Rhythm of the Amazon Nov 26-Dec 19, 2018

[mj_holiday]

There is a chain called Passport Health.  We first met with them for a consultation and took their recommendations to our PCP.  And yes we were told there is a shortage of YF vaccine in the US, we were  told the US supply was sent to Brazil and other South American countries.  That is why PCPs do not administer this.  In our city is was Passport Health or (I heard) county health department.

[Ep010835]

2 hours ago, mj_holiday said:

There is a chain called Passport Health.  We first met with them for a consultation and took their recommendations to our PCP.  And yes we were told there is a shortage of YF vaccine in the US, we were  told the US supply was sent to Brazil and other South American countries.  That is why PCPs do not administer this.  In our city is was Passport Health or (I heard) county health department.

After reading your post about travel docs, I did a search and found Passport Health. Happily, they have an office fairly close to us. We'll be contacting them for an appointment. I noticed on their website that they do not take insurance. Guess we'll pay and submit for reimbursement. Did you have any issues getting reimbursed by your insurance carrier?

 

In your case, did you get the YF shot from PH during your initial visit with them?

 

What about Typhoid and Hepatitis A & B? The CDC website recommends these too. 

[mj_holiday]

I called to make an appt with Passport Health, I wanted just a consultation.  They asked all the countries we would be visiting.  When we got there they had a booklet prepared for us with a lot of information and recommendations.  Yes they recommended typhoid, Hep series, YF, malaria prevention, tetanus. . . . . this first visit did have a charge but we got a lot of info.  We took the list to our PCP to work out which to get.  We did not take malaria prevention for a couple reasons: our PCP basically said it has not changed much since DH took it in Southeast Asia (it made him sick) and we can be treated for malaria.  We made another appt with Passport Health for the YF shot.

We have Medicare as primary and I have submitted it but haven't heard anything yet.

Visiting Passport Health and then our PCP gave us the information to make a decision for us.

[Ep010835]

6 minutes ago, mj_holiday said:

I called to make an appt with Passport Health, I wanted just a consultation.  They asked all the countries we would be visiting.  When we got there they had a booklet prepared for us with a lot of information and recommendations.  Yes they recommended typhoid, Hep series, YF, malaria prevention, tetanus. . . . . this first visit did have a charge but we got a lot of info.  We took the list to our PCP to work out which to get.  We did not take malaria prevention for a couple reasons: our PCP basically said it has not changed much since DH took it in Southeast Asia (it made him sick) and we can be treated for malaria.  We made another appt with Passport Health for the YF shot.

We have Medicare as primary and I have submitted it but haven't heard anything yet.

Visiting Passport Health and then our PCP gave us the information to make a decision for us.

Excellent information. Thank you! 

Clearly, you are a planner. So am I. 

[briar14]

We have received some of these shots/medications at Walgreens in SC. The pharmacist worked with Medicare and our supplemental insurance—all were covered. 

[Ep010835]

3 hours ago, briar14 said:

We have received some of these shots/medications at Walgreens in SC. The pharmacist worked with Medicare and our supplemental insurance—all were covered. 

 

Very nice of the him/her do take the time to do this. Many that I've come across over the years wouldn't have taken the time to help. 

Which shots did Medicare/supplement cover? Do you recall?

[CruisetheCs]

On 12/31/2018 at 6:07 PM, Travelcat2 said:

It is important to keep in mind that anyone that has an immune issue cannot take live vaccines but can get a letter from your physician stating that you cannot have the vaccine.  

 

My DH and I had physician letters but were never asked to show them (and I do not know of anyone on any Amazon cruise that were asked for proof of vaccination or the letter.  As the TS indicated, we did not see one mosquito.  

 

Based on this experience, if you have any doubt that you can have the vaccine (YF), get the letter instead.  Why take a chance with your health?????  Definitely not worth it.

 

P.S.  There has apparently been a shortage of Yellow Fever vaccine in the U.S. so it may be difficult to find a place that has it.  and, if they do, it will be costly.

 

Those who do not get vaccinated are also taking a chance with their health. The question is which chance one weighs overall as more formidable, the chance of having a reaction to the vaccine or the chance of getting yellow fever.

 

Immunosuppression occurs to varying degrees and for varying reasons. Thus there are times when live vaccines might still be recommended for someone who is immunocompromised. There is considerable medical literature on this topic if one searches on live vaccines for immunocompromised individuals. 

 

IMO, it is important to get sound individualized medical advice from knowledgeable health care providers who can assess all the individual’s health parameters before making a decision regarding vaccination for yellow fever. It is also important for anyone making a decision about the matter to be as informed as possible about the likely risks and benefits of either taking or not taking the vaccine. 

 

People have different tolerances for risk and after getting all the information possible, individuals may make different choices in similar circumstances.

[SC Retired Cruiser]

Thank you for your thoughtful write-up and fantastic pictures.  It brought back fond memories of our trip on the Mariner two years ago.  I fully agree that Terry Breen's seminars are not to be missed.  We learned so much on that trip. 

 

 

[briar14]

8 hours ago, Ep010835 said:

 

Very nice of the him/her do take the time to do this. Many that I've come across over the years wouldn't have taken the time to help. 

Which shots did Medicare/supplement cover? Do you recall?

We are traveling right now on Mariner (wonderful wonderful cruise!) so do not have records at hand. I know I received typhoid and some of the hepatitis shots and believe they told me that yellow fever was available at one Walgreens location in the Greenville SC area. Medicare covered the typhoid and hepatitis. They were prescribed by our dr. because she knows we travel frequently.

[Travelcat2]

Everyone who travels needs to have the hepatitis and tetanus shots - I'm a bit surprised that some posters have not had them or they are not up to date.  In terms of Yellow Fever inoculations, if you are over the age of 65 or have immune issues, I would check with my physician.  Very simple.  Based on what we have heard and read, the risk of having a negative reaction to the Yellow Fever inoculation is much  higher than getting Yellow Fever. 

 

On our Amazon cruise, many passengers were upset that they took the time and spent the money for Yellow Fever inoculations and did not need them.  Personally I would not overthink this issue.  I've been following the Amazon cruises for years and have not heard of anyone getting sick.  We were pleased that we did not let fear guide our decision to not have the Yellow Fever inoculation and were able to have a wonderful and healthy Amazon cruise.  

 

Note:  We have been to almost 100 countries over the past 30 years and have never had the Yellow Fever inoculation.  We took the malaria meds. once - they made us sick and that was the end of that!  After all of that travel, we are fine and the worst thing that has happened was my DH getting pneumonia on the ship (he and I have since had pneumonia shots).

 

The one thing that I can add about visiting the Amazon is that the heat is horrendous.  Admittedly, I do not do well in hot weather but the Amazon takes heat and humidity to another level.  

[Ep010835]

On 1/2/2019 at 8:00 PM, Travelcat2 said:

On our Amazon cruise, many passengers were upset that they took the time and spent the money for Yellow Fever inoculations and did not need them.  Personally I would not overthink this issue.  I've been following the Amazon cruises for years and have not heard of anyone getting sick.  We were pleased that we did not let fear guide our decision to not have the Yellow Fever inoculation and were able to have a wonderful and healthy Amazon cruise.

I've seen others post that say neither RSSC nor "the authorities" (whoever they may be) ever check for proof or YF or other inoculations. Has this been your experience?

I've not seen an official position from RSSC on being vaccinated. Have you and I've missed it? 

 

The one thing that I can add about visiting the Amazon is that the heat is horrendous.  Admittedly, I do not do well in hot weather but the Amazon takes heat and humidity to another level.  

Gotta love the Equator, I guess. Never been there. Looking forward to it. I'm a hot weather kinda guy. Wife definitely is NOT. Should be interesting!

 

[Henk123]

There are also countries that check whether you have been vaccinated against Yellow Fever
 if you have visited a country before where Yellow Fever is possible.

Edited January 4, 2019 by Henk123

[Wendy The Wanderer]

On the subject of Yellow Fever, I've also read somewhere here on CC recently that the ten-year expiry on the YF shot has now been changed to "life".  I'm going to check with my travel doctor in the spring to see if that's true or not, but if so, we'll never have to have this shot again.

[flossie009]

On 1/2/2019 at 10:24 PM, CruisetheCs said:

IMO, it is important to get sound individualized medical advice from knowledgeable health care providers who can assess all the individual’s health parameters before making a decision regarding vaccination for yellow fever. It is also important for anyone making a decision about the matter to be as informed as possible about the likely risks and benefits of either taking or not taking the vaccine. 

 

I agree. It is most important that individuals obtain advice from their own medical practitioners, rather than relying on information given by others.

 

 

9 hours ago, Ep010835 said:

I've seen others post that say neither RSSC nor "the authorities" (whoever they may be) ever check for proof or YF or other inoculations. Has this been your experience?

 

For our recent Regent cruise to Africa, Regent stated clearly in advance that Yellow Fever certificates or waivers would be required for some ports.

The certificates/waivers were collected from guests at check-in and were returned towards the end of the cruise.

 

 

53 minutes ago, Wendy The Wanderer said:

On the subject of Yellow Fever, I've also read somewhere here on CC recently that the ten-year expiry on the YF shot has now been changed to "life".  I'm going to check with my travel doctor in the spring to see if that's true or not, but if so, we'll never have to have this shot again.

 

Yes, we also understand this to be the case. This is an extract from the UK NHS website:

"The yellow fever vaccine provides lifelong protection for most people.

Booster doses and new vaccination certificates used to be recommended every 10 years for people who continued to be at risk of the infection, but this is no longer necessary in most cases.

All vaccination certificates are now valid for life, including older ones with an expiry date on them"

 

However, as said previously, individuals should check this information with medical practitioners based on their own circumstances and travel plans.

They should also check on what requirements the cruise line may have regarding the provision of certification.

[Travelcat2]

10 hours ago, Ep010835 said:

 

 

As has been mentioned, Regent does state that you need to either have the Yellow Fever vaccination or have a waiver on some itineraries.  Sometimes they make it sound as if a waiver would not be accepted.  This, in my opinion, is the problem.  Regent needs to be specific about what is required.  Some people are risking sickness or worse in order to have this particular vaccination and I do not feel that it should be done for nothing.  

 

From what I have read on CC, the cruise from Lisbon to Cape Town did require the vaccination due to the ports they were visiting.  Visiting the Amazon is a different scenario, different country and different continent.  And, while I have not heard of proof of the vaccination being shown to Regent for the Amazon itineraries in the past three years, that is not to say that there was not an issue with Yellow Fever in the past or could have issues in the future.

 

To be clear, I am not saying that you should not have the YF vaccination if it is required by Regent but rather Regent should not require it if it is not necessary.  All we are doing here on CC is to give our experiences.

 

Also, some General Practitioners are not aware of which countries (or parts of countries) require what shots/vaccinations - they have to look it up like we do.  So, I would check with Regent first, and then, if required, check with your doctor.

 

Despite not seeing mosquitos in the Amazon, just about everyone wore insect repellant.  I doubt if mosquitos would get anywhere near a group of Regent passengers on excursion as the cloud of insect repellant around them would keep anything away 🕷️  🕷️  🕷️

 

P.S.  To be even more clear, I have no idea what the circumstances are in countries other than the U.S. and   Canada.  Perhaps you can get a YF inoculation at a doctors office  - waivers may have different requirements, etc.

 

Edited January 4, 2019 by Travelcat2

[UUNetBill]

3 hours ago, flossie009 said:

I agree. It is most important that individuals obtain advice from their own medical practitioners, rather than relying on information given by others.

What?!?  You're telling me I can't completely trust free medical, financial, or legal advice provided by total strangers on some anonymous website?  I'm shocked - shocked, I say!!

 

[Ep010835]

Really GREAT information, all. 

Many thanks!!

[GOARMY]

Quick comment, to reinforce several recent opines on this Thread.  Specifically obtaining YF, Hep series, Typhus, tetanus, pneumonia, and malaria pills  (have I forgotten something?) before an Amazon River adventure; and taking malaria pills during that trip.    

 

Did Navigator Amazon May-June 2017.  Great experience, which began four months' previously when planning medication sequencing.  Every situation is unique to the participant.  This was true in my case, which was different from my wife's.  Somewhere on a previous CC Thread, I went into some detail on this--so will not repeat that tome, other than it is a good idea to keep records of all previous inoculations.

 

In our case, had the advantage of access to facilities at Evergreen Hospital, Kirkland, WA.  (My wife was a R.N. there, retiring in 2012.)  Evergreen has an Infectious Disease Unit, and within that Unit, a Tropical Disease Specialist (TDS).  So--we made an appointment.  To prepare for that, provided specific information as to itinerary and time of year.  Again fortunate that our Primary Care Physician(s) have direct affiliation with Evergreen.  So--all medical file histories were available, to include shot records.  Another benefit is that Evergreen is a County Hospital equipped to handle all sorts of situations.  The Unit confirmed availability of all meds.  (No shortage of YF vaccine, for example.)

 

Our TDS appointments were scheduled back-to-back.  The Physician (who advised doing a 6-month "Residency" in various areas of New Guinea as part of his certification)  laid out a timeline for getting us ready for the trip.  As to YF:  Yes, Regent advised a record would be required as to either acquiring that shot; or having a Physician's letter explaining why not.  And, again Yes--when checking in at Miami, a Regent rep. reviewed our documentation.   Which was a Form prepared by the Hospital which we stapled to our Passports. 

 

Took the necessary shots; got the malaria pills; used those pills during the cruise. Stayed healthy.  Did not consume ANY food or drink offered by locals in the Amazon area.  Simply a "warning" from our Doctor.  Plenty of interesting, very-large bugs viewed each morning aboard Mariner which had, unfortunately, been attracted to that ship.  And yes, the exterior lights were dimmed.  Did not see a mosquito; maybe a mosquito saw me, and just buzzed by. 

 

This cruise was one of those once-in-a-lifetime itineraries which we are glad we did; but will probably not do again.  For those considering a first-time Amazon cruise:  be sure to schedule a tour of the Manaus Opera House; and take in the Boa Bimba (sp?) folkloric two-hour performance. 

 

GOARMY!

 

      

 

 

[Travelcat2]

GOARMY - it was your comment about the "very-large bugs" that left us disappointed when we could not find even one bug on the deck - or anywhere else (not that seeing bugs was a goal of ours🕷️)

 

Agree that it is once in a lifetime experience and although I didn't want to visit the Amazon, we both glad that we did.

[GOARMY]

Travelcat:  As to our experiencing a plethora of large bugs on Navigator's exterior each morning when actually on the River--which you did not:  This difference may have been due to your segment being about six months later.  Our onboard lecturer made some reference to this, but exact details elude me.  Point being:  experiences will differ in several aspects due to time of year.  The Amazon has its own eco system which is constantly evolving. 

 

This brings up an interesting aspect as to the "Greatest River in the World" which may be of benefit to those first-timers contemplating the  Amazon adventure.  A May-June timeline will catch The River at high flood stage.  This situation necessitated several onshore itinerary adjustments or cancelations.  In one case, the scheduled Port-of-Call (can't recall which one) was, literally under water.  So--no stop.  In another instance, a stop scheduled when going upriver en route to Manaus had to be rescheduled for a visit following Manaus, while on the way back to The Atlantic.  And, apparently, our 2017 situation recorded The River at the second-highest historic flood level. 

 

No big deal(s).  Because, in my case, prior medical history and issues with malaria (Vietnam 50 years-ago) meant restriction--on Doctor's orders--to very-few onshore visitations (see my earlier post), particularly at any area removed from "civilization", as that term applies to villages and tourist stops along the way.   Just stayed on Navigator.  But, once back in The Atlantic: really poignant stop at an island within swimming distance from the Real Devil's Island.  The TS described this stop very well.  Yes, steep steps.  However--keep walking around the bend.  There is (was) a pathway up to the top. 

 

And again, a general warning:  extreme heat.   Take at least-two bottles of water when on any tour.  And, of course, Regent has figured this out.  There was an onshore "watering" stop available right where the tenders landed at Devil's Island.  Also, covered areas so folks could stay out of direct sunlight when waiting to board a tender back to Navigator. 

 

What a contrast:  did that tour; back on Navigator in time for lunch in air conditioned comfort. 

 

GOARMY!

 

 

  

[Travelcat2]

GOARMY - did not think about the time of the year - thank you for bringing that to our attention.  November seems to be better weather and bug wise.  The one thing that is difficult to explain is just how bloody hot it is in the Amazon.  So glad that we did it so I won't have to do it again.

[Ep010835]

1 hour ago, Travelcat2 said:

The one thing that is difficult to explain is just how bloody hot it is in the Amazon. 

 

I'm gonna love it!! 🌞🌞🌞

Not altogether sure wife has thought completely through this part. 

[Hambagahle]

GOARMY -- you said above  "Took the necessary shots; got the malaria pills; used those pills during the cruise. Stayed healthy.  Did not consume ANY food or drink offered by locals in the Amazon area.  Simply a "warning" from our Doctor. "

 

VERY good advice.  To which I add - if you do order bottled water or whatever do NOT then ask for ice to add to it!  I was in Cairo once and saw a Frenchman at the next table order Perrier.  he sent it back because it arrived opened.  Insisted (correctly) on a closed bottle.  And then asked for ice to put in it.   I just about went under the table!!

 

I have always wanted to go to the Amazon but Ken (husband) won't go.  He then proceeds to tell me that if I go  I will have to confront Anacondas...  which I am sure is not true.  Anyone care to comment (without photos please - I hate snakes!!)

[GOARMY]

Oh, the horror!  Of snakes, I mean.  Yes, there are snakes.  And, if one wanders off any path on a land tour when in The River area, that person is not being prudent.  But, this could also apply to Arizona, or eastern Washington State, where the rattlers rattle. 

 

Specifically--we saw plenty of snakes.  But these were confined in a "Recovery Zoo" which was part of a Manaus tour.  There were snakes; there were all kinds of other critters which had been found in the area--in bad shape--and were "in hospital" rehabbing.  This, as I recall, was part of a tour that included the Manaus Opera House, referenced in my earlier post. 

 

GOARMY!

 

[Sharle]

We were on this cruise as well. We had gotten the YF shots several years ago for an Africa trip so did not have to make any decision this time. We did not eat or drink anything but ship provided bottled water while on shore in the Amazon so did not feel that typhoid or HEP vaccines were needed. Didn't see any mosquitos either. Other than the day at Devil's Island, where it was so humid, I did not feel the temperature was excessive. Then again, I live in SW Florida.

 

It was a fantastic experience. Even enjoyed the excursions on the Caribbean Islands. Despite always feeling they are all the same.

 

The Coffee Connection, in answer to a previous question, still has the great coffee machine. Yes, it used to be in the Navigator lounge. although the bar tender there still makes coffee, the tables and food has been moved across the "aisle" from the lounge. Unfortunately it also houses the computers and tech guy which does make it crowded.

 

I saw pink dolphins from the ship. They were fascinating. We saw grey dolphins while on an excursion.