Did you know that even if you don’t live in one of South Africa’s three malaria-endemic provinces – Limpopo, Mpumalanga, or KwaZulu-Natal – or haven’t travelled to a malaria-endemic area, you could still contract malaria? One unusual, though not rare, route of infection is through odyssean malaria (also known as suitcase malaria, airport malaria, or taxi malaria). Odyssean malaria refers to a malaria infection in one or more people who have not travelled to a malaria-endemic area. It occurs when infective mosquitoes are accidentally transported or ‘hitchhike’ by air, road, rail, or sea from malaria-endemic areas to malaria-free regions. The mosquitoes will bite the first person they come into contact with in the non-endemic area, whether a tourist or a local. Odyssean malaria can also happen through blood transfusion and contaminated hospital equipment, etc.
In early October 2025, the National Institute for Communicable Diseases (NICD) was notified of three malaria cases in the Free State, a non-endemic province, involving three family members with no recent travel to a malaria-endemic area. Preliminary investigations suggest these are odyssean malaria cases.
Odyssean malaria in South Africa
High volumes of people, goods and vehicles regularly entering Gauteng from malaria‐endemic areas increases the likelihood of infected mosquitoes being inadvertently transported (via road, rail, air, or freight) into the province; hence, most odyssean malaria cases have been detected in this province. According to the Public Health Bulletin South Africa report “Odyssean Malaria in South Africa, 2014 – 2023”, 82 of the 99 (97 laboratory-confirmed and two probable) odyssean malaria cases reported and investigated between 2014 and 2023 were from Gauteng. However, these cases can occur anywhere, as demonstrated by the recent cluster in the Free State. Although odyssean malaria cases are sporadic and relatively uncommon, awareness and prompt responses are critical, as odyssean malaria is associated with an unacceptably high fatality rate.
What should healthcare workers do?
Delayed diagnosis and treatment of malaria can lead to severe illness or death. Healthcare workers should maintain a high index of suspicion for malaria in any patient presenting with fever or unexplained illness, even when there is no travel history to a malaria-endemic area. Although odyssean malaria cases are rare, malaria should always be included as a differential diagnosis in patients with unexplained fever and thrombocytopenia. A multidisciplinary approach – involving clinicians, laboratories, entomologists, and public-health teams is essential to investigate, confirm and respond effectively to odyssean malaria cases.
Malaria endemic areas in South Africa
Malaria transmission in South Africa generally occurs in the low-altitude regions of northern KwaZulu-Natal, Limpopo, and Mpumalanga provinces, bordering Mozambique, Eswatini, Botswana, and Zimbabwe. All countries neighbouring South Africa, except Lesotho, are malaria-endemic. The high transmission malaria season in South Africa generally runs from September to May, coinciding with the hot, rainy summer months, when the breeding conditions for malaria mosquitoes are optimal.
Malaria symptoms
The early symptoms of malaria are non-specific and can therefore easily be misdiagnosed with other infections, such as COVID-19, tick bite fever, and pneumonia. Common malaria symptoms include:
- Fever and flu-like illness
- Shivering, chills, and sweating
- Muscle aches and fatigue
- Abdominal discomfort, nausea, vomiting, or diarrhoea
- Loss of appetite, sore throat, or cough
How is malaria managed and treated?
Uncomplicated malaria can be treated effectively with oral antimalarial medication, provided diagnosis and treatment are prompt. If diagnosis and/or treatment are delayed, malaria rapidly progresses to severe disease, particularly in non-immune individuals, increasing the risk of adverse outcomes. The choice of medication depends on the severity of the illness and must be informed by the national malaria treatment guidelines.
What should the public do to prevent malaria?
- Reduce mosquito breeding: Drain standing water and cover containers.
- Use personal protection: Consider the use of non-pharmaceutical (e.g. DEET-based repellents, pyrethroid based plug-ins) and/or pharmaceutical (e.g. doxycycline, atovaquone-proguanil) measures. The effectiveness data of natural remedies like citronella and lemon verbena are limited.
- Dress appropriately: Wear long-sleeved shirts, trousers and socks when outdoors in the evenings.
- Sleep safely: Keep windows and doors shut at night. If available, use window/door screens, air conditioners or bed nets.
Odyssean malaria is uncommon and sporadic, but awareness and early action can save lives. Stay alert, not alarmed – recognising malaria early, wherever you are, makes all the difference. Malaria is preventable, treatable, and curable – let’s stay vigilant and keep South Africa malaria-free.
For more information about malaria, click here.
