Travel Health Guide: Peru — Altitude Sickness, Malaria & What to Pack
Planning a trip to Peru? Get physician-written guidance on altitude sickness for Cusco and Machu Picchu, malaria prevention for the Amazon, and every vaccine you need.
Travel Health Guide: Peru — Altitude Sickness, Malaria & What to Pack
Peru is one of the most medically complex destinations for US travelers — and one of the most rewarding. Travelers headed to Cusco or Machu Picchu need altitude sickness medication, starting at elevations above 11,000 feet. Those visiting the Amazon basin require malaria prophylaxis, and all travelers should pack treatment for traveler's diarrhea, which affects approximately 40 to 60 percent of visitors to Peru. Recommended vaccines include hepatitis A, typhoid, and routine immunizations. Yellow fever vaccination is required for entry into certain jungle regions. As a physician, I recommend preparing at least four to six weeks before departure — longer if you need vaccine series. This guide covers everything you need, region by region.
Quick Facts: Peru Health Snapshot
Overview: What Makes Peru Medically Unique
Peru spans three dramatically different ecosystems — the coastal lowlands, the high-altitude Andes, and the Amazon rainforest — and each one carries its own health risks. Most US travelers visit Cusco and Machu Picchu, which sit at 11,152 feet and 7,972 feet respectively. Altitude sickness is the number one medical issue I see in travelers returning from Peru.
If you're adding an Amazon leg to your trip, the health profile changes completely. Suddenly you're in a region with active malaria transmission, dengue risk, and yellow fever exposure. The jump from Andes to Amazon is one of the biggest health environment shifts of any single-country itinerary in the world.
The good news: every one of these risks is manageable with the right preparation. Here's what you need by region.
Altitude Sickness: The #1 Risk in Cusco and Machu Picchu
Cusco sits at 11,152 feet (3,399 meters) — higher than the highest point in the continental United States. Acute mountain sickness (AMS) affects an estimated 25 to 50 percent of travelers arriving in Cusco without acclimatization, according to the Wilderness Medical Society. Symptoms typically begin 6 to 12 hours after arrival and include headache, fatigue, nausea, dizziness, and sleep disturbance.
In rare cases, AMS can progress to high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE), both of which are medical emergencies requiring immediate descent.
How to Prevent Altitude Sickness in Peru
Acetazolamide (Diamox) is the gold standard medication for altitude sickness prevention. The standard dosing protocol is 125 mg twice daily, starting one to two days before ascending to altitude and continuing for two days after reaching your highest elevation. Acetazolamide works by stimulating faster, deeper breathing, which helps your body acclimate more efficiently.
In my clinical experience, travelers who take acetazolamide as directed experience significantly fewer and milder altitude symptoms than those who try to tough it out or rely on coca tea alone.
Key points about acetazolamide:
- It requires a prescription (not available over the counter in the US)
- It contains a sulfonamide component — if you have a sulfa allergy, discuss alternatives with your physician
- Side effects include increased urination and mild tingling in the fingers and toes, which are harmless
- It is not a substitute for gradual acclimatization — build in an extra day in Cusco before heading to Machu Picchu if possible
Acclimatization tips (in addition to medication):
- Arrive in Cusco one to two days before major activities
- Stay hydrated (dehydration worsens altitude symptoms)
- Avoid alcohol and sleeping pills for the first 48 hours
- Eat lighter meals
- Ascend gradually — don't go directly from Cusco to higher-altitude destinations like Rainbow Mountain (17,060 feet) on day one
Ibuprofen is a reasonable backup for mild headache, but it does not prevent AMS and should not replace acetazolamide in high-risk itineraries.
Machu Picchu specifically: The ruins themselves sit at 7,972 feet, which is lower than Cusco. Many travelers feel better at Machu Picchu than in Cusco. If you take the train from Cusco, you'll descend significantly in elevation, which is a relief. However, you'll return to Cusco afterward, so acclimatization still matters.
Get your altitude sickness prescription before you leave. Wandr physicians can evaluate you online and ship acetazolamide (Diamox) to your door — no travel clinic visit required. Start your health assessment
Malaria in Peru: Who Needs Antimalarial Pills
Not all of Peru has malaria risk — and this is where many travelers and even some general practitioners get confused.
Malaria transmission in Peru occurs primarily in the Amazon basin and lowland jungle regions (including Loreto, Ucayali, and Madre de Dios departments). The key malaria species in Peru is Plasmodium vivax, which is less deadly than P. falciparum but still causes significant illness.
The CDC recommends malaria prophylaxis for travelers to:
- The Amazon basin and jungle lowlands
- Rural areas below 2,000 meters elevation in certain departments
Malaria risk is generally LOW for travelers who are only visiting:
- Lima (coastal city, minimal risk)
- Cusco city and the Sacred Valley
- Machu Picchu
If your Peru itinerary includes only Lima, Cusco, and Machu Picchu, you likely do not need antimalarial medication. However, if you're heading into the Amazon (Iquitos, Puerto Maldonado, Manu National Park), prophylaxis is strongly recommended.
Which Antimalarial Should You Take?
For Peru's Amazon regions, the CDC recommends:
- Atovaquone-proguanil (Malarone): Start 1-2 days before entering a malaria-endemic area, continue daily throughout, and for 7 days after leaving. Well-tolerated, no significant sun sensitivity. The most commonly prescribed option for travelers.
- Doxycycline: Start 2 days before travel, continue through exposure, and for 4 weeks after. More affordable, but requires strict sun protection (photosensitivity) and should not be taken by pregnant travelers.
- Mefloquine: Weekly dosing (start 2 weeks before). Less commonly prescribed for Peru due to potential neuropsychiatric side effects.
Chloroquine is NOT effective for Peru — drug resistance is well-documented in the region.
Combining altitude and Amazon on one trip? You need both acetazolamide and an antimalarial, and we can prescribe both. See your options at Wandr
Traveler's Diarrhea in Peru: Be Prepared
Traveler's diarrhea is the most common illness affecting US visitors to Peru. Studies estimate it affects 40 to 60 percent of travelers to developing regions of South America, and Peru's combination of street food culture, fresh produce, and regional water supply variability makes it a high-risk destination.
In Lima, higher-end restaurants and hotels have improved significantly, but risk remains throughout the country — including in Cusco and rural Andean communities. The pathogens most commonly responsible include Escherichia coli (ETEC), Campylobacter, Shigella, and Giardia.
What to Pack for Traveler's Diarrhea
Prescription antibiotic (for treatment, not prevention):
- Azithromycin is the first-line treatment recommended by the CDC for Latin America, including Peru. A single 1g dose or a 3-day course can dramatically shorten the duration of illness.
- Ciprofloxacin is an alternative, though resistance is rising in some regions.
- Pack one or the other — don't wait until you're sick to try to find a pharmacy.
Over-the-counter support:
- Loperamide (Imodium): Slows intestinal motility. Useful for symptom management, especially when you need to travel. Do not use if you have fever or bloody stool.
- Oral rehydration salts (ORS): Critical for replacing electrolytes. Dehydration from diarrhea at altitude is especially dangerous.
Food and water safety in Peru:
- Drink only bottled or purified water — including for brushing teeth in rural areas
- Avoid ice in drinks unless you're confident it came from purified water
- Eat street food thoughtfully: high-turnover cooked foods at busy stalls are generally safer than raw preparations
- Ceviche is a beloved Peruvian dish, but raw seafood carries Vibrio and other risks — stick to reputable restaurants
Get a traveler's diarrhea antibiotic prescription before you leave. Wandr can evaluate you and ship azithromycin or ciprofloxacin directly to you. Start your assessment
Vaccines for Peru: What You Need
Required Vaccines
Yellow fever is not required for all travelers to Peru, but it is required for entry into certain jungle departments and may be required upon returning to some countries after visiting Peru. Specific yellow fever requirements:
- Required for travelers entering jungle areas (Loreto, Ucayali, Madre de Dios, and parts of Cusco and Puno departments)
- Some countries require proof of yellow fever vaccination if you're traveling from Peru
The yellow fever vaccine requires a 10-day lead time before entry into endemic areas, so plan ahead. You'll receive an International Certificate of Vaccination (the "yellow card") as proof.
Note: Yellow fever vaccine is a live vaccine and is contraindicated for some travelers (immunocompromised individuals, certain age groups, pregnant women). Discuss this with your physician.
Recommended Vaccines
Routine Vaccines to Verify
Before any international trip, confirm you're current on:
- COVID-19 (per current CDC guidance)
- Influenza (annual)
- Tetanus-diphtheria-pertussis (Td/Tdap)
- MMR (measles-mumps-rubella)
Book your travel vaccines through Wandr. No need to call pharmacies to check availability — find a vaccine appointment online in minutes. Book vaccines
Other Health Risks in Peru
Dengue Fever
Dengue is transmitted by the Aedes aegypti mosquito and is present in many Peruvian jungle regions and some coastal areas. Unlike malaria mosquitoes, dengue mosquitoes are most active during daytime hours. There is no FDA-approved vaccine for dengue recommended for most US travelers. Prevention is behavioral: use DEET-based repellent (at least 20-30%), wear long sleeves and pants during peak mosquito hours, and stay in screened or air-conditioned accommodations.
Zika Virus
Zika transmission has been documented in Peru's lowland regions. Pregnant travelers or those planning to become pregnant should consult their physician before visiting areas with active Zika transmission. The CDC maintains current Zika risk maps at cdc.gov/zika.
Rabies
Peru has a significant rabies burden from dogs and bats. If you're trekking, visiting caves, or spending extended time in rural communities, pre-exposure rabies vaccination is worth discussing with your physician. If you're bitten or scratched by an animal in Peru, seek medical attention immediately — post-exposure prophylaxis (rabies immune globulin and vaccine series) must begin as soon as possible.
Leptospirosis
Leptospirosis risk exists in jungle regions with freshwater exposure. Travelers rafting rivers, swimming in jungle streams, or visiting flooded areas should be aware of this bacterial infection, transmitted through water or soil contaminated with animal urine.
Health and Safety Tips for Peru
Mosquito protection:
- Apply DEET repellent (25-50%) to all exposed skin — especially during dusk-to-dawn hours for malaria prevention
- Use permethrin-treated clothing for jungle travel
- Sleep under a bed net if accommodations lack screens or air conditioning
Sun and UV exposure:
- UV radiation at altitude is significantly more intense than at sea level. In Cusco, UV index regularly exceeds 14 (extreme) even on overcast days. Wear SPF 50 sunscreen and reapply frequently.
Water safety:
- Bottled water only — including for ice, brushing teeth, and rinsing produce in rural areas
- Water purification tablets or a SteriPen are useful for trekkers
Cold and temperature extremes:
- Cusco nights drop well below freezing in the dry season (May through October). Pack layers.
- The Amazon is hot and humid year-round. Lightweight moisture-wicking clothing is essential.
Food safety:
- Lima's top restaurants are generally very safe. Cusco's tourist-area restaurants are moderate risk. Rural communities and markets carry higher risk.
- Cooked, hot food served at high-turnover establishments is generally the safest bet.
Travel Insurance for Peru
Travel insurance is not optional for Peru — it's essential. Medical evacuation from a remote Andean or jungle location can cost $30,000 to $100,000 or more. Altitude-related emergencies occasionally require emergency air transport to Lima.
Look for a policy that covers:
- Medical evacuation and repatriation
- Emergency hospitalization
- Trip interruption for medical reasons
- Adventure activities (if trekking or rafting)
Many standard travel insurance policies exclude pre-existing conditions or activities like high-altitude trekking — read the fine print carefully.
Get travel insurance through Wandr. Compare options and get covered before your trip. Explore travel insurance
Peru Travel Health Packing Checklist
Prescription medications:
- Acetazolamide (Diamox) — for altitude sickness prevention
- Antimalarial (Malarone or doxycycline) — if visiting Amazon regions
- Azithromycin or ciprofloxacin — for traveler's diarrhea treatment
Over-the-counter:
- Loperamide (Imodium) — diarrhea symptom management
- Oral rehydration salts (ORS)
- Pain/fever reliever (ibuprofen or acetaminophen)
- Antihistamine
- Antacid
Protection:
- DEET repellent (25-50%) — essential for jungle travel
- Permethrin spray for clothing
- SPF 50 sunscreen (UV is extreme at altitude)
- Sunglasses with UV protection
- Lip balm with SPF
First aid:
- Blister treatment (Machu Picchu involves significant walking)
- Wound care supplies
- Hand sanitizer
Documentation:
- Yellow fever vaccination card (if visiting Amazon regions)
- Travel insurance documents with 24-hour emergency number
- Copy of all prescriptions
Frequently Asked Questions: Peru Travel Health
Do I need malaria pills for Machu Picchu and Cusco?
No. If your itinerary is limited to Lima, Cusco, the Sacred Valley, and Machu Picchu, malaria prophylaxis is generally not required. Malaria risk in Peru is concentrated in lowland Amazon regions below 2,000 meters. Consult your physician if any part of your trip includes jungle areas like Iquitos or Puerto Maldonado.
What is the best medication for altitude sickness in Peru?
Acetazolamide (Diamox) is the most evidence-backed medication for preventing acute mountain sickness. The standard dose is 125 mg twice daily, starting one to two days before ascending to altitude. It requires a prescription. Ibuprofen can help with headache symptoms but does not prevent AMS.
How high is Machu Picchu, and will I get altitude sickness?
Machu Picchu sits at approximately 7,972 feet (2,430 meters). This is significantly lower than Cusco (11,152 feet) and most travelers experience less altitude discomfort at the ruins themselves. However, you'll likely spend time in Cusco before and after, where altitude sickness risk is considerably higher.
What vaccines are required for Peru?
No vaccines are officially required for US travelers entering Peru with a US passport, except yellow fever if you're entering Amazon jungle departments. However, hepatitis A and typhoid are strongly recommended for all travelers. Verify your routine immunizations are current.
Is the water safe to drink in Peru?
No. Tap water in Peru is not safe for tourists to drink, including in major cities like Lima and Cusco. Drink bottled or purified water throughout your trip. This includes water used for ice and brushing teeth, especially outside of major hotels.
When should I start taking altitude sickness medication before going to Peru?
Start acetazolamide one to two days before arriving in Cusco or any other high-altitude destination. The medication needs time to work before you ascend. Do not wait until you feel symptoms — prevention is far more effective than treatment once AMS begins.
Do I need yellow fever vaccine for Peru?
Yellow fever vaccination is required for travel into certain Peruvian Amazon departments (Loreto, Ucayali, Madre de Dios, and others). If your trip is limited to Lima, Cusco, and Machu Picchu, it is not required. Some travelers also need proof of yellow fever vaccination upon leaving Peru and entering neighboring countries — check requirements for your full itinerary.
How do I treat traveler's diarrhea in Peru?
The first-line treatment is azithromycin (a prescription antibiotic). Pack it before you leave — do not try to find it in a Peruvian pharmacy while sick. For mild cases, rest, oral rehydration salts, and loperamide (Imodium) for symptom control are helpful. Seek medical attention for fever above 102°F, bloody stool, or symptoms lasting more than 72 hours.
Is Machu Picchu safe for pregnant travelers?
Pregnancy complicates both altitude and antimalarial medication decisions. Some altitude sickness medications (including acetazolamide) are not recommended during pregnancy. Yellow fever vaccine is contraindicated in pregnancy. If you are pregnant and planning a trip to Peru, consult an OB-GYN and a travel medicine physician before finalizing your itinerary.
How far in advance should I see a doctor before traveling to Peru?
At least four to six weeks before departure. Some vaccines (particularly yellow fever) require a 10-day lead time before entering endemic areas, and vaccine series may require multiple doses spaced weeks apart. Starting earlier gives you more flexibility.
About the Author
This guide was written by the Wandr Health physician team, founded by an emergency medicine physician with direct experience treating travelers. Wandr Health is a physician-founded travel health platform that provides online consultations, prescription medications, vaccine booking, and travel insurance for US travelers.
Medical Disclaimer
This guide is intended for informational purposes and does not constitute medical advice. Travel health recommendations may change based on updated CDC and WHO advisories, disease outbreaks, and individual health factors. Consult a licensed physician before making decisions about medications, vaccines, or your personal health needs for travel. Check the CDC Travelers' Health website (cdc.gov/travel) and the WHO International Travel and Health guide for the most current recommendations.
Sources
- Centers for Disease Control and Prevention (CDC). Peru Travelers' Health Destination Page. Accessed April 2026.
- Wilderness Medical Society. "Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness." Wilderness and Environmental Medicine, 2019.
- World Health Organization (WHO). "International Travel and Health: Peru." Accessed April 2026.
- Fricker HS, et al. "Altitude sickness at Machu Picchu and Cusco, Peru." Journal of Travel Medicine, 2020.
- DuPont HL. "Acute Infectious Diarrhea in Immunocompetent Adults." New England Journal of Medicine, 2014;370:1532-1540.
- CDC Yellow Book 2024. Chapter: Altitude Illness. Accessed April 2026.
- CDC Yellow Book 2024. Chapter: Malaria. Accessed April 2026.
Last updated: April 25, 2026