Germ
00:00:09.120 – 00:00:11.200
Mogethin My name is Germ.

Worm
00:00:11.280 – 00:00:12.160
I’m Worm.

Germ
00:00:12.240 – 00:00:25.320
Welcome to the Germ & Worm Travel Health podcast, episode 79 Don’t Talks with strangers. It’s a big planet. See it in good health. I’m Dr. Paul Pottinger, also called Germ. I’m a professor of Infectious diseases at the University of Washington in Seattle.

Worm
00:00:25.320 – 00:00:33.610
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
00:00:33.610 – 00:01:35.110
Well, Chris, here it is again. We have the best job in the world. It’s not the pay, it’s the fun.

Because we’re answering all these fun questions about travel health from listeners across the country and around the world this week. Is there dengue fever in India? And if so, what should I do about it? What in the world is going on with hepatitis B immunization policy in America?

Can I trust official federal guidance on international travel risks and Botox clinics overseas and self Botoxing? What could possibly go wrong? Spoiler alert. A lot these questions and many more. Please contact us with your questions, stories and tips for success.

Just send us an email germanwormmail.com or visit our website germandworm.com finally, our medical 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. Oh, and Chris, before we start, I would be so grateful if you could lead us off with another edition of why you should go.

Worm
00:01:35.110 – 00:06:11.190
It’s time for our new feature, why you should go. When we discuss a country that we love and think you should visit today’s nation, Uganda.

Uganda, situated in East Africa, may look like a small country when you look at a map of Africa, but only because other nations in Africa are huge. Algeria, for example, is three and a half times the size of Texas.

Uganda is about the same size as the US State of Oregon, which is the ninth largest US State. So it’s bigger than Great Britain. It’s landlocked with respect to the ocean but not lakes.

It borders huge Lake Victoria, which is Africa’s biggest lake. It’s the world’s biggest tropical lake and the second biggest lake in the world.

Uganda was a protectorate of the British empire between the 1890s and 1962, when it became independent. It’s not known for its peaceful transfer of power, but the violent days when Idi Amin was president in the 1970s are long gone.

It’s been reasonably stable since Museveni the president since 1986 has been in power. Official languages are English and Swahili. It’s a low income country with a per capita income of only around $1,300 per year.

I got to know Uganda fairly well. I taught there annually for a decade at a tropical medicine course based in Jinja, a lovely town on Lake Victoria.

This actually was the same course that Paul Pottinger taught. He went every year to Tanzania to teach. I went to Uganda. You fly into Entebbe, a lovely town on Lake Victoria.

And speaking of which, Lake Victoria is one of my favorite aspects of Uganda. It has the Sese Islands, which is this huge archipelago of 84 islands accessible by ferry from Kampala.

Also there’s this really interesting chimpanzee sanctuary island that I went to and was just fascinating. From Entebbe, it’s an easy taxi ride to kampala, the capital 20 miles to the north. Kampala is a bit of a handful.

It’s got a population of around 2 million. It’s crowded, it’s noisy, but it’s a good base from which to explore the rest of the country. Uganda has 10 national parks.

I’ve been to Murchison Falls a couple of times to the north of Uganda. It’s maybe four or five hours out of Kampala by car. It has lion, leopard, elephant, buffalo, rhino, hippos, crocodiles.

And I’ve been to Queen Victoria to the west on the DRC border where there are tree climbing lions, which are super interesting. A thing I like about Uganda is that as a rule, its game parks are less crowded than those that you would find in Tanzania or Kenya.

In Kenya, for example, maybe the easiest way to find a lion is to look for a group of 10 vans full of tourists in a circle around the lion. In Uganda, there’s fewer game in the parks, but you can drive for hours and see very few other tourists.

It’s a birder’s paradise with over a thousand species of birds identified. If you like whitewater rafting, you can raft the Nile. Outside of Ginger, where the Nile starts, this is class five. So it’s pretty high adrenaline.

The food is good. There’s this thing called chapati, which is an unleavened flatbread, actually comes from India. You can get matoke inexpensive all over the country.

This is pounded plantains. And there’s this fun street food called Rolex, like the watch, which is a chapati rolled with an omelette inside.

You do want to see a travel medicine provider prior to your trip. You need a medication for Malaria. And you do need to be immunized, including yellow fever and typhoid fever. One, caution, Stay away from bota.

Botas, that’s the local term for these motorcycle taxis. It’s a fairly dangerous way to get around. So I would be in a vehicle, a car, not on a boat, a boda.

Now, I do have to say that the U.S. department of State recently bumped up their travel advisory for Uganda From a Level 2, exercise increased caution to Level 3, reconsider travel due to terrorist activity. So maybe wait until this drops down to a level two before you visit. Uganda is not hard to get to.

There’s direct flights from Istanbul, Addis Ababa, Nairobi and elsewhere. There are hotels and Airbnbs, both rural and urban, all over the country.

Over the years, I have enjoyed talking with Ugandans, from doctors to taxi drivers to other folks. As a rule, people are welcoming, friendly and chatty. In my view, Uganda is lovely. It’s not overrun with tourists like some places I could mention.

I think you should add it to your bucket list.

Germ
00:06:11.190 – 00:06:25.390
Okay, Chris, this first question comes to you from Mac in Singapore. Is there dengue fever in India, and if so, what should I do about it?

Worm
00:06:25.390 – 00:07:03.450
Yes, there is. So in that whole region in India and also Pakistan, there’s actually a lot of dengue fever.

It’s in both urban and rural areas and it’s common. And there’s other things which are additional inducements to wear insect repellent, such as chikungunya.

So basically, wearing bug repellent in the Indian subcontinent is a good idea. And it’s the usual stuff. I would do D or picaritin to exposed skin.

Treat your clothing with permethrin, and if you don’t have air conditioning, sleep under a bed net. That’ll bring down the risk of dengue fever and chikungunya and other things that are spread by insects.

Germ
00:07:03.450 – 00:07:35.770
I agree. And you know, if you do make that trip, and I hope you do, these are beautiful, incredible, interesting places to go.

Even if you live in the beautiful, amazing Singapore, there are other places to see. Please understand that the immunizations, the vaccines we have for dengue, you know, they may not be available in Singapore, although they might.

But if you’re going to spend significant time with some exposure risk in India or Pakistan, you can get immunized there against dengue fever. So that’s something that’s worth considering.

If I were going to make that trip, I think it’s something that I would do and I’m glad you’d consider doing that yourself.

Worm
00:07:35.770 – 00:07:48.070
Paul. Oh, dear. This is going to take some discussion. Paul, did the US really change its hepatitis B immunization recommendations recently?

Germ
00:07:48.150 – 00:13:40.320
Recently as in two hours ago? Yeah. We’re recording this conversation on Friday the 5th of December, 2025.

And ripped from the headlines and from the blogosphere, it is true. What’s happened is an unforced error which is going to cost lives. The background is that there is an infection called hepatitis B.

It’s one of our Alphabet soup of viral hepatitis. Hepatitis B is a real problem because unlike hepatitis A, which is an RNA virus that causes an acute GI illness and then usually gets better.

Hepatitis B, that’s a DNA virus, right, Chris? That means that you don’t catch it from food, you catch it from blood products, including intimate objects that are shared toothbrushes.

This kind of thing can be spread from mother to baby. It can also be spread through sexual contact, but because it’s made of DNA, it never goes away.

It’s really a chronic, incurable disease and it’s a stealth killer. Because people with acute hepatitis B infection, they may get sick, but they may not. They may not realize that they have this illness.

And that means that they can have this virus chewing away and inflaming their liver for months and years and decades.

And that’s why it is a leading cause of cancer and cancer death in parts of the world where they do not have a comprehensive hepatitis B immunization protocol. What we’ve done in this country for many years is to embrace the idea of vaccinating against hepatitis B.

There’s a wonderful, terrific, very effective hepatitis B vaccine.

We love and appreciate this here in Seattle because the technology that makes that vaccine was patented, I think, originally here at University of Washington, using yeasts to assemble these virus like particles, it’s not live attenuated. It can’t give you hepatitis. It’s a totally safe vaccine and it’s wonderful and it works extraordinarily well if only we would give it to people.

So for many years, the concept was look for hepatitis B infection in, for example, pregnant women.

And if they have Hep B infection, remember to give the shot to the kids early in life, if we possibly can, to try to reduce the chance of them catching this infection and think about immunizing people before they become pregnant. It was a seek and destroy concept and it helped a little, but it was not good enough. It failed.

It failed because there are so many gaps in our American health care system that some years ago, decades ago, we made a change. And what we said Was, hey, this is a very safe vaccine without any real side effects, and it works well, let’s give it to everybody.

And at the time of delivery at birth, every child in America should be immunized against hepatitis B. When we embraced that approach, it became a blanket.

It was not always done, but almost always done as a standard recommendation from acip, the Advisory Committee on Immunization Practices. And it has saved so many lives. It’s tremendous.

I was speaking just yesterday with a colleague who does public health and ID in Alaska, America’s greatest burden of hepatitis B infection. Their prior approach of looking for this in women who were pregnant or thinking of getting pregnant, it just didn’t work.

Well, what transformed the Alaskan experience? Universal hepatitis B immunization, just like everywhere else. And yet that’s exactly what they have stopped doing today.

As of a couple of hours ago, in a contentious debate made by people who are part of the Advisory Committee for Immunization Practices, some of whom are excellent and have tried to raise their voice, others of whom have drowned those other people out, they’ve decided to go backwards and say that, no, we shouldn’t give this to everybody at birth. Rather, we should just give it to people who are, who are born from mothers who may be seropositive for hepatitis B. We should do maternal testing.

We should wait a couple of months and then talk to pediatricians about this and do it as part of an informed decision with our doctors when we meet with them after kids are born. It’s a mistake. I mean, it can work. It could save some kids, but it’s not based on evidence. It places kids at risk, and we know that.

The reason we went to universal immunizations at birth is because it works for everybody. You’re not going to have to people falling through the cracks. So this is a mistake. It’s an unforced error.

It’s yet another example that to do public health work, you need to have a heart and a soul and care about people. We also need a brain. It’s up there. Just go looking for it. You’ll find that brain if you just consider using it. And these people are not doing it.

The folks who have voted against this, the folks who have taken us backwards again, they’re just not very smart. Now they think they’re doing the right thing. Their theory is, oh, this is an std.

We should not give an STD vaccine to kids when they’re born because they’re not going to have sex. Some sort of dark, weird conspiracy that hep B vaccine might Cause autism. It does not. We’ve known that forever.

So I don’t know why they’re doing this. It’s a dark conspiracy. It’s oddball. Most Americans don’t support this. No doctors support it, no real doctors. And yet they’re doing this.

We can reverse this policy, and once we get a new administration, we will try to fix it. But I assure you there will be people who catch hepatitis B because of this change and who get sick and die or need a liver transplant.

This is not a curable infection. It’s not an acute issue. It’s a chronic, lifelong thing.

And I remember Chris visiting Beijing in the early 1990s, maybe 1991, and I wasn’t yet a doctor, but I was thinking about going to med school. I’m just interested in this. So I visited an academic hospital in Beijing. They’re very kind.

They showed me their hospital and it was just ward after ward of people fighting hepatoma, liver cancer. I said, why do you have all this liver cancer? Is it alcohol? They laughed. They said, it’s hep, baby. This is hepatitis B.

We cannot get rid of it because we don’t have a vaccine. It was the leading cause of cancer death in China. Now that’s changed, thanks to hepatitis B.

Now with our leading killer, I think is lung cancer, because they all smoke like chimneys. But it was striking. And this is exactly the direction that this policy could, if not reversed, take us towards your thoughts on this shit show.

Worm
00:13:40.320 – 00:15:33.370
A couple thoughts. First, just to emphasize what you just said about how successful this universal approach has been.

Since 1991, hepatitis B infections in the US in children and teens have come down by 99%. That’s huge. That means fewer kids dying of hepatitis B.

And hepatitis B, which if you get it as a kid, is likely to develop into a chronic case, can lead to hepatitis and elevated risk of liver cancer. So it’s been a very successful strategy. And let me just give an analogy for what I think is going on with public health decisions now.

Suppose you’re a town and suppose you need to build a big bridge over a big river. Suppose you got to build an eight lane highway bridge over a big river by your town.

Well, obviously to do that you’re going to hire someone who knows architecture and engineering, and maybe they’ve made bridges before and they understand the physics and the materials involved.

What you wouldn’t do is hire someone with no engineering background, no architecture background, who’s never built a bridge, but also has ideas in his head because of conspiracy Theories that he thinks he’s going to make a better bridge than has ever been made before. It’s going to be different than conventional thinking. That obviously is nuts. That would be dangerous. That’s what’s going on in public health.

Now we have someone, RFK Jr. Secretary of Health and Human Services. No medical background, but he’s worse than the ignorant person. An ignorant person would listen to experts.

RFK Jr thinks he has ideas that are better than the experts. Like changing this very successful hepatitis B policy. So I am appalled. I am horrified, I am disgusted. As Paul said, this is going to kill people.

And I’m really sorry to see this happening. It’s unreal. I would laugh if the stakes were not so high.

Germ
00:15:33.370 – 00:16:02.590
Agree. And to our listeners, for you personally, make sure that you’re immunized against hepatitis B. You should be.

If not, ask your physician about it. And please socialize this and talk with everyone you know, especially people who are thinking of having kids.

This is really about protecting the next generation. I think most people are going to choose to continue to do this, but it’s about those speed bumps, those barriers.

It’s people slipping through the cracks. That’s the threat. And I care about everyone. And so I’m just hoping that we can do whatever we can to change course on a national basis.

Worm
00:16:02.590 – 00:16:29.740
Yeah, the US Health system certainly has its problems and issues and I could go on for some time about what I seeing as being flaws in the way we practice medicine here in the U.S. but perhaps our biggest success is the elimination of childhood diseases and other chronic diseases such as hepatitis B. The near elimination due to vaccine. And so to attack us on what is our best strength and there’s the most evidence for the benefit is just.

Germ
00:16:29.740 – 00:16:59.550
Nutso. We have a lot of problems in this country. Let’s focus on those, not the stuff that we’ve already figured out.

That’s what just makes me so flummoxed and hopping mad. Well, Chris, along similar lines in a way, here’s a question from me to you.

Can Our listeners trust U.S. department of State travel advisories or are those advisories really influenced more by politics than reality?

Worm
00:17:00.910 – 00:18:58.950
Good question. Complex answer. So first, little background.

The US Department of State has a four level advisory category for every country in the world. So they you’re a 1, 2 or 3 or 4. So one is exercise normal precautions. That would be say Japan or Canada. Two, exercise increased precautions.

That’s most of Mexico. Three, reconsider travel, heightened threat.

Four, they advise do not travel and out of the roughly 200 countries, about 20 are level 4, about 20 level 3, and the rest are mixed 1 and 2. In answer to your question, these are pretty good and as a general rule, pretty reliable.

They obviously advise you to stay away from war zones, recent disaster areas, dangerous epidemics, things like that. However, politics does creep into this, and I give you a couple examples.

China was recently downgraded in the direction toward more safety from a 2 to a 1. And this suspiciously came out right at the same time as a prisoner exchange between the US And China, almost like a quid pro quo.

And so the timing of this suggests that politics may be tied into this. Maybe there was a bit of a deal that was made.

Similarly, El Salvador is now Category one, and it used to be considered a very dangerous place to go to. In part, this is legit. There’s been a big crime crackdown there, a big crackdown on gangs. Indeed, it is less dangerous than it was.

However, this downgrade to Category one happened at the same time as some negotiations between their government and ours. And so I think that politics was part of it in the real world. Was part of it. So, in general, I like these rankings.

You know, I avoid category four countries myself, but take it with a grain of salt and maybe do a little research to see if there’s been some discussion between their government and ours or a trade deal that might have massaged this one direction or the other.

Germ
00:18:58.950 – 00:19:31.000
I love that idea of using US State Department levels of security as a guide. A starting point. That’s your starting point.

You may know a lot about a particular country and have a very safe plan for being there. Even if it’s a level three, that may be okay. It may actually be okay in a level four too, but it should be individualized.

So this is not a perfect situation. And as always, we want our listeners to.

To be thoughtful and to do their own research and take more than one source of information that’s trusted and reputed and reliable into account.

Worm
00:19:31.000 – 00:19:57.960
Also, my belief is that in general, safety is more determined by what you do than by where you go.

You can convert any country into a dangerous place, and you can convert most countries into a safer place by following simple precautions like we talk about on this show, everything from. From immunizations to avoiding motorcycles.

So I think danger is primarily determined by your behavior and that most of the world is very reasonable to go.

Germ
00:19:57.960 – 00:20:09.840
Yeah, other countries list the United States as a dangerous place to go because of all of our handgun violence. And they’re not wrong.

I still feel generally safe in my country, although the gun crisis is crazy, so it cuts both ways.

Worm
00:20:09.840 – 00:20:26.810
Good question coming at Paul. Injecting yourself with botulinum toxin purchased online. What could go wrong?

Germ
00:20:26.810 – 00:24:04.460
We now have an answer to that obvious question, which is a lot can go wrong. You can actually get botulism.

So this is outrageous, and it’s something that I should have seen coming but didn’t. Comes to us from the Centers for Disease Control. Notes from the field in the Morbidity and Mortality weekly report, late November 2025.

This MMWR report, it’s brilliant. It really tracks down three cases that came to public health attention here in the United States of people with botulism.

They got the botulism because they purchased some Botox online and gave it to themselves and they overdosed. What is botulism? Botulism is a toxidrome. It’s an illness caused by poisoning.

And the poison comes to us through a bacteria called Clostridium botulinum C. Botulinum makes this poison, which just happens to interfere with the way our nerves work. And so it shows up clinically to people with this really weird series of failures of the peripheral nervous system.

And in particular, these were people who showed up with severe botulism. They had double vision. They had inability to speak. They had difficulty moving their eyes, controlling their eyes. They had difficulty breathing.

They had weakness in their upper extremities. This is botulism. And in severe cases, of course, this can be fatal because people stop being able to breathe at all.

Traditionally, botulism is something that we would worry about with respect to food sources. You know, a can of food, it’s been sitting on a shelf for a long time, gets fat and puffy, starts blowing up full of gas because it’s spoiled.

Well, the spoilage comes from, among other things, Clostridium botulinum. So that’s why you always look at a can of food before you dig into it. Does it look rusty? Does it look punctured? Is it puffy?

Any of those things happen? You do not eat that canned food, obviously. Well, this is why.

So what’s happened here, of course, is that there’s this incredible advance in science, I guess, where people realize that ultra tiny amounts, like the littlest, littlest amount of Botox, botulism toxin, can actually be beneficial because it paralyzes muscular contraction.

You put this around somebody’s eyes, gets rid of their crow’s feet, or you put it on their forehead, they look younger because they can’t wrinkle their forehead. You also can’t tell what they’re thinking because they can’t make facial expressions. But anyway, this is something that’s been around.

It does have very legitimate, not only cosmetic, but legitimate medical purposes. Somebody has a spastic bladder muscle, it can be injected into the bladder to give people better bladder function. So it’s a good thing.

I am all about the Botox if it’s done right. But it has to be FDA cleared, it has to be safe. It has to be administered by somebody who’s trained to do it. These folks, these three people did not.

They bought it online for themselves, they shot themselves up with Botox and of course they ended up with botulism. No surprise. So I’m not turning off people from getting their Botox on. I’m just saying, number one, don’t do it yourself.

Number two, make sure that if you’re going to do this either domestically or overseas, you know who you’re talking to. This should not be. It really needs to come from a licensed healthcare professional.

And my worry in the context of travel health is that someone might go overseas to have more affordable access to Botox. I get it. But gadzooks, what is going to be your plan if you end up with botulism? Who’s going to take care of you? Who do you sue?

What’s your, what’s your, what’s your safety net?

If you have a safety plan because you trust a physician or licensed healthcare professional, then you’re in good situation if you’re doing this overseas. Folks, we’ve talked about medical tourism before. This would be one potential threat. Now again, these cases were not overseas, they were domestic.

But it’s just a friendly reminder that whether you’re overseas or here in the good old U.S. of A, you don’t want to mess around with the botulism.

Worm
00:24:04.460 – 00:24:37.160
Yeah, as a general rule I avoid sticking needles into myself and I would recommend that you do the same if the needle has been into somebody else first, as it might have been if you go to a place, a tattoo place in a low income country where they don’t clean the needles. Among other things that could spread would include hepatitis B, hepatitis C and hiv.

And also something about buying something cheap online and then injecting yourself just worries me. There’s so many things that could go wrong. So I agree with Paul. If you’re going to do this, I would go through a licensed domestic healthcare pro.

Germ
00:24:37.160 – 00:24:56.130
Chris, question comes to us from one of our listeners, Anonymous. And that’s totally fine.

What’s the best way to get medications if I’m abroad for a prolonged duration. Will Amazon pharmacy or other online service delivery from the USA?

Worm
00:24:56.130 – 00:26:14.560
Oh, good question. Complex answer. First off, don’t assume that you can buy more of it abroad either with or without a prescription.

And of course US prescriptions are not valid overseas.

So if there’s a particular type of birth control pill that you like or other medication, there may be different brands, different chemicals, only available overseas. So suppose you are going somewhere for two years, you’re not planning on coming back, you want medications for that time.

What doesn’t work is anything convenient. So convenient things would be mailing FedEx, something like that.

I mean, this is anecdotal, but I haven’t heard of anyone having long term success with that if you mail it. I’ve heard a lot of anecdotes about things being held up at customs forever or just confiscated. FedEx doesn’t do that to my knowledge.

The strategy that I’ve heard that works is either coming back yourself and getting another 12 months of the medication or involving a family member to drug to act essentially as a drug mule. You know, have your cousin who’s visiting you anyway bring 12 months of your medication.

But I’m afraid outside of a person transporting it personally, I have not heard of an effective way that’s reliable to mail medications overseas. But I’d be curious listeners, if you have found strategies that work, please let Paul and me know.

Germ
00:26:14.560 – 00:26:18.510
I think they made a movie about that, didn’t they? My Cousin Vinny the Drug Mule?.

Worm
00:26:18.510 – 00:26:22.790
I thought you would say that one about the Turkish prison? Midnight Express.

Germ
00:26:22.790 – 00:26:23.910
Yeah, Cousin Vinnie Express.

Worm
00:26:25.670 – 00:26:30.470
That’s why you should not augment your income by transporting narcotics over international.

Germ
00:26:30.630 – 00:26:38.830
Borders. For the record, germ and worm do not recommend drug muling. But when it comes to an anti hypertensive or something like this, it’s probably pretty benign.

Worm
00:26:38.830 – 00:27:16.280
All right, next question for you, Paul. A reader writes, I am traveling to France and Italy this spring and I’m 68. I’m generally in good health.

I’ve not yet gotten my RSV shot, although my primary care doc asked me to do so. I’m not anti vax, but I wonder whether we have real world information about how well it works and whether I need it for a trip to Europe.

Again, Europe, not a low income country. Thanks in advance.

Germ
00:27:16.280 – 00:30:08.810
Yeah, thank you. So good question. Thanks for asking about RSV like we’ve talked about here on the podcast. RSV is the respiratory syncytial virus.

It’s a virus that we get by Breathing in droplets from someone who coughs or sneezes or speaks or sings and is sick, and we breathe in those droplets, and then it can cause either a mild respiratory illness or, unfortunately, in some people, a very severe illness, especially in newborns, where can be deadly serious. And yes, as we get older, as our immune system becomes less robust, it can also be a threat to the health and safety of older Americans.

So for that reason, we’re really excited to have some RSV vaccines on the shelf right now in the United States. This is recommended to all American adults age 75 and above.

And for those who are aged 50 to 74, they should also get a single dose of RSV vaccine if they have higher risk situations, if they have comorbidities that place them at high risk of severe RSV disease, chronic lung disease, chronic heart disease, diabetes, impaired immune system. Those are people who should probably get this even between ages 50 and 74. So thinking about you personally at age 68. Yeah, you’re kind of in between.

You’re not quite 75 yet. That’s great. So it’s not mandatory for you to get this from a recommendation perspective, but think about your own risk factors, please.

And if you are in one of those higher risk categories, I would very strongly encourage and. And thank you in advance for getting your RSV shot, because it’s safe. And yes, to answer your question, it’s very effective.

In fact, just recently, we have publication regarding Pfizer’s RSV vaccine, showing that in the first season it was available, it was more than 90% effective in those older patients who received it. I’m going to say that again.

In this particular study, researchers included almost 9,000 people with an acute respiratory illness related to an ED visit or a hospitalization. And among all those 9,000 people, 7.8% had a positive RSV test.

And among those who tested positive, just 0.3% had received that Pfizer vaccine, whereas that was 3.6% of control. So it was a dramatic improvement. 90% reduction in those who had gotten the vaccine.

A few people will still get the vaccine and go on to develop RSV infection. It can happen, but the risk of that happening, at least in the context of being sick enough to go to the emergency room, was reduced by 90%.

So it works great. That’s mostly an American experience. You’re going to France, Italy. Super fun. Yes. They also have RSV over there. This is a cosmopolitan infection.

It’s true any place.

There are people on Planet Earth, France, Italy, they totally have the RSV I think you should go enjoy the food, the wine, the conversation, the museums. You don’t have time for rsv. And especially if you’re in one of those higher risk populations, I would strongly encourage you to do it.

Chris, what’s your thought?

Worm
00:30:08.810 – 00:30:50.180
Yeah, I agree. And first let me backtrack a little. In full disclosure, can this vaccine have side effects? The answer is yes, of course.

Every vaccine can have side effects.

Specifically this has been found sometimes in people to cause a little bit of pain at the injection site, redness, some swelling, where you get it, even fatigue, headache, muscle and joint pain. However this takes tends to be mild and short term. But every vaccine, every medication, doing anything has side effects.

So we don’t compare the benefit to zero. We compare the side effects to the benefit of the vaccine. Benefit is relatively huge. Potentially life saving side effects are rare and mild.

So in my book it’s much the better choice to get the vaccine.

Germ
00:30:50.180 – 00:31:16.910
Chris, question to you from Zan of Ljubljana, Slovenia in the United States. Do dogs need to be given boosters for rabies?

Here in Slovenia, as a dog owner, I receive regular reminders from my vet to give them a booster.

Worm
00:31:16.910 – 00:31:47.500
Oh, thank you, Zan. First disclaimer, my license from Washington state lets me take care of people only that species.

So I am not a veterinarian, I don’t take care of dogs. This is just what I gleaned by doing a little bit of research.

But basically here a dog booster is recommended every one to three years, depending on local regulations and depending on the type of the vaccine. So yeah, you do need boosters. I don’t know. Do you know Paul, do you’re a dog owner, do you get a reminder from your vet for boosters?

Germ
00:31:47.500 – 00:33:28.589
Yeah, they’re very good about this. Look, there’s different vets with different systems, but yes, this is part of our standard veterinary care experience over here and with my adorable pet Morkie Leo. Yeah, he’s fully immunized and it’s something that we keep up with and the dogs tolerate this vaccine very well.

This is something that is ultra super duper, incredibly low risk.

At least here in Washington state where I live, we just do not have terrestrial rabies and I’m happy to keep it that way because there ain’t no rabies vaccine that’s gonna take away my sweet Leo. Not a chance. So thanks for asking about this. I think the implication is really for travel health with your traveling with your pooch.

There are new setups that allow us to travel with animals across international borders used to be at least a month of quarantine.

Now we know and trust these vaccines, rabies vaccines in dogs so well that many countries have adopted a system where there is a chain of custody and trust that that dog really has received their vaccine. It now becomes so much easier to travel internationally with your pet pooch.

Everyone, thank you so much for joining us for episode 79 of Germ and Worm. As always, we do welcome your questions on travel health.

Just Visit our website germanworm.com that way you can submit questions but also search prior episodes and binge our podcast to your heart’s content. If you enjoy Germ and Worm, please subscribe, rate us favorably on your device and spread the word with friends, family and follow us on the socials.

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

Worm
00:33:28.589 – 00:33:32.390
I’m Worm. It’s a big planet. See you in good health.

Germ
00:33:32.390 – 00:33:54.440
We’ll see you next time.

This podcast is designed to inform, inspire and entertain. However, this podcast does not essentially establish a doctor patient relationship and therefore 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 the University of Washington or UW Medicine.