter). In many parks, operating procedures are in place to protect wildlife and travelers. These include mandatory COVID-19 testing, limited group capacity, and required mask use to enter. Travelers should check with tour operators and park websites ahead of travel for up-to-date requirements and follow park requirements to help keep both wildlife and people safe and healthy.
For current information on COVID-19 at their destination(s), travelers to Africa should consult the U.S. Embassy website. All travelers going to Africa should be up to date with their COVID-19 vaccines.
Influenza and tuberculosis
While on safari, when trekking, or when visiting local communities, travelers can potentially encounter livestock species susceptible to influenza (e.g., chickens, pigs, waterfowl) and TB (e.g., cows). Chimpanzees, gorillas, and other wildlife are also susceptible to influenza and TB (see Tuberculosis chapter). Responsible tourism requires persons with respiratory illness to refrain from wildlife trekking or other activities that involve close contact with wildlife. The influenza season is from April–September in the Southern Hemisphere and year-round in countries near the equator. Therefore, it is recommended that travelers are up to date with the influenza vaccine (see Influenza chapter).
Soil- and waterborne infections
Schistosomiasis
Freshwater lakes, ponds, and rivers all pose a risk for exposure to Schistosoma species, a parasite found in freshwater snails (see Schistosomiasis chapter). Travelers should consider all freshwater sources to be contaminated and avoid bathing, swimming, wading, or other freshwater contact in disease-endemic countries. River trips (e.g., Nile River white water rafting) present a risk for schistosomiasis (also known as bilharzia). Swimming in the ocean or well-chlorinated pools does not pose a risk for schistosomiasis.
Vector-borne diseases
Travelers should take steps to avoid arthropod bites to reduce their risk for vector-borne infections (see Mosquitoes, Ticks, and Other Arthropods chapter).
Chikungunya, dengue, Zika
Chikungunya, dengue, and Zika are arboviruses transmitted by Aedes species mosquitoes in game parks throughout Africa (see Chikungunya, Dengue, and Zika chapters). Aedes mosquitoes predominantly bite during the day.
Malaria
Malaria is endemic to Sub-Saharan Africa, and transmission occurs in most game parks. Most infections are caused by Plasmodium falciparum. All P. falciparum in Sub-Saharan Africa is considered chloroquine-resistant. Safari activities often include sleeping in tents and observing animals at dusk or after dark, sometimes near water holes, all of which increase the risk for exposure to malaria-carrying Anopheles mosquitoes. Appropriate malaria chemoprophylaxis and personal protection—wearing long-sleeved shirts and long pants, using insect repellents, and sleeping under permethrin-impregnated mosquito netting—are essential (see Yellow Fever Vaccine and Malaria Prevention Information, by Country [and associated maps] and Malaria chapters).
Rickettsial diseases
African tick bite fever is endemic to much of Sub-Saharan Africa; among returning travelers, it is the most commonly diagnosed rickettsial disease (see Rickettsial Diseases and Post-Travel Dermatologic Conditions chapters). Travel-associated cases of African tick bite fever often occur in clusters of people exposed while participating in common activities (e.g., bush hiking, game hunting, safari tours). Travelers can protect themselves from infection by taking precautions to prevent tick bites (see Mosquitoes, Ticks, and Other Arthropods chapter).
Trypanosomiasis
Day-biting tsetse flies (Glossina species) transmit African trypanosomiasis (sleeping sickness), a disease only rarely seen in travelers. Several reports document trypanosomiasis in travelers returning from visits to national parks or game reserves, including Kenya's Maasai Mara National Reserve. Advise travelers that neutral-colored clothing seems to deter the flies.
Yellow fever
Travelers going on an African safari should consult a travel medicine specialist for the very latest information regarding yellow fever at their destination. Currently, the World Health Organization and the Centers for Disease Control and Prevention (CDC) recommend yellow fever vaccination for much of Sub-Saharan Africa (see Yellow Fever Vaccine and Malaria Prevention Information, by Country [and associated maps] and Yellow Fever chapters).
Some countries require proof of yellow fever vaccination in the form of a valid International Certificate of Vaccination or Prophylaxis, also known as the "Yellow Card," as a condition of entry. Moreover, some safaris cross international borders to include ≥1 country. Assist travelers by checking the requirements for each country on their itinerary, including countries they only transit through on the way to their destination.
Viral hemorrhagic fevers
Crimean-Congo hemorrhagic fever, Ebola disease, Lassa fever, Marburg virus disease, and Rift Valley fever are viral hemorrhagic fevers (VHFs) found in and around some game parks in Sub-Saharan Africa. Although travelers are rarely affected, zoonotic exposure to VHFs can occur through direct contact with wildlife (e.g., bats, non-human primates, rodents, some antelope), insect (e.g., mosquito) or tick bites, and contact with blood or body fluid of livestock.
Travelers who touch or come into proximity of bats (e.g., spelunking, visiting bat caves) are at greatest risk for Ebola virus or Marburg virus exposure. Several confirmed cases of Marburg virus disease occurred in travelers visiting Kitum Cave in Kenya or Python Cave in Maramagambo Forest, Uganda. Caution travelers against visiting locations where VHF outbreaks are occurring, to avoid contact with bats and rodents, and to avoid blood or body fluids of livestock or animal carcasses.
Environmental hazards and risks
Altitude illness and acute mountain sickness
Travelers who opt for the mountain ranges within the East Africa Region should adequately prepare for temperature variations on their trek to the summit. The most common risk that mountain climbers face is altitude illness. Travelers climbing with a guide service should check that guides are trained to recognize and are equipped to treat altitude sickness (see High-Altitude Travel and Altitude Illness chapter). Altitude illness occurs when the body fails to adjust to elevated height levels, usually at 3,048 m (10,000 ft) or higher. Symptoms may include shortness of breath, fatigue, vomiting, rapid heart rate, dizziness, nausea, or headache.
Prevalence rates of acute mountain sickness (AMS) were 75%–77% in recent studies of 4- and 5-day ascents of Mt. Kilimanjaro (see Box 11.1.1.1). People using the carbonic anhydrase inhibitor acetazolamide were much less likely to develop AMS on 5-day ascents, but ≥40% of people taking this medication still reported AMS symptoms. For any traveler planning to ascend to elevations >8,000 ft, be sure to discuss the signs and symptoms of altitude illness and provide guidance on its prevention and treatment.
Box 11.1.1.1
Animal bites and wildlife-related injuries
Wild animals are unpredictable. Travelers should follow verbal and written instructions provided by safari operators and guides and should take extra precautions if camping or traveling without a guide in a national park. Wildlife-related injuries usually occur when travelers disregard rules (e.g., when they approach animals too closely to feed or photograph them). People should never try to feed, handle, or pet unfamiliar animals, whether domestic or wild. If bitten or scratched by a macaque, travelers should be evaluated for B virus post-exposure prophylaxis (see Zoonotic Exposures: Bites, Scratches, and Other Hazards chapter).
Rabies exists throughout Africa; dogs and bats are the primary animal reservoirs (see Rabies chapter). Warn travelers not to enter caves where bats roost and shelter. Advise travelers to properly clean the wound and consult a physician for rabies post-exposure prophylaxis in case of animal bites or scratches or suspected bat exposures (e.g., sleeping in a cabin or tent where bats are found).
Consider pre-exposure prophylaxis for people whose planned activities will increase their chances of direct animal encounters (e.g., adventure travelers, animal sanctuary visitors, campers, cave explorers [spelunkers], participants in veterinary care or wildlife management programs). Additional considerations for pre-exposure prophylaxis might include whether rabies immunoglobulin and rabies vaccination are available in the visited country in case of exposure.
Climate and sun exposure
Some parks are located at higher elevations and closer to the equator, making proper sun precautions imperative for avoiding sunburn, heat exhaustion, heat stroke, and dehydration. Advise travelers to seek shade, when possible, to avoid the sun during midday hours, and to carry water (see Heat and Cold Illness in Travelers chapter). In addition, advise travelers to wear sunglasses, protective clothing, and hats, and to use a broad-spectrum (protects against both ultraviolet A and ultraviolet B) sunscreen, SPF ≥15. Advise mountain trekkers to apply sunscreen and wear clothing that protects against ultraviolet exposure. Recommend that travelers bring sunscreen and sunburn remedies with them because selection can be limited and expensive once abroad (see Sun Exposure in Travelers chapter).
Natural disasters
Natural disasters (e.g., earthquakes, flooding, landslides, volcanic eruptions) have all occurred and have affected international travelers in recent years. During the rainy season, floods and landslides can be more common. Safari-goers should expect sudden road closures, plan alternative routes, and take precautions during storms. Dust storms might occur during the dry season and in desert locations. Poor air quality (see Air Quality and Ionizing Radiation During Travel chapter) can exacerbate asthma or other lung diseases. Encourage all travelers to enroll in the U.S. Department of State's Smart Traveler Enrollment Program to receive up-to-date information in the event of a disaster.
Safety and security
Crime
Within game parks, crime is unusual; robberies and car-jackings are more common in urban areas (see Safety and Security Overseas chapter). Travelers should check with the U.S. Department of State's Bureau of Consular Affairs ahead of travel to learn more about safety and security risks before traveling.
Traffic-related injuries
In Sub-Saharan African countries, the rates of fatal motor vehicle crashes are among the highest in the world. Travelers should fasten seat belts when riding in motor vehicles and wear a helmet when riding bicycles or motorbikes (see Injury and Death During Travel chapter). Within game parks, serious motor vehicle crashes are rare because poor and rugged road conditions generally discourage speeding. Travel in rural areas between parks is high-risk, especially after dark. If possible, travelers should avoid nighttime driving in Sub-Saharan Africa, and pedestrians should take extra care to watch for speeding vehicles. Travelers should avoid boarding overcrowded buses and avoid driving or riding on motorcycles and motorbikes.
Availability and quality of medical care
Travelers should work with their healthcare professional to ensure that any underlying illnesses are managed before travel (see Travelers with Chronic Illnesses chapter). Before leaving the United States, each traveler also should be certain they have international health insurance coverage. Because surgical support or other advanced health care might not be available in the destination country, encourage travelers to purchase an additional medical evacuation insurance policy (see Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance and What to Do When Sick Abroad chapters).
Recommend that travelers carry a personal medical kit with sufficient medication to treat allergies, chronic conditions, routine health needs, and emergencies (see Travel Health Kits chapter). Warn travelers with food allergies that food labels might not reliably indicate potential allergens and that lack of emergency services and language barriers can compound the risk for any severe allergic reaction that requires emergency medical care (see Severely Allergic Travelers chapter). Prescribe an epinephrine auto-injector for severely allergic travelers. Options for feminine hygiene products can be limited on safari, so advise travelers to pack an adequate supply.
Symptoms of many diseases acquired in Africa can surface weeks and occasionally months after exposure, sometimes long after the traveler has returned home. Obtain a thorough travel history from all patients presenting for care (see Post-Travel Evaluation of the Ill Traveler chapter).
- Centers for Disease Control and Prevention (CDC). (2009). Imported case of Marburg hemorrhagic fever: Colorado, 2008. MMWR: Morbidity and Mortality Weekly Report, 58(49), 1377–1381. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5849a2.htm
- Gainor, E. M., Harris, E., & LaBeaud, A. D. (2022). Uncovering the burden of dengue in Africa: Considerations on magnitude, misdiagnosis, and ancestry. Mosquito-Borne Virus Ecology, 14(3), 233. https://www.doi.org/10.3390/v14020233
- Jackson, S. J., Varley, J., Sellers, C., Josephs, K., Codrington, L., Duke, G., . . . Baillie, J. K. (2010). Incidence and predictors of acute mountain sickness among trekkers on Mount Kilimanjaro. High Altitude Medicine & Biology, 11(3), 217–222. https://www.doi.org/10.1089/ham.2010.1003
- Morgan, O. W., Brunette, G., Kapella, B. K., McAuliffe, I., Katongole-Mbidde, E., Li, W., . . . Montgomery, S. P. (2010). Schistosomiasis among recreational users of Upper Nile River, Uganda, 2007. Emerging Infectious Diseases, 16(5), 866–868. https://www.doi.org/10.3201/eid1605.091740