From a health perspective, a seven day journey up the Amazon River into the jungle, even on a luxury river boat, is nothing like the luxury cruise in the Mediterranean or Caribbean, that I have taken thus far. The rain forest environment is hot and humid, and vicious little mosquitoes carry nasty organisms that cause malaria, yellow fever, dengue fever and other diseases. The first reminder of the isolation and primitive nature of the area into which we will be traveling, came from the disclaimers and advice in the information package from the travel agent through whom we booked this cruise. Then I did some serious reading and decided I needed to speak with a medical travel expert who would be current on what precautions would be needed to keep us fit and healthy.

So once back from my Aegean Odyssey cruise, I went to consult a doctor  at a Travel Clinic. The first facts she wanted to establish in order to lay out a prevention plan were the exact dates and duration of travel, and the precise locations that I would be visiting at a given time. As I will be following up the Amazon River cruise with travel from Argentina to Brazil and then to South Africa, my itinerary is in fact more complicated than just the cruise on the Amazon River.

So basically here is the broad outline from which we derived a management plan and timing for immunizations and other preventative measures. Your preventative health plan may differ depending on the specifics of your travel.

Basically I considered the preventative measures in two broad categories.

1) General preventative health concerns which should be considered regardless of travel destination

2) Specific risks related to the proposed travel: Travel precautions and pre-travel immunization

Thinking specifically about immunizations and vaccines, under the first category comes things like keeping immunizations up to date for Diphtheria, Tetanus, Pertussis (DTP) and Polio, Hepatitis A and B, Influenza. As several of my friends have recently experienced shingles (a flare up related to varicella (chicken pox) in childhood, I decided to get the shingles vaccine too.

Immunizations specific to this South America trip: The main infectious hazards are of two kinds, enteric diseases that are spread by contaminated food and water (typhoid, cholera, and other causes of traveler's diarrhea) or those spread by insect vectors like mosquitos - malaria, yellow fever, dengue fever).  Two red flags for this journey into the jungle are that it is an area where Yellow Fever and Malaria are endemic. In fact to enter Brazil, having been in a yellow fever endemic area, I will require an International Certificate of Vaccination or Prophylaxis against Yellow Fever.

Then there is a concern about enteric diseases such as typhoid, and E. Coli , the most common cause apparently of traveller's diarrhea. I thought salmonella and campylobacter were as common but apparently not. Our information sheet also contained a stern warning about not eating food from street vendors as you can't trust the sanitation of the preparations. I am not normally that adventurous in foreign countries so  it made perfect sense to me.

My immunization protocol:  I  immediately had three injections, one for Yellow Fever ( good for 10 years), a booster shot for Tetanus, diphtheria, attenuated Pertussis and Polio, and the first of three shots for Hepatitis B. The second Hep B shot will be done a month from now, and the third in 6 months after that.

As well as the injectable immunizations, there were three oral preparations recommended. Vivotif (typhoid vaccine) which could be taken immediately, Dukoral for Travellers diarrhea - to be taken in two doses completed one week before leaving on trip (it is effective for only 3 months), and Malorone, an anti-malarial.

Although there are other options for malaria prevention, I opted for Malarone: This is an oral medication taken as one tablet one day before entering endemic area, one tablet daily while in the endemic area, and continued for a week after leaving the area. So I need to take that with me and remember to use it.

Dukoral is an oral vaccine that protects against cholera and gastroenteritis caused by E. Coli. Cholera is a serious disease of the intestines that is acquired by consuming water or food that has been contaminated by the bacteria Vibrio cholerae. Cholera can cause severe diarrhea and dehydration. Not nice and can be very dangerous.

The recommendation for adults is two doses a week apart with the second dose at least a week before departure as the protection takes a week to kick in. Apparently immunity is good for about two years. That's lucky because it does not taste good. So you mix effervescent granules of sodium hydrogen carbonate that come in a small packet, into 5 oz water, add the vial if vaccine, stir and drink. No eating or drinking for an hour before and an hour after taking this stuff.

Vivotif is an oral vaccine against typhoid,  which caused by the bacteria salmonella typhi (S.typhi). Typhoid is spread through the ingestion of food or water, contaminated with S. Typhi and can cause high fever, muscle aches, severe headache, weakness, confusion or agitation, loss of appetite, stomach pain, diarrhea or constipation, and rose-colored spots on the skin. Kidney failure, severe bleeding or development of chronic carrier status are complications of untreated typhoid fever.  Vivotif contains attenuated S. Typhi  in an enteric coated pill. The usual dose of this medication is one capsule taken every other day (e.g., day 1, 3, 5, and 7) for a total of 4 capsules. Take each capsule with at least 4 ounces (120 mL) of cool or lukewarm water (not warmer than 37°C or 98.6°F) approximately 1 hour before or 2 hours after a meal. This will stimulate the immune system to produce antibodies against the bacterium. I took each dose first thing in the morning, which meant I had to wait at least an hour before I could have my morning coffee. That, and a mild nausea that got slightly worse with each dose, were the only side effects I experienced.

So from a prevention perspective I have been immunized or protected against yellow fever, typhoid, cholera, E.Coli, hepatitis A and B, polio, diphtheria, Pertussis, tetanus and hopefully the current strains of influenza. As well I have a Deet preparation to spray on my clothes, a cedarcide preparation to spray on my sleeping area and a go-away-bug preparation for my skin.  Oh and of course unscented shampoo, conditioner, sunscreen and moisturiser so bugs won't think I am a flower.