Living in Peru : your everyday companion

by
Ryan Maves, M.D.

Familiarity breeds contempt. Every year, between 5-15% of the world’s population is infected with the influenza virus. These infections usually cause a typical upper respiratory illness, one of many lumped together as the “common cold,” but in a significant minority of cases, more severe disease and even death may result. Much of this illness occurs in the background; individual people may die of pneumonia, heart attacks, or some other common cause, but their sickness was the result of an initial influenza infection. The Centers for Disease Control and Prevention (CDC) in the United States estimates that some 36,000 people die in the US every year as the result of influenza. In Perú, the annual number of cases and deaths due to influenza are still being determined, but we can reasonably expect them to be at least proportional to those in the US. (Perú’s population of 29 million is a little less than 10% than that of the US.) With influenza such a common illness, we rarely pay it much attention, until something changes.

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Article stated:  "...separate seasonal influenza vaccines for people who travel frequently between the hemispheres..." 

We've already had the yellow fever vaccine in June 2005 while in Peru because it was required by Peru, we were told, in order to go into the jungle, even though we had no intention of going into the jungle.  Upon hearing that, we were then told, on the day they gave it, that there was some dengae fever spreading in the jungle and coming close to the city (Huanuco City, which is where we were at the time), and the 2 nurses felt sure it'd be required for us to have it before entering the US because the US had declared that part of Peru off limit to US travelers.

It was 2 nurses giving them for free from the medical clinic there in the city, but they were in the Huanuco City Plaza.  What they were doing appeared to be done with complete sanitation and professionalism, and their total confidence in us not being able to get back into the US created concern, so we let them inject us on the park bench.  We were sick for a week with fever, aching all the way to the bones, vomiting, etc.  Cocoa leaf tea and bottled electrolites were the only thing we could eat, and told not to eat anything else, and those two things pulled us through.

Will people, like us, coming to Peru in the next month or so, be required to have the flu vaccine(s) prior to entering Peru?  If it is not required now, will it change for ANY reason in the future?

We do not plan to take any of the swine flu vaccines, seasonal or otherwise.  We are seeking a way to avoid it legally. 

The above article says that we have to be allergic to components of the vaccine to avoid receiving it.  Don't know how one can prove that ahead of time, just as we weren't able to know ahead of time what kind of reaction we'd have to the yellow fever vaccine (hoping, of course, that it wasn't contaminated--is this "normal" to be giving vaccines in the city plaza??).

Anyway, what is the official, legal word regarding flu vaccine(s) in Peru for both tourists and those coming for residency, both now and in the future, prior, during, or after entering Peru?

Thank you.  Keep up the great work you do with this website!

Thank you Dr Maves. A very informative article that put to rest my apprehension about forthcoming visit to Peru. I suppose influenza in the Southern Hemisphere is a disease of late autumn and winter, which means that the odds of 'catching it' will be reduced substantially when I arrive in August.

Thank you for the kinds words and the great comments.

In response to Vaughn and Lynda Robison, you make an interesting point about yellow fever vaccines and how it might relate to influenza. Most vaccines really have two functions: to protect the individual patient, and to protect people other than the person who received the vaccine by blocking the spread of infection. 

In the case of yellow fever, many governments require proof of vaccination to prevent the spread of the disease into their countries. Influenza vaccination has a similar "double benefit", even though the direct benefit to the person getting the shot is greater. (We're much more likely to get influenza than we are to get yellow fever, thankfully.) Studies in Japan have shown that vaccinating children against influenza is an effective way to protect the elderly, for example.

People who work in health care or are in close contact with people at high risk for influenza complications should be vaccinated in influenza even if they themselves are at low risk. For example, I need to get the vaccine every year because I'm around patients with bad lungs, immune system disorders, and so forth, and I don't want to give them influenza. Similarly, a family member who takes care of a grandparent with chronic illnesses should strongly consider getting the vaccine to protect their grandparent.

You asked about allergies, and I should have been more specific. Influenza vaccines are made in a process that involves growing them in chicken eggs. People who are allergic to chicken eggs should not receive the vaccine as a result.

There are currently no legal requirements in the US or Peru to have influenza vaccination as a requirement for travel, and I am not aware of any such plans. I would encourage you to at least think hard about getting the regular influenza vaccine and the forthcoming H1N1 vaccine. I think it's the right thing to do, and I intend to get it myself, but it's a decision you'll have to make on your own. Anyway, please consider it, but it's not mandatory.

In repsonse to Shrinivas Tilak, thank you for the kind words. I suspect you're right, but the H1N1 influenza is not really observing the normal seasonal pattern of influenza in the Northern Hemisphere. Based on that, it's difficult to know what it's going to be doing here in August. (And August is still winter in Peru.) You shouldn't worry about your trip, though. As above, I'd get the regular seasonal flu vaccine as a sensible precaution, but it's not a requirement, just a good idea.

Gracias a todos,
Ryan Maves