GERM
00:00:09.360 – 00:00:11.360
Cайн уу! My name is Germ.

WORM
00:00:11.440 – 00:00:12.320
I’m Worm.

GERM
00:00:12.400 – 00:00:25.760
Welcome to episode 121 of the Germ and Worm travel health podcast. Beavers, skunks and goats. Oh my. It’s a big planet. See it in Good Health. I’m Dr. Paul Pottinger. You can also call me Germ. I’m an infectious diseases specialist at the University of Washington.

WORM
00:00:26.110 – 00:00:31.390
I’m Dr. Chris Sanford, also known as Worm Family Medicine Doc, also at the University of Washington.

GERM
00:00:31.790 – 00:01:16.570
Okay, today we’re going to answer questions about travel health as we always do, Chris, from listeners across the country and around the world, including how is CDC still functioning with such drastic workforce cuts, political violence, Can I avoid it anywhere I go around the world? Any updates about those skin heater thingies that stop mosquito bites from itching?

And did hundreds of people really just catch rabies from being attacked by beavers? A reminder to our listeners, please contact us with your travel health questions, stories or your tips for success. We’d love to hear from you.

Just see us online: germandworm.com or send us an email germandorm@gmail.com we always start with our medical disclaimer.

This podcast is designed to inform, inspire and entertain. But before you travel, please see a qualified healthcare professional for recommendations specific to you and to your itinerary.

WORM
00:01:16.890 – 00:01:21.450
Paul, you’ve got a trip coming up, a cruise. Who’s it with and where are you going to?

GERM
00:01:21.450 – 00:03:01.000
Yeah, it turns out I’m enjoying the cruising life.

I never saw myself as a cruiser, so I on several occasions as a family we have done these really exciting expedition cruises with Lynnblad and National Geographic. So National Geographic co sponsored them. Lindblad is the operator, designer of the ships and they operate the cruises.

So basically they’re Lindblad ships and it’s staffed by naturalists, scientists and crew sponsored by Nat Geo and they’re super fun. So that’s what have we done so far. We went to many years ago down to Galapagos, which is a wonderful cruise, just the best.

And also Costa Rica, which we enjoyed very much. And of course Julie and I went on this spectacular three week cruise down to Antarctica, South Georgia, Falklands.

That was just about, almost just over a year ago. Still feels like it was yesterday. It was so fun. So we’ve had a blast with that.

And yes, we now have an upcoming cruise coming up soon here up to Alaska with the same group and in fact it’s the same ship that we were on down in Costa Rica. So I love these cruises because you’re the goal is to Explore.

So they’re taking you with scientists and naturalists to see interesting parts of the world. And there’s lectures every evening. So you’re learning from scientists and people who really know what they’re doing.

There’s always a professional photographer, a videographer, teach you how to use your camera. Even if you have a big, fat, expensive camera like I do, you don’t really know how to use it. They will walk you through that process.

And the vibe is just very relaxed, it’s very laid back, but people are just excited to be there. So it’s not fancy and it’s certainly not the drunken hullabaloo you’d see in these big.

Maybe there’s 100 people on the boat, something like this, or they’re small. And that’s the vibe that we like a lot. And there’s always a good sauna and /or Jacuzzi, which I also enjoy doing.

WORM
00:03:01.080 – 00:03:09.400
Now, speaking of thermal issues, isn’t it true that on your Antarctica cruise perhaps you were tired of comfort that you and your wife jumped into ice water?

GERM
00:03:09.800 – 00:03:50.630
Yeah, we were. That was a super fancy, luxurious cruise. We were never cold except when we chose to be. So that included. Yeah, the polar plunge. We did that.

In fact, it’s a whole thing. Almost everybody on the ship does it. And we did it together. And super cold when we did that. I don’t think that’s going to be an Alaska thing.

We’ll find out. I can tell you in Antarctica, the water was incredibly pure and clear. We jumped in and it’s even. There are photos taken of this.

We didn’t know until later that they had moved us at the last minute by two miles down the channel because there was a leopard seal down underneath the ship waiting for us to jump in. Like waiting for garbage scraps or something, which the ship doesn’t dump overboard. Anyway, they will eat your very living flesh. So we decided.

They decided not to tell us this.

WORM
00:03:50.630 – 00:03:52.070
Before we told them. Oh, but it’s worse.

GERM
00:03:52.710 – 00:04:07.190
It turns out the cold was not the thing that was going to kill us. It was the carnivorous leopard seal. But anyway, we got away from that, too. This trip to Alaska will be super fun for me.

It’s a part of Alaska I’ve not seen before at the coastal waterways. It sounds super interesting and I’m really looking forward to it.

WORM
00:04:07.190 – 00:04:08.070
Sounds very fun.

GERM
00:04:08.550 – 00:04:12.630
I will let you know how it goes. Stay tuned. Maybe even some notes from the field while we’re up there.

WORM
00:04:12.830 – 00:04:13.390
Yeah, yeah.

GERM
00:04:16.910 – 00:04:30.470
Okay, Chris, I want to start this episode actually on a serious note because We’ve just received word, really tragic news about someone who died here in the Cascade Mountain range just a few days ago. Would you give us an overview what happened here? Yeah.

WORM
00:04:30.470 – 00:05:29.690
This is a sad story, a really unfortunate event.

A couple from Oklahoma were hiking in the Enchantments, which is a lovely series of mountains, actually not that far from Puget Sound, where Paul and I live. And it was September, and they didn’t perhaps realize how quickly the weather can change here.

So they hiked up to a fairly high altitude, and it started to snow, and then it really snowed, and suddenly there was one to two feet of snow. And they were then trapped at about 7,000 to 8,000ft of elevation. Their clothes were soaked through. The sun started to go down.

They didn’t have overnight gear.

They were able to reach out to emergency services, but by the time they were reached, the woman was dead and the husband was severely hypothermic and had to be hospitalized. So this is a cautionary tale.

It’s terrible to happen to this family, but it reminds us that even when the weather is good, there’s a reason they call the 10 essentials. The 10 essentials?

GERM
00:05:30.250 – 00:06:30.060
Yeah. This is just a terrible story. And for those who don’t know, the Enchantments, I mean, they’re named because they are enchanting.

It’s a super beautiful mountain range within a mountain range close to the town of Leavenworth, Washington. I have hiked through that area before. It’s notorious because it’s incredibly pristine and they make it very difficult to spend the night there.

You actually need to get, for most of the high traffic times of the year, you need to get a permit to go up there. Those permits are hard to find, and they police the area as they should, you know, very carefully. So oftentimes the reputation is, yeah, it’s hard.

Just don’t spend the night and walk through. And that way you can do it without a permit.

Anyone can walk through the Enchantments, as I have done before, including with some traditional rock climbing. So anyway, it’s super beautiful, but it can also be very, very hazardous.

In this particular case, just by coincidence, the previous day I happened to be climbing not too far away from there in the Cascades, a mountain called Mount Pugh. And actually, Chris, you might know Mount Pugh because I know you used to live up there.

WORM
00:06:30.060 – 00:06:31.220
Yeah, yeah, I’ve hiked it too.

GERM
00:06:31.490 – 00:09:23.680
Yeah, so it’s a beautiful hike up there. I was there with my friends Tom and Doug. We had a great experience that previous day. Beautiful conditions.

We were marveling at it, honestly, how can we have such nice summer like conditions in mid September here in the Seattle area? And we did that because we knew what the weather was going to do.

And in fact, we were scheduled to hike this day when this poor person did not survive Sunday. But we were looking at the modeling and said, hey, it’s going to be raining. We can’t do it that day. Let’s do it the day earlier.

During our hike, we said, thank God we’re not up here on Sunday because this place would be completely unsafe just in terms of falling hazard and slipping hazard. Someone actually died on this route on Mount Pugh a few months ago. There’s now a nice memorial to their memory right there.

I assume that they fell in some snow. In other words, when these areas are warm and dry, they’re great. And when they’re cold and wet, they’re dangerous from falling hazard.

And as this poor person and their husband found out, you know, from hypothermia too, this is the issue. It can change in a heartbeat. These mountains are not that tall. This part of the Cascades, it’s just, you know, a few thousand feet high.

But that’s enough if you have the right combination of precipitation and wind. And if you’re not defended against that, if you’re exposed, you will die of hypothermia. When I was a kid, Chris, they used to call it exposure.

Someone died of exposure. Now we say what it is, it’s hypothermia. Hypo meaning low, thermia, meaning temperature. Your body core temperature will drop.

There’s many times that we’ve all been through this. You’ll be out and catch chill. You’ll shiver. Shivering is the body’s response to this. When we fire those muscles that’s generating heat.

As human beings, we can only live in a certain narrow band of core temperatures. That works fine as long as you’re dry. If you can dry off and keep feeding the fire, meaning you have enough calories, you can stay warm.

But once you get wet and in the context of wind, it is stunning how quickly this can happen. This was not just about, you know, sub freezing temperatures. It was about that wind chill factor is what I’m trying to say.

And folks, please come visit us here at Washington State. It is super beautiful. We are so lucky to have zones like the Enchantments. It’s beautiful and I do recommend it, but you just have to be willing–anytime in the high country, you have to be willing to put your Put your, put your plans on hold. I don’t know how else to say it. We lost someone this way.

Someone of Korean descent but who had come from a different part of the state or different part of the country, as I recall, died this way not long ago. This happens year after year where people are drawn to our state. It’s like a magnet. It’s attractive. They want to come and they’ve made a lot of arrangements and greater time and expense to get away from work and childcare. And by God, they’re going to climb the mountain. But the mountains don’t care. They’re not there to judge you, they’re not there to harm you.

They simply are. And so you can do this safely if you’re flexible, humble and willing to adapt. That’s, you know, our hearts go out to this family.

It just sounds terrible. Terrible. And we hope that our listeners will learn from this sad situation.

WORM
00:09:23.840 – 00:09:38.400
Yeah, a couple of pointers. Check the weather report before you hike. That’s easy to do.

And B, take clothes as if it’s going to rain and or snow pretty much regardless of the current weather and that will help your odds tremendously.

GERM
00:09:39.190 – 00:10:40.310
Agree. And finally, just to circle back to what you said before Chris, about the 10 essentials for hiking.

This is a little bit old school, but it’s not wrong.

The 10 essentials are usually said you should have a navigation aid, a flashlight, sunscreen, ability to take care of yourself if you’re sick, a first aid kit, an emergency shelter, good insulating layers, the ability to start a fire, some kind of repair kit or knife, extra water and extra food. Those are the ten so called essentials.

And I think as we as a spirit species get more and more high tech and more savvy, better connected with each other, it’s really tempting to cut back on some of these. I can tell you when I just the other day when I was up in the mountains, I did not bring an emergency bivvy shelter. Why?

Because I knew that the weather was going to be favorable and I had extra layers. So if I did get injured, I would be waterproof and could make a bivvy. So I was able to save a little bit of weight that way.

Technically speaking, I shouldn’t have done that. I’ll tell you what I did bring was three headlamps in case we got benighted.

So once you get experience, you may be able to modify these 10 essentials. But generally speaking, they’re a good guide to stick to.

WORM
00:10:40.950 – 00:11:18.160
Yeah, redundancy for the important stuff is a good idea. Just recently at Burning Man, I was thinking, oh, I’m taking four sources of light. Is that too many? I think two flashlights and two headlamps.

Well, at least two of the four died during the trip. So by the end of my nine days, I was really glad I had redundant lighting sources. Paul, this is for you. Next question.

CDC has reduced their workforce significantly with new administration. How much have they reduced it and what impact has this had on the health of Americans?

GERM
00:11:18.240 – 00:16:02.230
This is just really bad news. And I think, you know, look, germ and worm are about empowerment and happy times and traveling safe.

But we also have to acknowledge that our federal government here in the United States has made a whole bunch of blunders and bad errors, intentional or otherwise. Here’s one example.

We’ve talked about this many times, that the people who serve at CDC are generally wonderful, but now they’re serving under terrible leadership. And within the last few days, a series of stories have come out.

Really taking an accounting of this, Chris, just by the numbers, how many people used to work at CDC and do today? So this is stunning.

If in the last few months, according to National Public Radio, and I think they’re right, CDC has lost around 3,000 employees, plus an additional 1,300 employees who aren’t exactly fired yet, but they’re on administrative leave in total, that means just in recent months, we have a reduction in CDC of about 33% of their staffing. I’ll say that again. One third of people who used to work at CDC a few months ago no longer do. This is stunning.

And these are numbers that we think are reliable and provided by the staffing union at cdc. There’s been mass firings.

There’s also been an exodus of people who don’t want to get fired or just don’t want to serve under these really intolerable and unsustainable circumstances, you can’t blame them. But the impact is very real. I mean, think about any other organization. If you fired a third of the people.

Look, maybe there’s a bunch of industries out there where that could happen all the time. Public health ain’t one of them. CDC has never been, in my opinion.

It’s never been adequately staffed to begin with, even under the good old days of good old presidents. And now to slash it like this is just redonculous. Just redonculous. And it’s a huge, huge problem.

Think about the impact this is having on our global response. I’m not just talking about being good neighbors to our friends overseas. I’m talking about good old national security in the United States.

What we don’t need here in America is Ebola virus. Like, it’s bad news. Bundabujo is a dangerous disease. It’s out of control in Central Africa.

And we’re just doing everything wrong to try to keep ourselves safe when we don’t help keep people safe over there.

So by withdrawing from World Health Organization, by failing to adequately address these public health emergencies, we’re doing everybody a disservice. The germs don’t care. They don’t care who’s president. They don’t care what they tweet on Truth Social. They just, they do what they do.

We have to be humble about this and recognize that, you know, when CDC employees are asked about this, they say the same thing.

More than 99% of employees who are recently surveyed, 604 out of 605 CDC employees who were surveyed, said that the administration’s changes to the CDC had reduced its capacity to respond to a public health emergency. And that’s classic with respect to think about what we did with our last US Ebola experience.

We had Ebola, Zaire type that was here right between 2014 and 2016. And at that time 10 years ago, it feels like a long time ago. But CDC sent public health professionals to thousands of deployments in West Africa.

This is no longer the case. So this is just not happening. And the graph is just stunning when you look at these reductions in force.

So we have a Secretary of health, so called Secretary of Health. I call him the Secretary of madness.

Whether it’s him or the worm in his brain that’s talking RFK Jr. Who’s saying that he wants to reduce chronic diseases. And yet that’s not happening.

We have slashing to areas looking at how to reduce tobacco use, how to prevent violence and injuries, how to improve women’s health. These preventative core issues, domestically and otherwise, they’re all being cut. And so this is really, really sad and frustrating.

So, you know, to me, we’ve talked about this before. We’re all angry, we’re all upset. If you’re listening to German worm, you’re probably of a like mind. So we’re, we appreciate your solidarity.

The question is what to do. So number one, as my friend Gloria Steinem said, if you’re not angry, you’re not paying attention. So let’s just acknowledge that this is bad news.

Number two, get lit. Get upset. Do something about it. We are now on the verge of an important election here in the United States.

In which the opposition party that I happen to support called the Democrats.

We have the opportunity to take back the federal government, not the executive branch, that’s cooked for at least another couple years, but the legislative branch. Both houses are up for grabs now. So please talk about it.

I think if people are upset about the economy or the price of gas, how much a gallon of milk costs. Okay, fine. That’s the thing. These are the issues that I think cut across party lines.

And who knows, we may have listeners planning to go into a Thanksgiving holiday with family members they don’t normally see or normally talk to. Maybe they come from different political backgrounds.

These are some of the talking points that you might, you might get people to change their mind or if nothing else, just have them stay home and not vote for the bad guys. That’s my thought about this. What do you think, Chris?

WORM
00:16:02.310 – 00:16:53.330
Yeah, these cuts are maddening if we only look at being cost effective.

If we take human misery off the table and just look at health from a cost effective standpoint, it is so much cheaper to prevent someone who is going to smoke, someone who’s going to drink too much, someone who’s going to die in a car crash or to prevent an infectious disease with a vaccine than it is to treat the person who didn’t get that counseling or prevention and then goes on to get the illness or the trauma. It is so much cheaper. Nothing is as cost effective in all of medicine, in all of health, as public health, as prevention.

And this is the center for Disease Control and Prevention. And so to take money away from the most cost effective part of our health system is just going to make a messy system worse.

So this really breaks my heart. It is so fundamentally stupid.

GERM
00:16:54.610 – 00:17:17.579
Hear, hear, my friend. Hear, hear. Chris, a question to you from a listener who’s preferred to remain anonymous, which is always totally fine. The question is simple.

The answer may be complicated. How can I avoid political violence and political chaos when I choose to travel overseas?

I would travel as a United States citizen with a U.S. passport.

WORM
00:17:17.899 – 00:19:00.870
Yeah, thank you for that. Couple thoughts. One, I would go to the Department of State, U.S. department of State, @state.gov and check out their four step system.

Number one, super safe. We’re talking Canada, Japan. Number two, increased caution, probably reasonable for most people. Three, reconsider travel.

About 10% of countries are that. Four, avoid travel. About 10% of countries fall into that category, places with active warfare or other issues.

So number one, avoid all four category four places just off the bat. I think that’s a good idea. And as they Say, reconsider travel for category three. Now, suppose a place is category two or three and you go there.

One thing I’d recommend is don’t totally avoid the media.

Whether you’re reading the local media or the international media or, heck, the New York Times from the United States, check something at least once a day. And there’s an example. Recently this came up in Kosovo, one of the countries of the former Yugoslavia, where this would have been a good idea.

There was a verdict in war crimes of the former president, and a lot of people didn’t like the verdict. And there were protests, there were riots. No Americans or other tourists were hurt. These things don’t tend to intentionally target tourists.

But, you know, if the police are spraying their water things and tear gas, you could get caught in the crossfire. So what I would do is at least once a day, check the headlines and just make sure nothing funky is going on.

Also, if there’s something weird going on, ask your hotel or Airbnb guide what’s going on. So if you hear, probably protests or potential riots or, heaven forbid, explosions or fires, talk to people, see what’s going on.

Don’t be in a bubble.

GERM
00:19:01.350 – 00:20:07.890
I think that’s really wise advice. When I was in Mallorca recently, it’s interesting. We were there just on the heels right after the conclusion of a bunch of protests against tourists.

They said they didn’t want so many tourists. It turns out Mallorca is considered another province of Germany. There’s so many German tourists who come down there that against German people.

But apparently it’s something that makes those people angry. So I looked into this a little bit by talking to people who were on the ground. They said, no, no, you’re American, you’re fine.

Boy, words never spoken before, looking for Americans to show up. Very few Americans go to Mallorca. So, anyway, thanks for the question.

Thanks for traveling safely and thanks for your adaptability, your willingness to follow the news and consider a change in travel plans. Politics, change, anger comes, goes. There are places I’ve been where I’ve traveled in the past. I would never go today and vice versa.

So that’s part of the burden and the joy of this situation. And to my understanding, I think you’re right, Chris. I still think that generally we can trust advice from U.S. department of State.

There’s probably some shenanigans and monkey business in there, but if there’s someplace that’s listed as a level four, as we’ve said before, please consider not going.

WORM
00:20:07.970 – 00:20:36.630
And these places change as circumstances Change and to name names. 20 Years ago I would have gone to Russia. I would not go there today. Six years ago I went to Ukraine with my wife. Had a lovely time.

I would not go there now. Just recently I went to Colombia, which I wouldn’t have gone to 20 years ago.

20 Years ago, I would have gone to Venezuela, which I would not go to now. So one lesson from that is if a place is open now, go there. Because some of these places may be tumultuous in 20 years, years or so.

GERM
00:20:37.510 – 00:20:38.710
Yeah, that’s so true.

WORM
00:20:49.510 – 00:21:07.130
Paul, question for you. We hate mosquitoes for many reasons.

They spread all these diseases, but also, even if they don’t spread a disease often, the bites are super itchy and irritating. There are these new gizmos that purport to reduce the itching just by heating the skin. Do you have any info on that?

GERM
00:21:07.210 – 00:24:41.560
Yeah, we talked about this before, these anti itch skin heaters. So this auspicious timing of the question is my daughter was recently in Italy and brought one of these devices with her. She asked me about it.

I said, look, we’ve talked about it on German Worm. Listen to the episode. They’re out there.

I don’t know that they’re well tested and the data behind them is encouraging, but I’ve never used one myself. But she said, good enough for me, took one of these. And she did two things that were smart.

First of all, she brought one of these devices which worked well. As I mentioned in a moment. She also was smart in choosing her roommate, who apparently is just the most attractive intoxicated, like the mosquitoes.

Just couldn’t leave her roommate alone. So she would hang out close with this other person who would attract the bites. But anyway, yes, the answer is they can really make a difference.

So the brand, this is an n of 1, as we’ve talked about. Testimonial from my family. The brand that she used was called Heat it, which I think is a nod towards that Michael Jackson song Beat it.

But I don’t think it plays that little tune. What is the heated device? So it’s a little USB C dongle, a little doodad that you plug into the bottom of your phone, at least for the iPhone.

It probably works with Android too. And once you plug it in, there’s an app that’s on your phone. You control it with the app and you can tell it what’s happened to you.

Is it a mosquito bite or a fly bite? What’s the level of itching? And basically you then take the other part of the device and put it right on the bite. It’s a small probe, if you will.

And when you tap the app, it talks by bluetooth to the little probe. And it heats up your skin. Not to the degree to which it could harm you, it won’t burn you, but it gets hot.

And it can get either hot or very hot, depending on what you require. And she told me that it was like a miracle that it instantly got rid of of the itch and irritation.

And she gets these, for whatever reason, she’s sensitive to these bites. So she was thrilled with the outcome and several other people on her expedition did the same thing. So I looked into this some more.

I actually tried it myself last night when she brought it back. And yeah, it’s super easy to use. It’s not dangerous, it’s not unpleasant, it’s not like it’s zapping you or shocking you.

It’s just a hot spot on your skin. Why does this work?

I guess we don’t fully understand, but it’s thought that this is a neurosensory counter stimulation where you have thermosensory and nociceptive fibers, your sense of temperature and your sense of pain, they travel together.

And so, you know, when you get an itching sensation or painful sensation, there’s also the opportunity for the temperature sensors to get involved in that signal.

So if you overwhelm those with say, a little hot spot on your skin, it just crushes the signal that are coming in that are telling your body that it’s in pain. So this, it’s a noxious heat counter stimulation and it has to do with the C fibers that go under the skin.

There is science and anatomy behind this and there are some clinical studies that look at this too. What I’m curious to know is whether any one of these particular devices may turn out to be superior in a head to head trial compared with others.

I’m not aware of those yet. Although if there’s one of these companies that thinks they’ve got the best mouse trap on the market, I think they should do that.

But honestly, to me, it was just really encouraging to see that just the thermal pulses up to 41 or 43 degrees centigrade. It’s not that hot like a, like a high fever. Ah, it’s like the temperature outside.

When I was in Mallorca recently, it’s like that, like if you just this little pulse of temperature, it can really reduce the itch and the pain of mosquito bites. And so, you know, to some of our listeners who really suffer with this. Let’s face it, some people get mosquito bites. It’s no big thing.

For some people it’s a thing. And so please consider checking this out.

I can’t tell you that the Heated brand is better than others, only with my n of one that it seems to be safe, well tolerated and worth a look.

WORM
00:24:41.880 – 00:24:50.760
And a couple follow up questions. Paul, how big is this thing? Is it going to add to the weight in my luggage? And do you recall roughly how expensive is it?

GERM
00:24:50.840 – 00:24:56.200
Yeah, good question. So for the size. No, no, it’s tiny. In fact, the concern is that you could lose it. It’s smaller than a USB drive.

WORM
00:24:56.280 – 00:24:56.640
Okay.

GERM
00:24:56.640 – 00:25:50.280
Remember the old days, have like a thumb drive or usb. It’s like that, but even smaller. So it’s weightless. Essentially the big issue is not losing the darn thing.

You would put it perhaps on a keychain or something like that. It’s a little fob, if you will. And as for the cost, yeah, I’m on a site you may have heard of. It’s. This is an online shopping site.

It’s named after a big river in South America. And I just typed in heat it bug bite relief. And here it is. It’s 25 bucks and we’ll arrive if you’re in a big city like tomorrow.

So it’s affordable, it’s small and I think may be worth a look, especially if you know you’re likely to get bitten in spite of covering yourself up and using bug avoidance measures. This may be something that some of our listeners want to look at. That’s the one that’s controlled by the iPhone.

There are others that are freestanding. Those are a little bit bigger. They look kind of like an electronic ear thermometer. That’s another model you could do if you wish.

They’re not cheaper and I don’t know that they’re better.

WORM
00:25:52.760 – 00:26:03.400
Paul, I’ve seen in the news recently a few reports about potential exposure to rabies with various animals, including beavers and goats and skunks. Can you fill us in on that?

GERM
00:26:03.800 – 00:28:21.970
Yeah, unfortunately I can’t. I mean, it’s like, it’s just the craziest thing.

So this is ripped from the headlines of our colleagues at Centers for Disease Control with an alert that they published 14th of September 2026. So earlier in this episode we talked about the reductions in force at cdc.

There’s still people there working, trying their darn best to keep the lid on. And here’s an example where things have just gone sideways.

Warning from the CDC as of mid-September 2026, that there’s been a rise in outreach from doctors and other healthcare providers around the country asking about exposures to rabies. In fact, from July through August, there was a 17% increase in these outreaches to CDC compared to the same period from the previous year.

So it seems like more people are doing more crazy stuff with more animals and there’s, or at least there’s more doctors asking about the possibility of rabies exposures. That’s important because this is a fatal infection. It’s caused by a virus that we cannot cure.

But if we can give people an immunization combination of vaccines and also passive immunization with something called rabies immunoglobulin, we can very safely arrest this process almost always. So it’s all about asking these questions. So in a way I’m glad that people are asking about this, but I’m not glad about is how it’s happening.

This is sort of crazy. So here’s some examples of how this is going on.

In the state of Maryland, there were three different attacks by rabid beavers at two different Maryland state parks. I’m going to say that again.

Somebody in Maryland went out into a swamp or going out for a day of hunting, fishing or something and were attacked by beavers with rabies. Now, I’ve only been doing ID for pertinent 20 years and I’ve never heard of this.

I mean, these are, these are not known to be carnivorous animals, but they somehow got in trouble, apparently with rabies. Remember, any mammal in theory, can do this.

The only time you’re not really worried about rabies is an animal that dies pretty quickly because it has a short half life, short lifespan. And so I guess beavers are long enough lived and they could potentially be bitten by some other rabid animal. So this seems to have happened.

No one knows how those poor beavers got infected. Were they feasted on by a bat tussle with a raccoon that was rabid? We don’t know.

But what is clear is that apparently we have three attacks by rabid beavers in Maryland state parks. It’s got to be the most benign of mammals. Like all it does is eat wood and tend the forest. And this is just so sad.

WORM
00:28:21.970 – 00:28:22.970
Make some dams.

GERM
00:28:22.970 – 00:30:36.270
Make some dams some damn. Make some damn noise. No, it’s. That’s exactly right. So that was, that was sad. So just a reminder that this can happen.

If you’re approached by a beaver in the day, do not pet it. Remember those teeth are sharp, and apparently they can really chomp into you. Sharp enough like chisels to cut down a tree.

There was this other crazy experience, not Maryland, but North Carolina, also reported by cdc, in which not making this up. It’s potentially possible that several hundred people may have been exposed to rabies by exposure to baby goats at a mobile petting zoo.

So a number of things are here. Number one, mobile petting zoo. Like, what is that? And I just thought that was an adorable idea.

But there’s got to be some kind of regulation around this. When I think of goat exposures, I got to tell you, rabies, not at the top of the list. We have something else called coxiella, or so called Q fever.

That’s the classic thing for baby go. You ask any ID doctor, you say the word baby goat, they say Q fever. This is completely different, and that’s stunning.

We don’t know how this happened, but apparently these baby goats were diagnosed by a legit veterinarian as being rabid. And it’s thought that they were probably mauled or exposed to a skunk. So skunks do live in the community, especially back east. Skunks can be rabid.

Don’t mess with skunks in the day, night, or anytime.

And apparently these little baby goats somehow got exposed to rabies by a skunk, and then people came along, or rather, the goats came along in a mobile setup and were petted, apparently by hundreds of people. So this is stunning. I got to tell you, our rabies countermeasures, Chris, they’re precious. They’re expensive. We don’t have a lot of this.

So the idea that we have one setting leading to hundreds of potential exposures, it could be very expensive, a huge waste of everybody’s time and money, and yet we have to take it seriously.

So, as a reminder, if you are exposed to rabies, you do need to see a medical doctor right away, because we can give you vaccines and rabies immunoglobulin. The total cost, if you’re going to pay out of pocket, could be more than 10,000 bucks. And I don’t know about you, but that’s a lot of money.

And so we really want to try to avoid this in the first place. So please be careful with beavers, goats, or any other kind of mammal in between.

And I’m just so sorry that in this case, people apparently trusted an outfit to bring healthy animals to them as a mobile petting zoo. And it turns out that may have actually been, unfortunately, the wrong decision.

WORM
00:30:36.750 – 00:31:09.960
And just to review the Pre Exposure series. It’s not a routine childhood shot, so we don’t give it to all kids. We don’t even give it to all travelers.

It’s basically recommended for folks before exposure at potential elevated risk. So backpackers, obviously, anybody working with animals.

There’s now one series that’s only two shots, not three, and these go in the arm and there’s not high side effect. Decades ago they went in the belly and they hurt. We haven’t used those for decades.

In terms of strategy, to quote Ogden Nash, if called by a panther, don’t answer.

GERM
00:31:19.960 – 00:31:48.690
Everybody, thank you so much for joining us here on episode 121 of Germ and Worm. It’s been our pleasure to talk with you today.

If you’ve enjoyed what you heard here today, you can support us by subscribing, rate us favorably on your device, and spread the word with friends, family and on social media. Those are free ways to support our podcast. You can also support us by reaching out.

We would love to hear from you, your questions, your tips for success, or suggested corrections. Easy to find us germandworm.com or send us an email germandworm@gmail.com I’m Jerm.

WORM
00:31:48.690 – 00:31:51.700
I’m Worm. It’s a big, big planet. See it in good health and we.

GERM
00:31:51.700 – 00:32:12.060
Look forward to seeing you next time.

This podcast is designed to inform, inspire and entertain, but it does not establish a doctor patient relationship and so it should not replace your conversation with a qualified healthcare professional. Please see one before your next adventure.

The opinions in this podcast are Dr. Sanford’s and Dr. Pottinger’s alone and do not necessarily represent the opinions of University of Washington or UW Medicine.