Germ
00:00:00.160 – 00:00:11.680
Ran annim! My name is Germ.

Worm
00:00:11.680 – 00:00:12.640
I’m Worm.

Germ
00:00:12.880 – 00:00:28.400
Welcome to the Germ and Worm Travel health podcast, episode 78, E bikes. Be afraid, Be very afraid. It’s a big planet. See it in Good Health. I’m Dr. Paul Pottinger, also known as Germ. I’m a professor of Infectious diseases at the University of Washington in Seattle.

Worm
00:00:28.400 – 00:00:36.420
I’m hi, I’m Dr. Chris Sanford, also known as Worm, Associate professor in the Departments of Family Medicine and Global Health, also at the University of Washington.

Germ
00:00:36.420 – 00:01:17.770
Chris we have some great questions from our listeners today, including were children really killed by the COVID vaccine? Is the flu virus getting worse over time? How can I protect myself against ciguatera intoxication and E bikes? Are they safe?

These questions and many more. Please contact us with your own travel health questions, stories or tips for success.

Just reach out to us by email germanwormmail.com or see our website germanworm.com finally, our disclaimer. This podcast is designed to inform, inspire and entertain. However, you should not use this podcast as clinical care before you travel, please see a qualified healthcare professional for recommendations specific to you and your itinerary.

Worm
00:01:18.330 – 00:01:35.340
Paul the first topic I think we should talk about, the FDA just came out with this claim that we need to be even more careful about the COVID vaccine than ever because it killed 10 children. So I’ll let you start, but is this true? And why are they saying that?

Germ
00:01:36.380 – 00:06:14.250
What the hell’s going on here? So it’s evolving. We’re recording this conversation 1st of December 2025. As of a couple of days ago, we have reports in the lay press that someone called Vinay Prasad who claims to be a doctor, maybe they are.

They are currently director of the FDA center for Biologics Evaluation, and this is the part of the FDA that usually gives grant certification to vaccines. For example, and apparently there was an internal email from this person called Vinay Prasad to other people in the agency.

And in this email, which is really a memo internally, they said that they had found at least 10 children who had died after and because of receiving the COVID vaccine, and that there were no fewer than 10 out of 96 child deaths that were reported through VAERS. So what’s going on? What is VAERS and what, what’s this person talking about?

VAERS is the Vaccine Adverse Event Reporting System, and VAERS has been around for a long time. It’s a great way that the FDA can keep track of issues that may pop up and develop after a drug or vaccine or a biologic is approved.

In this case, they’re focusing on vaccines.

So if you as a healthcare professional think that a vaccine adverse event has happened, they really do request that we share those adverse events through vaers. It’s free, it’s relatively painless thing to do. I’ve done this before.

My not related to this particular vaccine or these claimed issues, but all doctors know about this.

And so supposedly this person has gone back and looked through reports, apparently 96 child deaths that were reported up through VAERS and decided that no fewer than 10 of them were because of those kids receiving the COVID vaccine. We have no other information and as the time of this recording, we don’t know who those 10 kids were. What kind of investigation has happened?

Color me ultra skeptical on this one. So it’s a developing story. We’ll bring this back as we learn more. I am ultra doubtful that this is correct, but how is the process supposed to work?

What’s supposed to work is that you as a healthcare provider, doctor, nurse, someone who’s given a vaccine or taking care of someone who’s got an issue that may be related to the vaccine, you report this up through VAERS and then a professional who is an epidemiologist, a vaccine focused person at FDA does the investigation contacts that person, tries to figure out whether this was in fact associated in time or actually linked as cause and effect. That’s obviously the big question here.

For example, we know that children who received the COVID vaccine, if they were boys of a certain age, they were at higher risk than people who did not receive the vaccine of getting something called pericarditis, which is inflammation of the sac around the heart. And the only thing of greater risk for pericarditis in that age group was actually getting the COVID infection.

So this was protective against pericarditis.

But it was clear, based on timing, a number of reports in this country and elsewhere that some of those vaccines could actually trigger this in those adolescent boys. And thus recommendation came down from FDA and ACIP, CDC to consider some things that would be special in those cases. So VAERS works. We’ve seen this work many times before here. It is not clear that it’s working. Or rather the question is what are they really talking about?

And if there has been a full scale investigation of each of these deaths, which is the most serious adverse outcome, especially in a child, I mean, it’s just completely outrageous. This has to be taken ultra seriously and I just cannot believe that this is coming to light now.

I mean, you know, kids are not getting the COVID vaccine anymore, which is a separate topic we can talk about. But I would suspect that these reports are going back to the dark days of the first Covid outbreaks.

Did they actually die of COVID infection in spite of having gotten the vaccine due to one of the bad issues of the COVID infection itself? Or was it something totally different? We just do not know.

And for someone who claims to be a doctor, who is supposedly head of a big part of FDA to do this internally as a memo, is just unprecedented. It’s very, very strange. And I mean, I’m not surprised seeing it come out of this particular administration.

It’s all about conspiracy theories and lack of scientific scrutiny. So no surprise that we’re hearing it come. But you know this. I am just ultra skeptical and maybe I’m wrong. I mean, clearly science doesn’t care.

Science doesn’t care who you vote for, who put you on what committee. It just says please do the investigation. So let’s see what the investigation is. At the moment.

I would not change my recommendations for Covid vaccination for kids or anyone else based on this because I’m so skeptical. Chris, what’s your thoughts on this?

Worm
00:06:14.410 – 00:07:22.430
Well, RFK Jr. Who’s Secretary of Health and Human Services, does not know how science works. How science works is first you do the research, then you see what you find and from that you generate your conclusions and your recommendations.

What RFK Jr does is he comes up with his conclusion from based on whatever. He then looks to research to support that, which is obviously Looney Tunes. Vaers is a great system. I’ve worked with that for my whole career.

It’s sort of like a big vacuum cleaner.

Just sucks up anything, any information after you give a vaccine and it sucks up both things related to the vaccine and things that are unrelated to the vaccine. And after you get the reports, you have to look at them with a critical one by one and see what might be tied to the vaccine.

I’m afraid that this is part of the general anti vaccine sentiment directed by RFK Jr. And like Paul, I’m very skeptical about this. So I think it needs to be investigated.

But it makes me sad to see such an esteemed and high quality institution as the CDC and the FDA brought down to politics by poor leadership 100%.

Germ
00:07:23.870 – 00:07:30.910
Chris, a question to you from Marcella of Guanajuato, Mexico. I’m not yet vaccinated for flu this season. Is it too late?

Worm
00:07:30.910 – 00:08:32.950
Ooh. Thank you, Marcella. The answer is no. So first, what’s optimal timing for next year?

Or in 2026, I’d recommend you get it maybe September, October, pretty early in the season. That seems to be the best time. However, there’s benefit really, at any time.

In the Northern Hemisphere, the flu season goes until April or sometimes even May. So certainly if you get it now, December, it’s going for a good chunk of the season.

So I’d go to your pharmacy or your doctor’s office today and get it now. Last year was a particularly nasty flu season. It was the worst in 15 years. And actually in the US 280 kids died.

Children died of influenza last year, which is the highest since 2024. There’s a little concern this year that the flu shot may not be a perfect match for circulating strains.

But at a minimum, it gives partial protection, A, from getting any kind of influenza and B, if you do get it, it tends milder and it’s unlikely you’re going to be so sick you have to be hospitalized. So is it too late? No. Would I get it every year? Yeah, I would and I do.

Germ
00:08:33.590 – 00:09:17.160
One of my friends and colleagues, the brilliant Dr. Frank Riedo here in the Seattle area, when he talks with people about the flu shot and other respiratory vaccines, he says, look, it’s like driving a car. You wear a seatbelt: it’s not going to prevent you from getting in a car crash, but if you do, you’re more likely to survive and come through it with smaller injuries. It’s like that here with the flu shot, also the COVID shot, you can still get sick, but who has time to go through a full blown legitimate influenza?

Even if it’s not this subclade K that people are worried about, you’ll still be laid low. I mean, I don’t know about you. I don’t have time for the flu. I got things to do, I got things to see and my life is just too busy for this.

So, yes, I think this person. Thank you very much, Marcela. Get your flu shot on and feel great about that.

Worm
00:09:25.940 – 00:09:31.540
And Paul, related case. There was a case of avian flu in a person in Washington state?

Germ
00:09:31.860 – 00:13:06.430
Yeah, there was. In fact, a person has died this way. So this is extraordinarily rare, in fact unprecedented.

What happened was that just within the last few weeks, someone was diagnosed with flu here in Washington State.

They happen to live out towards the coast in Grays harbor county and were very sick with a respiratory generalized illness, made their way to higher level of care and the team of doctors there very quickly diagnosed them with influenza. This happens for people with flu.

We were Just talking about this a second ago, what was different about this was the ability of the hospital, clinical microbiology lab, virology lab, to understand that this was an unusual flu. This was not the usual human flu that we see. It was a very rarely encountered H5N5 flu.

Remember, the H stands for hemagglutinin, the N stands for neuraminidase. We do CL classify influenza strains, whether it’s flu A or flu B, based on their H and n determination. So H5N5 is not a human bug. It’s bird bug.

And this person happens to keep backyard poultry. They raise their own poultry in the backyard.

And so there was very close contact between this particular patient and a flock of birds in the backyard.

Presumably those backyard birds got infected from the droppings of birds that were coming down the Eurasian flyways, perhaps from Alaska down towards Antarctica or whatever they were doing. These migratory birds, geese, that kind of thing, they. They can stop by.

They see there’s a nice backyard, they’ll stop by there, mingle with the flock in the backyard, and then they fly away.

What they’ve left behind in their droppings can be flu, and that flu can be picked up by the backyard birds when they eat from the same spot on the grass or in their. Their kibble, whatever it is you feed a bird. So I think that’s what happened here.

Unfortunately, it jumped from the birds into this person, and this person did not survive. An older person with, we think, some relatively immunosuppressed situations. So this is rare.

It was intimate contact with birds and someone who was at high risk for bad flu. Regardless of the source. Can you still travel to Washington state? Yes, Please come visit us. We’d love to have you.

Number one for all of our listeners, if you’re thinking about getting backyard birds, that’s a big deal. It’s actually not something that people can just jump to.

You want to make sure that your backyard poultry is protected in time and space from mingling with migratory birds, ducks, geese, if you can keep them separate, then it’s wonderful idea to have backyard eggs, I suppose, but you have to take that seriously.

And then number two, if you’re visiting somebody and they have a backyard flock, reconsider, or at least stay the hell away from those backyard birds. They’re cute, they’re adorable.

You want to pet the chickens or whatever it’s going to be, please reconsider doing that because this is unfortunately increasing risk. There’s a theoretical risk that you could even get sick. Chris, if you eat undercooked Bird meat or undercooked eggs.

So backyard birds, it’s, it’s a romantic idea. Some people do this and love it and it can be done safely, but it has to be done right.

Otherwise these rare events might become theoretically more common.

At the moment, it does not look like we have any evidence of person to person spread and hopefully this virus has not adapted too well to the human body. Unfortunately, this person paid the price for that exact reason. It was really very dangerous for that person.

Okay, question to you, Chris, from Jens of Aras, Denmark. Ciguatera. I’m worried about catching it. Can I only get it from reef fish? What fish should I watch out for? Ciguatera.

Worm
00:13:06.430 – 00:14:28.000
Oh, thank you for the question. So first, ciguatera is a type of food poisoning and you get it usually from eating a reef fish.

And this what happens is there’s a toxin in this algae called dinoflagellates. Fish eat the algae and this toxin is concentrated as it moves up the food chain.

The drag about this is unlike most types of food poison, you can even get it from well cooked fish. Some places it’s common would include southern Florida, the Bahamas, British Virgin Islands, Puerto Rico and Hawaii.

But it’s present to some degree around the world. In terms of the fish that tend to spread this, it would include the reef fish, amberjack, barracuda, grouper, moray eel, parrotfish.

And what I’d recommend you do if you’re going to be eating seafood, really I do this for pretty much any foreign country I go to is just poke around online a little bit.

There was a case recently, recently actually in Madagascar, that big island nation off of Africa where people were eating shark and they got ciguatera poisoning from shark. This is not a fatal illness, but you get neurologic symptoms, vomiting, diarrhea, skin change sensation.

Things that usually go away after a while, but it can be a real pain for a while. So usually reef fish only occasionally shark, but it changes from year to year, country to country. I would do a little research before you travel.

Germ
00:14:28.630 – 00:14:41.990
I agree with you and as we’ve talked about before, it’s one you don’t want. That reversal of hot and cold, that’s the weirdest thing. You take a cold shower and it feels hot.

You get in a hot shower, it feels cold, it doesn’t kill you, but it’s strange as hell and it will definitely ruin your vacation.

Worm
00:14:42.150 – 00:14:59.410
Yeah, I’ve seen people coming back from the Caribbean with this and it’s weird. They feel like they’re going psychotics. They go, I put A piece of ice on my thigh and it feels hot. I put something hot on and it feels cold.

And there’s no laboratory test for this, so it’s pretty much a clinical diagnosis. Luckily, like I say, it’s a pain, but it tends to go away of its own accord.

Germ
00:14:59.960 – 00:15:00.200
Agree.

Worm
00:15:07.480 – 00:15:17.400
All right, Paul, next question for you. And this comes from Mary in Canton, Ohio, United States. Where in the world do I need to get Hepatitis A vaccine for?

Germ
00:15:17.560 – 00:16:35.640
Thanks, Mary. Canton, Ohio. You need Hep A vaccine. Any part of Ohio. You need any place on planet Earth, you need the Hep A vaccine. You got a pulse?

You need the Hep A vaccine. Now, the relative risk of catching hepatitis A will vary from place to place. I do appreciate the question.

You know, where there are issues of food safety, where there’s poor sanitation, where the feces are more likely to get into your food and your drink, that’s where it’s higher risk. And there are many parts of the world where that’s higher risk than Canton, Ohio. But the bottom line is this is such a totally safe vaccine.

It is such a miserable infection, occasionally, actually dangerous, even fatal. That’s rare. But it can happen. It will definitely lay you low. You don’t want hepa and it can happen any place. Can happen right there in Canton, Ohio.

If your food is prepared at a restaurant by someone who happens to have that virus, it may be shed in their shite and that may then make its way into your food through their fingertips, for example. That’s true in the United States, coast to coast. It’s true around the world.

If you’ve not yet had your hepatitis A vaccine, it’s not too late to no worries. Regardless of where you want to travel, get your Hep A vaccine series on. It’s usually two shots is all that it takes. Very effective.

And that’ll give you the greatest confidence to travel any place you want to go for the rest of your life. You’ll be immune to hepatitis A. Yeah.

Worm
00:16:35.640 – 00:17:06.470
Most kids have had this, at least in the US because it became one of the standard vaccinations in the 1990s, but older people have not. And whereas this is often a mild disease in children, it can be serious or even life threatening in adults.

It doesn’t become a lifelong carrier state like hepatitis B and C do, but it can be serious above age 40, 2% death rate. In general, it’s more common in low income nations and less common in the rich countries. But there’s risk everywhere.

So get two shots six months apart and you’re good for life.

Germ
00:17:14.800 – 00:17:43.080
Chris, a question to you from me, which is about E bikes. I read an article in the New York Times this weekend talking about someone who had been grievously injured after hitching a ride on an E bike.

And they really dug into some of the epidemiology of E bikes in terms of their risk of injury. We’ve talked with your cousin Tom Sanford, doctor who’s smart about this. We didn’t talk too much during that conversation about E bikes.

Give me your take on E bikes from a travel safety perspective, please.

Worm
00:17:43.400 – 00:19:28.840
Sure. First, regular bikes, analog bikes, I think are beautiful things.

Put on a helmet and the injury rate is very low, particularly if you’re on a dedicated bike lane. E bikes are a whole different beast, really. They’re more akin to motorcycles. They’re getting bigger, they’re getting faster, they’re under regulated.

A lot of people don’t wear helmets. And emergency rooms around the world are seeing the result of this. Both the riders of these E bikes and people who are struck by them.

So if you are going to ride one, you know. Wear a helmet, don’t be drunk, obey the speed limit. But it’s an area where the technology is evolving much quicker than regulation.

And I have read case after case of people who have been injured or killed on E bikes because they treat it like a toy. And it’s really more akin to a motorcycle, as I say, which has a higher injury and fatality rate.

I know I’m frustrated locally when I’m on just my regular bicycle and some motorcycle like thing thing zooms past me. An E bike, it’s heavy, it’s got wide tires and I know if I collide with it that I’m going to lose.

And also I was in Amsterdam recently and it was kind of scary because it was really dense with tourists and there were all of these different motorized gizmos zooming within inches of me in every direction. And not just E bikes, but I don’t know the name of it.

Paul, what’s that unicycle thing where like you stand on a little platform and there’s just one wheel below it? But anyway, those would zoom by me, then an E bike would go by me and then some four wheel thing would go by me.

So really, I mean, it’s getting scary to be a pedestrian in almost any tourist zone. So that’s a long way of saying E bikes are like motorcycles and they carry motorcycle risk. So personally, I don’t ride one.

If you do, you want to follow the rules.

Germ
00:19:29.000 – 00:20:06.210
I think those things are called One wheels, which is the most apt name ever. Scare the hell out of me. As we’ve talked about before, it’s about the attitude of the rider.

I don’t care what the tech is or what class of vehicle it is. You got to be sensible about this. You know, here in Seattle, I just noticed this by coincidence yesterday. There’s a whole bunch of rental bikes.

They’re not even bikes anymore. They literally don’t have the pedals. They’re called gliders or something like this. Basically these are electric mopeds.

And hopefully people will ride them when they’re not in inebriated state because it really feels like a high risk situation, both for the rider and for the collateral damage, all the pedestrians around.

Worm
00:20:08.940 – 00:20:20.460
Paul, this comes to you. And this is from Julie in Seattle. Sometimes when I’m visiting friends in Europe, they like to go collecting mushrooms. Is this reasonable?

And what should I look out for?

Germ
00:20:20.940 – 00:22:35.760
You should decide how, how much you like those friends and how much they like you. So what’s the deal with mushroom? The point is, you really need to know what you’re doing. There are no shortcuts. Please be careful. So mushrooms.

Look, I love me a good fungus. I like having all kinds of mushroom salads. I cook mushrooms different ways, eat them raw. Mushrooms are good unless they kill you.

How does this happen? There’s just this incredible variety of macro fungi mushrooms on our planet. They are so, so interesting.

Incredibly beautiful, by the way, ecologically, very important. They turn trees that fall down into dirt. I mean, they are the recyclers of our planet.

And so I think they’re beautiful, I think they’re interesting and they can be super tasty. But if you get the wrong one, they’ll kill you.

And usually this is because they contain poisons that if ingested, can be very difficult to process, especially by the liver. So that’s the classic way that we in medical school are taught to look out for things.

Someone with fulminant hepatic failure, no other known risk for their liver failing. We always get that dietary history about mushroom consumption because this is a huge problem. Once it happens, we don’t have an antidote.

Except don’t eat any more mushrooms prey and get listed for liver transplant. They can be such catastrophic cases. And unfortunately there are well described cases where entire families have been destroyed by this.

So the issue for me is that these fungi, although they are beautiful, the ones that are dangerous look an awful lot to me like the ones that are not dangerous. And so you really need to know exactly what you’re doing.

And if you are trained and you are a mycology and you’re a mycological specialist and you know exactly what you’re doing, then go for it again.

There are many safe mushrooms, but the idea of meeting somebody, going to the woods and having them forage around for mushrooms, you really need to do your homework. Not just for the mushrooms, but the mushroom picker.

There’s an old saying, there’s old mushroom pickers and there’s bold mushroom pickers, but there’s no old bold mushroom pickers. You have to know what you’re doing. I personally, because I don’t know what I’m doing, I would, would not forage for mushrooms with somebody.

I guess I don’t have any close friends. Chris, maybe you’re one if you know what you’re doing in the woods with mushrooms, because if you do, I’ll do it with you.

But otherwise there’s no way in hell I’m going to do this with anybody.

Worm
00:22:35.760 – 00:23:10.580
Yeah.

In answer to your question, it depends if you have a sense of how well your friends know mushrooms, if they’re new to that pursuit, you know, maybe just eat something else. If you have confidence that they really know what they’re doing, you could eat them. That’s your personal decision.

Me, I, both in the US and abroad, I get mushrooms at one of two places, restaurants and grocery stores, and that’s it, because I don’t know what I’m doing. So, yeah, people do collect it. It’s a hobby. If you know a lot about it, it’s probably reasonably safe.

But given that the wrong one can kill you, you definitely want to have a high index of suspicion.

Germ
00:23:18.990 – 00:23:35.950
Hey, Chris, here’s a question for you along the lines of technology. I want to get your thoughts on this from today’s New York Times.

Someone says, I have a small hobby drone and I love to travel, but drone laws are different in each country. Is there any type of organization that’s trying to make regulations on an international level?

Worm
00:23:36.030 – 00:24:33.400
Yeah, that’s a great question. I saw that article, too. And as the New York Times pointed out, it’s really complicated and different countries have different rules.

However, countries do have rules and laws, and actually you could get in trouble with the police if you don’t follow the local rules. Again, the technology is evolving quicker than the regulation. But a drone in the wrong place can do a lot of harm.

I mean, if, obviously, if it hits a jet, that could be catastrophic. There is a United nations aviation agency which is trying to produce frameworks and guides and rules that will be adopted internationally.

In general, the European rules are similar to the US Ones. But basically you want to do some research. A lot of countries require you to take a test to make sure that you know the rules.

What I wouldn’t do is just go to country X and start flying your drone and assume all will be good. Do some research, see if you have to take a test and that will help the odds that you won’t do anything bad.

Germ
00:24:33.880 – 00:25:28.080
I really love this question. I also have a drone. In fact, I’m thinking about getting a second drone, but I do not travel with it.

In fact, even here in the United States, it’s incredibly complex to get it done properly. People do this without permission all the time. It’s usually fine, except when it’s not.

What if you are over somebody’s backyard and they’re nude sunbathing? You’re going to cause a ruckus. What if you whack into a rescue drone or a helicopter or something? Please take it seriously.

I mean, this is one that I really think is important to get right. And you know, if you’re looking for a way to get in real trouble when you’re overseas, get in trouble with the law.

And this could be something that you never know. The local authorities may really be upset about if people break the rules.

So that’s one way to get in trouble with Health and Wellness overseas is get thrown in the local slammer. So I think this is one that hopefully we will get something that’s more unified, but I’m doubtful.

I think it’s just always going to be a pain in the neck.

Worm
00:25:28.160 – 00:25:41.870
Yeah. Particularly if you are around a military facility, a police facility, or an airport.

There’s a very high level of suspicion among the local people and indeed, you may meet the local penal colony.

Germ
00:25:42.510 – 00:26:23.760
Exactly right.

Everyone. That’s a wrap for episode 78 of German Worm. As always, we welcome your questions on trip, travel, health.

Just Visit our website, germanworm.com There you can submit questions, search prior episodes, and binge our content to your heart’s content. If you enjoy German Worm, please subscribe, rate us favorably and spread the word with friends, family and on the socials.

Those are free ways to support this podcast. I’m Germ.

Worm
00:26:23.760 – 00:26:26.640
I’m Worm. It’s a big planet. See it in good health.

Germ
00:26:26.640 – 00:26:48.110
And we’ll see you next time. This podcast is designed to inform, inspire and entertain.

However, it does not establish a doctor patient relationship, and therefore this podcast 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.