IAMAT |International Association of Medical Assistance to Travellers| IAMAT |International Association of Medical Assistance to Travellers|

Travel Health Journal

Boat on the Amazon River. Photo by Kepler Web, FreeImages.

The Amazon: Staying well on your river cruise

River cruising in the rainforest

The Amazon basin is a vast region that spans 9 countries. Travellers visit the region for its incredible biodiversity and the chance to experience wildlife and the rainforest firsthand. There’s no doubt about the amazing flora and fauna in the Amazon, but the confined spaces of a cruise ship and infections transmitted by insects, animals, and microorganisms can be a risk to your health. Here’s how to stay well as you explore.

Staying healthy in the Amazon

Most Amazon cruises begin in the city of Manaus, Brazil or Iquitos, Peru. In the Amazon region, the extent of some diseases (such as Schistosomiasis and Chagas) remains unknown. Luckily, you don’t have to leave your health to chance: There are many things you can do to reduce your risk of getting sick.

In addition to basic travel health precautions, check your itinerary and consider the health risks below. (And don’t forget to book an appointment with your health practitioner or travel medicine specialist at least 6 weeks before departure!)


Insect bite prevention is key in any tropical area and the Amazon is no different.

For the best protection, use multiple methods to prevent mosquito bites during the day and at night:

  • Wear neutral-coloured clothing (beige or light grey). If possible, wear long-sleeved, breathable garments.
  • Use insect repellent containing 20%-30% DEET or 20% Picaridin on exposed skin. Re-apply according to manufacturer’s directions.
  • When you are using both sunscreen and insect repellent, apply the sunscreen first and wait 20 minutes for it to be absorbed by your skin, then apply repellent on top. (Repellent decreases the effectiveness of sunscreen so you may have to re-apply more frequently.)
  • Pre-soak or spray your outer clothing and gear with permethrin, an insecticide that kills mosquitoes.
  • Ensure that door and window screens in your cabin work properly. Regularly empty any containers of standing water near your cabin (such as vases).
  • Sleep in an air-conditioned cabin to prevent mosquito bites. (Mosquitoes don’t like cold air or air currents.) If air conditioning is not available, sleep under an insecticide-treated mosquito net.


Antimalarial medication is a must for travellers on an Amazon River cruise. There is high risk of multi-drug-resistant malaria throughout the Brazilian Amazon region, including Manaus and the trans-Amazon highway. Malaria is also present in the Amazon regions of Peru, Colombia, Venezuela, Ecuador, Bolivia, Guyana, Suriname, and French Guiana.

Malaria mosquitoes bite from dusk to dawn with peak biting times between midnight and 4am, they don’t hum, and don’t leave an itchy welt after biting. You may not even know that you’ve been bitten. Be meticulous about preventing mosquito bites, especially if you will be on land at dusk or in the early morning.

Consult your healthcare practitioner or a travel medicine specialist at least 6 weeks before your trip and take antimalarial medication as prescribed.

Learn more about Malaria

Chikungunya, Dengue, and Zika viruses

These viruses are spread by daytime-biting Aedes mosquitoes. Chikungunya, Dengue, and Zika virus infections can be asymptomatic (you may not feel sick or have any symptoms). You typically recover in about a week if you do fall ill.  Common symptoms include fever, severe headache, muscle and joint pain, rash, nausea, and vomiting.

In severe cases, Dengue can progress to Dengue Hemorrhagic Fever, which can be fatal. Joint pain from Chikungunya can be debilitating and can last for months. Zika Virus has been linked to Guillain-Barré syndrome (progressive muscle weakness that can lead to temporary paralysis) and microcephaly (decreased head size which may lead to developmental delays) in infants born to pregnant women infected with the virus.

All 3 viruses are circulating in South America. Take precautions to prevent mosquito bites during the day.

Visit our Health Risks database to learn more about Chikungunya, Dengue, and Zika virus.

Yellow Fever

Yellow Fever is also transmitted by daytime-biting Aedes mosquitoes. Vaccination is recommended for all travellers over 9 months of age visiting the Amazon basin.  The Yellow Fever vaccine is valid for life so depending on your health status if you have been vaccinated in the past, you may not need to be vaccinated again.

Learn more about Yellow Fever vaccination

The Yellow Fever vaccine is currently in short supply in North America and the shortage is expected to continue until mid-2018. Some travel clinics no longer have Yellow Fever vaccine in stock. Clinics that have the vaccine may only vaccinate travellers to countries that require proof of vaccination for entry. Depending on your itinerary, you may or may not need proof of vaccination to enter a country in the Amazon.

Take meticulous insect bite prevention measures during the daytime (including using insect repellent, treating clothes and gear with permethrin, and wearing light-coloured, long-sleeved clothing if possible).

Animals and ecotourism

The diversity of the Amazon is one of its greatest attractions, whether you are a birder, sport fisher, photographer, or simply enjoying the view. Appreciate animals from a distance and be mindful of how your trip puts you in contact with wildlife.

Keep in mind the risk of Rabies. Avoid petting or playing with animals like dogs and monkeys, even if they seem friendly. If you are bitten or scratched by an animal, thoroughly wash the wound with soap and water, rinse it with an antiseptic, and seek medical attention right away.

Tell your travel health practitioner if you are planning any activities that will bring into direct contact with animals. They may recommend that you get the pre-exposure Rabies vaccine before your trip.

Water and recreation

Leptospirosis and Schistosomiasis are both risks if you will be canoeing, rafting, swimming, or fishing in the Amazon.

The bacteria that cause Leptospirosis are spread through lakes and rivers contaminated with animal urine. Leptospirosis can cause very serious illness, including heart failure, kidney failure, and meningitis if it is not treated with antibiotics.

Schistosomiasis is caused by a parasite that lives in freshwater snails. If left untreated, it can cause irreversible damage and cancer. The extent of Schistosomiasis in the Amazon is unknown.

Avoiding contact with fresh water is the best way to reduce your risk of Leptospirosis and Schistosomiasis, but this may not be possible if you’re canoeing into smaller tributaries or fishing. If you’re planning activities that will bring you in direct contact with fresh water, ask your travel health specialist how to prepare.

Quick tips:

  • Avoid contact with fresh water, including swimming or wading in canals, swamps, lakes, and rivers.
  • If this isn’t possible, wear protective clothing and footwear. If you must pass through streams or swamps, wear high waterproof boots or hip waders.
  • Stay away from the banks of streams and rivers. The snails that spread Schistosomiasis live in shallow water. There are fewer snails in the deeper ends of lakes, rivers, and streams where water tends to flow faster.
  • If you accidentally come into contact with fresh water, towel dry wet skin immediately to reduce the possibility of infection.

Cruise health basics

There’s no foolproof way to prevent illnesses caused by norovirus, E. coli, and salmonella, but minding your food and water goes a long way toward keeping you healthy.

Tips for good health on board:

  • Wash your hands thoroughly and often.
  • Eat only freshly prepared foods that are steaming hot. (Avoid raw vegetables like salad and buffets where food has been sitting out.)
  • Only eat fruits that you can peel yourself.
  • Drink boiled, treated or bottled water from a reliable brand. Ask your cruise company what’s available on board and on excursions.
  • Influenza circulates year-round in tropical areas and can spread quickly through contained spaces like ships. Get a flu shot as part of your pre-travel checkup if it’s available before your departure.
  • Hepatitis A is transmitted through contaminated food and water. The Hepatitis A vaccine provides long-term protection against this common virus.
  • If you get sick, report it immediately to the ship’s staff. Larger cruise ships often have on-board medical staff.

Read our Cruise Health Basics tipsheet for detailed information.

A note about insurance…

It’s a good idea to consider your travel insurance needs when you book your trip. Amazon river cruises visit remote areas and medical assistance may not be close at hand. Smaller ships may not have on-board medical staff. Consider your risk tolerance, your current health status, evacuation and repatriation coverage, and the cost of your trip when purchasing insurance.

Photo by Freeimages.com/Kepler Web.

Article by Daphne Hendsbee.