librarychica85

Hi all,

Next month my h and I will be traveling to Peru. We'll be visiting Lima and the Sacred Valley. I know for these areas no vaccinations are required but immunizations like Hep A, B and typhoid are recommended. I like to air on the side of caution when I travel so am planning on getting these but I was just wondering what other people have done. did any of you take diamox while there? Did you find it effective? (I'm asking here since I like to hear actual traveler's opinions and experiences, not just medically trained professionals who have never been to the country in question).

My other question is concerning confirming flights while in Peru. I read that all the airlines there recommend you confirm flights prior to traveling so you don't get bumped. Forgive my ignorance but do they just mean checking in online in advance? I didn't think in today's automated age, they meant calling someone/being on hold etc? When I travel I always check on my flight status but wasn't sure if confirming had a different connotation/

Thanks all for any insight/tips you have!

crellston

I would take the opposite approach and always consult a trained medical professional. Just visiting a country does not make you a medical expert. The side effects of drugs like Diamox may well be affected by an individual's medical history so if you do have any existing conditions it would be best to see your own GP.

The most effective way to acclimatise to altitude is to ascend gradually. If visiting Cusco by air the best way is to go straight to the Sacred Valley from the airport spend a few days there maybe in Ollantaytambo of Urumbamba and explore the Sv from there. This applies even if you decide to take drugs such as Diamox. Unfortunately, there is no way of knowing how you may be affected as age, sex and fitness etc. have no bearing on AMS.


Re- confirming flights is not really necessary anymore in the days of online check in although I would be inclined to check the flight number/ schedule a couple of days beforehand as flights do sometimes get changed due to weather/ strikes etc. I would also ensure that you are in Lima a day before your homeward international flight just to be on the safe side.

librarychica85

Thanks for your reply. I didn't mean that I wouldn't not be consulting with a medical professional because I still will be. I was just interested in hearing other people's experiences on a casual, conversational level. And yes, I've read that altitude sickness can affect anyone-not just one body type, age, etc.
Thanks again.

Kathie

I have all of my travel immunizations. Ask your doctor if you need a measles/mumps/rubella booster as well.

We are headed to Peru in November, and my doctor wrote a prescription for diamox. I will fill it and take it along. We plan to of to the Sacred Valley right after we land in Cusco, in hopes of mitigating altitude effects.

macboo

I'm agreeing with the other posters. Check with your personal medical advisors at home. hepatiitis shots might not be necessary --- unless you're the person who ends up in a hospital in Peru. Then you need it.

Kathie

macboo, I'm going to disagree with you about hepatitis. While one doesn't need Hep B unless one is doing some exchange of bodily fluids, you should have Hep A even if you are staying at home. It is a food and water borne illness and there are outbreaks in the US, Canada, and Western Europe as well as in developing countries.

mlgb

Since there is a combination Hep A/B shot, my doctor was agreeable with prescribing the combo shot. However I think you need at least a month for the shot to be effective.

As for typhoid, it is treatable with antibiotics and the vaccine (or pills) are not 100% effective, so I opted not to get it for my first few trips to Peru but have done so in the last few years. You need two weeks for the injection (and the shot was in short supply in the US last year).

I think also an important vaccination to get is influenza, if you haven't ever had the H1N1 type of flu.

I agree with going to a lower elevation for your first few nights after flying in to Cusco. Try to take it easy for the first half day, limited uphill hiking and carrying heavy luggage while your body adjusts. I bring Diamox and wait and see how I feel, so far I haven't needed it but I travel with enough time and flexibility to take a day or two off for adjusting if necessary. I use ibuprofen(Advil) or Tylenol for headache, on Day 1 at the first sign of headache, and also when going to the next higher elevation.

Don't forget to bring immodium (immodio).

I also start taking probiotics and eating more yogurt before I travel, and bring PeptoBismol to take daily as a preventative (it can be hard to find in other countries, it is called Bismutol in Peru and you need to buy it from a pharmacist!) Also, it shouldn't be taken, nor should aspirin, if you plan to take Diamox. So far I've been fairly lucky with only two episodes of tummy trouble in multiple trips. My favorite hotel says I now have a "Peruvian stomach".

lmschmale

Ask your doctor about prescribing you slow-release Diamox (there's a cheaper generic version, too). You take 5 pills in total, one every 12 hours, and you take the first pill 24 hours before you reach the altitude (so in my case, it was 24 hours before landing in Cusco). It worked great for us - no side effects, no headaches, and no altitude sickness - but obviously this shouldn't in any way replace advice from your doctor. (Note that this is what we did at the advice of my doctor, even though we subsequently traveled to Lake Titicaca, which is at a much higher altitude than Cusco.)

Kathie

mlgb writes: "As for typhoid, it is treatable with antibiotics and the vaccine (or pills) are not 100% effective, so I opted not to get it for my first few trips to Peru but have done so in the last few years. You need two weeks for the injection (and the shot was in short supply in the US last year)."

I'm glad you've opted for the typhoid vaccine the last few years. There are antibiotic-resistant strains of typhoid. And it's pretty miserable to have typhoid. If you can prevent it, why not? Nothing is 100% effective, but the typhoid vaccines are effective enough for me to opt for them. Note that the shots last only 2 years, the pills last 4 years.

mlgb

That is less of an issue in Latin America than in Asia, Kathie. There are still antibiotic treatments that work.

It can sometimes be difficult for people on short notice to access typhoid in the US, since it isn't a routine vaccination anymore.

If you can't get it, follow the guidelines about where and what to eat (no street food, only peeled produce or that which has been washed with purified water, drink bottled water, avoid food that has been sitting around eg at buffets). I'd probably avoid fresh water fish as well, because there are still hygiene deficiencies in the Andes upstream of the metropolitan centers.

Typhoid case do occur in tourists but fortunately are fairly rare in Peru.

sf7307

Several years ago we traveled to Southeast Asia for the first time so we got Hep A/B, which is good for life as I recall. I think its a series of shots (3?). We're in the "just do it and get it over with" camp.

We also took the typhoid pills, which are good for five years.

Of course, we keep our tetanus up to date, and I get a flu shot every year anyway.

We did take Diamox during the trek portion of our Peru trip. I would not have taken it (and didn't) for Cusco and the Sacred Valley, but we went up to 15,000+ feet. Obviously, since we took it, we really don't know if it was effective or not (have no idea how we would have done without it). I actually needed a hit of oxygen two times in the middle of the night at about 12,500 ft), but I was fine during the day, even over the pass.

crellston

Kathie - "Note that the shots last only 2 years, the pills last 4 years" - maybe the US uses different vaccines but in the UK the oral vaccine lasts for only a year but the shots last for 3 - 5 years ( depending upon which doctor you talk to!) .

Just been for my thyphoid booster and there is also a shortage in the UK. What is going on?

mlgb

crellston, I think I researched this last year, and there was a recall as well as a pause in manufacturing. There were only two makers of the vaccine.

Perhaps UK doctors decided to stop offering the vaccine last year and haven't caught back up, don't know?

There were some timing issues for me last fall and I would not have been able to keep the pills refrigerated and take them in time to become effective. My provider had to get special permission to give me the injection instead. They had very limited supplies.

Kathie

The vaccines are different in the UK and the US. I didn't know that there was an oral vaccine that only lasts a year. (One more reason to check with your own doctor about this.)

Antibiotic-resistant typhoid is a major issue in SE Asia, but I recently read that there is antibiotic resistant typhoid basically everywhere there is typhoid now.

A few years ago there was a shortage of the oral vaccine in the US. The big pharmas say that making vaccines doesn't produce enough profit...

mlgb

The shortages of typhoid vaccine continue in the UK, apparently. GSK is still not able to supply until the end of the year.

https://www.gov.uk/government/upload...te_211_v17.pdf

In the US the same dosage of the Typhim VI (manufactured in France) indicates two years before a booster.

I doubt there is anything different other than the labeling.

Private clinics may have it but will ask you to make an appointment and perhaps make a deposit! Wonder what they are charging?

Glad I got mine last year.

In looking into this again it said GSK decided to focus on childhood immunizations and defer making typhoid vaccine.

crellston

When I visited my GP last week I got the last dose of typhoid vaccine - my wife insisted that I take It as I am so accident prone that if anyone was going to get thyphoid would be me!

She has reserved a dose from next month's batch which is rationed to 10 doses per doctors surgery. To put this into context, ours is a very large surgery covering some 20k patients.

At least it is free in the UK!

mlgb

LOL crellston. No riding of animals, okay?

I am also lucky that my health plan give free travel jabs, including YF.