Vaccines and Health for Overland Travel in South America

Health is the item on the departure checklist that the most people underestimate. Most Brazilian overlanders approach the vehicle, the documents, the currency and the connectivity with care. And they leave the human side for the last minute, thinking that "getting a vaccine can be sorted out in the week before." It will go wrong: several vaccines need time to take effect, the International Certificate doesn't come out overnight, and altitude medication needs a prescription in advance.

This article is the complete health checklist for an overland trip through South America. It works for a short two-week trip as well as for a long route of months. Those who follow the order of the steps prepare with room to spare and leave relaxed. Those who ignore it find out, usually at a border, that a signature or a stamp was missing.

In short: the basic package is yellow fever (mandatory for Bolivia, Peru, Ecuador, Colombia), tetanus up to date, hepatitis A and B, MMR and COVID-19. For rural areas, typhoid fever and rabies join the recommended list. Start at least 45 days before departure. Add to that international health insurance, a first aid kit and specific care for altitude if the route passes through Bolivia, Peru or northern Chile and Argentina.

Vaccines: mandatory and recommended

Mandatory to cross the border

• Yellow fever: mandatory to enter with a car in Bolivia, Peru, Ecuador, Colombia, Venezuela, Suriname, Guyana and French Guiana. Argentina, Chile, Uruguay and Paraguay don't require it but recommend it. Brazil is a transmission country, so to return from some of these countries proof is also required. Once taken, a single dose is valid for life (schedule updated by the WHO).

Recommended for any route

• Tetanus (dT or dTpa): booster every 10 years. Essential for any trip with a chance of injury, and overland always has a chance.
• Hepatitis A: risk from contaminated water and food. Strong in rural areas of Bolivia, Peru and northern Brazil. Two-dose schedule (6-month interval).
• Hepatitis B: risk from any contact with blood, needles, deep wounds. Three-dose schedule (stretched over 6 months).
• MMR (measles, mumps, rubella): sporadic outbreaks in several countries of the region.
• COVID-19: schedule updated according to the current recommendation.

Recommended for specific routes

• Typhoid fever: for those going to rural areas with poor sanitation (deep Bolivia, rural Peru). Single dose, valid for 3 years.
• Rabies (pre-exposure schedule): for routes where contact with wild animals or street dogs is likely. Three doses over a month.
• Influenza: annual, especially for those traveling in autumn and winter.

Most basic vaccines are free in the public network (UBS). Some optional ones (typhoid fever, pre-exposure rabies) are usually paid at private clinics.

International Certificate of Vaccination (CIVP)

To cross the border of a country that requires yellow fever, verbal proof isn't enough. You need the International Certificate of Vaccination or Prophylaxis (CIVP), issued by Anvisa. It goes together with the rest of the checklist of documents for crossing borders.

How to get it:

1. Get vaccinated against yellow fever at a UBS or clinic, at least 10 days before the trip, because the vaccine needs to take effect for the certificate to be issued.
2. Go to the Anvisa website (Gov.br) and request the CIVP online. You just upload the vaccination record. Issuance is free.
3. Print or download the PDF with the QR Code. This is the document you present at the border.

In-person alternative: Anvisa at international airports and ports. No appointment needed, but with lines.

Note: the electronic CIVP (digital, with QR Code) has been accepted at almost every border since 2021. But some small-town borders still prefer the physical document. Always print it.

First aid kit: what fits in the box

A kit that fits in a medium-sized box and covers 90% of real travel situations. The rest of what goes in the car is in the complete list of what to pack.

Bandages and antiseptics:

• Band-Aids in assorted sizes
• Sterile gauze and medical tape
• 70% alcohol and chlorhexidine
• Saline solution (small bottle for rinsing)

Basic medications:

• Pain reliever (paracetamol, dipyrone)
• Anti-inflammatory (ibuprofen)
• Antihistamine (loratadine, dexchlorpheniramine)
• Antiemetic (dimenhydrinate, for car sickness and altitude sickness)
• Anti-diarrheal (loperamide)
• Oral rehydration salts in sachets
• Insect bite ointment
• Healing ointment

Specific items:

• Insect repellent (DEET or icaridin)
• Sunscreen SPF 50+ (at altitude the sun burns much faster)
• Thermometer
• Tweezers to remove ticks or splinters
• Small scissors

For ongoing use:

• Regular medication (with a copy of the prescription for the border)
• Contraceptive, if applicable
• Spare contact lenses or glasses

Almost every mid-sized city in South America has a pharmacy. But on a remote route, having the kit saves a round trip of hours to solve a small problem.

International health insurance

A private medical consultation in Argentina, Chile, Uruguay and Bolivia is usually cheaper than in Brazil at commercial exchange rates, and generally accessible. But hospitalization and surgery change the equation. Without insurance, the bill can be very high.

It's worth getting international health insurance especially for:

• Long trips (over 30 days)
• Routes with high altitude (Bolivia, Peru, northern Chile and Argentina)
• Itineraries with adventure activities (trekking, severe off-road)
• People over 50 or with a preexisting condition

What to evaluate when buying:

• Coverage per event (don't confuse it with total coverage): how much it covers for hospitalization, for surgery, for dental emergencies.
• Medical repatriation: in a serious case, the cost of going back to Brazil can be absurd. Make sure you're covered.
• Geographic coverage: confirm that it covers every country on the route.
• Sports and activities: some insurers exclude trekking above a certain altitude, off-road and mountaineering. Read the policy.
• Deductible: how much you pay before the insurance kicks in.

Bonus: some premium credit cards already include international travel insurance with reasonable coverage. It's worth checking before buying a separate plan.

Altitude: the care you can't improvise

If the route goes through Bolivia (Uyuni, La Paz, Lagoons), Peru (Cusco, Puno), northern Argentina (Salinas Grandes, Hornocal) or Chile (Altiplano Lagoons, Tatio), altitude becomes the protagonist. Altitude sickness (soroche) starts to affect people from 2,500m and becomes more likely above 3,500m.

Common symptoms:

• Strong headache
• Nausea and loss of appetite
• Fatigue and weakness
• Insomnia on the first night at altitude
• Shortness of breath with small exertion

Prevention that works:

• Gradual ascent: spend 2 to 3 days at moderate altitude (2,000 to 3,000m) before going above 4,000m. Those who fly straight from Lima to Cusco suffer more than those who go up by car.
• Intense hydration: twice as much water as normal.
• No alcohol in the first two days at altitude.
• Light food: a heavy meal complicates things.
• Coca leaf or coca tea: a local tradition that really works. Sold in any market in the Andean region.
• Acetazolamide: a medication that helps with acclimatization. Requires a medical prescription before the trip. Don't take it without guidance.

In case of severe altitude sickness (mental confusion, extreme difficulty breathing, persistent vomiting), descending immediately is the treatment. Don't try to take medicine and keep going.

Use GT Overlander to size up acclimatization on the route. By describing the trip in natural language, the AI builds the route considering altitude. Useful for avoiding the common mistake (going up too fast) that costs a whole day of travel lost to a heavy head.

Water, food and critters

• Tap water: drink bottled water in Bolivia, Peru, parts of northern Brazil and rural areas in general. In the capitals of Argentina and Chile, treated water is safe. When in doubt, boil it or use purifying tablets.
• Fruits and vegetables: if you're going to eat them raw, wash them with bottled water. Tourist restaurants usually treat them. At a small-town market, it's better to avoid raw vegetables.
• Undercooked meat: avoid it at a dubious establishment. Risk of brucellosis (beef) and cysticercosis (pork).

As for critters:

• Mosquito: dengue, Zika and chikungunya in almost all of Brazil and northern South America. Malaria in specific Amazon regions (Acre, Roraima, Amazonian Bolivia, Peruvian jungle). Always use repellent.
• Tick: spotted fever in southern and southeastern Brazil and northern Argentina. Do a body check after a hike.
• Spider: extra attention in southern and southeastern Brazil.
• Snake: unlikely on a tourist route, but be careful when stopping in the wild.

When to start preparing

45 days before departure is the comfortable minimum to:

1. Book a medical appointment to review that vaccines are up to date and to prescribe altitude medication if needed.
2. Get or update vaccines with time for them to take effect.
3. Request the CIVP from Anvisa, 10 days after the yellow fever vaccine.
4. Research and buy international health insurance.
5. Renew the prescription for ongoing medication with a legible copy.
6. Buy the first aid kit and organize it in the box.

Those who leave it for 2 weeks before can still get several vaccines, but lose the full effect of some. With 1 week before, it's no longer possible to do yellow fever with the CIVP in time: you have to postpone the trip or work around the route to avoid countries that require it.

Frequently asked questions

I got the yellow fever vaccine more than 10 years ago, do I need a booster?

The WHO updated this in 2014: one dose is valid for life. But some countries still require a booster every 10 years by their own criteria. When in doubt, check the destination country's official website before traveling. The booster does no harm.

Can I get several vaccines on the same day?

In general yes, following medical guidance. But avoid mixing with a live-virus vaccine on the same day if it's the first dose of some. The doctor who administers them will advise you.

What if I get severe altitude sickness on an isolated route?

Descend as fast as possible. Don't improvise. On a route like the Bolivian Altiplano Lagoons, that can mean interrupting the trip and going down to the nearest city at a lower altitude. Accept losing a stop, health first.

Does my Brazilian travel insurance or health insurance already cover me abroad?

A traditional Brazilian health plan does not cover care abroad. You need specific international travel insurance, or health insurance with an international extension (more expensive). Confirm with your provider before the trip.

What should I do if I'm seriously injured on a route with no hospital nearby?

Plan A: drive to the nearest mid-sized city. On almost any tourist route there is a city with a hospital within a radius of 100 to 200 km. Plan B: call the health insurance hotline, they will direct you to the nearest care. For a serious emergency, some countries have an air rescue service (included in comprehensive insurance).

Wrapping up

Health on an overland trip isn't a dramatic topic, it's a topic of organization. Whoever starts 45 days before solves almost everything in a week of attention, and leaves relaxed. Whoever leaves it for the last minute finds out, usually at a bad moment, that the item you can't work around is missing. The good news: after you do it once, the basic package stays up to date for years. You just renew an insurance, do a check, and set off again.