Swaziland (Eswatini)

Country fact file

Allgemeine Informationen

The information on these pages should be used to research health risks and to inform the pre-travel consultation.

Travellers should check the Foreign Office travel advice page (where available) which provides information on travel entry requirements in addition to safety and security advice.

Travellers should ideally arrange an appointment with their health professional at least four to six weeks before travel. However, even if time is short, an appointment is still worthwhile. This appointment provides an opportunity to assess health risks taking into account a number of factors including destination, medical history, and planned activities. For those with pre-existing health problems, an earlier appointment is recommended.

All travellers should ensure they have adequate travel health insurance.

A list of useful resources including advice on how to reduce the risk of certain health problems is available below.

Ressourcen

• Food and water hygiene

• Insect and tick bite avoidance

• Personal safety

• Sonnenschutz

What vaccinations do I need for Eswatini?

Details of vaccination recommendations and requirements are provided below.

All travellers

Travellers should be up to date with routine vaccination courses and boosters as recommended in the UK. These vaccinations include for example measles-mumps-rubella (MMR) vaccine and diphtheria-tetanus-polio vaccine. Country-specific diphtheria recommendations are not provided here. Diphtheria tetanus and polio are combined in a single vaccine in the UK. Therefore, when a tetanus booster is recommended for travellers, diphtheria vaccine is also given. Should there be an outbreak of diphtheria in a country, diphtheria vaccination guidance will be provided.

Those who may be at increased risk of an infectious disease due to their work, lifestyle choice, or certain underlying health problems should be up to date with additional recommended vaccines. See details on the selective immunisation programmes and additional vaccines for individuals with underlying medical conditions at the bottom of the 'Complete routine immunisation schedule' document and the individual chapters of the 'Green Book' Immunisation against infectious disease for further details.

Certificate requirements

Please read the information below carefully, as certificate requirements may be relevant to certain travellers only. For travellers further details, if required, should be sought from their healthcare professional.

There is no risk of yellow fever in this country, however, there is a certificate requirement.

Under International Health Regulations, a yellow fever vaccination certificate is required from travellers aged 9 months or over arriving from countries with risk of yellow fever transmission and for travellers having transited through an airport of a country with risk of yellow fever transmission.

According to World Health Organization (WHO), from 11 July 2016 (for all countries), the yellow fever certificate will be valid for the duration of the life of the person vaccinated. As a consequence, a valid certificate, presented by arriving travellers, cannot be rejected on the grounds that more than ten years have passed since the date vaccination became effective as stated on the certificate; and that boosters or revaccination cannot be required.

View the WHO list of countries with risk of yellow fever transmission.

Most travellers

The vaccines in this section are recommended for most travellers visiting this country. Vaccines are listed alphabetically.

Hepatitis A

Hepatitis A is a viral infection transmitted through contaminated food and water or by direct contact with an infectious person. Symptoms are often mild or absent in young children, but the disease can be more serious with advancing age. Recovery can vary from weeks to months. Following hepatitis A infection immunity is lifelong.

Prävention

All travellers should take care with personal, food and water hygiene.

Hepatitis-A-Impfung

As hepatitis A vaccine is well tolerated and affords long-lasting protection, it is recommended for all previously unvaccinated travellers.

Hepatitis A in brief

Tetanus

Tetanus is caused by a toxin released from Clostridium tetani bacteria and occurs worldwide. Tetanus bacteria are present in soil and manure and may be introduced through open wounds such as a puncture wound, burn or scratch.

Prävention

Travellers should thoroughly clean all wounds and seek medical attention for injuries such as animal bites/scratches, burns or wounds contaminated with soil.

Tetanus vaccination

Travellers should have completed a tetanus vaccination course according to the UK schedule. If travelling to a country or area where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously. Country-specific information on medical facilities may be found in the 'health' section of the FCDO foreign travel advice pages.

Tetanus in brief

Typhus

Typhoid is a bacterial infection transmitted through contaminated food and water. Previous typhoid illness may only partially protect against re-infection.

Prävention

All travellers should take care with personal, food and water hygiene.

Typhus-Impfung

Oral and injectable typhoid vaccinations are available.

Typhoid in brief

Some travellers

The vaccines in this section are recommended for some travellers visiting this country. Information on when these vaccines should be considered can be found by clicking on the arrow. Vaccines are listed alphabetically.

Cholera

Cholera is a bacterial infection transmitted by contaminated food and water. Cholera can cause severe watery diarrhoea although mild infections are common. Most travellers are at low risk.

Prävention

All travellers should take care with personal, food and water hygiene.

Cholera-Impfung

This oral vaccine is recommended for those whose activities or medical history put them at increased risk. This includes:

• aid workers

• those going to areas of cholera outbreaks who have limited access to safe water and medical care

• those for whom vaccination is considered potentially beneficial.

Cholera in brief

Hepatitis B

Hepatitis B is a viral infection spread through blood, semen and vaginal fluids. This mostly occurs during sexual contact or as a result of blood-to-blood contact (for example from contaminated equipment during medical and dental procedures, tattooing or body piercing procedures, and sharing of intravenous needles). Mothers with the virus can also pass on the infection to their baby during childbirth. This country is considered to have an intermediate or high prevalence of hepatitis B.

Prävention

Travellers should avoid contact with blood or body fluids. This includes:

• Avoiding unprotected sexual intercourse.

• Avoiding tattooing, piercing, public shaving, and acupuncture (unless sterile equipment is used).

• Not sharing needles or other injection equipment.

• Following universal precautions if working in a healthcare or other higher risk setting. A sterile medical equipment kit may be helpful when travelling to resource poor areas.

Hepatitis B vaccination

Vaccination could be considered for all travellers and is recommended for those whose activities or medical history put them at increased risk. This includes:

• Those who may have unprotected sex.

• Those who may be exposed to contaminated needles through injecting drug use.

• Those who may be exposed to blood or body fluids through their work (e.g. health and aid workers).

• Those at high risk of requiring medical or dental procedures or hospitalisation e.g. those with pre-existing medical conditions, those who may require travelling for medical care abroad, or those travelling to visit families or relatives.

• Long-stay travellers.

• Those who are participating in contact sports.

• Families adopting children from this country.

Hepatitis B in brief

Tollwut

Rabies is a viral infection which is usually transmitted following contact with the saliva of an infected animal most often via a bite, scratch or lick to an open wound or mucous membrane (such as on the eye, nose or mouth). Although many different animals can transmit the virus, most cases follow a bite or scratch from an infected dog. In some parts of the world, bats are an important source of infection. Rabies symptoms can take some time to develop, but when they do, the condition is almost always fatal.

Rabies in Eswatini

Rabies is considered a risk and has been reported in domestic animals in this country. Bats may also carry rabies-like viruses.

Prävention

Travellers should avoid contact with all animals. Rabies is preventable with prompt post-exposure treatment. Following a possible exposure, wounds should be thoroughly cleansed and an urgent local medical assessment sought, even if the wound appears trivial. Post-exposure treatment and advice should be in accordance with national guidelines.

Tollwut-Impfung

A full course of pre-exposure vaccines simplifies and shortens the course of post-exposure treatment and removes the need for rabies immunoglobulin which is in short supply worldwide. Pre-exposure vaccinations are recommended for travellers whose activities put them at increased risk including:

• those at risk due to their work (e.g. laboratory staff working with the virus, those working with animals or health workers who may be caring for infected patients).

• those travelling to areas where access to post-exposure treatment and medical care is limited.

• those planning higher risk activities such as running or cycling.

• long-stay travellers (more than one month).

Rabies in brief

Tuberkulose

TB is a bacterial infection most commonly affecting the lungs but can affect any part of the body. When a person with TB in their lungs or throat coughs or sneezes they could pass TB on to other people. TB is curable but can be serious if not treated. The BCG vaccination helps to protect some people, particularly babies and young children who are at increased risk from TB. This country has reported an annual TB incidence of greater than or equal to 40 cases per 100,000 population at least once in the last five years.

Prävention

Travellers should avoid close contact with individuals known to have infectious pulmonary (lung) or laryngeal (throat) TB. Those at risk during their work (such as healthcare workers) should take appropriate infection control and prevention precautions.

Tuberculosis (BCG) vaccination

BCG vaccine is recommended for those at increased risk of developing severe disease and/or of exposure to TB infection. See UK Health Security Agency Immunisation against infectious disease, the 'Green Book'. For travellers, BCG vaccine is recommended for:

• Unvaccinated, children under 16 years of age, who are going to live for more than 3 months in this country. A tuberculin skin test is required prior to vaccination for all children from 6 years of age and may be recommended for some younger children.

• Unvaccinated, tuberculin skin test-negative individuals at risk due to their work such as healthcare or laboratory workers who have direct contact with TB patients or potentially infectious clinical material and vets and abattoir workers who handle animal material, which could be infected with TB.

Tuberculosis in brief

What about malaria in Eswatini?

Malaria is a serious illness caused by infection of red blood cells with a parasite called Plasmodium. The disease is transmitted by mosquitoes which predominantly feed between dusk and dawn.

Symptoms usually begin with a fever (high temperature) of 38°C (100°F) or more. Other symptoms may include feeling cold and shivery, headache, nausea, vomiting and aching muscles. Symptoms may appear between eight days and one year after the infected mosquito bite. Prompt diagnosis and treatment is required as people with malaria can deteriorate quickly. Those at higher risk of malaria, or of severe complications from malaria, include pregnant women, infants and young children, the elderly, travellers who do not have a functioning spleen and those visiting friends and relatives.

Prävention

Travellers should follow an ABCD guide to preventing malaria:

• Awareness of the risk – Risk depends on the specific location, season of travel, length of stay, activities and type of accommodation.

• Bite prevention – Travellers should take mosquito bite avoidance measures.

• Chemoprophylaxis – Travellers should take antimalarials (malaria prevention tablets) if appropriate for the area. No antimalarials are 100% effective but taking them in combination with mosquito bite avoidance measures will give substantial protection against malaria.

• Diagnosis – Travellers who develop a fever of 38°C (100°F) or higher more than one week after being in a malaria risk area, or who develop any symptoms suggestive of malaria within a year of return should seek immediate medical care. Emergency standby treatment may be considered for those going to remote areas with limited access to medical attention.

Risk areas

There is a risk of malaria in the northern and eastern regions bordering Mozambique and South Africa, including all of the Lubombo district and Big Bend, Mhlume, Simunye and Tshaneni regions: atovaquone/proguanil OR doxycycline OR mefloquine recommended.

There is a very low risk of malaria in the rest of the country: awareness of risk and bite avoidance recommended.

Recommended antimalarials

The recommended antimalarials for Eswatini are listed below. They are recommended for certain areas only. If these are not suitable please seek further specialist advice. Please note, the advice for children is different, the dose is based on body weight and some antimalarials are not suitable.

Atovoquone/Proguanil

Atovaquone 250mg/Proguanil 100mg combination preparation:

• start one to two days before arrival in the malaria risk area

• for adults, one tablet is taken every day, ideally at the same time of day for the duration of the time in a malaria risk area and daily for seven days after leaving the malaria risk area

• take with a fatty meal if possible

• for children paediatric tablets are available and the dose is based on body weight.

Doxycyclin

Doxycycline 100mg:

• start one to two days before arrival in the malaria risk area

• adults and children over 12 years of age take 100mg daily, ideally at the same time of day for the duration of the time in a malaria risk area and daily for four weeks after leaving the malaria risk area

• take with food if possible; avoid taking this drug just before lying down

• not suitable for children under 12 years of age.

Mefloquin

Mefloquine 250mg:

• this drug is taken weekly, adults take one 250mg tablet each week

• start two to three weeks before arrival in the malaria risk area and continue weekly until four weeks after leaving the malaria risk area

• for children the dose is based on the body weight.

What other risks are there?

There are some risks that are relevant to all travellers regardless of destination. These may for example include road traffic and other accidents, diseases transmitted by insects or ticks, diseases transmitted by contaminated food and water, or health issues related to the heat or cold.

Some additional risks (which may be present in all or part of this country) are mentioned below and are presented alphabetically.

Biting insects or ticks

Insect or tick bites can cause irritation and infections of the skin at the site of a bite. They can also spread certain diseases.

Diseases in Southern Africa

There is a risk of insect or tick-borne diseases in some areas of southern Africa. This includes diseases such as African Trypanosomiasis (sleeping sickness), African tick bite fever, Crimean-Congo haemorrhagic fever, Rift Valley fever and West Nile virus.

Prävention

All travellers should avoid insect and tick bites day and night. There are no vaccinations (or medications) to prevent these diseases. Further information about specific insect or tick-borne diseases for this country can be found, if appropriate on this page, in other sections of the country information pages and the insect and tick bite avoidance factsheet.

Chikungunya

Chikungunya is a viral infection spread by mosquitoes which bite mainly during daytime hours. It causes a flu-like illness and can cause severe joint and muscles pains which usually improve in 1–2 weeks but may persist for months or years. It is rarely fatal. This country has reported chikungunya cases in the past or shares a land border with a country that has reported cases recently. Information on current outbreaks, where available, will be reported on our outbreak surveillance database.

Prävention

Vaccination is not recommended. Travellers should avoid mosquito bites, particularly during daytime hours.

Influenza

Seasonal influenza is a viral infection of the respiratory tract and spreads easily from person to person via respiratory droplets when coughing and sneezing. Symptoms appear rapidly and include fever, muscle aches, headache, malaise (feeling unwell), cough, sore throat and a runny nose. In healthy individuals, symptoms improve without treatment within two to seven days. Severe illness is more common in those aged 65 years or over, those under 2 years of age, or those who have underlying medical conditions that increase their risk for complications of influenza.

Seasonal influenza in Eswatini

Seasonal influenza occurs throughout the world. In the northern hemisphere (including the UK), most influenza occurs from as early as October through to March. In the southern hemisphere, influenza mostly occurs between April and September. In the tropics, influenza can occur throughout the year.

Prävention

All travellers should:

• Avoid close contact with symptomatic individuals

• Avoid crowded conditions where possible

• Wash their hands frequently

• Practise ‘cough hygiene’: sneezing or coughing into a tissue and promptly discarding it safely, and washing their hands

• Avoid travel if unwell with influenza-like symptoms

A vaccine is available in certain circumstances (see below). In the UK, seasonal influenza vaccine is offered routinely each year to those at higher risk of developing severe disease following influenza infection, and certain additional groups such as healthcare workers and children as part of the UK national schedule. For those who do not fall into these groups, vaccination may be available privately. If individuals at higher risk of severe disease following influenza infection are travelling to a country when influenza is likely to be circulating they should ensure they received a flu vaccination in the previous 12 months.

Avian influenza

Avian influenza viruses can rarely infect and cause disease in humans. Such cases are usually associated with close exposure to infected bird or animal populations. Where appropriate, information on these will be available in the outbreaks and news sections of the relevant country pages.

Outdoor air quality

Poor air quality is a significant public health problem in many parts of the world. Exposure to high levels of air pollution over short time periods (e.g. minutes/hours/days) and longer time periods (e.g. years) is linked to many different acute and chronic health problems. These effects are mainly on the respiratory (lungs and airways) and cardiovascular (heart function and blood circulation) systems.

Current information on world air quality is available from the world air quality index project.

Prävention

Travellers with health problems that might make them more vulnerable to the effects of air pollution who are travelling to areas of high pollution should:

• discuss their travel plans with their doctor, and carry adequate supplies of their regular medication.

• take sensible precautions to minimise their exposure to high levels of air pollution.

• check local air quality data and amend their activities accordingly.

• take notice of any health advisories published by the local Ministry of Health and Department for Environment, and follow the guidance provided.

It is unclear if face masks are beneficial at reducing exposure and may make breathing more difficult for those with pre-existing lung conditions. Those who choose to use one should make sure that the mask fits well and know how to wear it properly.

Schistosomiasis

Schistosomiasis is a parasitic infection. Schistosoma larvae are released from infected freshwater snails and can penetrate intact human skin following contact with contaminated freshwater. Travellers may be exposed during activities such as wading, swimming, bathing or washing clothes in freshwater streams, rivers or lakes. Schistosomiasis infection may cause no symptoms, but early symptoms can include a rash and itchy skin ('swimmer's itch'), fever, chills, cough, or muscle aches. If not treated, it can cause serious long term health problems such as intestinal or bladder disease.

Prävention

There is no vaccine or tablets to prevent schistosomiasis. All travellers should avoid wading, swimming, or bathing in fresh water. Swimming in adequately chlorinated water or sea water is not a risk for schistosomiasis. Drink water that is boiled, filtered or bottled. Application of insect repellent before exposure to fresh water, or towel drying after possible exposure to schistosomiasis are not reliable in preventing infection. All travellers who may have been exposed to schistosomiasis should have a health check to test for schistosomiasis infection.

Sexuell übertragbare Infektionen

Sexually transmitted infections (STIs) are a group of viral, bacterial and parasitic infections spread during sexual intercourse or by intimate contact. Certain STIs can be more difficult to treat due to higher levels of antibiotic resistance and some STIs that are rare in the UK may be more common in other world regions. Anyone who is sexually active is at risk of getting an STI wherever they are in the world. Risk is higher for travellers who:

• have sex without a condom

• have sex with new or casual partners

• engage in sex tourism

• have sex under the influence of drugs or alcohol

Symptoms of STIs vary depending on the type of infection; some may only cause mild or unnoticeable symptoms. If symptoms do occur, they can include a rash, discharge, itching, blisters, sores or warts in genital and/or anal areas, pain when peeing and flu like symptoms. If left untreated, STIs can cause serious long term health issues such as fertility problems, pelvic inflammatory disease and pregnancy complications.

Prävention

Using condoms consistently and correctly with new or casual partners is the most effective way to reduce risk of STIs. Travellers can also reduce their risk of STIs by:

• ensuring they are up to date for all UK recommended vaccines, including if appropriate gonorrhoea, hepatitis B, mpox and human papillomavirus (HPV) vaccines

• considering HIV Pre-Exposure Prophylaxis (PrEP) if appropriate

Travellers should seek medical advice and give their travel history if they think they may have an STI, even if they have no symptoms. They should also have a test for STIs if they have had sex without condoms with a new or casual partner while abroad. In the UK STI testing is free and confidential.

Source and disclaimer

This travel health information is based on data supplied by NaTHNaC (the National Travel Health Network and Centre). All intellectual property rights in the data are owned by NaTHNaC. It must not be copied, reproduced, distributed, amended or offered for sale without NaTHNaC’s prior written consent.
Patient.info ensures that this information is reviewed and updated on at least a weekly basis. However, NaTHNaC’s data is accurate only as at the date it was prepared, and Patient.info is solely responsible for maintaining its accuracy and completeness after that date. NaTHNaC accepts no liability for the use of this data by Patient.info or its users.