There are day trips that drive 3 hours to an airport (not Nasca) and start the overflight there, about $500.

I thought you were trying to do this on the cheaper side. If you get yourself down to Nazca, then it's about $100 for the flight itself, plus the cost for the bus.

Have you checked to see what time you need to arrive in Iquitos if you are travelling by boat to a lodge? Typically they do not like to travel in the afternoon. If you are flying from Arequipa, I think you have to connect in Lima.

I'm still considering options. I am not trying to do it on the cheap necessarily, just travel like a middle class Peruvian would do it, so about 1/3 the cost of a tour. I am not trying to replicate a backpacking younger person trip with bedbugs and diarrhea. I was able to add a day so will look into things more in depth, taking a break now, a vacation from vacation planning. Passport apps mailed today!

Middle-class Peruvians are definitely taking the bus to Nazca instead of paying $600/pp to fly!! And quite often you will find even upper-middle (and a few nuns) in the lie-flat overnight buses.

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Me too! I have put my planning for our Mexico trip into hibernation. I used to be good at planning but just cant seem to get into the groove for this trip!

Laughing but it is more than a little pathetic:

I finally called my local clinic's travel section and got the breakdown on the yellow fever vaccine:

$408 for the jab
$200-$400 additional for a "consultation" that is required

Of course none of this is covered by insurance, travel care is strictly called out as not covered care.

So I guess buying a blank WHO yellow vaccine booklet from Amazon, then getting the jab at the Lima airport or Lima clinic, or at a public hospital in a pinch.

That is beyond ridiculous! Here in the UK it is one of the vaccinations not available on the NHS so we have to pay privately. The going rate here in London for a YF jab is £69 ($88). Someone is making vast profits over there!

Too bad you don't have Kaiser. Because they are a regional vaccine center they have the facilities to store live vaccines. It was free for me (did it before I turned 60) after that it isn't recommended. Also turns out they now say you only need it once, so in that case I didn't need it at all (Got one as a child when we moved to the Caribbean. As an aside, my mother came down with malaria there.) There are probably bigger risks such as dengue or zika vs YF unless you can determine that there is an active outbreak of YF when and where you are going (unlikely).

Doesn't the Lima clinic issue the yellow book when you get jabbed? And since you don't need proof why bother with the yellow book anyways? Unless your main goal is sourcing a cheap one for future travel where proof may be asked for.

I'd be willing to bet no one asks to see your yellow book in Peru. Honestly, since you are not going to have time for the vaccine to take effect anyways, and you risk side effects, I would just skip getting it. But you won't find any doctor willing to tell you that. Also now that you are going at the end of dry season, chances are even lower, but I would still always use insect repellent as your main line of prevention.

PS you can find a 4+ to 5 star hotel in Paracas for around $200 a night. Perhaps the spouse would enjoy a night at Hotel Paracas while you continue on to Nazca (see Expedia now for some pretty amazing pricing for oceanfront rooms). I did enjoy both the Ballestas boat trip and the trip out to the Paracas reserve, as well. I'm sure the hotel would book the excursion if you didn't want to DIY.

Cruz del Sur is a recommended bus line that stops in Paracas, Maybe $50 return all the way to Nazca, half that to Paracas. I've usually bought the tix at a kiosk in Lima a few days ahead, but I think you can also reserve online.

I must admit that since yellow fever can be fatal, and because there are a variety of medical conditions that affect the likelihood of severe reactions to exposure and to the vaccine, I would think the best advice would be to pay the cost of the consult and advance innoculation. JMO.

Yes YF is fatal and hence anyone who is under 60 and without other medical conditions should get one. We don't know how old tom is, but for older people, the risk of a severe reaction is probably higher than the risk of contracting YF in Peru in the dry season. Unlikely that anyone at a commercial clinic will do those calculations for you, however as Kaiser has their own travel medicine clinic and supply, they did have a recommended cutoff of 60 YO. I believe that age even qualifies you for an official "contraindication" finding on your yellow card.

First line of defense...avoid getting bitten by mosquitoes!!

They recommend Ultrathon as a longer-lasting repellent. Walmart should be able to get it for you if it isn't in stock elsewhere.

I'm not a physician, but would note that the YF vaccine is a live (if attenuated) virus. Even those who are under age 60 can be at risk for serious side effects -- which can include death -- depending on other health factors. Such reactions are rare, but that's why consultation is often advised -- so a person's unique risk factors can be taken into consideration. My travel physician (at Georgetown University Medical Center) went through the specific risk probabilities I would face in each of the locations I planned to visit before my trip to Peru, and I felt every penny of that consultation worthwhile.

I endorse mlgb"s recommendation to do everything possible to avoid mosquito bites.

Statistically , the risk of major side effects is very low. There is a significant increase in risk for people over 60 but it still remains low. See below an extract for the UK NHS website ;the link https://www.fitfortravel.nhs.uk/advi...20administered

Of course nothing magically changes on your 60th birthday. I think I had a second jab just before my 60th , had it been a year later, I doubt much would have changed....

"Rare side effects

Rarely, serious complications can occur after receiving the yellow fever vaccine. These are more common in those over 60 years of age. These include:

• Yellow fever vaccine associated neurological disease (YEL-AND) is a condition affecting the brain and nervous system, leading to symptoms such as confusion and problems with movement and co-ordination. The risk of YEL-AND occurring is estimated as follows:
  • over 60 years of age = 2.2 cases per 100,000 doses of vaccine administered
  • less than 60 years of age = 0.8 cases per 100,000 doses of vaccine administered

• Yellow fever vaccine associated viscerotropic disease (YEL-AVD) produces a condition similar to yellow fever itself, with multi organ failure and death in approximately 48% of cases. The risk of YEL-AVD occurring is estimated as follows:
  • over 60 years of age = 1.2 cases per 100,000 doses of vaccine administered
  • less than 60 years of age = 0.3 cases per 100,000 doses of vaccine administered

If you have recently received the yellow fever vaccine and feel unwell please contact your GP or the 111 service if your GP practice is closed. You should let them know that you have recently received yellow fever vaccine.

In a medical emergency, when someone is seriously ill and their life is at risk, dial 999.

Vaccination in Those Older Than 60 Years of Age

If you are 60 years of age or older, it is possible for you to receive yellow fever vaccine, but only if you are fit and well, fully understand the risks of vaccination, and have a real risk of getting yellow fever infection at your destination (rather than requiring the vaccine just for certificate purposes). A healthcare practitioner will discuss your risk of disease at your destination and the potential risks of the vaccine, to help you to make an informed decision regarding whether or not to get vaccinated."
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If I were paying $200-400 for a consultation I would expect more than my doctor reading from a website which is likely to be the case. A doctor is not the best person to analyse the relative risk of vaccination -v- getting yellow fever, one would need an actuary for that, though he will clearly be in possession of info re pre existing conditions which may have a bearing. Another factor is that the YF data available in a country like Peru is likely to be very sketchy and so realistically, it would be very difficult to compare the relative risks, especially when visiting different areas at different elevations, with any degree of accuracy.

Yes, this is the main goal, and since both Amazon and the Peru clinics charge about $10 for the booklet, it isn't worth the risk that they are out of booklets.

The CDC site is circumspect about the YF vaccine and age 60, saying something like "only to be used for those visiting high risk areas." Of course, who else would be getting it? Are there recreational vaxxers out there, just doing vaccines for kicks?

I suspect the international travel consultation is with a nurse practitioner, and not an MD. My state law allows nurse practitioners to prescribe drugs. Sometimes these people are called physician's assistants, depends I think on the state.

I did get my YF vaccine for free, decades ago, before insurance tightened up on all that.

So a Lima question:

I was trying to avoid 3 stays, but it isn't easy, and now that I am going clockwise it's harder. Looking at something like this, with 3 stays in Lima:

First 2 nights in Lima, to sort out the currency supply and get vaccine and meds, and get 2 nights rest in the same bed. Fly to Cusco early enough to get a taxi tour going to Ollantay.... and get there before dark.

Then coming back from Nasca (assuming now CdS to the San Isidro bus station) should the long Lima stay come here or at the end of the trip before early flight out?

In a sense the 3 or 4 night stay makes sense here, then leave for airport to fly to Iquitos, return from Iquitos then the evening before early flight out for home, is that too tight? Are those reliable flights, appear to have 6 or more a day IQT>>LIM. Could also put the long stay here at the end of the trip, then coming from Nasca go right from the bus station to an airport hotel to fly out the next morning.

Sorry I missed way up in post #33 the YF vax is for your wife. And mainly for a future trip to East Africa because with her/your insurance it would be very expensive in the US.

Probably good to have a conversation with Ceiba Tops (if that's your final Amazon basin choice) about transfers. When I stayed in a lodge farther down the Amazon (off of a tributary) there was constant rescheduling of the return flight, although it gave me a chance to have an interesting conversation with another semi-stranded passenger at the Iquitos airport. I don't know if September changes things up (I went in high water season). Also, I believe some of the aircraft flying that route have been upgraded. Bearing in mind that there are a variety of reasons that flights can be delayed, not just weather. Labor issues, moving planes around due to other cancellations, etc...

• If you are taking a bus from Nazca back to Lima, that is a LOT more reliable than flying from Iquitos to Lima.

As you have booked your return flight early, It will be less traffic that time of day. Even in all of my trips to Peru, the only time I ever stayed near the airport was when I was on a (free) connecting flight to Arequipa the next morning. I never did that on the final leg, always allowed at least two nights in Lima (to have a day's cushion, or full day for shopping and a final nice dinner). In the early morning hours the trip back to the airport is less stressful, so you don't really have to spend the night there.

Another shout out to my favorite Lima hotel (3B) and neighborhood (Barranco). They would likely be very helpful if you have trouble finding that YF jab, also. Much more than a big chain.

OK, so looking at 2 initial nights in Lima, then 1 night later when in transit from Nasca to Iquitos, then 3 or 4 nights at the end before flying out. It’s a lot of Lima.

Ceiba Tops: now considering no nights in Iquitos, then 3 nights at explorama which is farther from Iquitos and up a tributary, and a sister lodge of CT. Arriving and departing times for boats from Iquitos are on the website.

And seriously -- it's those individual risk factors that could prove of greatest import!

But honestly, I don't understand why anyone would assume that a competent travel physician -- an infectious disease specialist -- would simply read aloud from the CDC website. Or why anyone would assume that such specialists would not be informed by recent research that has not yet been incorporated into the CDC or other broadly available websites. Or why one would assume that the assessment of relative risk is dependent solely upon Peruvian YF data rather than, say, other data about risk factors, the distribution of YF-vector mosquitos, etc.

I do understand that not all travel clinics are staffed by travel physicians. At least in the US, one should be able to determine the credentials of the treating professional upon scheduling and before actually attending an appointment. Which is not to say that I doubt the value of physician extenders -- AFAIK, many are highly competent professionals.

Obviously, only the person contemplating the vaccine can actually weigh the personal risks and benefits, but I, for one, am glad to be able to call upon a qualified infectious disease expert to obtain the information I can't get by simply perusing the internet.