1. Amazon basin bordering Brazil (especially Loreto province), other rural areas below 2000m (incl Amazon basin bordering Bolivia):
There is a low risk of malaria. Advise mosquito bite avoidance.
2. Lima and the coast south of Chiclayo:
There is no risk of malaria. Advise mosquito bite avoidance.
Special risk groups
In low risk areas, antimalarials may be considered in exceptional circumstances for travellers who are at higher risk of malaria (such as long term travellers visiting friends and relatives), or of severe complications from malaria (such as the elderly [>70 years], the immunosuppressed, those with complex co-morbidities, pregnant women, infants and young children).
Travellers with an absent or poorly functioning spleen should be dissuaded from travel to any area with risk of malaria, but where travel is essential awareness, rigorous bite avoidance and antimalarials should be advised.
Travellers should be up to date with routinely recommended vaccinations according to the routine UK immunisation programme.
Vaccination could be considered for travellers whose activities put them at increased risk, including those visiting friends and relatives, and frequent or long-stay travellers to areas where sanitation and food hygiene are likely to be poor.
Vaccination recommended for all previously unvaccinated travellers. Hepatitis A vaccine is well tolerated and affords long-lasting protection.
Vaccination recommended for travellers whose activities or medical history put them at increased risk, including those who may have unprotected sex, those who may be exposed to contaminated needles (eg, through injecting drug use or receiving medical or dental care), those who may be exposed to blood or body fluids through their work (eg, health workers), long-stay travellers, those who are participating in contact sports and families adopting children from this country.
Vaccination recommended for travellers whose activities put them at increased risk, including those at risk due to their work (eg, health workers or those working with animals), those travelling to areas where access to post-exposure treatment and medical care is limited, those planning higher risk activities such as running or cycling, and long-stay travellers.
Vaccination is recommended for travellers aged 9 months of age and older travelling to the following areas below 2,300m: the regions of Amazonas, Loreto, Madre de Dios, San Martin, Ucayali, Puno, Cuzco; Junín, Pasco and Huánuco and designated areas of the following regions far-north of Apurimac; far northern Huancavelica; far-north-eastern Ancash; eastern La Libertad; northern and eastern Cajamarca; northern and north-eastern Ayacucho, and eastern Piura.
Vaccination is generally not recommended for travellers whose itineraries are limited to areas west of the Andes (regions of Labayeque and Tumbes and designated areas of western Piura and south, west and central Cajamarca), but could be considered for a small subset of travellers to such areas who are at increased risk because of:
- Prolonged travel
- Heavy exposure to mosquito bites
- Inability to avoid insect bites
Vaccination is not recommended for travellers whose itineraries are limited to areas above 2,300m, areas west of the Andes not listed above, the cities of Cuzco and the capital city of Lima, Machu Picchu, and the Inca Trail.
Travellers should have completed a primary vaccination course according to the UK schedule. If travelling to a country where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously.
Vaccination recommended for travellers at increased risk of developing severe disease and/or of exposure to TB, including unvaccinated children under 16 years of age who are going to live for more than 3 months in this country and unvaccinated, tuberculin skin test negative individuals under 35 years of age at risk because of their work (eg, healthcare workers, prison staff and vets).