Peru

Destination overview

Peru is the third largest country in South America (after Brazil and Argentina) and one of the most popular destinations for tourists to the region who are interested in ecology, adventure, gastronomy, or history (Map 11.2.4.1). The country is divided longitudinally by the Andes Mountains range, creating a variety of ecosystems ranging from coastal beaches, snow-capped peaks in the Andes Mountains, and the Amazon rainforest. The history of Peru is rich and goes back to the Caral civilization that developed on the coast around 3000 BCE, the Inca Empire in the highlands during 1400–1532 CE, and the colonial period lasting until 1821 CE. Peru lies almost entirely between 70°W and 80°W longitude (the same as most East Coast states in the United States). Peru has a single time zone and no daylight savings time changes. Jet lag is not a common problem for most U.S. travelers to Peru because the time is at most 3 hours different from western states of the United States during the winter season.

U.S. citizens visiting Peru do not need a visa. Most tourists fly into the capital, Lima, a mega-metropolis with nearly 10 million people. The city is divided into districts, and most visitors to Lima stay in San Isidro, Miraflores, Barranco, or, less often, in the downtown, also called El Centro de Lima. The U.S. Embassy office is in the Santiago de Surco district; contact information is available on their website. Popular activities in Lima include historic city tours, night life, and fine dining at internationally renowned restaurants.

Along the Pacific Ocean coast, Peru has beach resorts such as Punta Sal (Tumbes Region) and Máncora (Piura Region) in the north and Paracas (Ica Region) in the central coast. Cities near the coast with tourist attractions include: Trujillo, with the pre-Incan ruins of Chan Chan; Nazca, with the pre-Inca geoglyphs etched in the desert; and Arequipa, a starting point for travelers to the world's second deepest canyon, Valle de Colca.

A 1-hour flight separates Lima (elevation 161 m; 528 ft) on the Pacific coast from Cusco (elevation 3,400 m; 11,152 ft), where most travelers start their journey through southern Peru. A United Nations Educational, Scientific and Cultural Organization (UNESCO) World Heritage site, downtown Cusco was built over the capital of the Inca Empire and features a mixture of Inca stonework and colonial baroque architecture. In addition to museums and monuments, the city offers accommodations ranging from budget hostels to luxury hotels. The nearby ruins of Sacsayhuamán, Puka Pukara, Tambomachay, and Q'enco are included in some tour itineraries. The Valle Sagrado (Sacred Valley), with the towns and ruins of Písac, Calca, Urubamba, and Ollantaytambo, can be visited with day tours or can serve as the starting point for an adventure to Machu Picchu.

Machu Picchu was named a UNESCO World Heritage site in 1983 and was included in the New Seven Wonders of the World in 2007. This mountaintop citadel includes more than 200 structures masterly adapted to the terrain with giant walls, terraces, stairs, and ramps cut or entwined naturally in the rock. To reach Machu Picchu, travelers must take a train to the town of Aguas Calientes at the base of the mountain or hike their way to the ruins. The 66-km (41-mile) train ride from Poroy train station to Aguas Calientes takes about 3 hours; Poroy train station is about 13 km (8 miles) from Cusco. Travelers can also catch trains to Aguas Calientes from Ollantaytambo station, about 2 hours outside of Cusco.

In the Andes, high-elevation destinations include: Cajamarca; Huaraz with the Cordillera Blanca Mountain range and Huascarán National Park; Huancayo; and Ayacucho. East of the Andes is the Amazon rainforest; Iquitos, bathed by the Amazon River and reachable only by plane or boat, is the largest and best-known city in the region; other cities in the Amazon basin include Pucallpa and Puerto Maldonado. Adventure and nature tourists often visit Manú National Park in Madre de Dios.

Map 11.2.4.1

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SOURCE:

Centers for Disease Control and Prevention

A map of Peru highlighting its departments, major rivers, mountain ranges, and national parks. The map shows Peru bordered by Ecuador just above, Colombia towards the top right, Brazil and Bolivia to its right, and Chile just below, with the Pacific Ocean to the left. Major locations such as Lima, Cusco, and Machu Picchu are labeled. National parks such as Pacaya Samiria, Manu National Park, and Tambopata are marked in red. The Andes Mountains and Cordillera Blanca are also depicted, along with major rivers like the Amazon and Ucayali. A small map in the bottom left corner shows Peru’s location in South America.

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Infectious disease risks

Peru follows the World Health Organization's Expanded Program on Immunization, which includes most vaccines used in the United States. Although vaccination rates in Peru are high in the general population, recent outbreaks of vaccine-preventable diseases have occurred, including diphtheria (2020) and measles (2018–2019). Travelers to Peru should be up to date with all routine vaccines. Consider booster doses for adults according to Advisory Committee on Immunization Practices recommendations. Travelers to Peru should receive hepatitis A vaccine because risk is present throughout the country. Risk factors for hepatitis B virus transmission and vaccination in non-immunized travelers should be discussed before departure.

Enteric infections and diseases

Peru is considered a moderate- to high-risk country for enteric infections and travelers' diarrhea (see Travelers' Diarrhea and Post-Travel Diarrhea chapters). Travelers should be advised on food and water precautions and self-management of travelers' diarrhea. Food cooked and served hot is safe, but fresh produce, fruits, and vegetables can be vehicles for infection. Peruvian cuisine that includes raw fish or meat (e.g., ceviche, tiradito, carpaccio) is popular but poses a risk for foodborne illnesses. Cold sauces added to some dishes might carry infectious pathogens.

Cholera

Vibrio cholerae O1 was reintroduced into the Americas in the early 1990s after an outbreak that started in Peru and spread to the rest of the region. Cholera is still under surveillance in Peru, but no cases have been reported in many years. Epidemic cholera is not a risk, and cholera vaccine is not indicated for travel to Peru (see Cholera chapter).

Cyclosporiasis and cryptosporidiosis

Cyclospora cayetanensis, named after the local Universidad Peruana Cayetano Heredia, is endemic to Peru. C. cayetanensis infection is transmitted through contaminated food and water and causes acute diarrhea. Untreated infection can last for longer than a month and can have an intermittent or relapsing course. Treatment is with trimethoprim-sulfamethoxazole, which is not usually prescribed for other causes of diarrhea in travelers.

Cryptosporidium parvum and Cryptosporidium hominis follow a similar epidemiology and cause acute diarrhea. However, symptoms last more than 2 weeks and relapses are not rare. Both can cause severe diarrhea, particularly among immunocompromised hosts. Children are at increased risk. Oral rehydration is the most effective supportive therapy. Nitazoxanide is approved for treatment in immunocompetent hosts older than 1 year. Travelers can reduce their risk for cyclosporiasis and cryptosporidiosis by carefully adhering to food and water precautions (see Food and Water Precautions for Travelers chapter).

Giardiasis

Transmitted by ingestion of contaminated water and sometimes vegetables, Giardia duodenalis infection presents with abdominal pain, bloating, "sulfur" belching, and vomiting. Giardiasis is more frequent among hikers, travelers to rural areas, and people who consume fresh juices. Travelers should avoid potential sources of infection, including drinking water and recreational water that could be contaminated. No vaccine against giardiasis is available.

Hepatitis A

Hepatitis A virus (see Hepatitis A chapter) is transmitted by contaminated food and water and is endemic to Peru. Vaccination is highly effective and strongly recommended for all unvaccinated travelers. Whereas hepatitis A vaccine is routinely given to U.S. children, adult travelers may have not received the vaccine.

Travelers' diarrhea

Peru is considered a moderate- to high-risk country for travelers' diarrhea. The risk is not uniform around the country, and some tourist areas in Lima may have lower risk. Viral, particularly norovirus, and bacterial causes of diarrhea are common in travelers to Peru. Various pathogenic Escherichia coli strains, Campylobacter spp., and Shigella spp. cause diarrhea in Peru. Travelers should practice frequent hand hygiene with soap and water or hand sanitizer containing ≥60% alcohol. They should avoid uncooked foods and untreated water, including tap water at hotels and restaurants. Bottled water is usually safe, as are carbonated beverages including sodas, but ice is not. For infants, breastfeeding is safest; if feeding infant formula, travelers should use bottled or cold boiled water to reconstitute formula (see Travel and Breastfeeding and Traveling Safely with Infants and Children chapters).

For more information about prevention and treatment of travelers' diarrhea, see the Travelers' Diarrhea and Post-Travel Diarrhea chapters.

Typhoid fever

Typhoid fever (caused by Salmonella enterica serotype Typhi) was highly endemic to Peru before the 1990s. The incidence of typhoid has decreased significantly since then, but it remains endemic. The disease can be life-threatening, and the bacterium has developed resistance to multiple antimicrobial agents. Most travelers to Peru should receive 1 of the recommended typhoid vaccines, particularly those visiting rural areas (see Typhoid and Paratyphoid Fever chapter).

Respiratory infections and diseases

Peru has endemic, seasonal respiratory infections, not all of which are preventable by routine vaccines. Upper respiratory infections and influenza-like illnesses are common among travelers to Peru.

Coronavirus disease 2019

All travelers going to Peru should be up to date with their COVID-19 vaccines.

Influenza

Influenza circulates at different seasons in the Southern Hemisphere than in the Northern Hemisphere. In Peru, the influenza season follows the Southern Hemisphere pattern, which has its peak during April–September. The influenza vaccine recommended for use in the Northern Hemisphere often, but not always, protects travelers against the virus strains circulating in the Southern Hemisphere that same year.

Tuberculosis

Tuberculosis (TB) is endemic to Peru, and multidrug-resistant and extensively drug-resistant TB are reported. Avoidance and prevention are crucial. Infection risk is highest among long-term travelers, especially people who visit friends and relatives, expatriates, missionaries, "voluntourists" (for a definition, see Humanitarian Aid Workers chapter), and healthcare workers (for screening and management recommendations, see Tuberculosis chapter).

Sexually transmitted infections and HIV

HIV infection rates are low in the general population. HIV is more prevalent among risk groups including commercial sex workers and men who have sex with men, particularly in major cities such as Lima and Iquitos. Antimicrobial-resistant strains of Chlamydia trachomatis and Neisseria gonorrhoeae are well described in Peru. Travelers should practice safe sex and use barrier protection (e.g., condoms). Heavy alcohol or drug consumption has been associated with increased risk behaviors. Condoms are widely available for purchase in pharmacies around Peru (see Sex and Travel chapter).

Vector-borne diseases

Vector-borne diseases are endemic throughout the country, especially at low elevations (<2,300 m; 7,550 ft). Exposure depends largely on destination, trip type, and duration. Travelers should cover their skin with clothing as much as possible, apply insect repellents properly and often, and observe other measures to prevent arthropod bites (see Mosquitoes, Ticks, and Other Arthropods chapter). For travelers going to malaria- or yellow fever-endemic areas of Peru, chemoprophylaxis or vaccination might be indicated (see the following sections for details or Yellow Fever Vaccine and Malaria Prevention Information, by Country chapter).

Arboviruses: dengue, Chikungunya, Zika, and Oropouche

Dengue is the most common arbovirus in Peru, with significant recent outbreaks affecting coastal cities, including Lima, and many of the rainforest areas (see Dengue chapter). Low risk exists in the southern coast and no risk is present at high-altitude destinations such as Cusco city, the Sacred Valley, and Machu Picchu. Transmission occurs throughout the year in tropical areas but predominantly during the rainy season. Similarly, Chikungunya and Zika virus infection risk exists throughout the country (see Chikungunya and Zika). Except for during outbreaks, cases are sporadic. These viruses are transmitted by "day-biting" Aedes mosquito species at <2,300 m (approximately 7,550 ft) elevation. Vertical transmission of Zika virus infection is associated with adverse pregnancy outcomes and fetal neurologic disease (see Pregnant Travelers chapter and the Centers for Disease Control and Prevention (CDC) Travelers' Health website. Oropouche, formerly a rare infection which emerged in 2024, is mainly confined to isolated regions outside regular tourist routes. It is transmitted by biting midges, and the same Environmental Protection Agency-approved repellents recommended for flies or biting flies are effective at reducing exposure (see Mosquitoes, Ticks, and Other Arthropods chapter).

Carrion's disease

Bartonella bacilliformis, the cause of Oroya fever and verruga peruana (together known as Carrion's disease), is a bacterium transmitted by Lutzomyia sand flies. Endemic to some areas in Ancash (Caraz Province), Cajamarca, and Cusco (Urubamba Province), B. bacilliformis and other related species pose a low risk for travelers visiting common tourist routes. Nevertheless, travelers to the listed areas should practice insect-bite precautions (see Mosquitoes, Ticks, and Other Arthropods chapter).

Leishmaniasis

Leishmaniasis in Peru manifests as cutaneous disease with chronic skin ulcers in exposed areas or as mucocutaneous disease with chronic skin ulcers with metastatic nasal mucosa lesions that can appear years after skin lesions. This parasitic infection is transmitted by the bite of Lutzomyia sand flies endemic to Inter-Andean valleys and the tropical Amazon rainforest. Travelers visiting the Manú National Park in Madre de Dios are at greatest risk. No vaccine or chemoprophylaxis is available. Travelers should observe insect-bite precautions (see Mosquitoes, Ticks, and Other Arthropods and Leishmaniasis chapters).

Malaria

Malaria transmission occurs on the eastern side of the Andes at elevations below 2,500 m (approximately 8,200 ft), including all of the Amazon rainforest and a few isolated areas on the northern coast. The risk of malaria is insignificant in the central and south coast, Lima Province, and destinations at high altitude, including Cusco city, Machu Picchu, Sacred Valley, and Lake Titicaca. The most common malaria species in Peru are Plasmodium vivax (80%) and Plasmodium falciparum (20%). Travelers planning to enter endemic areas should receive malaria chemoprophylaxis (i.e., atovaquone-proguanil, doxycycline, mefloquine, or tafenoquine) effective against chloroquine-resistant malaria and mosquito-bite prevention counseling (for prescribing details, see Yellow Fever Vaccine and Malaria Prevention Information, by Country and Malaria chapters; and Map 1.5.38).

Map 1.5.38

SOURCE:

Centers for Disease Control and Prevention

This map of Peru outlines malaria prevention recommendations across the country. Areas shaded in orange show regions where chemoprophylaxis (preventive medication) and mosquito avoidance are recommended. This includes the eastern side of Peru such as Loreto, Ucayali, Madre de Dios, and parts of Cusco province, Huánuco, Junín, San Martín, Amazonas, and Cajamarca as well as a few other small areas throughout the country. Areas shown in brown indicate mosquito avoidance only recommended. This includes regions such as Piura and Tumbes. Beige represents regions that have no known malaria transmission, which is the western part of Peru including Lima.

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Yellow fever

In Peru, areas of yellow fever endemicity overlap areas of malaria endemicity. CDC recommends vaccination for all travelers aged ≥9 months going to areas with risk for yellow fever transmission (see Yellow Fever Vaccine and Malaria Prevention Information, by Country and Yellow Fever chapters; and Map 1.5.13). Peru does not require proof of yellow fever vaccination for entry.

Map 1.5.13

SOURCE:

Centers for Disease Control and Prevention

A map of Peru highlights yellow fever vaccination recommendations. Vaccination is recommended in the eastern regions of Peru. Regions where vaccination is recommended include all of Loreto, Ucayali, and Madre de Dios as well as parts of Puno, Cusco, Junín, Pasco, Huánuco, Piura, Amazonas, Cajamarca, and most of San Martín. Indicated by teal shading, vaccination is generally not recommended in Tumbes, parts of Piura, and most of Lambayeque. Vaccination is not recommended in the coastal regions of Peru including Lima, indicated by the beige shading.

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Environmental hazards and risks

Altitude illness

Travelers visiting destinations above 2,500 m (8,200 ft), such as Cusco city (3,339 m; approximately 11,000 ft) and Lake Titicaca (3,812 m; approximately 12,500 ft), and those hiking or mountaineering in the Andes Mountains (e.g., climbing Huascarán Mountain [6,768 m; approximately 22,200 ft] in the Cordillera Blanca range or doing the Salkantay trek [4,630 m; 15,190 ft] in Cusco) are at risk for altitude illness, including acute mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema. Prophylaxis with acetazolamide should be prescribed and gradual ascent should be recommended for travelers at risk. See the High-Altitude Travel and Altitude Illness chapter, for details regarding altitude illness and its medical management.

Animal bites and rabies

Bat-transmitted rabies is more common than dog-transmitted rabies in Peru. However, dog rabies occurs in the south in the regions of Arequipa and Puno and southern areas of Cusco. Pre-exposure prophylaxis should be considered for travelers at risk, including expatriates, children, those planning to spend time in rural areas hiking or cycling, and veterinarians or researchers who may have contact with bats. Travelers should not pet unknown or stray animals. Rabies vaccine is widely available in Peru, but rabies immune globulin is not. All animal bites should be evaluated by a healthcare professional (see Zoonotic Exposures: Bites, Scratches, and Other Hazards chapter). Significant exposures are an emergency, and the traveler should be referred to the nearest destination that can provide immunoglobulin (see Rabies chapter). Medical evacuation insurance can cover the cost of emergency travel (see Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance chapter).

Climate and sun exposure

Sunburns are a common problem among travelers to Peru, with risk present in the coast and rain forest. Solar radiation in the highlands of Peru is high, and short exposures are associated with sunburns. Travelers should carry and use sunscreen appropriately. Travelers to areas where sunscreen and insect repellent are needed should apply sunscreen first and then the repellent. Products combining sunscreen and repellent are less effective and should be avoided (see Sun Exposure in Travelers chapter).

Safety and security

Pickpockets and theft of personal belongings occur in large cities and tourist areas (see Safety and Security Overseas chapter). Travelers should be aware of their surroundings, should pay attention to their property, and should not resist robberies in order to prevent escalation of violence. Walking in groups or with a tour guide, especially at night, is recommended. Travelers should avoid withdrawing large sums of money from ATMs at once, keep their money in a secure pocket, and carry small amounts of cash. Most restaurants and major venues accept major credit cards. Whenever possible, travelers should make advance arrangements and payments. Travelers should not accept drinks from strangers at restaurants or clubs. Encourage U.S. citizens and nationals traveling and living in Peru to enroll in the U.S. Department of State's Smart Traveler Enrollment Program to receive information on safety conditions and to help the U.S. Embassy in Peru contact them in an emergency.

Crime

Violent crimes and assaults are common in Peru, and tourists may be impacted. Travelers should avoid excessive alcohol consumption and illegal drugs, as well as gatherings where people are intoxicated. Drug trafficking, possession, and consumption are illegal. Marijuana, in small amounts and with a prescription (which must be locally obtained or validated), is allowed for medicinal purposes. Importing marijuana or its derivatives requires an official permit; confirmation of current regulations is advised before attempting. Ayahuasca, a hallucinogenic preparation, is commonly offered to tourists in Peru. The ayahuasca rituals are not illegal, but the safety and regulations for recreational use have not been established. Travelers taking psychoactive medications (e.g., antidepressants) who try ayahuasca could be at increased risk for adverse outcomes; consultation with a physician knowledgeable about potential drug interactions is advised (see Poisonings, Envenomations, and Toxic Exposures During Travel chapter).

Political unrest

Peru is a republic with a democratic government. Political and social unrest is common in Peru, and travelers should avoid demonstrations, which often turn violent (see Safety and Security Overseas chapter).

Terrorism

Peru experienced a long period of terrorism during the 1980s and 1990s. Terrorist groups associated with drug-trafficking gangs are now relegated to small areas in the jungle of Peru away from normal tourist routes. Outside those areas, these groups do not represent a risk for travelers to Peru.

Traffic-related injuries

Roads are treacherous and traffic rules are often not followed. Trauma and death due to traffic accidents occur among travelers (see Injury and Death During Travel chapter). Travelers should wear seat belts. Travelers should avoid hailing taxicabs in the street and instead reserve transportation through a hotel or use cell phone applications to obtain transportation. Tipping cab drivers is not customary. Drivers do not usually stop for pedestrians, and travelers should be cautious when crossing the street. Helmets are advised for those riding on bicycles, mopeds, or motorcycles.

Availability and quality of medical care

Peru has a mixed public and private healthcare system. Health care in the public sector must be paid for in advance and often has low standards. Travelers who need health care should access private hospitals (clínicas privadas). Private hospitals in Lima, particularly in Miraflores and San Isidro, provide good health care and many accept international insurance (see Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance chapter). Many personnel in these hospitals understand English, and some physicians may have received training in the United States. Health care outside Lima is not as good, and travelers with complex problems need to be evacuated to Lima or to their home country. Hotels may be associated with private hospitals and may be able to contact a physician to evaluate travelers. Language may be a barrier to care, especially in public hospitals. The U.S. Embassy in Peru has a list of hospitals and physicians that can provide care in English. Purchasing medication in Peru can be challenging; counterfeit medications are present, and some medicines might not be available or could have different names. Travelers visiting friends or relatives could identify healthcare sources through their local acquaintances.

Medical tourism

Peru is not a common destination for medical tourism (see Medical Tourism chapter). Medical tourism is not recognized or regulated by the local medical college, which makes it both dangerous and illegal.