Peru

Despite the long journey to get there, Peru remains on the bucket list for many Australian travellers, principally to
experience the spectacular Inca ruins of Machu Pichu, but also for a taste of the Amazon around either Iquitos in the
north or Puerto Maldonado in the south, as well as the Colca Canyon and Nazca Lines. Many travellers to Peru also visit
Bolivia and Ecuador / Galapagos Islands - the following health issues apply to these destinations as well
The following information provides some broad and general guidelines about health risks and recommendations for
these destinations. This should not be taken as a substitute for personal consultation with a doctor with experience in
travel health.

Most Common Health Issues

Traveller's Diarrhoea
This is the one most travellers to developing countries experience sooner or later, with watery diarrhoea and sometimes
vomiting. It is caused by bacteria, such as E.coli, Campylobacter, Salmonella and Shigella, and sometimes by other bugs
such as giardia. Careful food and drink choices (no tap water), as well as hand hygiene, help in prevention. It is treated
with rehydration if mild but if inconvenient, with a bowel stopper such as loperamide (Gastrostop or Imodium) and if
more severe or persistent with an antibiotic or giardia treatment. These are best obtained prior to travel. We stock kits
containing all of these medications.

Altitude Sickness in Cuzco/ Andes

In order to visit Machu Pichu (2430m) travellers arrive in Cuzco (3400m), which often involves a flight from Lima (sea
level). As a result most travellers experience some degree of altitude sickness due to lower oxygen levels. Typical
symptoms involved develop a few hours after arrival and include nausea, headache, loss of appetite and disturbed sleep
due to altered breathing patterns. Some individuals are more prone than others. Even at this modest altitude,
occasionally more severe forms occur, involving fluid on the lungs (severe shortness of breath) and swelling of the brain
(confusion, severe headache and unsteadiness ). To reduce risk:
1. Stay in the Sacred Valley(at a lower altitude) for a couple of days and nights after arrival in Cuzco
2. Avoid over exertion on arrival
3. Look for an itinerary that involves overland travel up to Cuzco, for example via Arequipa, as this will allow your body to
acclimatise more gradually
4. Consider taking the prescription medication Acetazoleamide (Diamox), which shifts the acid base balance in your blood
so you get more oxygen in. It can be used as a preventive medication the day before flying to Cuzco and for the first few
days at altitude, until acclimatised. It has some minor side effects and contraindications (see Altitude Sickness fact sheet).
4. Be aware of the above symptoms and report to your tour guide if you or anyone you are with is suspected of suffering
the more severe forms as medical assistance or evacuation to a lower altitude may be necessary
There is no scientific evidence that coca tea is effective for altitude sickness, although it is a mild stimulant.

Trekking the Inca Trail

This 43 km four day trek requires a reasonable level of fitness as there are three mountain passes (the highest is 4215m).
You will be remote from medical care. Get your legs fit to climb, wear in your boots, carry a good medical kit (including
treatment for altitude, pain, diarrhoea and first aid). Do your homework.
Those with heart, lung or other chronic medical conditions should have a medical check-up and think twice about
undertaking the trek, as the alternative is to take the train to Machu Pichu.

Malaria
This mosquito born parasite occurs almost exclusively deep in the Amazon rainforest. Most travellers to Peru are at low
risk, and there is some controversy (even among doctors who specialise in travel health) as to whether preventative
medication should be taken for a few days in the Amazon basin. Certainly the areas around Puerto Maldonado are lower
risk than those around Iquitos. The wet season (January to May) carries higher risk. The mosquitoes usually bite between
dusk and dawn. Preventive medication should be discussed with a doctor experienced in travel health. Mosquito bites
should be avoided by covering up exposed skin and with DEET containing repellents. Sleeping accommodation should be
mosquito proof e.g. by sleeping under impregnated mosquito netting. Even if all precautions are taken, any fever even up
to a month or two after leaving the area should be presumed to be malaria until proven otherwise, which usually means a
prompt visit to a reputable medical clinic.

Yellow Fever Vaccination Requirements and Recommendations

This is a very serious but rare mosquito borne disease and occurs in the Amazon. Most travellers to Peru require or are
recommended the vaccination either for disease protection, prevention international spread or for bureaucratic reasons.
Australia and many South American countries require proof of Yellow fever vaccination if you've been in any part of Peru
within the previous 6 days. An official certificate of vaccination is required and provided by those clinics licenced to
administer the vaccine. Some people should not have the vaccine because of medical contraindications, such as the
elderly, pregnant women, those with immune suppression from illness or medication and those allergic to eggs. In these
cases a medical exemption may be issued by a registered yellow fever clinic, or the advice may be not to travel. This
vaccine has common mild side effects and very rarely more serious reactions. This is a complex topic and advice should be
sought from one of our travel health specialists.

Other diseases from Mosquitoes/Flys/Bugs - use repellent

Dengue is common on the North coast. Cutaneous Leishmaniasis is a rare disease in travellers from sand fly bites in the
valleys of the Andes and in the Amazon- it causes disfiguring facial ulcers. Chagas is a chronic disease caused by a parasite
transmitted by a bug that drops down from the roofing of poorly constructed houses, also very rare in travellers. Sleep
under nets in such accommodation.

Animal Bites
Immediate and thorough irrigation and cleaning of animal wounds, followed by a course of shots for rabies is essential. A
tetanus booster may also be necessary. Animal bites are prone to becoming infected and early treatment with antibiotics
may be necessary See more below under Rabies.

Vaccinations
Required Vaccination (for some)
Yellow Fever this is a complex topic - see comments under yellow fever above

Routine Vaccinations for all travellers

All international travellers should be up to date or immune to the following as these are transmissable diseases which
may have serious complications:

Measles
Chickenpox
Influenza - especially for the elderly or those with underlying medical conditions

In addition a tetanus booster if more than 5- 10 years since last vaccinated is advisable to avoid having to get a booster
shot in Peru in the event of a tetanus prone wound

Recommended Vaccinations for most travellers to Peru

Hepatitis A is a food and water borne virus that infects the liver and causes jaundice. Many people in the developing
world have natural immunity, but travellers generally do not. The vaccine is very safe and effective, a single injection
providing immediate protection for 6-12 months, after which a booster shot provides long-term immunity.
Hepatitis B is a blood borne virus, but may also be sexually transmitted. Accidents, injuries and sometimes even medical
treatment in the developing world can expose travellers to this disease. Hepatitis B is highly infectious and can lead to
chronic liver disease and liver cancer. All children and young adults born since 1990 in Australia have generally been
vaccinated
Other vaccinations to consider
Rabies is a virus spread from infected animals to humans through bites, scratches and exposure to saliva. If not properly
treated and rabies develops, the disease if fatal. Travellers should avoid close contact with either wild, stray or domestic
animals; in particular dogs, cats, monkeys and bats. For travel to Peru, vaccination against rabies is often recommended
for those at particularly high risk, for example those working with animals or travelling for longer periods.
Typhoid fever is a bacterial infection which is caught through ingesting contaminated food and water. Mortality is in the
order of 1 in 10 in some settings. Resistance to common antibiotics is also widespread so treatment has become more
difficult.
Cholera is rare except in humanitarian crises e.g. refugee camps, however, because the vaccine provides some cross
protection against common E Coli diarrhoea, vaccination may be recommended.