IAMAT |International Association of Medical Assistance to Travellers| IAMAT |International Association of Medical Assistance to Travellers|

Country Health Advice Peru

General Health Risks: Malaria

Malaria is transmitted by the night-time - dusk to dawn - biting female Anopheles mosquito.

Malaria - Overview How to Protect Yourself Against Malaria World Malaria Risk Chart

Risk is present in the country; areas of risk are specified:

Risk is present in all regions (cities and rural areas) of the Andean valleys below 2300 m / 7545 ft and the Amazon region, including the tourist areas of Manú National Park, Tambopata National Reserve (Madre de Dios), and Pacaya Samiria (Loreto). 

Note: Lima, Cuzco, Puno, Machu Picchu, Lake Titicaca, and the departments of Lima, Ica, Arequipa, Moquegua, Tacna are risk free.

Malaria risk is present below the altitude of : 2300 meters

High risk months for Malaria are: January to December

Malaria transmission vector(s): A.albimanus, A.darlingi, A.pseudopunctipennis

Incidence of Plasmodium falciparum Malaria: 15%
Of the five species of human malaria parasites, Plasmodium falciparum is the most dangerous. The remaining percentage represents malaria infections that may be caused by one or more of the following parasites: Plasmodium vivax, Plasmodium ovale, Plasmodium malariae, and Plasmodium knowlesi.

Areas with drug resistant Malaria: Multidrug resistant P. falciparum malaria is present in all malarious areas of Peru. Chloroquine resistant P. vivax malaria has also been reported. The antimalarial medications listed below are effective for this country.

Suppressive Medication Guide

All malaria infections are serious illnesses and must be treated as a medical emergency. In offering guidance on the choice of antimalarial drugs, the main concern is to provide protection against Plasmodium falciparum malaria, the most dangerous and often fatal form of the illness.

Regardless of the medication which has been taken, it is of utmost importance for travellers and their physician to consider fever and flu-like symptoms appearing 7 days up to several months after leaving a malarious area as a malaria breakthrough. Early diagnosis is essential for successful treatment.

In addition to the suggested antimalarial medication, use a mosquito bed net and effective repellents to avoid the bite of the nocturnal  Anopheles mosquito. 

The medications listed below are effective against malaria in this country. Discuss with your healthcare provider which antimalarial regimen is best suited to your needs. Take ONE of the following:

Chloroquine

TAKE IN WEEKLY DOSES OF 500 mg (300 mg base). 

START 1 WEEK BEFORE ENTERING MALARIOUS AREA, CONTINUE WEEKLY DURING YOUR STAY AND CONTINUE FOR 4 WEEKS AFTER LEAVING. TAKE IT AFTER A MEAL TO AVOID STOMACH UPSETS.

Note: The bitter taste makes the drug unpalatable. Minor stomach upsets, itching skin, nausea and diarrhea may occur. It may also cause blurred vision and a transitory headache.

Hydrochloroquine

TAKE IN WEEKLY DOSES OF 400 mg (310 mg base).

START 1 WEEK BEFORE ENTERING MALARIOUS AREA, CONTINUE WEEKLY DURING YOUR STAY AND CONTINUE FOR 4 WEEKS AFTER LEAVING.

Note: An alternative to chloroquine that may be better tolerated.

Atovaquone-proguanil

Brand names: Malarone, Malanil and others; generics available.

TAKE 1 TABLET DAILY (ATOVAQUONE 250 mg + PROGUANIL 100 mg).

START 1-2 DAYS BEFORE ENTERING THE MALARIOUS AREA, CONTINUE DAILY DURING YOUR STAY AND CONTINUE FOR 7 DAYS AFTER LEAVING.

Note: Take at the same time every day with food or milk.

Doxycycline

Brand names: Vibramycin and others; generics available.

TAKE 1 TABLET DAILY (100 mg).

START 1 DAY BEFORE ENTERING MALARIOUS AREA, CONTINUE DAILY DURING YOUR STAY AND CONTINUE FOR 4 WEEKS AFTER LEAVING.

Note: When taking this drug, avoid exposure to direct sunlight and use sunscreen with protection against long range ultraviolet radiation (UVA) to minimize risk of photosensitive reaction. Take with large amounts of water to prevent esophageal and stomach irritation.

Mefloquine hydrochloride

Brand names: Lariam, Mephaquin, Mefliam and others; generics available.

TAKE 1 TABLET OF 250 mg (228 mg base) ONCE A WEEK.

START 1-2 WEEKS BEFORE ENTERING THE MALARIOUS AREA, CONTINUE WEEKLY DURING YOUR STAY AND CONTINUE FOR 4 WEEKS AFTER LEAVING.

Note: Side effects include nausea and headache, including neurological side effects such as dizziness, ringing of the ears, and loss of balance. Psychiatric side effects include anxiety, depression, mistrustfulness, and hallucinations. Neurological side effects can occur any time during use and can last for long periods of time or become permanent even after the drug is stopped. Seek medical advice if any neurological or psychiatric side effects occur.

ALTERNATIVE TO THE ABOVE REGIMENS

Primaquine phosphate


TAKE 1 TABLET DAILY OF 52.6 mg (30 mg base).

START 1-2 DAYS BEFORE ENTERING THE MALARIOUS AREA, CONTINUE DAILY DURING YOUR STAY AND CONTINUE FOR 7 DAYS AFTER LEAVING.

Note: This medication is only recommended for travellers on short term trips to areas where P. vivax Malaria is predominant. Primaquine is also used to treat relapses of P. vivax Malaria.

Primaquine is contraindicated for persons with G6PD (glucose 6-phosphate dehydrogenase) deficiency. Screening for G6PD levels must be done prior to prescribing/using this drug.

For further details, cautions, contraindications, or alternatives if you cannot take one of these regimens, including guidelines for pediatric dosages and Emergency Self Treatment, download our whitepaper How to Protect Yourself Against Malaria.

The recommendations for malaria prophylaxis outlined here are intended as guidelines only and may differ according to where you live, your health status, age, destination, trip itinerary, type of travel, and length of stay. Seek further advice from your physician or travel health clinic for the malaria prophylactic regimen most appropriate to your needs.


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