Germ
00:00:10.560 – 00:00:11.600
Xin chào! My name is Germ.

WORM
00:00:11.680 – 00:00:12.560
I’m Worm.

Germ
00:00:12.720 – 00:00:25.520
Welcome to episode 124 of the Germ and Worm travel health podcast. Plague, black death or hot air? It’s a big planet. Seed in Good Health. I’m Dr. Paul Pottinger, also called Germ. I’m an infectious diseases specialist at the University of Washington.

WORM
00:00:25.770 – 00:00:31.290
I’m Dr. Chris Sanford, also known as Worm, a family medicine doc, also at the University of Washington.

Germ
00:00:31.290 – 00:01:19.670
Chris, here are some of the great questions we’re getting today. Plague in Russia. What is really going on? Should I avoid traveling to countries where I can’t buy travel insurance ahead of time? What communications devices should I carry when I hike? And African swine fever? Is it just in Africa? And is it just for swine?

A reminder to our listeners, Please contact us with your travel health questions or suggestions. We’d love to see you Visit our website, germandworm.com or send us an email: germandworm@gmail.com.

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.

Chris, I’m headed to D.C. this week and then to South Africa. A little bit of work and a lot of fun for both situations. What about you? Any travel coming up?

WORM
00:01:19.670 – 00:01:28.970
You know, I’m going to exotic, distant San Diego. That’s where I went to med school. Meeting up with my old med school roommate. And we’re just gonna look at the waves for a week.

Germ
00:01:29.210 – 00:01:36.290
Look at the waves for a week. San Diego is as good a place to do that as any. I’m actually going to be there in a couple of weeks from now, beyond this.

WORM
00:01:36.290 – 00:01:37.930
So it’s a pleasant town.

Germ
00:01:38.010 – 00:01:39.490
It is a. It’s a great, great place.

WORM
00:01:39.490 – 00:01:47.290
I mean, we made fun of it for being a little boring when we lived there. We called it Bland Diego, but that’s a cheap shot. It’s actually a very nice town, either.

Germ
00:01:47.290 – 00:01:49.850
You could do a lot worse than San Diego, that is for sure.

WORM
00:01:50.640 – 00:02:12.160
All right, Paul, first question coming to you. This doesn’t have a simple answer.

Basically, as sat phones become more common and other communications devices like locator beacons, is it now the standard of responsible travel to go with when you go hiking and you’re otherwise in the wilderness to travel with one of these communications devices?

Germ
00:02:13.120 – 00:05:08.990
I actually, I think it is a pretty simple answer, to be clear. And the answer is yes, you need to have the option to be connected. Let me say that again.

When you travel in the wilderness, you should have the option to be connected back to your world.

It doesn’t mean that it needs to rule your roost or that you need to be listening to your earbuds the whole time, or that you’re texting on the Instagram with everybody. But you need to be able to get help if you’re out there.

So in fact, in my experience with the evolution of iPhone and I suspect this will happen with other mobile phones as well, you know, you can now today SOS for help from iPhone. In fact, that’s going to be enhanced soon enough I think to essentially reproduce what they’re getting close to what you’re getting with 5G.

And you can be able to just text and stream from them as well over satellite network, which is insane to me. Just so different from what I had when I was in the throes of my seven Summits project.

But so that’s one thing that is in almost everybody’s pocket now. Not every iPhone out there can currently do it. You need to have an updated iPhone 15 and later. But so many people do.

And I just, I love that idea because they can use it if they need to, if they’re in trouble, but they don’t have to be ruled by it. And if you don’t like the iPhone life, there are other ways to go. I think the Garmin Inreach is a terrific way to go.

That’s a personal locator beacon which can also have two way chatting communication. It’s a little bit clunky, it’s also very easy to use and it’s something that’s relatively cheap, it’s lightweight.

I also carry one of those when I’m out in the backcountry as a, as a form of backup. I think it’s actually a bit more robust and its ability to get through some of the tree cover if you’re actually hurt and in trouble out there.

And there are many other ways to go from satellite phones and beyond.

So I think if we’re talking about I’m going to go outside, I don’t want to be online, but I don’t want to die because I’m in a hypothermic situation, etc. Then you have these options that’s different from someone who wants to be in constant communication there.

I think that’s when you really might look into a Thoraya or Iridium phone. Those are other ways to go. But those technologies, Chris, I think those are going away.

I honestly think they’re going to be replaced soon enough by the, by essentially the iPhone I would simply say this. Whatever you choose, it’s not enough by itself. Right? You still have to prepare. You still have to know what you’re doing.

And even if you call for help, it may be too little too late.

If I’m not mistaken, we saw that here in the Cascades just a few weeks ago where a couple from Oklahoma went through the enchantments and were caught unfortunately in a blizzard. I think they were able to somehow get help.

I don’t know the details of what tech they used and rescue team reached them, but one of them had died by the time that they were found. So this can still lead to tragedy. You have to be prepared. But as a backup, yes. I do think this is requirement and is it unethical to go without it?

I just think it. I would say it’s foolish to travel without that.

WORM
00:05:09.070 – 00:06:01.050
Yeah, I think I agree. And just expanding a little bit on the preparation. Learn how to use your gizmo before the bad thing happens. Totally.

When your traveling companion falls and breaks their leg, that’s not the time to look up the number for who to call or how to use your thing. So there’s no point in buying it and then just stuffing it in your day pack and figuring it out later.

The other point I would make is do recall your group should try to be self sufficient first.

So there’s good reasons and bad reasons to call for help because it’s a big deal, it’s expensive and sometimes it’s even dangerous for a team to go into the wild to look for you. So you need to exhaust your group resources first.

So yeah, someone breaks a leg and can’t walk, you know, call the number if you’re tired or if you’re hungry. Well, maybe not. Maybe just sit down for half an hour and have an energy bar and then rethink it again.

Germ
00:06:01.130 – 00:06:17.290
Oh my gosh. I mean, needless to say, only call for help when you need it and please do, but for God’s sakes, don’t abuse the system. These are volunteers.

People can be hurt or killed trying to come help you. Yeah, let’s not be part of that. Nobody in German or nation would ever behave that way. I’m sure they’re too smart to do that. Oh, and by the way, in terms of the preparation, the other thing to call back to our previous episode, we talked about an app called what3words. W3W.

And that’s one that gives you. Well, there’s a three word code for every three meter square on planet Earth. So if you were going to call for help.

You should not just rely on the geolocation beacon of that device. I would enter the what3 word code in that text as well. It makes it totally clear exactly where you are.

And there are so many examples of people who’ve asked for help.

They didn’t say exactly where they were or the nature of the, of the issue and then the battery dies, right, because you got to keep these things charged or they lose connectivity for some reason and then the, the rescue team knows that there’s a problem somewhere and it makes things so much harder. So what three words as a way to tell people exactly where you are? I really do recommend it.

WORM
00:07:04.610 – 00:07:18.910
Yeah. And you know who uses that?

Actually I was at Burning man recently and one of the paramedics who actually has a big social media under the name the Electric Medic. He uses what three words when he’s on the Open Playa to find somebody. He said it was super essential and helpful.

Germ
00:07:18.910 – 00:07:29.950
It should be a requirement I would think in blackrock. Chris, here’s a question from one of our listeners. Should I avoid countries if I can’t get travel insurance before I go?

WORM
00:07:29.950 – 00:09:23.730
Oh, good question, good question. This is coming up more and more as travel insurance becomes more widely available.

I checked recently for my trip to Bhutan and Brunei and I go to this site called Square Mouth and I actually hired this company called Trawic and I think I cut them about $170 to cover me for evacuation insur and up to 250,000 in medical and other costs associated with illness. And I noted down at the bottom of the site for Square Mouth there was this notice that said coverage is not available in the following countries.

And I’ll list these.

Afghanistan, Belarus, Cuba, Democratic Republic of Congo, Haiti, Indonesia, Iran, Iraq, Lebanon, Liberia, Libya, Myanmar, North Korea, Palestinian territory, Russian, South Sudan, Sudan, Syria, Ukraine or Yemen. Now this matches almost exactly the US Department of State category four countries for which they advise do not travel. And so back to your question.

Should you go to one of these countries if you can’t get travel insurance?

I think the bigger reason not to go there is just because they’re not stable places, they’re fairly dangerous which is why you can’t get travel insurance. That’s not an absolute and my own personal preference doesn’t match exactly to this.

I went to Cuba, I’ve been a couple times over the last three years. I had a lovely time and I’m planning on going to Indonesia in the next few years.

However, the other is on the list currently as we speak, 20, 26, I would give a pass. And also I couldn’t get insurance.

So not only is the risk higher that something bad is going to happen, but if I do, maybe I can’t leave the country for political or logistical reasons or it’s going to cost me a fortune. So that’s a long way of saying kind of sort of, yeah, if you can’t get insurance, there may be a very good reason for it.

So that should be a big red flag in your travel planning.

Germ
00:09:24.370 – 00:09:56.910
They don’t insure these places for a good reason because they just can’t get you out safely. It would require life threatening military conflict and potential armed conflict to get you out.

So that is a big warning sign that you may be on the wrong pathway. And if you are doing this for some other reason, you’re working for Department of State, etc.

You need a plan for extrication that does not involve a private company. Right. There has to be some other sponsor who says here’s the plan for how to get you out and here’s how we’re going to coach you to do this.

So it’s, you can think of that unfortunately as essentially a military operation and that’s not something most of our listeners should be dealing with.

WORM
00:09:56.910 – 00:10:06.830
Yeah, the best statisticians don’t work at universities, they work at insurance companies. And because it involves a lot of money and I pay attention to their decisions.

Germ
00:10:07.150 – 00:10:08.749
Yeah. Even if it’s unfortunate.

WORM
00:10:15.550 – 00:10:35.370
Ooh, Paul, coming up for you, there was a report recently, a concerning report out of Russia that a young laboratory worker actually died of pneumonia and this laboratory worker was working with plague. Can you tell us a little bit about that? And should we be worried about an outbreak of plague coming out of Russia now?

Germ
00:10:35.930 – 00:12:31.750
Yeah, happy to spoiler alert. No, we should not worry too much about an outbreak of plague coming out of Russia. But it is a warning sign to us.

And although we have more questions than answers, it’s a good reminder that all of our listeners should be up to date on this. So we are told by authorities within Russia that a young person, apparently previously healthy, 28 year old woman, died of pneumonia.

She had been working at the Irkutsk Research Anti Plague Institute near Lake Baikal. And what the official stance from the Russians is that she died of pneumonia. They do not know what caused that pneumonia.

They claim that they have looked for plague and have not found it as the cause.

The concern of course is that she’s working in an anti plague institute and maybe she picked up plague from the Anti Plague Institute and died of pneumonic plague. That, of course, is the big reason why this has raised all kinds of red flags and has shown up on everybody’s instafeeds and on the news and such.

So what the Russians tell us that they have done is to place approximately 200 direct and indirect contacts of this individual index case under medical observation and quarantine.

And they’ve watched that person, both the people in their community and those who are in the hospital, to make sure that they did not develop a secondary case of plague in case this original person did in fact have a contagious case of the plague. And they tell us that this has not happened. So experts at World Health Organization say that they’re not aware of any confirmed secondary cases.

Indeed, we don’t know that this was plague in the first place. So first of all, what is plague? It’s a bacterial infection caused by a germ called yersinia pestis. It comes in two big flavors.

One is bubonic, where people get fever and rotten, inflamed lymph nodes. They’re called buboes. That’s why at Halloween time people say boo, because it means death or bubo. It’s where that comes from in the Middle Ages.

WORM
00:12:31.750 – 00:12:32.430
I never knew.

Germ
00:12:32.590 – 00:15:10.640
It’s because we had a couple of outbreaks of this, the Justinian plague. A second plague, it killed potentially a third of everybody in Europe. So that’s still in our general consciousness.

That’s where Halloween sort of kind of comes from, apparently. And bubonic plague, it’s awful. Most people will survive it, but not everybody does without treatment. Then there’s the pneumonic plague.

Pneumonic, of course, is what we get when we breathe in the germ. It goes straight to the lungs and that can be much more rapidly fatal.

Instead of big bumps on rotten lymph nodes, you get a terrible case of pneumonia and die. So both of them are very treatable. This is not an antibiotic resistant strain.

We have all kinds of antibiotics that could work against this, including Cipro and doxy. The aminoglycosides work against this. The mode of spread is different.

We get bubonic plague when we’re bitten by a flea that’s been feasting on the blood of a rat, and the rat may be the reservoir of the plague. You get bitten by a flea and this is how that happens. At least that’s one theory of how this might have gone down. In Europe.

It’s usually more about direct contact with that person. Pneumonic is different. You could get infected with the dust that’s been befouled and spoiled by the poop of a prairie dog in Colorado, for instance.

The concern is that somebody may be weaponizing Yersinia pestis, turning it into a form that is easier to breathe in and that can be more deadly more quickly. Look, you should not catch plague from another person. It’s not how this works.

Even doctors and nurses and hospitals caring for someone with bubonic plague, we give them antibiotics, we wear gowns and gloves. And after a couple days, you don’t even need that because you’ve killed off the germ.

For the pneumonic case, can that be spread from one person to another? At one phase of the illness, if they cough on you and you breathe in, they’re their respiratory droplets. You could catch it in theory.

It’s hard to do. And that number of spread, what we call the R naught, is close to one.

In other words, for every one person who’s infected, they might at most spread it to one other person and then the epidemic flames out. And indeed that seems to be what happened here. Again, we don’t know that this person actually had pneumonic plague.

Maybe she died of COVID or something else. I would think that if they’d found an explanation, they would have told us.

I’m still concerned that this person probably did unfortunately have an exposure within the lab, probably did die of pneumonic plague. But I’m just conjecturing here. If you’re curious about the plague, please go Back to episode 67 of Germ and Worm.

We’ve talked about it in a bit more detail, including the American context. Bottom line looks great on headlines for the news.

Not something that I think would deter me from from visiting in an area where there is this infection.

Now, I wouldn’t recommend people go to Russia for other reasons that happens to do with geopolitical conflict, but not because of this concern for plague.

WORM
00:15:11.040 – 00:15:41.020
And also, plague happens around the world in low numbers every year, even in the U.S. mostly in the Southwest. There’s an average of about seven human plague cases per year. And about 80% of these are bubonic.

So we even get a little occasional rare mnemonic just spontaneously from nature exposure in the US So. So it’s biblical in the sense that it’s in the Bible, but it’s not biblical in that it’s the wrath of God taking out large communities.

Germ
00:15:41.420 – 00:16:10.810
Agree, agree. And if we ever deserved a biblical slap down, maybe now is the time. But I don’t think that’s what’s going on in this particular case.

Okay, Chris, you know, back in episode 119 we gave an overview of recommendations for how to protect ourselves from respiratory infection. Here we are in the fall, we’re really getting into the high flu season and certainly here in Seattle we’re seeing a lot of flu.

Would you please give our listeners a quick overview again? Summary. How can people protect themselves from COVID and flu and rsv?

WORM
00:16:10.970 – 00:18:22.730
Right. The first thing I’ll touch on is reliable sources that are online.

And tragically, as Paul and I have discussed, we’re no longer sending people to the CDC for vaccine recommendations because it has been partially infiltrated by political input. Fortunately, there’s a number of very good evidence based medical associations where you can get their recommendations and I’ll list those.

Aafp, American Academy of Family Practice, aap, American Academy of Pediatrics, idsa, Infectious Diseases, Society of America, acog, American College of Gynecologists and Obstetricians and ama, American Medical Association. These all have strong evidence, evidence based, solid, trustable, reliable, non political vaccine recommendations.

And basically a lot of people can really bring their risk down of getting sick if they get the vaccines in the fall. So first Covid, I won’t go through this in detail, but all children 6 to 23 months. It’s recommended by the American Academy of Pediatrics.

And this varies from what the CDC site now says and then kids 2 to 18 years. Well maybe only people for risk of severe infection but I tell you they also say maybe considered when protection is desired.

And frankly if I was a parent I would desire protection so I would immunize my kids in that range. And then also older people as well for flu, essentially everybody above six months of age.

And this is both American Academy of Pediatrics and American Academy of Family Practice. And there’s different doses for elderly people that I want go into. Right now RSV is not recommended for everybody. One category it is recommended.

You can maybe talk a little bit about the younger people, but is older people. Older people can get more sick when they get RSV.

So ages 50 to 74 if they have high risk criteria and everybody over age 75 because that certainly can be a life threatening infection. And in terms of number you can get at once, you can get all three at once.

You can could get 10 vaccines if you needed that many different vaccines for different illnesses or more in one day. There’s no max number. So the fall is a good time to catch up on all of these.

Germ
00:18:23.210 – 00:19:16.190
Yeah, I totally agree and again for rsv, if you’re in that age bracket, as I am, between age 50 and 74, you know, you should really probably get your RSV vaccine.

If you’re in one of those high risk categories and it’s pretty broad, that’s a neuromuscular condition that impairs your ability to control your airway.

If you have chronic lung disease, chronic kidney disease, chronic liver disease, if you have diabetes that is impacting your end organs, for example, you require insulin if you’re an SGLT2 blocker, if you have significant obesity, if you’re moderately to severely immunocompromised, if you’re living in a long term care facility, even in that age bracket, or any other chronic medical condition that would put you at increased risk of having a bad outcome from a viral respiratory infection. If you’re not sure if you fit into one or more of those categories, talk to your medical doctor. It’s just amazing to me.

I think we are probably underutilizing this vaccine and that’s a shame. In that category.

WORM
00:19:16.190 – 00:19:26.990
Yeah, I’m in that same range, 50 to 74. And I got it because I have asthma, which isn’t, you know, a life threatening thing, but RSV could make it worse.

And plus I hate being sick and coughing.

Germ
00:19:27.150 – 00:19:29.790
Did you have any reactions to the RSV shot when you got it?

WORM
00:19:29.870 – 00:19:32.190
I had a mild sore arm for 12 hours.

Germ
00:19:32.350 – 00:21:03.190
I’ll tell you a reaction I got. Recently we talked about the new mRNA tech for influenza called Flusiva, which I still contend to be a great name for a kid in the south. “Flusiva! Get off the roof!” Or the name for a dog or something. So I love my MRNA tech, I think it’s brilliant. And so I did recently travel with my family on a small cruise to southeast Alaska, Canada.

And there’s no way I was getting on a cruise ship without both my Covid shot and my flu shot, I’ll tell you right now. But I wanted to do more. I wanted to get me my flusiva. And so we did. It was a real problem because it’s very hard to get here in Washington state.

I was not able to get it covered by my insurance company because I went to a, I went to a pharmacy that doesn’t usually contract with my insurance company. So I just paid cash, cash money for it, about 200 bucks per shot, which is crazy. My wife and I both paid cash. I really wanted my Flusiva so much.

Oh, I had all, I don’t know what cytokine it was. It was all the cytokines. Like the next day I was fine till like 10:32am and then it hit me like a storm and I was achy and felt feverish.

It was, I felt fluish. I didn’t look fluish, but I felt fluish and basically crawled into the bathtub and wallowed around like a walrus in the hot water.

And then exactly on schedule, 24 hours later, I was totally normal again. So I would take this to be a good sign that my fluciva really was really cranking up the antibodies. Yet to be continued.

Stick with us here on German worm. Let’s see if Paul can avoid influenza A during this upcoming season. Or if I get it, hopefully it’s a mild case.

I don’t mind at all that I had that one day of feeling miserable because there’s nothing worse than. The only thing worse than that is the actual flu itself. And I don’t want that.

WORM
00:21:03.190 – 00:21:34.340
Yeah, it’s the lesser of two evils for sure. Paul, next question coming to you.

And the question is about African swine fever, which isn’t getting a tremendous amount of press in the U.S. but some of the countries are worried about it.

When I flew recently back from Bhutan and Brunei, I stopped in Taiwan and there was a big video announcement about it with things they don’t allow in the country. Can you give us a little bit of a global update? What is African swine fever and where is it and what should we do about it?

Germ
00:21:34.580 – 00:24:24.640
African swine fever, it just sounds, it’s got everything. It’s got pigs, it’s got Africa. Look, what’s the story here? And I’ve seen these announcements as well.

They’re pretty strict about this in other countries. I’m not seeing that much, honestly, when I repatriate here to the the United States. But maybe we should. So here’s the story.

African swine fever, it’s in the name. So this is a fever of swine. So suids, meaning pigs and pig adjacent creatures, Babirusa’s warthogs.

What happens is that in Africa, this particular virus, it’s a double stranded DNA virus called the African swine fever virus. And it can live in an asymptomatic colonized state in these African pigs and piglets. It does not cause them harm.

But when it gets into a more domesticated herd, including not only Eurasian boars, but even domestic pigs, it can be very deadly. It causes a terrible fever. They can have a hemorrhagic disorder. These flocks are very much at Risk of them all spreading like wildfire.

It’s not measles, but it’s like that. Very catchy from pig to pig. And that, of course, has terrible implications for agriculture.

Folks, the good news here is that it is not contagious to human beings, so people cannot catch it. We as Homo sapiens are not at risk of getting it. Maybe some of our representatives in D.C. have enough pig blood in them that they could catch it.

But no, people don’t catch this. That’s good. But the key is that it can spread from one pig agricultural group to another, and that can happen through the flesh of a pig.

If you’re bringing pork products, meat, especially undercooked meat, or a snout or a tooth of a pig, that’s bad news. And so I think that’s what the video was presumably talking about in Taipei.

They don’t want any pig products coming to their country because once it gets into the domesticated flocks of swine, they’re gonna have to destroy many, many hundreds of thousands of them or more. So it’s a threat to agriculture.

The way that we do this is please don’t try to import pig products of any flavor when you come or go from one country to another. Certainly not coming out of these endemic areas in Africa. If you remember, when you come to the United States, it’ll say, have you been on a ranch?

Have you recently been in contact with animals? You bring any bioweapons or snails, that sort of thing? Hey, please, think about it.

Someone may have given you a necklace with a pig’s tooth on it or something like this. I remember when we were on safari in Kenya a couple years ago, my. My son got out of the combi and because he saw some bones.

So he started messing with the bones because he’s a biologist. I was like, matthew, you can’t touch that. There could be anthrax in there. Plus, don’t worry about African swine fever.

But there’s other things that can happen. So no trophies. Come home. Even if your kid gets sore with you about this.

And if you do have something and it occurs to you later as you go through that Customs app, or the question, please be forthcoming. You’re not going to jail for bringing in a pig hoof, but you can save our domestic swine flock.

WORM
00:24:25.130 – 00:24:47.210
Yeah, this is one of many reasons. It’s just good. Before you go to a new country to do a little research, just go online, do any of your medications, trip the local alerts.

Does anything you’re going to carry through it, do you have any pork jerky that’s going to make them fine you and take you off in a room and ask you a lot of questions and make you miss your connection. So a little research before a trip to a new place, always a good thing.

Germ
00:24:47.690 – 00:25:03.770
Agree.

And when you read about the fines for this, please understand they don’t fine you if you declare because all they have to do is destroy it on the spot, you’re fine.

It’s if you try to steal, sneak something in and then they find that you tried to sneak in a snout of a pig or a tusk of a babirusa, that’s when they’ll find you and kick you out, Right?

WORM
00:25:03.770 – 00:25:04.050
Right.

Germ
00:25:04.050 – 00:25:35.040
Hey, Chris, you know, we’ve been talking a lot about the prevention of dengue fever, this rotten viral infection. There is a good vaccine out there made by Takeda. It’s called Qdenga.

We do not have access to it here in the United States, but we’ve been talking about people who are dengue. Curious. Can they travel to other countries? Not necessarily for this reason. Vaccine tourism, no.

But if you happen to be somewhere overseas, could you actually get immunized? Is there another country that you’ve heard about recently that people might visit where they might pick up a dose or two of the Qdenga?

WORM
00:25:35.040 – 00:26:43.860
Yeah, there is. Unfortunately, the list of where it’s available continues to expand. I wish it was available in the U.S. but it isn’t.

So first off, it’s a good vaccine. It covers all four serotypes of dengue. It appears to have good protection. It’s fairly low side effect effect.

You can get a sore arm, maybe a low grade fever, but most people don’t.

It’s two doses three months apart and you don’t need any blood testing before you get it as you did with some prior dengue vaccines that are no longer on the market.

It’s available in a lot of countries around the world, primarily Europe, but a few other places what you’re referring to, it was just approved a few days ago in Australia, so it’s available there now. As I’ve mentioned, this vaccine is on my one year plan. I’m going to get this.

I go to tropical places enough to where I think it’ll be worthwhile, but I don’t know if I’m going to get it in Italy or the UK or Australia. I was just wishing I had this a few days ago when I was in Brunei. They don’t have malaria there, but they do have some dengue fever.

So I was very cautious in the rainforest to slather myself every day with Picaridin. But I wished I’d had this dengue vaccine.

So if you are a frequent traveler or to the tropics to places where there’s dengue, I would recommend this vaccine.

Germ
00:26:44.660 – 00:27:46.820
I’m with you. And thinking about Australia in particular, I’m looking here online to see how the Australian health authorities are deploying it.

So they will give it as part of their national health system to someone who’s already had at least one previous infection. Because as we talked about here, if you get a second infection with dengue with a different serotype, it can be very serious.

So they’re trying to prevent that.

But it’s also to be optional if you individualized on a cash dollar basis for 300 Australian dollars for people who are short term tourists going to those high risk areas. And that’s Bali, let’s face it. I mean, Yasi’s go to Bali and there’s a lot of dengue there. That’s what they’re trying to get rid of. So I’m with you.

Next time I’m in Australia, I’m going to try to do this. But friendly reminder, as you’ve pointed out before, Chris, it’s two shots at least 12 weeks apart.

Now it could be more than 12 weeks, but that’s what we’re shooting.

And so I don’t know that the Australians are going to have a new category visa, maybe the vaccine tourist visa, three month visa, be a great way for them to make some cash money. I’m not sure that that’s happening. So you do need to plan to get, please to complete the full schedule and get two shots at least 12 weeks apart.

WORM
00:27:46.820 – 00:27:52.060
Well, oh no, I have to plan to fun trips to places. I want to go to Australia and say Italy.

Germ
00:27:52.060 – 00:27:54.900
There you go. And not necessarily in that order.

WORM
00:27:58.350 – 00:28:06.750
Paul, this next question is coming for you. I read that in the Philippines there’s an uptick of leptospirosis which is not trivial. Can you tell us a little about that?

Germ
00:28:06.990 – 00:31:24.430
Leptospirosis is a bacterial infection. It comes to us when we drink or are splashed in the face. Our mucous membranes are exposed to water.

It’s usually flood water or post hurricane water or sewage. And in that water, the urine of animals, usually rats. Although it can also come to us from other mammals, including pigs and cows.

Why is this a problem? Rats in particular can be infected with or rather colonized by this bacteria.

It’s called Leptospira interrogans enteragans because it’s a Leptospira means left handed corkscrew. Enterogans means question because it’s bent in the shape of a question mark that that’s what it looks like.

So leptospiran terrigans can live in the kidneys of rats as an asymptomatic colonizer. It doesn’t usually kill the rat, but when the rat pees, it’s peeing out urine that’s befouled with Leptospira interrogans.

It’s not usually deadly in rats, but in people it can make you very sick indeed.

In fact, we talked about this in the previous episode 123 as a possible explanation for what might have been going on in Grand Canyon as one of the mystery illness causes there. We don’t know that that’s the case. But leptospirosis, it is no mystery. It’s very real.

It happens in the tropics when we are splashed by or drink water that’s, that’s befouled by rat urine. And that happens all the time. And apparently that’s happening right now as you point out correctly down in Philippines. And so this is an issue.

It happens in our context here in travel medicine, usually in people doing adventure racing, rafting in Indonesia for example, hot tropical places where with a lot of water exposure. Philippines is no exception and they’ve, they’ve got more than 7,000 cases that they’ve reported just recently since August of this year.

That’s a tripling of their usual baseline amount. So presumably there’s a lot of flooding. Climate change is part of this. There’s a lot of rats that are out there.

The bottom line is that if you’re going to go to certain parts of Philippines you should consider, well, when you talk with your healthcare provider, say hey doc, I’m going to Philippines, I’m going to be on Cebu, I’m going on holiday, see family. But what about this leptospirosis thing?

This is not necessarily something that you’re going to come into contact with in the city, although it could be if it’s monsoon season and there are floods.

And the sewers, the sewer system is backed up, but it’s usually when you’re going out into rice paddies or other places where you’re going to be wet a lot. So what you watch for is a terrible illness with fever. People can have significant liver involvement. Your eyes may actually turn yellow.

In some cases it goes to, to the lungs and makes it difficult to breathe. It can be very serious. It’s also easy to prevent Chris, with a single dose of doxycycline.

200 Milligrams of doxy once a week is something that we can do in this context. It’s not routine for us to give antibiotic prophylaxis and there’s problems with antibiotic prophylaxis.

Can give you a terrible sunburn, can give you esophageal irritation. It feels like an ulcer. So it’s something to talk with your doctor about.

But I have to say, if you’re going to have a real adventure race, experience, Philippines or otherwise, it is something to raise with the doctor you’re seeing because it’s not something that we typically put on the radar, is it? You and I do this when we do Travel Health, we’re thinking about malaria, we’re thinking about viral infections.

This is a bacterial infection that we should talk about. By the way. Doxycycline can also be used to prevent malaria.

And in some contexts you can actually kill two birds with one stone, kill two bugs with one antibiotic. And that’s a something to think about with your doctor.

WORM
00:31:24.510 – 00:31:46.750
Yeah.

Personally, if I was going say to the Philippines, to Manila, if I was going to say an office meeting only I’m indoors, I’m in skyscrapers, I wouldn’t take it. But if I was white water rafting, I certainly would.

And as Paul said, you can get a twofer if you’re going to his own with malaria, you can do a lower dose 100 milligrams once a day, which is good for malaria. But it also that’ll prophylaxia for leptospirosis.

Germ
00:31:46.990 – 00:32:19.400
Correct? Correct. Foreign. Thanks everyone for joining us here on episode 124 of German Worm. As always, we really welcome your questions on Travel Health.

Just send them to us or suggestions corrections. Other things you want to talk about, send us an email germandworm@gmail.com or visit our website germandworm.com if you like what you hear.

We would appreciate it if you could subscribe rate us favorably and spread the the word with friends, family and on the socials. Those are free ways to support our podcast. I’m Germ.

WORM
00:32:19.400 – 00:32:22.400
I’m Worm. It’s a big planet. See it in good health.

Germ
00:32:22.400 – 00:32:44.440
See 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 do see one before your next adventure.

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