In March 2017, the Centers for Disease Control and Prevention (CDC) received official reports of possible locally-transmitted cases of malaria detected in non-endemic areas of Limpopo, North West, and Gauteng Provinces.
Forty-nine cases were reported between the end of February through March 12, 2017 in Thabazimbi and Lephalele municipalities in the western Waterberg District of Limpopo Province. Two cases were reported at the beginning of March in Swartruggens in North West Province, and two cases were reported mid-February in the Doornpoort neighborhood north of Pretoria in Gauteng Province.
The South African National Institute for Communicable Diseases has responded by doing case investigations, enhancing surveillance, and implementing vector control measures. Healthcare providers have been educated on the symptoms, diagnosis, and treatment of malaria, and the public has been informed about the symptoms of malaria.
Limpopo Province has known ongoing endemic malaria transmission restricted to the northeastern part of the province by the border of Mozambique and Zimbabwe. However, Waterberg District where the cases were reported, is not an area known to have malaria transmission, and cases occurred in persons with no history of travel to malaria-endemic area. At this time, CDC recommends antimalarial medication for travelers going to the western part of Waterberg District in Limpopo Province. The effective antimalarial options for travel to Limpopo Province are atovaquone-proguanil (Malarone ®), doxycycline, and mefloquine.
North West and Gauteng Provinces are not endemic for malaria. The reported cases had no history of travel to a malaria-endemic area, although the cases in Doornpoort had contact with individuals who had traveled to Mozambique and Zimbabwe. No new cases have been reported since the first week of March in Swartruggens, and since mid-February in Doornpoort. While antimalarials are not recommended, travelers to Swartruggens and Doornpoort should take measures to avoid mosquito bites.
In addition to malaria, other diseases are spread by mosquito bites, therefore measures to prevent mosquito bites should be taken regardless of area of travel. These measures include using insect repellent when outdoors, staying in an air-conditioned or well-screened building, and sleeping under an insecticide treated bed net during the peak biting period for mosquitoes (dusk and dawn).