How important are all these vaccines for Peruvian travel?
April 18, 2014 4:10 PM   Subscribe

I will be spending a month this summer in the high jungle plateau of Tarapoto, Peru. I am trying to get my preventative care in order, and will be getting Hepatitis A and typhoid vaccines, as well as taking anti-malarial medication. I don't think I will be getting the yellow fever vaccine, the Hepatitis B vaccine, or the rabies vaccine; the first due to lack of access and the latter two due to risk factors and cost, respectively. Would you try harder to find access to the yellow fever vaccine or rethink the other two, or am I good with the three I'm doing?

I have been advised that I should try to get the yellow fever vaccine by my local health department, but neither my doctor, the health department, nor any of the regional pharmacies (Walgreens, etc.) can get it to me due either to not having it (health department) or not being authorized to dispense it (doctor, Walgreens, etc.). How worried should I be about not getting this vaccine?

Also, I will be taking several excursions into the jungle and will be deliberately seeking out wildlife to observe/photograph/draw. The CDC somewhat iffily recommends getting the rabies vaccine. I can probably get it, but it costs about $300 and I've hard it's also painful/laborious. I'm leaning towards not getting it.

Finally, the health department thinks I should get the Hepatitis B vaccine, but I'm not planning on any risky behavior (unprotected sex/needles/tattoos) so I'm also leaning against it due to cost and risk.

Thoughts on all the above?
posted by vegartanipla to Health & Fitness (17 answers total)
If you are going to the jungle by bus, the government has posts along the highway where you can get the yellow fever vaccine. If you have a couple of days in lima before that, tou can get it there in a million places. Any hostel or hotel will point you in the right direction.

I would get hep b just in case. I am from Peru and it's standard over there. Even if you don't have sexual contact with anyone, I'm pretty sure it can be transmitted with any blood contact and it is a really unpleasant possibility to consider if by accident you cut yourself or something.
posted by Tarumba at 4:25 PM on April 18, 2014 [2 favorites]

Also, Tarapoto is full of bats. If you can afford it at all, get the rabies vaccine. Otherwise make sure you keep yourdistance, especially if they look "hurt"
posted by Tarumba at 4:29 PM on April 18, 2014 [1 favorite]

I would definitely get hep b just in case. I wouldn't worry about rabies. My doctor said that it's the same treatment whether you get it preventatively or after possible exposure, so it's worth risking it (and don't do things like pet street dogs).
posted by brilliantine at 4:32 PM on April 18, 2014

Have you tried checking with your state health department, as opposed to your local one? It may mean a drive to your closest major city, but it should be available there.

I would get the Hep B vaccine even if you aren't planning on any risky behavior, because that's part of the point of vaccines, to protect you against unanticipated events.
posted by ambrosia at 4:35 PM on April 18, 2014

If you are travelling to other countries during this trip, you might want to check if there are any yellow fever vaccination entry requirements, i.e. some countries want evidence of vaccination if you have come from a country with a risk of yellow fever.
posted by AnnaRat at 4:39 PM on April 18, 2014 [1 favorite]

My doctor said that it's the same treatment whether you get it preventatively or after possible exposure

FWIW that's not necessarily true. If you've had the shots preventively, you will have to get the vaccine again... but you won't have to get a ton of immunoglobulin.
posted by Coatlicue at 4:44 PM on April 18, 2014 [2 favorites]

Ghietting them there is an option, though you should consider that there is going to be a waiting period before the vaccine is effective. I got the yellow fever vaccine in cusco, peru and it was actually a big pain. we visited tons of clinics looking for it, and most did not have it. We ended up getting it at the one hospital in town that had it, and it was a huge rigamorole of standing in this line then that one and caring forms to different departments of the hospital. It would have been impossible if we had not spoken enough spanish to understand what was going on. It ended up being around $40 I believe.

Hep b on the other hand was super easy. Went to a private clinic, paid about $20, out in half an hour. Not a bad vaccine to have even back home, though you'd have to follow up with the other shots in the series if you wanted the immunization to be long term.
posted by geegollygosh at 5:26 PM on April 18, 2014

Rabies shots these days are neither painful nor laborious. But in the US, they are very expensive. The main risk about not getting them is that immunoglobulin treatment may not be available/accessible in remote areas where you might be travelling.

(I received post exposure prophylaxis after receiving an animal bite in Thailand, and this was very standard (and cheap... like $10-15 per shot) but was never offered immunoglobulin. This may have been because the bite was relatively low-risk, or because it wasn't available... no way to know!)
posted by yonglin at 5:36 PM on April 18, 2014 [1 favorite]

I think only Brazil and Australia still require yellow fever immunization certificates on entry. I got yellow fever shots at specialist travel doctors clinics in Australia and NZ, they're easy to google up because they're called things like "the travel doctor". Maybe you have them in the US too. Tarapoto isn't lowland jungle so you're not at too much risk from mosquito-borne diseases. I would go for the Hep B just in case, it can't hurt right? You never know what might happen. As for rabies, I think the biggest carrier in eastern Peru is vampire bats, which you won't find around Tarapoto so it's probably not necessary to get vaccinated.

BTW you will be in one of the most beautiful parts of the world, have a wonderful time!
posted by nomis at 5:56 PM on April 18, 2014

Rabies shots these days are neither painful nor laborious. But in the US, they are very expensive. The main risk about not getting them is that immunoglobulin treatment may not be available/accessible in remote areas where you might be travelling.

(I received post exposure prophylaxis after receiving an animal bite in Thailand, and this was very standard (and cheap... like $10-15 per shot) but was never offered immunoglobulin. This may have been because the bite was relatively low-risk, or because it wasn't available... no way to know!)

I'd get the rabies vaccine beforehand so you won't have to pay as much for the immunoglobulin later if you get bitten since you won't need as much. A friend and I just got back from Bali, where she was bitten by a monkey. While the rabies vaccine itself isn't expensive, she had to get the immunoglobulin which ended up costing around $5000 for the amount she needed and she's not that big. We also had to run around to a different clinic to find it.

On the other hand, I've also had post-exposure prophylaxis, but didn't have to get the immunoglobullin because even though I was nipped by a stray, rabies isn't around in Hong Kong.
posted by astapasta24 at 6:41 PM on April 18, 2014

There is a combo Hep A and hep B vaccine called Twinrix that is less expensive than having both hep A and hep B vaccines separately. Hep A is an oral/fecal virus that is easily and commonly contracted in places where lots of people have it, and where good handwashing hygiene after bathroom use or diaper changing is an issue. I'm thinking street food and lack of soap and water for the vendors. Adults who contract hep A often get really, really ill, though you would recover. It would ruin your trip and leave you exhausted for months.

Hep B is highly transmissible sexually and through any sort of blood to blood contact. (It can be contracted with household contact with someone who is infected, but this is probably not an important risk factor in your case). I think hep A is probably more important, but since Twinrix saves you a stick, I'd inquire. I'd also really think carefully about having sexual contact during your trip if you're not vaccinated. (This also goes for the US. Hep B is no joke. It can cause liver cancer and is entirely preventable with vaccination).

Both vaccines are given on a schedule that requires a six-month final shot, but having only some of the series will give you short term immunity, especially for hep A. You can get the last dose late, and will still be protected while you are traveling. Don't wait too long to get your initial injection, though, as immunity needs time to develop. FYI, the schedule for Twinrix is 0, 1 month, 6 months. Same with Hep B. Hep A is dosed in 2 shots when given alone, 0 and 6 months.
posted by citygirl at 6:47 PM on April 18, 2014 [2 favorites]

Hep B is important in case you end up in a hospital and receive any sort of transfusion. Get it now if you possibly can. If you end up not needing it this trip it's good for any future trips where Hep B is a risk.
posted by SakuraK at 12:45 AM on April 19, 2014

I agree with SakuraK about hep B. I'm unsure of the situation in the locality where you're traveling but there are many rural and under-resourced hospitals that don't exactly have the same resources and blood banks as we do in the USA. Some places even reuse needles because they don't have enough in stock. Many places don't have blood banks to screen transfusions. One of the most common causes of morbidity and mortality in travelers to less developed countries is trauma. What if you need a blood transfusion? Just get the hep B vaccine.

This NYT article mentions the fact that 81% of rabies in Peru is from bats. "More than half the Amazon villagers interviewed said they had been bitten; vampire bats can drink without awakening their victims." I noted the comment above saying there are no vampire bats specifically where you're going, unknown which other bat species in Peru carry rabies or whether their bites would wake you up.... (!!)
posted by treehorn+bunny at 1:07 AM on April 19, 2014

You can go to any cvs and get a twinrix vaccine.
posted by empath at 6:30 AM on April 19, 2014

Best answer: What you need is a travel clinic. Unlike Walgreens or similar, they specialize in exactly this. They should have all the vaccines you need on hand, and be able to answer your questions about what is most important. Search Google Maps or similar for a travel clinic in your area and give them a call!
posted by unsub at 10:44 PM on April 19, 2014 [1 favorite]

Best answer: Hi! I spent quite a bit of time in Tarapoto. It's a beautiful place! Check out the Ahuashiyacu waterfall, and the nature reserve and animal sanctuary at the end of the road into the jungle. If you're in town and want some really good traditional Peruvian food, go to Pataraschca. My friend owns the Cordillera Escalera lodge just outside of town on the jungle road so I usually stay there. His next door neighbor has a huge collection of Amazonian orchids! If you want to get out of the city, I recommend going to the parada and catching a group taxi up to San Roque. There's a hostel called Hunab Ku right in town (I think it's still open), and an artist retreat center called Sachaqua that I stayed at for six weeks (you'll need to contact Trina in advance to book a room).

You do NOT need to take anti-malaria pills. Tarapoto is too high altitude to support the mosquitoes that carry this virus. If you go way down, deep into the Amazon basin you might consider it. Anti-malarials have awful, awful side effects and are not worth it in my opinion unless you are in a seriously high risk area, which the locals will inform you about. Also, buying them down there is 90% cheaper than up here. Same drugs, just way less expensive. You want Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline, which are all carried in pharmacies down there and do not require a prescription.

For what it's worth, I have traveled all over northern Peru, including going deep into the jungles outside of Iquitos for months at a time, and I never take anti-malarials. If you stay under a net at night and wear bug spray during the day it's generally fine.

Peru does require a yellow fever vaccine, so do get that. They will also vaccinate you for free at the airport if you don't have it already (this is time consuming and annoying, so I don't recommend it). Hep shots are worth it if you can afford it. Have fun and safe travels! Feel free to memail me if you want more recommendations for the area :)
posted by ananci at 3:29 PM on April 20, 2014 [1 favorite]

Response by poster: I finally got my old vaccination records yesterday (had to wait for my official request to get authorized and returned) and it turns out that I have had the Hep B series already. Am still on the hunt for the yellow fever vaccine - the regional (I've expanded beyond local) health departments have thus far not even answered their phones, so we'll see... unsub's advice for a travel clinic sounds promising, though! I'm getting the typhoid and Hep A vaccines tomorrow.

Already have the anti-malarials in possession but ananci's right that malaria isn't in the highlands, so if I can't tolerate them it hopefully won't be horrible to stop them.
posted by vegartanipla at 5:42 PM on April 24, 2014

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