The most common illnesses are caused by contaminated food and water. In Lima, water supplies are chlorinated and should be safe to use for washing fruits and vegetables. Although many Limeños drink the tap water, travelers should drink bottled, boiled, or purified water and drinks to avoid any issues. Many higher-quality hotels do purify their water, so inquire with the concierge. In the provinces, water may not be treated. Wash fruits and vegetables before eating, and avoid ice unless it is made with purified water. If you have problems, mild cases of traveler's diarrhea may respond to Imodium (known generically as loperamide) or Pepto-Bismol. Drink plenty of fluids; if you can't keep fluids down, seek medical help immediately. Infectious diseases can be airborne or passed via mosquitoes and ticks and through direct or indirect physical contact with animals or people. Some, including Norwalk-like viruses that affect your digestive tract, can be passed along through contaminated food. If you are traveling in an area where malaria is prevalent, use a repellent containing DEET and take malaria-prevention medication before, during, and after your trip as directed by your physician. Speak with your physician and/or check the Centers for Disease Control or World Health Organization websites for health alerts, particularly if you're pregnant, traveling with children, or have a chronic illness.
International Medical Group. 800/628–4664; www.imglobal.com.
International SOS. 800/523; www.internationalsos.com.
Wallach & Company. 800/237–6615; 540/687–3166; www.wallach.com.
Shots and Medications
No vaccinations are required to enter Peru, although yellow fever vaccinations are recommended if you're visiting the jungle areas in the east. It's a good idea to have up-to-date boosters for tetanus, diphtheria, and measles. A hepatitis A inoculation can prevent one of the most common intestinal infections. Those who might be around animals should consider a rabies vaccine. As rabies is a concern, most hospitals have anti-rabies injections. Children traveling to Peru should have their vaccinations for childhood diseases up-to-date.
According to the CDC, there's a limited risk of cholera, typhoid, malaria, hepatitis B, dengue, and Chagas' disease. Although a few of these you could catch anywhere, most are restricted to jungle areas. If you plan to visit remote regions or stay for more than six weeks, check with the CDC's International Travelers Hot Line.
Centers for Disease Control & Prevention. 800/232–4636; www.cdc.gov/travel.
World Health Organization. www.who.int.
Specific Issues in Peru
The major health risk in Peru is traveler's diarrhea, caused by viruses, bacteria, or parasites in contaminated food or water. So watch what you consume. If you buy food from a street vendor, make sure it's cooked in front of you. Avoid uncooked items, ones that have been sitting around at room temperature, and unpasteurized milk or milk products. Fresh fruit juices are generally fine, though it’s wise to only purchase them from the cleaner stalls. Drink only bottled water or water that has been boiled for several minutes, even when brushing your teeth. Order drinks sin hielo, or "without ice." Note that water boils at a lower temperature at high altitudes and may not be hot enough to rid it of the bacteria, so consider using purification tablets. Local brands include Micropur.
Mild cases of traveler's diarrhea may respond to Imodium, Pepto-Bismol, or Lomotil, all of which can be purchased in Peru without a prescription. Drink plenty of purified water or tea—manzanilla (chamomile) is a popular folk remedy.
The number of cases of cholera, an intestinal infection caused by ingestion of contaminated water or food, has dropped dramatically in recent years, but you should still take care. Anything raw should be eaten only in the better restaurants.
Altitude sickness, known locally as soroche, affects the majority of visitors to Cusco, Puno, and other high-altitude locales in the Andes. Headache, dizziness, nausea, and shortness of breath are common. When you visit areas over 10,000 feet above sea level, take it easy for the first few days. Avoiding alcohol will keep you from getting even more dehydrated. To fight soroche, Peruvians swear by mate de coca, a tea made from the leaves of the coca plant. (If you are subject to any type of random drug testing through your workplace, know that coca tea can result in a positive test for cocaine afterward.) Some travelers swear by the prescription drug acetazolamide (brand name, Diamox), which should be taken 48 hours before arriving at altitude. Whether that's an appropriate course is for you and your health-care professional to decide.
Spend a few nights at lower elevations before you head higher, especially if you are hiking or climbing in the mountains. If you must fly directly to higher altitudes, plan on doing next to nothing for the first day or two. Drinking plenty of water or coca tea or taking frequent naps may also help. If symptoms persist, return to lower elevations. If you have high blood pressure or a history of heart trouble or are pregnant, check with your doctor before traveling to high elevations.
Mosquitoes and sand flies are a problem in tropical areas, especially at dusk. Take along plenty of repellent containing DEET. You may not get through airport screening with an aerosol can, so opt for a spritz bottle or cream. Local brands of repellent are readily available in pharmacies. If you plan to spend time in the jungle, be sure to wear clothing that covers your arms and legs, sleep under a mosquito net, and spray bug repellent in living and sleeping areas. You should also ask your doctor about antimalarial medications. Do so early, as some medications must be started weeks before heading into a malaria zone.
Chiggers are sometimes a problem in the jungle or where there are animals. Red, itchy spots suddenly appear, most often under your clothes. The best advice when venturing out into chigger country is to use insect repellent and wear loose-fitting garments. A hot, soapy bath after being outdoors also prevents them from attaching to your skin.
Over-the-counter analgesics—available at the airports in Lima and Cusco, as well as most pharmacies in those cities—may curtail soroche symptoms, but consult your doctor before you take these. Always carry your own medications with you, including those you would ordinarily take for a simple headache, as you will usually not find the same brands in the local farmacia (pharmacy). However, if you forgot, ask for aspirina (aspirin). Try writing down the name of your local medication, because in many cases the pharmacist will have it or something similar.