Peru has two distinct health profiles
Most Canadian Peru travellers combine Machu Picchu + Cusco with an optional Amazon extension (Iquitos or Puerto Maldonado). These two parts of the trip have very different health requirements — and confusing them is the most common Peru pre-travel planning mistake.
Part 1: Cusco, Machu Picchu, Sacred Valley
Altitude sickness — the #1 overlooked risk
Cusco sits at 3,400 m. Machu Picchu is at 2,430 m. Most Inca Trail trailheads are above 3,000 m. Acute Mountain Sickness (AMS) is common in travellers who fly straight into Cusco — even fit, healthy adults.
Symptoms: headache, nausea, fatigue, dizziness, poor sleep. It can start anywhere from a few hours to a few days after arriving at altitude.
Prevention:
- Flying into Cusco is a rapid ascent to 3,400 m: where you can, sleep your first night or two lower (the Sacred Valley is lower than Cusco), and don't fly in and trek the same day
- Avoid alcohol, sleeping pills and over-exertion for the first 48 hours
- Stay hydrated (coca tea is a local tradition but evidence is limited)
- Acetazolamide (generic Diamox): a prescription medication that Canadian guidance considers for a rapid ascent above 3,000 m, starting 24 hours before
Our physician can prescribe acetazolamide if it suits you and goes over safe ascent at your pre-travel consultation; see our altitude sickness guide. This is one of the most valuable parts of a Peru pre-travel visit.
Other vaccines for the Cusco/Machu Picchu route
- Hepatitis A: all travellers — food contamination risk
- Typhoid: all travellers — recommended even for Lima and Cusco
- Dukoral: optional (not routinely recommended)
No malaria prophylaxis needed for Cusco, Machu Picchu, Lima, or the Sacred Valley — these areas are malaria-free.
Part 2: Amazon Peru (Iquitos, Puerto Maldonado, Madre de Dios)
Yellow Fever — recommended
Yellow Fever vaccination is recommended for the Peruvian Amazon (Peru has no entry requirement). Some lodges and boat operators near Iquitos specifically check vaccination certificates. Our physician confirms whether you need it and refers you to a Government of Canada designated Yellow Fever Vaccination Centre, which gives the vaccine and issues the ICVP certificate.
Malaria — required for Amazon regions
Malaria prophylaxis (Malarone or doxycycline) is required for Iquitos, Puerto Maldonado, Madre de Dios, and Amazon jungle lodges. This is a distinct requirement from the Cusco/Machu Picchu portion — if your trip combines both, you need prophylaxis only for the Amazon days, but our physician may recommend taking it through the whole trip for simplicity.
Book your Peru consultation
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Sources: PHAC — Peru Travel Health | CDC Yellow Book — Peru
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