South Africa has one of the most complex infectious disease landscapes in the world: high HIV/TB burden, ongoing risk of cholera and typhoid in water-insecure communities, measles outbreaks in under-vaccinated populations, seasonal influenza, COVID-19, and periodic outbreaks of Ebola and Marburg virus in neighbouring countries. For medical aid members, the key principle is consistent: hospitalisation for any communicable disease is PMB-covered. Preventive vaccines and chemoprophylaxis are largely day-to-day or OOP. This guide covers the most relevant communicable diseases and their coverage.
The Core Principle: Treatment vs Prevention
| Category | PMB? | Notes |
|---|---|---|
| Hospitalisation for any acute communicable disease | Yes — PMB | All acute infectious disease hospital admissions are PMB regardless of plan tier |
| GP/outpatient treatment for acute infection | PMB (acute event) | ER and acute outpatient treatment |
| Diagnostic testing (cultures, serology, PCR) | PMB (acute episode) | Pathology benefit for acute diagnosis |
| Vaccination (routine childhood) | Varies | Childhood vaccines often funded; adult boosters may be day-to-day |
| Travel vaccines (yellow fever, typhoid, hep A, meningococcal) | No — OOP | Preventive travel health; not PMB |
| Prophylaxis (malaria, post-exposure HIV PEP) | PMB for occupational/emergency PEP; OOP for malaria prophylaxis | See Malaria article |
Notifiable Medical Conditions (NMCs) in South Africa
South Africa's Department of Health requires mandatory reporting of certain communicable diseases (NMCs) under the National Health Act. The following are the most medically significant for medical aid members:
Cholera
What it is: Acute watery diarrhoea caused by Vibrio cholerae toxin. SA has experienced outbreaks (Hammanskraal 2023; cross-border from Zimbabwe/Mozambique). Severity ranges from mild gastro to profuse rice-water diarrhoea with rapid dehydration.
PMB: Yes — hospitalisation, rehydration (IV/ORS), antibiotic treatment (azithromycin or doxycycline) are all PMB-covered as an acute infectious disease.
Prevention: Safe water, hand hygiene. Oral cholera vaccine (Shanchol) available OOP for travellers to endemic areas.
Typhoid Fever
What it is: Systemic infection caused by Salmonella typhi, acquired via contaminated food/water. Incubation 7–21 days. Sustained fever, headache, abdominal pain, rose spots on trunk. Complications: intestinal perforation (PMB surgical emergency).
PMB: Yes — treatment (IV/oral ciprofloxacin or azithromycin) and hospitalisation are PMB-covered.
Prevention: Typhoid vaccine (oral Vivotif or injectable Typhim Vi) — OOP; R300–R600/dose; recommended for travel to sub-Saharan Africa, India.
Measles
What it is: Highly contagious respiratory viral infection. SA has experienced outbreaks due to sub-optimal vaccination coverage. Serious complications: pneumonia, encephalitis, death in immunocompromised or malnourished children.
PMB: Yes — measles hospitalisation (for complications) is PMB-covered. Outpatient measles is managed symptomatically.
Prevention: MMR vaccine (measles-mumps-rubella) — covered as a childhood vaccine by most schemes; adults born before 1965 likely immune; born 1965–1990 may need serology check. Vitamin A supplementation for severe measles in children: essential (reduces mortality).
Rabies
What it is: Uniformly fatal viral encephalitis transmitted by bite of infected animal (dog, bat). Once symptoms develop, survival is essentially impossible. Prevention (pre- and post-exposure prophylaxis) is the only effective strategy.
PMB: Rabies post-exposure prophylaxis (PEP) — wound cleaning, human rabies immunoglobulin (HRIG), and rabies vaccine series — is a PMB emergency preventive event.
Critical: HRIG is expensive (R3,000–R8,000+) and must be given with the first vaccine dose in previously unvaccinated individuals. It is not always stocked at all hospitals — confirm with the ER.
Poison/Veterinary Helpline: For unusual bite exposures, call the 24h Poison Helpline: 0861 555 777.
Meningococcal Disease
What it is: Bacterial meningitis and/or septicaemia caused by Neisseria meningitidis. Most dangerous form of bacterial meningitis — can cause death or limb amputation within 24 hours. Distinctive petechial/purpuric rash (non-blanching red/purple spots) is a critical warning sign.
PMB: Yes — emergency PMB. IV ceftriaxone must be administered immediately in suspected meningococcal disease.
Prevention: Meningococcal vaccine — ACWY (conjugate vaccine) for travel to meningitis belt (sub-Saharan Africa); required for Haj pilgrims; indicated for immunocompromised patients (asplenic). OOP; R600–R1,200/dose.
If non-blanching rash + fever = DO NOT WAIT. Call 10177 immediately.
Ebola / Marburg Virus Disease (EVD/MVD)
What it is: Haemorrhagic fever viruses causing high mortality. SA has not had a confirmed EVD/MVD outbreak but is at risk from cross-border transmission (DRC, Uganda).
PMB: Yes — emergency hospital admission for suspected viral haemorrhagic fever is PMB-covered regardless of plan tier. Treatment is supportive (mAb therapies for Ebola — Inmazeb, Ebanga — are available for confirmed cases).
Notification: Ebola/Marburg are Category 1 immediate NMC notifications — the treating hospital notifies the NDoH; the scheme has no discretion to refuse admission.
COVID-19
What it is: SARS-CoV-2 infection. Currently endemic globally; most infections are managed at home. Severe COVID requiring hospitalisation (pneumonia, acute respiratory failure, post-COVID complications) is PMB-covered.
PMB: Hospitalisation for COVID-19 = PMB. Antivirals (nirmatrelvir/ritonavir — Paxlovid; remdesivir) for high-risk patients are covered under hospital/exceptional-needs benefit.
Vaccination: COVID-19 vaccines (mRNA or protein subunit) — coverage varies by scheme; many schemes now cover annual COVID-19 booster as a preventive benefit. Check with your scheme.
Gastroenteritis (Rotavirus, Norovirus, Bacterial)
What it is: Infectious diarrhoea and/or vomiting. Most cases self-limit within 3–5 days. PMB-covered if hospital admission is required (dehydration, inability to tolerate oral fluids, very young/old/immunocompromised).
Prevention: Rotavirus vaccine (childhood — Rotarix or RotaTeq): most schemes cover as childhood immunisation. Norovirus/traveller's diarrhoea: ORS sachets OOP; prophylactic bismuth or rifaximin OOP.
Vaccine Coverage Summary — What Medical Aid Covers
| Vaccine | Typically covered | Notes |
|---|---|---|
| Childhood EPI vaccines (polio, DTP, hib, hep B, measles, pneumococcal, rotavirus) | Yes — most schemes | Via GP or clinic |
| Influenza (annual) | Yes — most schemes | High-risk groups + anyone |
| Pneumococcal (Pneumovax/Prevnar) | Varies — adult risk groups | Adults ≥65, chronic disease, immunocompromised |
| HPV (Gardasil) | Varies by scheme | Some cover for girls/boys 9–14 |
| COVID-19 (annual booster) | Varies | Some schemes cover; confirm yours |
| Hepatitis B (adult, unvaccinated) | Varies | Usually covered for high-risk (HCW, travellers) |
| Hepatitis A | OOP | Travel vaccine |
| Typhoid, yellow fever, meningococcal ACWY | OOP | Travel vaccines |
| Rabies (pre-exposure) | OOP | For vets, wildlife workers, travellers |
| Rabies PEP (post-exposure) | Yes — PMB emergency | After bite from potentially rabid animal |
Day-to-Day Costs for Travel Vaccines
| Vaccine | Cost per dose (OOP) |
|---|---|
| Hepatitis A (Havrix / Vaqta) | R400–R700/dose (2-dose series) |
| Typhoid (Typhim Vi injectable) | R300–R500/dose |
| Yellow fever (mandatory for some countries) | R300–R500 at accredited centre |
| Meningococcal ACWY (Menveo / Nimenrix) | R600–R1,200/dose |
| Rabies pre-exposure (3-dose series) | R1,500–R2,500 total |
Key Questions to Ask Your Scheme
- Which routine adult vaccines are covered under my plan? (Flu, pneumococcal, COVID-19, HPV)
- If I have an emergency admission for a communicable disease — is it PMB-covered regardless of plan tier? Yes — by law.
- Is post-exposure rabies prophylaxis (HRIG + vaccine) covered? Confirm — it is PMB but not all scheme call centres know this.
- Is travel medicine consultation (pre-travel advice) covered? Usually day-to-day.
Talk to Eldon
Every communicable disease hospital admission is PMB — regardless of how minor your plan is. The Check shows what each plan on our panel pays for this, side by side, and Eldon advises from there.
See which plans pay for travel health and infectious disease coverage →