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I think there is plenty of good advice above. I have been to Huaraz twice and was pretty paranoid about what I ate and drank- I still had gastrointestinal illness both times. First, I would definitely get a hepatitis A and typhoid vaccine. I believe my second illness was typhoid which is quite a bit worse than typical traveler's diarrhea. I almost always ordered bottled water "con gas"- carbonated just in case someone was tempted to put tap water into bottles. The ceviche is quite good there but keep in mind it has raw fish "cooked" with lime juice- I waited until I was done with my climbs until I ate ceviche. I bring cipro with me but I would also recommend against taking it prophylactically as it can cause side effects (the tendonitis is quite rare but it can cause diarrhea- in the states it is a frequent cause of clostridium difficile diarrhea which can be quite severe and even life threatening). For minor diarrhea I would take imodium but if I had a fever I would not hesitate to take cipro. I think it is a good idea to avoid raw foods/ fruits. I think it would be very hard to guess which restaurants are "safer" than others- keep in mind that locals are immune to the bugs such as e. coli that cause most traveler's diarrhea so eating with the locals is probably not any safer or more dangerous than eating at a gringo place like Cafe Andino. As someone echoed above, the corn from the street vendors is really good but save it for the end of the trip.

I think that gastrointestinal illness and altitude are the biggest issues that can ruin a trip there. We did some medical clinics in the Huayhuash and in some villages they literally crap right into the streams (the outhouses are built right over the streams) so you can imagine that the water quality downstream is not very good.

boisedoc wrote:I think there is plenty of good advice above. I have been to Huaraz twice and was pretty paranoid about what I ate and drank- I still had gastrointestinal illness both times. First, I would definitely get a hepatitis A and typhoid vaccine. I believe my second illness was typhoid which is quite a bit worse than typical traveler's diarrhea. I almost always ordered bottled water "con gas"- carbonated just in case someone was tempted to put tap water into bottles. The ceviche is quite good there but keep in mind it has raw fish "cooked" with lime juice- I waited until I was done with my climbs until I ate ceviche. I bring cipro with me but I would also recommend against taking it prophylactically as it can cause side effects (the tendonitis is quite rare but it can cause diarrhea- in the states it is a frequent cause of clostridium difficile diarrhea which can be quite severe and even life threatening). For minor diarrhea I would take imodium but if I had a fever I would not hesitate to take cipro. I think it is a good idea to avoid raw foods/ fruits. I think it would be very hard to guess which restaurants are "safer" than others- keep in mind that locals are immune to the bugs such as e. coli that cause most traveler's diarrhea so eating with the locals is probably not any safer or more dangerous than eating at a gringo place like Cafe Andino. As someone echoed above, the corn from the street vendors is really good but save it for the end of the trip.

I think that gastrointestinal illness and altitude are the biggest issues that can ruin a trip there. We did some medical clinics in the Huayhuash and in some villages they literally crap right into the streams (the outhouses are built right over the streams) so you can imagine that the water quality downstream is not very good.

Actually the locals are not immune to these problems. Diarrhea from bad water is a serious problem there, especially for children.

point well taken. Diarrhea and malnutrition are rampant there. However, the bacteria that usually cause infection in travelers such as e. coli is usually not the problem. It is things like typhoid or parasitic infections such as amebic dysentery that cause problems in the indigenous population. We gave out tremendous amounts of antiparasitic agents but unfortunately most people will get reinfected. Definitely getting a healthy water supply would be a huge benefit in the rural areas.

The link below is from a good review article for anyone who might want more information:

http://cmr.asm.org/content/19/3/583.full

Woodie

UPDATE:

I got back from South America a few days ago. Using tips on this page I managed to NOT get sick in Huraz and I was only sick in basecamp with (something like) food poisoning for 1 day. It was about our third day in the Ishinca Valley and I must have eaten something funny - I had 10 bouts of vomiting throughout the night and visited the disgusting latrine 8 times, of course the temperature was like in the 20's, it was miserable - watch your food carefully in basecamp - it seems that every inch of the ground is covered in some sort of horse, burro, cow or sheep poop! Also, it may have been inadequate water treatment, so make sure to do it right and be rigorous with the water purification. The next day was just an acclimatization hike to the Ishinca glacier which I made it through with the help of 8 Immodiums (BAD IDEA - do not take that many - next day sucked) and the short sickness did not prevent me from participating in any summits - win!

In Huaraz I was mega-paranoid about using hand sanitizer at basically every conceivable opportunity. I also primarily ate packaged food from the supermarkets and ate out in the "gringo square" where el horno and some other nicer restaurants are. Some people on our trip's stomachs did not take nicely to ANY food when we ate out in Huaraz (even the highly praised El Horno) so YMMV.

AFTER climbing and back in Huaraz I experimented with some more interesting foods (fully expecting to get sick) but I survived those as well, including the infamous sex burger and some fried tongue.

By the way, we had lots of trouble finding electrolyte drink mixes and any sort of energy bar in Peru. I happened to have brought 6 lbs of bars/GUs/Drink mix and I wish I would have brought 3x as much for the 2.5 weeks of climbing. I think I am going to save some weight next time in toiletries (all available in Huaraz) and just bring more food next time.

Thanks for all the great suggestions again!