Is Cape Town malaria-free?

The short answer

Cape Town is not in a malaria transmission area. The National Institute for Communicable Diseases (NICD) describes where malaria is transmitted in South Africa, and the Western Cape, the province Cape Town belongs to, is not part of that description.

That answer covers a stay in the city. It changes the moment you plan a trip to the north-east of the country or to a neighbouring country, and a fever after such a trip is a reason to see a doctor without delay.

Where malaria is transmitted in South Africa

According to the NICD, malaria transmission has been limited to the north-eastern part of South Africa, mainly the low-altitude areas, below 1 000 m, of Limpopo, Mpumalanga and northern KwaZulu-Natal. Limited focal transmission may occasionally occur in the North West and Northern Cape provinces, along the Molopo and Orange rivers (NICD, Malaria frequently asked questions, January 2024).

The national Department of Health's prevention guidelines give the same geography (South African Guidelines for the Prevention of Malaria). Neither text names the Western Cape. That is what people mean when they call Cape Town malaria-free: there is no area of local transmission here, so the official advice on chemoprophylaxis, which applies before entering an endemic area, is not written for a stay in the city.

The NICD also publishes a national malaria risk map, dated December 2025, which grades areas from "very low to no risk" up to "moderate risk" (NICD, National malaria risk map). It is the document to open before you plan the northern leg of a trip.

Why malaria-free does not mean impossible

Most malaria seen in South Africa is caught somewhere else. The NICD reports between about 6 000 and 14 000 notified cases a year over 2019 to 2022, and says the majority were imported, meaning the infection could be traced to travel outside the country. It names Mozambique as the place where most imported malaria is acquired.

There is a second, smaller route. Infected mosquitoes can travel long distances by road, rail and air and transmit the infection where they land, which the NICD calls odyssean malaria. For that reason it advises that malaria should still be considered in a feverish patient with no other obvious cause of fever and no recent history of visiting or living in a malaria area, particularly in large urban areas. We mention it because it explains why a doctor in Cape Town may ask about travel, or test for malaria, when you have not left the city.

Season and neighbouring countries

Malaria in South Africa is distinctly seasonal, the NICD says, with the highest risk during the wet summer months from September to May.

Across the border, the picture is wider. All of South Africa's neighbouring countries except Lesotho have malaria transmission, according to the NICD, while Eswatini, Botswana, Namibia and Zimbabwe have more limited risk areas.

Planning a trip north from Cape Town

If your itinerary includes a malaria area, the time to deal with it is before you leave Cape Town. The NICD says the need for chemoprophylaxis, in addition to protection against mosquito bites, should be determined before entering an endemic area. It depends on the area, the type of accommodation, when and for how long you will be there, and personal factors such as age, current medication and other illnesses.

The NICD adds that no preventive regimen is 100% effective, and that advice from a medical practitioner with travel medicine experience should be sought well in advance of travel. We do not name medicines or doses on this website. If you would rather discuss your plans with a doctor at the place you are staying in Cape Town, see home and hotel doctor in Cape Town.

Protection against mosquito bites is needed alongside any preventive medicine. The malaria vector mosquitoes feed between dusk and dawn, both indoors and outdoors, the NICD notes.

Fever after a trip to a malaria area

Treat a fever after travel to a malaria area as urgent. The national prevention guidelines advise seeking immediate medical help for any flu-like symptoms at any time up to six months after leaving a malaria area.

Timing can mislead. The NICD gives an incubation period that may be as short as 7 days after exposure and averages 10 to 21 days in non-immune people who took no chemoprophylaxis; it can be longer after prophylaxis. The first symptoms are non-specific, and fever with flu-like symptoms is common. The NICD names influenza and COVID-19 as the most common reasons malaria is misdiagnosed, which is why you should tell any doctor where you have been and when.

Diagnosis needs a blood test, either a blood smear or a rapid antigen test, and the NICD warns that a negative result does not exclude malaria: tests should be repeated until a diagnosis is confirmed or the symptoms resolve. The doctor who sees you decides which test and where.

Some signs mean the illness may already be severe. The NICD lists jaundice, any change in mental status and an increased breathing rate among the features that place a patient in the category of complicated malaria. If you notice jaundice (yellowing of the skin or eyes), any change in mental state such as confusion, or fast breathing, call 10177 or 112, or go straight to a hospital emergency unit.

Sources

• NICD, Malaria frequently asked questions, updated January 2024: https://www.nicd.ac.za/wp-content/uploads/2024/01/Malaria-FAQs_19Jan2024.pdf (checked 27 October 2026)
• National Department of Health, South African Guidelines for the Prevention of Malaria, updated January 2019: https://www.nicd.ac.za/wp-content/uploads/2019/03/National-Guidelines-for-prevention-of-Malaria_updated-08012019-1.pdf (checked 27 October 2026)
• NICD, National malaria risk map, December 2025: https://www.nicd.ac.za/wp-content/uploads/2025/12/National_Risk_Map-02-Dec-2025.pdf (checked 27 October 2026)
• NICD, Disease index, malaria: https://www.nicd.ac.za/diseases-a-z-index/malaria/ (checked 27 October 2026)