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Do I Need the Rabies Vaccine Before My Trip?

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Key Takeaways:
  • Rabies is serious, often fatal disease that is prevalent in much of Asia, Africa, and Latin America.
  • Rabies is vaccine-preventable.
  • If you are traveling to rural areas of the developing world, the pre-exposure vaccine may be a crucial part of your travel planning.

You’ve planned your exotic trip abroad, and you know that a variety of pre-travel vaccinations may be necessary to keep you healthy and well during your travels.  Depending on your destination and itinerary, the Rabies Vaccine may be a crucial part of your pre-travel health regimen; this widespread disease can have serious, or even fatal, consequences.  Although rabies is preventable with a vaccination, over 55,000 people die each year from the disease, primarily in Africa and Asia where prevention and treatment are not widely available.  Be sure to take adequate precautions by visiting a Travel Health Specialist for individualized recommendations, but read on for disease and vaccine information and prevention strategies.

The Facts About Rabies

Rabies is a virus that is classified as a zoonotic disease. This means that the virus can be transferred from animals to humans. The virus is located in the saliva of infected animals and is typically transferred through a bite or scratch. Most humans who contract rabies are infected by a dog, but bats, skunks, foxes, raccoons, jackals, and other wild animals are also carriers of the disease.

It’s very important to receive treatment when bitten or scratched by an animal. Sometimes, rabies symptoms don’t show up for months, but, once they do, the disease is often fatal. Early symptoms of the disease may include a headache, fever, and weakness.  As the virus progresses, more serious symptoms develop. These symptoms can include anxiety, restlessness, trouble sleeping, confusion, hallucinations, difficulty swallowing, drooling, and agitation.

Preventing Rabies

Both pets and humans can be vaccinated against rabies. Pets can get their vaccinations from a veterinarian, and this method is a very cost-effective means of reducing disease transference. Unfortunately, however, pet vaccinations are typically not prevalent in the rural areas of many developing countries.  Therefore, if your travel plans include stops in rural villages, the pre-exposure vaccine may be a crucial one for you.

The rabies pre-exposure vaccine is available at all Passport Health travel clinics.  Note that even if you’re not traveling, this vaccine could be recommended for you if your job requires that you come into regular contact with animals, so animal handlers and veterinarians should be up-to-date on this vaccination.  The vaccine is  recommended for those who plan to travel in parts of the world where rabies is still prevalent, such as Asia, Africa, and many parts of Latin America. Travelers who will be spending a lot of time outdoors hiking, camping, and exploring should also be vaccinated.

The human rabies vaccine is given in three doses. The second dosage is administered seven days after the first. For those who are continually exposed to animals or the rabies virus, it’s recommended that they be tested occasionally for immunity to the disease and that a booster be given when it is needed.

Travelers to countries where rabies poses a health risk should take care to avoid infected animals.  Avoid any animal that is acting strangely, including domesticated pets. Outdoor travelers should take care to avoid wild animals.

Treatment for Rabies

In the event of an animal bite or scratch, immediate treatment is necessary to mitigate the possibility of disease onset. The wound needs to be thoroughly cleaned, and if a pre-exposure vaccine has never been received, then a post-exposure prophylaxis needs to be administered. The recommended first-aid procedure to clean the wound includes washing and flushing it for 15 minutes with water and soap, iodine, or any other substance that can kill the virus.

In summary, remember that rabies is a very serious disease carried by millions of animals all over the world. If the disease is spread to a human, it is usually fatal unless that person gets treatment. The risk of rabies would be greatly reduced if more pets received a rabies immunization, but such vaccines are largely unavailable or are viewed as too expensive in many developing countries.  Therefore, if your travels take you through the developing world, be sure to consider the rabies vaccination.

Unsure of Your Vaccination History? Titer Testing is for You!

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Key Takeaways:
  • Antibody titer testing measures the body’s immunity to disease.
  • Titer testing provides a cost-effective means of determining which vaccines are necessary when records are lacking.
  • Titer tests are available for individual and corporate clients at all Passport Health clinic locations.

Since childhood, we have been immunized against a range of diseases to keep our bodies healthy and well.  However, it can be challenging to keep record of all of these vaccines throughout the years, especially as we move and change healthcare providers. No one wants to get an extra shot or pay for an immunization that is not necessary, and this is precisely where antibody titer testing comes in. A titer test is a measure of antibodies in the blood, providing a check of disease immunity. The results of a titer test then allow a clinician to determine whether a vaccination is required.

A titer test involves a simple blood draw. The sample is analyzed, and results are returned within 24 to 72 hours. All Passport Health clinics offer a full range of laboratory test services, including all antibody titer testing.

Perhaps you can’t remember for certain whether you had a case of a given disease in the past, have misplaced your immunization records over the years, or can’t get in touch with your Primary Care Provider to get your medical records.  A titer test, however, will give your clinician a measure of your immunity and solve these memory and record keeping problems. Therefore, titer testing and vaccinations go hand in hand.

Titer Testing: Cost Savings
Passport Health makes every effort to not re-vaccinate if vaccination is not, in fact, necessary by offering titer testing at all locations and to all patients. As a result, our experienced clinicians are able to save individual patients a significant amount of money by first checking immunity to Hepatitis A, Hepatitis B, Hepatitis C, Varicella, Rabies, and MMR, for example.

Moreover, a titer test is virtually no risk – it merely involves a simple blood draw with results available almost immediately.

Titer testing is similarly beneficial for Passport Health’s corporate clients. Cost savings are evident when comparing the cost of a titer test to the cost of vaccination. Titer testing is a crucial component of any vaccine credentialing program; call Passport Health today to learn how to integrate this service into your company’s wellness program!

Source:
https://health.nytimes.com/health/guides/test/antibody-titer/overview.html

Japanese Encephalitis Risk in South Korea

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Key Takeaways:
  • Japanese encephalitis can cause inflammation of the brain and approximately 25% of cases in which the brain is affected are fatal.
  • Travelers to South Korea should consider receiving the vaccination against Japanese encephalitis.
  • Children have a higher risk than adults of contracting Japanese encephalitis.
  • In a recent test conducted in the city of Busan, 64% of the mosquitoes that were examined tested positive for Japanese encephalitis. These findings prompted the Korea Centers for Disease Control to issue a nationwide alert.

A viral infection that is most commonly characterized by mild symptoms to no visible symptoms at all, Japanese encephalitis may also cause inflammation of the brain in a small percentage of infected humans. Symptoms of brain inflammation may include high fever, headache, tremors, coma, disorientation, and convulsions. Approximately 25 percent of cases in which the brain is affected are fatal. There is currently no specific treatment for Japanese encephalitis; however, much of the disease risk can be mitigated by receiving a vaccination and taking proper mosquito precautions.

Japanese Encephalitis Risk to Travelers

Risk of infection for those who will be traveling to areas that have reported cases of Japanese encephalitis is relatively low. Nevertheless, travelers are advised to take precautions, as infection may occur. The virus is transmitted to humans through the bite of infected mosquitoes that belong to the Culex species, namely Culex tritaeniorhynchus. Transmission most commonly occurs in rural agricultural parts of Asia, where rice production and regular flooding often take place. Transmission is seasonal in temperate parts of Asia with summer and fall being the times of year during which the highest number of human cases are reported. The disease may be transmitted at any time of the year in tropical and subtropical regions, though the number of cases may peak during the rainy season.

Japanese Encephalitis in South Korea

Travelers to South Korea, in particular, should consider receiving the vaccination against Japanese encephalitis. In a recent test that was conducted in the city of Busan, 64 percent of the mosquitoes that were examined tested positive for the disease. The results of the tests prompted the Korea Centers for Disease Control to issue a nationwide alert. Because mosquitoes in the area are most active until the end of October, people are advised to use mosquito nets and to limit their time spent outside during the warmer months. Researchers believe changes in climate are helping mosquitoes that are affected by the disease breed in ever greater numbers.

Most Vulnerable Groups

Children have a higher risk than adults of contracting Japanese encephalitis. In response to the perceived threat the disease may pose for children in the Korean peninsula, the global relief group Carnitas has vaccinated 430,000 children in the peninsula against the virus at the time of this writing. The group plans to vaccinate 2.3 million children against the disease by the end of 2013.

Travelers who are planning a trip to South Korea should consider visiting a travel healthcare professional several weeks before their trip. Travel health specialists offer clients the benefit of learning more about health concerns and how they may affect travel, receiving a pre-travel checkup, as well as vaccines and malaria prophylaxis drugs all in one place. Travel clinics also offer advice regarding passport-related issues, tips for remaining safe, as well as addressing other needs that may arise for people who are planning to go abroad. Whether you are a first time overseas adventurer or a seasoned travel veteran, scheduling an appointment with a travel health specialist is always the best way to prepare for an upcoming journey.

Source:
https://www.cdc.gov/japaneseencephalitis/index.html

Employee Physical Exams: Healthy Employees = A Healthy Bottom Line

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Industry-leading Research
Industry-leading Research
Key Takeaways for Employers:
  • The nation’s health crisis is taking a financial toll:  Employers spend an average of $18,000 per employee each year on costs related to illness and worker productivity.
  • Early detection of disease during a physical exam is a key means to cut costs that result from chronic disease.
  • Absenteeism, and the consequent need for sick pay, replacement employees, and re-training is extremely costly, as is the decline in productivity from sick employees.
  • Exam programs have been shown to significantly decrease rates of absenteeism and boost employee productivity.
  • Physical Examination Programs have a measurable, positive Return on Investment.

Healthcare expenditures are rising exponentially within the United States.  According to the Centers for Medicare and Medicaid Services, national healthcare spending comprised a shocking 17.9%[i] of annual GDP in 2011 – and this figure is expected to grow to 19.6% of GDP by 2021.  Since 1960, total health expenditures have increased at a significantly faster pace than the economy.[ii] One must wonder: What is the culprit?

In 2011, the nation spent $2.7 trillion on healthcare,[iii]  and studies have shown that approximately 75% of healthcare expenditures are spent on the treatment of chronic diseases such as hypertension and type 2 diabetes.[iv]  This percentage comes as no shock given that over 100 million Americans presently live with at least one chronic disease.[v]  However, disease does not only take a toll on individuals and their families; the burden of disease on employers is financially significant as well.  Employers now spend, on average, at least $18,000 per employee per year[vi] on costs directly related to illness and the impact of illness on worker productivity.

Taken at an aggregate level, these statistics are even more alarming. Poor employee health is anticipated to cost the national economy at least $260 billion each year in lost productivity.[vii]

Clearly, steps need to be taken to mitigate the nation’s health crisis and the resulting financial toll on employers.  Fortunately, the detrimental side effects and mounting costs of many diseases can be avoided altogether.  What is the best way to avoid disease?  The answer is simple: early detection.  Indeed, employee wellness programs that include physical exams and biometric testing can detect diseases in their earliest and most treatable stages, significantly reducing employer medical expenses and, of course, also potentially saving employees’ lives.

The majority of US employers offer some type of employee wellness services.  However, programs can be quite basic, and a 2012 survey released by the International Foundation of Employee Benefit Plans revealed that 30% of American employers[viii] currently do not offer employee wellness programs at all.

Is your company part of this 30%, or do your wellness initiatives lack a physical examination component?  Even though there is a cost associated with implementing a new program, physical examinations have a measurable, positive return on investment (ROI) on both your employees’ health and your company’s financial statements through reduced health care costs, lower rates of absenteeism, and enhanced productivity.

Poor employee health is expensive.  Employers spend $18,000 per employee each year on costs related to illness and lost productivity.  The national economy loses $260 billion annually due to lost productivity from sick workers.

Health Care Cost Reduction

The seven most common chronic diseases, hypertension, stroke, heart disease, diabetes, cancer, and mental and pulmonary disorders, cost employers at least $1.3 trillion each year.[ix]

However, many of these diseases can be readily detected during their early stages via the basic tests such as blood pressure monitoring, complete blood counts, chest X-rays, and urinalysis that comprise a typical physical examination, and early detection saves money.  Indeed, by providing employee wellness programs that include event-specific physicals, many nationwide employers have decreased their employee health care cost burden by $1 – $3 for every dollar spent.[x]  Other analyses show that wellness programs, including annual physical exams, have reduced employers’ health costs by an average of 26.1%.[xi]

In 2010, Health Affairs released an analysis of wellness programs that include employee physical exams.  This study found that such initiatives reduced companies’ health costs by $3.27 for every dollar spent.[xii]  Another investigation discovered wellness programs and physical exams diminish workers’ compensation and disease management costs by up to 32%.[xiii]

Here is yet another example of the cost-saving benefits of corporate physical examination programs.  Since 1983, Bank One has conducted executive physical exams at its corporate headquarters. During a three-year period, Bank One discovered that it paid $5,361 in medical claims for executives who received annual physical exams. In contrast, it paid $6,426 per executive who was not evaluated each year.  In other words, the company’s physical examination program allowed Bank One to save over $1,000 per employee on an annual basis.[xiv]

Physical Exams Save Money:
  • Annual physicals saved Bank One $1,000 per employee each year.
  • Lafarge North America saved $30 million over 3 years with a wellness program that included physical exams.
  • Chippewa County, Wisconsin, cut expenditures on county employee healthcare by $500,000 following the implementation of wellness services.

Further examples of cost-savings tied to physical examinations abound.  In an effort to ease medical costs, Chippewa County, Wisconsin, established a wellness program for county employees that includes a physical exam with biometric testing, resulting in a total health care cost reduction of $500,000 in 2008 alone.[xv] Lafarge North America, a large supplier of construction materials, saw similar results with its “Building a Better You” program, which includes on-site physicals. Over a span of three years, the company saved $30 million in medical and pharmacy costs and saw fewer employee hospital visits and less disability incidence due to healthier employees.[xvi]  Finally, by offering employees annual physical exams and other wellness initiatives, Confluence, a financial services software provider, decreased its healthcare premiums by 13%.[xvii]

As the previous examples demonstrate, the short-term costs of annual employee physicals are far less than the long-term expenditures that result from employee illnesses, hospitalizations, and surgeries.  Time after time, researchers have found that by investing proactively in employee healthcare, companies have been able to realize a much healthier bottom line.

Absenteeism

In addition to unpredictable or seasonal illnesses, employee absenteeism can be caused by hospitalizations, surgeries, and other medical procedures that become necessary to provide care for chronic conditions.  Multiple costs result when employees are away from work.  For example, businesses must pay for employee sick and disability leave and may need to invest time and money in finding a temporary or replacement employee.  However, it is possible to take preventative steps to mitigate these costs.  Indeed, according to a 2013 Cornell university study, by emphasizing and investing in employee health to identify diseases and latent conditions, many US-based companies have been able to reduce absenteeism by 28% while cutting health care and workers’ compensation claim costs by similar margins.[xviii]

Absenteeism is Expensive: Exams Offer a Healthy Return on Investment
  • Sick pay and hiring and training replacement employees add up.
  • Physical exams that identify diseases before they become serious conditions have reduced rates of absenteeism by 28%.
  • Studies have found that every dollar invested in employee wellness cuts the costs of absenteeism by $2.73.

US companies aren’t the only ones working to reduce absenteeism via investment in employee health, and the cost savings from lower rates of absenteeism has been noted worldwide.  In recent years, a wide range of global companies have taken steps to reduce the financial impact of absent employees by implementing employee physical exam programs. For example, by setting up on-site physical exam clinics, Parcelforce Worldwide, an express parcels provider, has decreased rates of employee absence due to illness by nearly 30%.  Similarly, Foyle Food Group’s physical exams have helped diminish absenteeism by 15% overall, have kept short-term absence below 3% of the workforce, and have decreased the number of employees out of work for more than seven days by 84%. Furthermore, Ernst & Young’s London headquarters’ annual employee physicals have resulted in a 3% fewer days lost to absence across the total workforce, even though the total size of the workforce has grown.[xix]

The financial benefits of physical exams and employee wellness programs have been well-documented in leading American-based healthcare publications and journals. Health Affairs noted that for every dollar spent on employee wellness, absenteeism costs fell by $2.73.[xx] The publication also revealed that wellness programs that include a physical exam can moderate sick leave, disability costs, workers’ compensation, and other health plan-based costs by at least 20%.[xxi]

Frequently, companies’ solutions to absenteeism, including temporary hiring and work-from-home alternatives, constitute immediate fixes instead of long term solutions to the problem.  However, as the previous examples demonstrate, by identifying employee illnesses during physical exams, companies can lessen the financial burden of absenteeism.  Importantly, exams also provide companies with an opportunity to make sure employees are up-to-date on all of their vaccinations, another crucial means of staving off seasonal illness and promoting general good health.

Productivity

Often, employees opt to continue to work on a full-time or part-time basis in the midst of illness, disease diagnosis, and other health maladies, but this decision can lead to weakened on-the-job performance, often referred to as “presenteeism”.  Employees who are physically weakened or overwhelmed by health conditions cannot fully concentrate on job responsibilities, leading to diminished productivity, project postponements, and below-average work quality, all of which negatively impact a company’s bottom line.

Employee productivity is a primary concern for any employer. In fact, a report released by Hewitt Associates found that 65% of surveyed employers viewed employee health and productivity as one of the top three business issues.[xxii]  Across the globe, organizations are reacting to employee presenteeism by developing worksite clinics and offering wellness programs with annual physicals to their employees.

For example, by providing on-site health clinics and physical examinations, Parcelforce Worldwide has increased employee productivity considerably.  Indeed, productivity increased by nearly 13 percent following implementation of the company’s exam program.  In a similar vein, AstraZeneca saved up to £700,000 as a result of wellness programs, and much of this savings was tied to enhanced employee productivity.[xxiii]   In yet another example, by offering employees prevention-focused healthcare programs such as blood pressure monitoring, GlaxoSmithKline has increased employee performance and productivity by 7 to 13 percent.[xxiv]

Employee productivity is a top concern for 65% of employers.  Multiple studies have shown physical examination programs boost productivity by up to 13%.

Conclusion and Implications

Employee wellness programs and physical exams have been broadly utilized by global companies to significantly diminish healthcare costs and reduce rates of absenteeism and presenteeism.  Such programs have a measurable ROI and will enhance your company’s bottom line.  Only one question remains: How can you best implement a physical examination program to save your company money?  Passport Health makes the answer simple.  Building on extensive corporate wellness contract experience and a history as the nation’s largest provider of travel medical and immunization services, Passport Health offers a wide array of examination options, including pre-travel, pre-deployment, and employment exams that are specifically tailored to the unique needs of any company.  To keep your employees well to work, set up a comprehensive Passport Health Physical Examination Program today!


[i] Centers for Medicare and Medicaid Services “National Health Expenditure Projections 2011-2021.”

[iii] Centers for Medicare and Medicaid Services, “National Health Expenditure Projections 2011-2021.”

[v]Deloitte, “Technology-Enabled Care at Home,” 2008.

[vii] Davis, Karen, et al., “Health and Productivity Among U.S. Workers,” The Commonwealth Fund, August 2005.

[viii] International Foundation of Employee Benefit Plans, Wellness Programs and Value-Based Health Care Third Edition, 2012.

[ix] Norman, Gordon. “Build a Better Business Through Better Healthcare for Employees,” International Foundation of Employee Benefit Plans, 2009.

[x] Society for Human Resource Management, “Study: Wellness Programs Saved $1 to $3 per Dollar Spent,” September 12, 2012.

[xi] Bolnick, Howard, “Wellness Programs: What Can Be Learned from US Company Experience,” Benefits & Compensation International, April 2009.

[xii] Baicker, Katherine, David Cutler, and Zirui Song, “Workplace Wellness Programs Can Generate Savings,” Health Affairs, February 2010.

[xiii] Bolnick, Howard, “Wellness Programs: What Can Be Learned from US Company Experience,” Benefits & Compensation International, April 2009.

[xiv] Burton, Wayne, et al., “The Value of the Periodic Executive Health Examination: Experience at Bank One and Summary of the Literature,” Journal of Occupational and Environmental Medicine, August 2002.

[xv] Fendrick, A. Mark, Kimbery Jinnett, and Thomas Parry, “Synergies at Work: Realizing the Full Value of Health Investments,” National Pharmaceutical Council, February 2011.

[xvi] Fendrick, A. Mark, Kimberly Jinnett, and Thomas Parry, “Synergies at Work: Realizing the Full Value of Health Investments,” National Pharmaceutical Council, February 2011.

[xvii] Shaw, Janis, “Incentivizing Good Health: A Mid-Sized Firm’s Success Story,” Society for Human Resource Management, October 25, 2012.

[xviii] Central Health Connection, “Health and Health Care Trends and Innovations in Central Texas,” October 2011.

[xix] Business in the Community, “Healthy People = Healthy Profits,” February 2009.

[xx] Baicker, Katherine, David Cutler, and Zirui Song, “Workplace Wellness Programs Can Generate Savings,” Health Affairs, February 2010.

[xxi]James, Julia, “Workplace Wellness Programs,” Health Affairs, May 10, 2010.

[xxiii] Business in the Community, “Healthy People = Healthy Profits,” February 2009.

[xxiv] Business in the Community, “Healthy People = Healthy Profits,” February 2009.

Which Vaccinations Do I Need for Peru?

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Machu Picchu, Peru

A trip to Peru with a hike up the Inca Trail is one of the top trips in the world. But, Peru is more than just ruins and trails. The jungles of eastern Peru are some of the most amazing in all the Amazon, and Lake Titicaca is a must visit.

Peruvian travel also poses certain health risks. Food- and mosquito-borne illness are common as well as travelers diarrhea, just to name a few. Be sure to take proper precautions before venturing to The Land of the Incas.

Which Vaccines Do I Need for Peru?

If you’re headed to Peru, you need to make sure that you take steps to safeguard your health. The CDC and WHO recommend visiting a travel health clinic at least four weeks before you leave.

Vaccines for Peru vary based on your specific itinerary. A Passport Health travel specialist will help you decide which vaccines are best for you. The CDC and WHO have recommended that travelers receive the following vaccines:

Is Malaria in Peru?

Malaria is a common mosquito-borne disease especially in South and Central America. Peru is no exception with an estimated 64,000 malaria cases each year. The Loretto region, a popular tourist destination, accounts for a high percentage of the Amazon’s malaria cases.
If you are planning to travel to the jungles of Peru, take some type of antimalarial medication with you. This is especially important during the summers.

What Other Health Concerns Should I Be Aware Of?

Peru is a generally safe place to travel. Follow the same rules you would in any developing country when it comes to food or other activities:

  • Street Food– While often incredible, street food can pose a serious risk to your health. The CDC recommends avoiding it at all times.

  • Water Sources– Peru does not have water sources as pure as those in North America. While in-country, avoid tap water and ice. Consider purchasing bottled water or other drinks in the area or bringing a water filter.

  • Dengue Fever– Peru has reported a large number of denuge cases at various times. As a mosquito-borne disease, repellents are the best way to protect yourself.

  • Zika Virus– While not yet prevalent in Peru, Zika virus has been documented there. Take extra precautions to avoid mosquitoes. This is especially true if you are pregnant or may become pregnant.

  • Chikungunya– There is currently a Level 1 health alert in place for chikungunya in Peru. The CDC recommends taking precautions for against mosquitoes to protect yourself from the disease.

Handy Tips for Enjoying the Peruvian Andes

First, bring sunscreen. Even if it is cloudy outside, you can still get a sunburn while exploring Machu Picchu or the Inca Trail. Select a good sunscreen that is SPF 50 or higher, and apply it several times throughout the day.

When you arrive in Peru, you will receive an Andean migration card instead of a visitor’s visa. You cannot lose this piece of paper as you will need it to stay in hotels and even leave the country. We recommend keeping it clipped to the front page of your passport.

When you go to Machu Picchu, you may need to bring your passport. This may vary based on your specific itinerary. But, consider doing so anyway as you can get a novelty passport stamp there.

Don’t be afraid to ask your hotel to help set up a trip for you. Many locations work with local guides and will be able to help you find a guide. They can arrange transportation for you as well. But, most locations are within a short distance of each other within cities.

If you plan on traveling long distance, such as Cusco to Puno, buses are the way to go. They are usually inexpensive, only about 40 soles, but can be time consuming. Consider traveling at night to maximize your free time.

Going to Peru? Make an Appointment with a Travel Health Specialist Today!

By scheduling a consultation with a travel health specialist, you can help ensure spend every minute of your trip enjoying Peru. Vaccinations can mean the difference between a great time and a serious illness. It makes sense to take care of your health before you go.

We Want To Hear From You!

Have you been to Peru? Share your favorite tips with us in our comments section below. Or reach out to us on Facebook or Twitter with your thoughts.

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