Staying Healthy in the Amazon Rainforest

The Amazon trips we suggest reach the rainforest in Brazil (Manaus and the Rio Negro), Peru (Iquitos and Puerto Maldonado) and Ecuador (the Napo River); our Amazon Rainforest guide covers all three. Amazon vaccinations and malaria advice differ between them, so take your itinerary to a travel clinic or doctor at least a month ahead, as the US CDC advises. Our Destination Consultants are not medical professionals and cannot give medical advice. The guidance below comes from the CDC, PAHO and Ecuador’s Ministry of Public Health, checked in November 2026.

Before you go: vaccines and medicines

The CDC asks every traveler to be up to date on routine vaccines, measles included, and recommends hepatitis A and B for most unvaccinated travelers to all three countries. In the rainforest, the big questions are yellow fever and malaria.

Keep the two yellow fever questions apart. For entry, the CDC says Brazil and Peru ask for no certificate. Ecuador’s Ministry of Public Health dropped its certificate rule for arrivals from Colombia, Peru, Bolivia and Brazil on August 28, 2025, making the vaccine a recommendation instead. The CDC’s Ecuador page still listed the old rule in November 2026, so if you pair Peru or Brazil with Ecuador, confirm with your airline or Ecuador’s embassy. Entry rules change, the CDC notes; our Amazon visa and entry page covers the paperwork.

As a recommendation, the CDC advises the vaccine from 9 months of age for the Amazon in all three countries, and in Brazil well beyond it, Rio de Janeiro, São Paulo and Iguassu Falls included. PAHO advises vaccinating at least 10 days before visiting areas where yellow fever circulates.

For malaria, the CDC recommends prescription prevention medicine in the table’s areas, started multiple days before the trip and taken during and after it, depending on the medicine; your doctor decides which. The CDC pages for Brazil, Peru and Ecuador carry the current details.

Mosquitoes and how to avoid bites

The CDC lists dengue and Zika for all three countries and notes elevated chikungunya risk in Brazil and Peru. Zika can pass from a pregnant woman to her baby, the CDC says, so pregnant travelers will want to raise it with their doctor.

The CDC’s bite advice: long sleeves, long pants and a hat; an EPA-registered repellent, such as one with 20% or more DEET, picaridin, oil of lemon eucalyptus or IR3535; permethrin on clothing and gear, never on skin; and a bed net where you sleep open to the outdoors.

The Tucano river cruise on the Rio Negro is a favorite of our co-founders Juergen Keller and Brad Nehring, and Juergen puts it this way: “everybody is afraid of the mosquitoes, but there ain’t no mosquitoes in the area where the Tucano goes, because the water is slightly acidic.” Of their own week on board: “we went now for a week on the Tucano and not a single time have we used repellent.” That is their experience on one blackwater river, not health advice; the CDC’s guidance applies on every Amazon trip, the Rio Negro included.

Water, food and the river

The US CDC’s general advice for travelers is to choose factory-sealed drinks wherever tap water might be contaminated, and to skip ice where clean water is a concern. Our Amazon food and drink guide covers what you will eat.

For Brazil and Peru, the CDC advises against swimming in fresh, unchlorinated water such as lakes and rivers. As of November 2026, it also reports increased leptospirosis cases in Peru, especially in the northern and Amazonian areas.

Remote lodges and river cruises

Distance shapes health planning here. Posada Amazonas in Peru is about two hours by motorized canoe from Puerto Maldonado; the Napo Wildlife Center in Ecuador is about four hours by motorboat and paddle canoe from Coca. The CDC notes that in Peru and Ecuador, rabies vaccines may only be available in larger urban medical facilities; ask your doctor whether to vaccinate beforehand. For evacuation cover, see our Amazon travel insurance page.

Peruvian Amazon trips often add Cusco and Machu Picchu, where the CDC lists no malaria and does not recommend yellow fever vaccine for travel limited to them. Altitude is the question there: see avoiding altitude sickness in Cusco. For crime and wildlife, see safety in the Amazon.

Amazon health FAQ

What vaccines do I need for the Amazon?

According to the CDC: routine vaccines including measles, hepatitis A and B, and yellow fever for the Amazon. Ask your doctor about typhoid and rabies too.

Is a yellow fever vaccine required for the Amazon?

For entry, the CDC says Brazil and Peru do not, and Bolivia and Colombia require it from all arriving travelers aged one and older. Ecuador’s health ministry dropped its rule in August 2025; confirm with your airline. Required or not, the CDC recommends it for the Amazon.

Is there malaria in the Amazon?

Yes, according to the CDC: across Brazil’s Amazonas state, Manaus included, in Peru east of the Andes below 8,200 ft (2,500 m), including Iquitos and Puerto Maldonado, and in parts of Ecuador’s Amazon provinces.

❗ A note from our team: we plan trips, we are not doctors. This page sums up what official health bodies such as the US CDC say about travel here. It is not medical advice, and official advice changes, so please check with your doctor or a travel clinic, ideally at least a month before you go.