Carrion's disease, the iconic disease in Peruvian medicine has been found in the mountains of Ecuador, Colombia and the Andean valleys of Peru. In the 1990s, the phenomenon of El Niño was associated with significantly increased risk of disease in Ancash, Cajamarca and Cusco. In Cusco in 1998 there was an acute phase epidemic in various Andean provinces and the jungle area. Between 2001 and 2005 the disease has spread or reactivated in different regions such as Ancash, Cajamarca, Amazonas, Piura, Cusco, La Libertad, Puno, and Ayacucho. In 2004 a major outbreak of the disease in all of Peru was presented, reporting more than 11 164 cases, and therefore diverse strategies based vector susceptibility studies was applied, lowering significantly the number of cases.