Speaker A
00:00:09.120 – 00:00:11.280
Que paso? My name is Germ.

Speaker B
00:00:11.600 – 00:00:12.480
I’m Worm.

Speaker A
00:00:12.800 – 00:00:27.280
Welcome to episode 87 of the Germ and Worm Travel Health podcast. Going to the Sunny Caribbe. 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.

Speaker B
00:00:27.280 – 00:00:35.180
I’m Dr. Chris Sanford, also known as Worm, and associate professor in the departments of Family Medicine and Global Health, also at the University of Washington.

Speaker A
00:00:35.340 – 00:01:09.600
Well, here’s an incredible experience. We have notes from the field. Both of us are overseas today. We’ll tell you more about that in a moment.

And we’ve decided to focus our efforts on the Caribbean, a beautiful place to go, full of specific travel health questions. Some of the things we’ll tackle today include how should we prepare for a trip to the Caribbean? Also, are there specific health concerns in the Caribbean that our listeners should know about? A riptide ripoff. What’s the latest on surviving in strong currents at the beach? And where is measles common in the Caribbean? And what should you do if you’re exposed?

Speaker B
00:01:10.080 – 00:01:15.200
So, Paul, let’s both talk a little bit about where we are at the moment. And why don’t you go first?

Speaker A
00:01:15.520 – 00:03:05.480
Yeah. Thanks so much. I’m coming to you right now from sunny Puerto Vallarta in Mexico, one of my favorite places.

Beautiful, sunny, tropical, and not much rain except for a little tropical shower each night. I’ve been away from home going on three weeks now, and I’m planning to be here for another week and a half. My trip so far has been highly varied.

I spent several days in Mexico City, beautiful city, the first time I’ve been to Mexico City. And it was spectacular. We did cultural tours, of course. We spent time on culinary tours as well.

And I learned a lot about the ancient and recent history, political and cultural, of the beautiful country of Mexico. And then I climbed a mountain called Pico de Orizaba, which is the highest mountain in Mexico and in fact, the third highest in North America.

That was a challenging and beautiful and really fun expedition. And it involved some acclimatization on smaller mountains times in beautiful haciendas and at guest hostels.

So a wonderful time in a part of Mexico I’d never seen. Then I joined my beautiful wife, Julia Quinn, in Paris for the season four Bridgerton premiere.

She wrote all the novels that Bridgerton is based on, and so she’s an executive producer. And we are so fortunate to join the cast and crew for the rollout of each Season.

And this was my first time to Paris since 1981 and basically, in other words, my first time there. What a beautiful, fun city.

And we had a great time with art, culture, architecture and a lot of really good food, including some walking, culinary tours. Anyway, now I’m back in Mexico working on a book that I’m writing about mountaineering. And this is my writer’s retreat, so lots going on with me.

Chris, where are you?

Speaker B
00:03:05.640 – 00:05:00.970
I’m all over the place. I’m in the middle of a five week trip which is a real luxury on New Year’s Day.

Flew into Merida, Mexico, poked around for a few days, took a bus to Campeche from where I went inland to this lovely, fairly deserted Maya site called Edsna. I have an interest in the Maya and the language and the culture and seeing the historic sites.

Then took a bus down south to Spujil because it’s near the big Mayan site of Kalak Mule, which I went to. And again it was nearly deserted, which was lovely. And there’s spider monkeys and howler monkeys up in the jungle. So that was very fun.

Took a bus to Chechumal, which is on the Belize border. Saw another Maya site there. Took a bus into Belize, into a city called Orange Walk.

Did a river trip from there from Orange Walk down to this Mayan site called Lamani, which was very fun. Saw a lot of crocodiles, saw a lot of iguana. Met up with my wife in Belize City.

We went inland, spent a night by the zoo, went on a zoo tour, which was very fun. Saw a jaguar and again monkeys and tapirs and other animals. Went inland to a jungle town, San Ignacio.

Stayed just outside it in Bullet Tree Falls, and again saw a couple Maya sites there, including the very large one down on the Guatemala border, Caracal. Went back to Belize City and then just yesterday took a water taxi to here, an island called Caye Caulker, which is super fun.

Real different sand island, kind of tiny, a little touristed, but really good snorkeling. And so we’ve, we’ve actually seen quite a bit.

And then in a few days I’m actually going to fly to San Salvador and spend another week in, in El Salvador. So this is super fun. My Spanish remains really bad, I’m eating well.

But it’s really nice just to be here, get away from the Seattle gloom, meet a lot of nice people.

Speaker A
00:05:01.210 – 00:05:48.660
Incredible.

Well, we’re both in the Caribbean living the life and so I just thought it was auspicious that we could talk about this particular topic before we jump in. Here is our medical disclaimer. This podcast is designed to inform, inspire and entertain, but you should not use this podcast as clinical care.

Before you travel to the Caribbean or elsewhere, please see a qualified healthcare professional for recommendations specific to you and your itinerary. With that, Chris, I’m going to start off with our one key question for the day. This comes to us from Leonardo of Quebec, Ontario.

I’m going to charter a sailboat for cruising in several countries in the Caribbean. Saint Martin, Saint Bartleme, Sabah, Saint Eustatius, Saint Kitts and Nevis. What should I be concerned about, health wise?

Speaker B
00:05:48.820 – 00:08:20.520
Well, first off, that sounds super fun and I’m envious. That sounds idyllic and beautiful and in general it’s I would call that a low risk itinerary. So indeed, we have opinions. We always have opinions.

But I would go for it and enjoy it. In terms of what to do to bring down the risk of anything averse occurring.

Of course, vaccines get all the routine ones on the standard schedule, including flu and COVID 19. And there’s one more actually to consider, especially if you’re going to be doing a lot of developing world travel in your coming years.

There’s not in the US a vaccine available for dengue fever, but there’s one called Qdenga, which is available in over 30 countries around the world, a lot of European countries.

And if you anticipate significant developing world exposure because there’s dengue in most tropical countries, then I would consider getting that vaccine. It appears to be safe. It’s only been tested in people up to age 60. You didn’t give us your age, two doses three months apart.

In any event, you want to use bug repellent because there is dengue in a lot of Caribbean islands, including the ones you mentioned.

And that’s we’ve said this before, you want to do something to your skin, like Dieter Picaridin, treat all your clothes with permethrin, sleep under a bed net if sleeping quarters are not air conditioned. In terms of malaria, you don’t need a malaria pill. There is some malaria on Hispaniola in the Caribbean. That’s really the only place.

And Hispaniola is the island that contains Haiti and the Dominican Republic. But with the ones you mentioned, no malaria, don’t need a malaria pill.

There are some other insect transmitted things, not things you can be vaccinated for like Zika, but there may be a tiny amount. So again, doing the bug repellent is important. One other thing I’ll mention concerning food in general I would hold off on tap water.

It may or may not be safe. There is some ciguatera poisoning throughout the Caribbean. And so I would hold off on eating reef fish.

And that includes fish such as barracuda, grouper, snapper shark, moray eel, lionfish. And that toxin remains will make you sick even if you cook the food well. So again, I would hold off on that type of fish in the Caribbean.

If you’re going to be scuba diving, I would look up where the closest chambers are. So for example, St. Martin. The closest one is St. Thomas in the US Virgin Islands. I do a little research there.

And Paul, I’ve touched on a few things. What would you add to that?

Speaker A
00:08:20.760 – 00:18:56.120
First of all, Leonard, are you looking for crew? How do I get onto this boat? It sounds like quite an amazing trip.

As a kid I was lucky on several occasions to to cruise with family in British Virgin Islands and U.S. virgin Islands. It’s so beautiful. And so that part of the world is a great spot for cruising. Assuming, Leonard, that you know what the hell you’re doing.

So I hope you’ve got the right plan and the right crew to cruise safely. If you do, I think it can be a spectacular trip.

We have gotten questions recently about the United States conquest, military conquest of Venezuela and that part of the Caribbean Sea. And of course, you know, they have used rockets to blow up boats in the Caribbean.

I think that’s done at least for the moment at the time we record this, which is late January 2026. So I don’t think you’ve got to worry about a drone striking you, mistaking you for a drug running ship or something like that.

So that part should be all good. And then it’s just what Chris said. This can be a safe and wonderful trip. Let’s think about the Caribbean generally.

And I want to move beyond Leonard’s specific itinerary. Are there other things that people need to worry about? There’s a few. There’s a few other oddballs that we get.

Questions about that I think we should discuss. One is called tungiasis. What is tungiasis? The common name is the chigo flea or chiggers. This is a flea that lives in the sand.

And if you walk barefoot on the beach where there are flea eggs, these fleas can get into your skin. It’s a burrowing flea, not just a biting flea, but a burrowing flea.

So it loves to get on your toes, especially the big toe or the space between the toes, and it will then burrow into your very living flesh and get bigger and bigger, and then basically incubate a whole clutch of eggs. This can end up looking about the size of a pencil eraser, less than a centimeter across, but they’re exquisitely painful and there’s pressure.

When you walk on a wart, some of you may have had plantar warts before. This is like that, but even more painful. And the problem is that they can also get secondarily infected if you mess with them.

The only treatment for tingiasis is to remove them carefully, surgically, under the care of a doctor who’s done this before. And if you do that, you can remove these things. But it’s really about prevention. A good reason to wear shoes.

Shoes, unless you are below the tideline on a beach. So if you notice a painful swelling on a toe, think about the possibility of tungiasis and get in with a medical doctor.

Likewise, there’s something called creeping eruption. This is the dog and cat hookworm and the creeping eruption. The medical term is cutaneous larva migrans.

And what this looks like is a weird little intensely itchy and uncomfortable red raised line that moves across the skin, usually on your feet or your ankles, but it can be anywhere on your body that comes into contact with the sand. These are worms, microscopically small worms that are cruising through your skin.

And where you see that red line, it’s tempting to want to go in and take a pair of tweezers or something and get rid of the worm. It doesn’t work that way. What you see is the red line is where that worm was a day or two before.

This is an allergic reaction to a worm that’s trying to get to your intestines, but it can’t because you’re not a dog. It’s built for dogs and cats. It’s lost in you as a dead end host, as a human being. And it causes this very annoying, irritating skin reaction.

So the way to prevent this again is wear your shoes.

And if you do choose to go on the beach, try to get to the part of the beach that’s below the tideline because that gets cleaned up and all the dog and cat poo gets washed out to sea once a day. If it happens to you, we have treatment for it. You can see a medical doctor for both topical and systemic treatment.

But I’m hoping you can prevent this. And finally, although that’s the dog and cat hookworm, there is indeed human hookworm.

Same exact story, except this one really can get into your intestines. So in addition to having that, itchy rash where the worm penetrates your skin. You will also end up with diarrhea.

At least that’s been my experience with patients. A medical doctor would look for this by checking in the short term with a blood test for eosinophilia.

But really we just check the poop and see if we can find worm eggs that are in there. Usually that’s not even necessary. When I see patients with this, they give me the story.

They went to the Caribbean, they took time on the beach within a bikini, or they were just walking on the sand, not below the tideline, but above the tideline. That’s going to be very classic for hookworm. Again, treatable. We can give you a medication called albendazole.

It’ll work, but I’m hoping, hoping to spare you from that.

Of all these parasites that we worry about, honestly, the one that’s emerging and gets a lot of press is called the screw worm, the human and animal screwworm. So screwworm is something that’s spread to us by the bite of a fly. And that fly, if it bites us, can insert this parasite into our very living flesh.

This is called the New World screwworm. And it’s a problem. Right? We’ve talked about this on episode 35. You could turn back hands of time and see what we had to say about it. Then.

Here’s an update. It’s still in the Caribbean. According to Centers for Disease Control, this particular New World screwworm is a threat to us mostly from agriculture.

It can get into cattle and it can be very painful and devastating for the cows. We need to keep it out of our cow agricultural supply. That has happened so far.

We haven’t yet seen that in the United States, but it’s right on the border, including in the state of Timulipas, which borders with Texas. And so that’s a threat to our animals. If you’re traveling over the border into Mexico, then you are theoretically at risk as a human being.

In fact, it’s rather remarkable that in both Central America and Mexico, both they’ve tracked more than a thousand cases. And we have reports of seven people who have not survived seven deaths associated with New World screwworm in human beings.

Currently, Tamaulipas has eight active animal cases, according to Centers for Disease Control. This is a rare one. This is not something that would turn me off from going to Mexico, but it’s a good reminder to do what Chris said.

Personal protective measures. Keep from getting bitten by mosquitoes and flies. And this rather rare issue should not be a problem for you.

Chris, here’s another question that comes up and I want to do another callback to a different episode, episode 56. Remember episode 56, appendix out before sailing, question mark.

And I want to talk about this because this particular questioner, Leonard, says he’s going to go cruising. And so the question that we got back on episode 56 is still relevant today. Should you get your appendix removed before you go sailing?

And what we talked about in that context remains true, that if you’re doing a long cruise, I’m thinking transoceanic, crossing the Atlantic, crossing the Pacific, a time when you’re going to be on a cruise away from medical care for weeks at a time, then it really is important to talk about the appendix. The appendix is just a little ticking time bomb we all keep down at the end of our large bowel.

And if it gets blocked, it can cause inflammation and infection can be very dangerous. And so there have been cases where people have chosen to go on these very long transoceanic cruises.

They’ve had their appendix removed preventatively ahead of time. That is not the standard of care. It’s controversial. And it’s even more controversial today because we have this new technology, antibiotics.

Can you just give antibiotics to someone who has appendicitis instead of removing their appendix? I mean, the answer is yes.

We know that this is true based on some very large and high quality studies performed here in the United States, that for people who choose to have antibiotics for their appendicitis and not to have it removed, number one, it has to be caught early. So we don’t want an appendix that has burst. Once you have a ruptured appendix, antibiotics alone really are not the way to go.

You need to have surgery, but if you get to it early and get an accurate diagnosis, you can take antibiotics and keep things under control. We’ve known that for a long time. And now it’s here in January 2026.

Happy news that we have a new paper published in the Journal of the American Medical Association. Antibiotic Therapy for Uncomplicated acute appendicitis, a 10 year follow up, the app, A C randomized clinical trial.

And what this shows is for people who have chosen antibiotics, how do they do, what’s their life look like? What’s the risk that the appendicitis would come back because you didn’t have it removed in the first place?

At 10 years of follow up, members of that clinical trial have been followed and we now know that the risk is approximately 35 or 40%. I’ll say that again.

4 out of 10 of those people who chose antibiotics up front will ultimately have another episode of appendicitis that could be handled in some cases with more antibiotics or it might require surgery. So I think when people are thinking about this, first of all, it would not apply to Leonard. He’s going to Inter Island.

I do not think he should have his appendix removed. But number two, we now know that that’s the story.

People who get surgery tend to have more complications, surgical complications, but on the other hand, they’re done. Once you’re done, you’re done. You never have to worry about this again. So as we talked about before, Chris, it’s a very individualized choice.

I wanted to share with you the happy news that our colleagues who are surgeons who have done the trial, including Drs. Giana Davidson and David Flum at University of Washington, you know, they’ve built a really beautiful website on this topic.

It’s called Appiornot.org. If you or a loved one is thinking about this and you find yourself in the emergency room, go to that website. It is a decision support tool. It allows any patient to hear their options in both English and Spanish.

And within 11 minutes they will have all the information they need to make a very informed decision. Uses little videos, it’s very interactive, it’s super high quality.

And in my opinion, this is the kind of technology we should bring to patients when they are deciding on any particular surgical procedure. We’re lucky to have it and I’m Happy to highlight appyornot.org Bottom line, I think, Leonard, you’re good to go.

And if you’re thinking of a transoceanic crossing, please check out that website too. What do you think, Chris?

Speaker B
00:18:56.120 – 00:20:08.810
Yeah, I didn’t even know antibiotics were an option until I went and studied in Lima, Peru to get my tropical medicine degree. When I went to medical school, it was pretty straightforward. You had appendicitis, you had your appendix out.

But as you say, actually people tend to get a very good outcome if they catch appendicitis early by treatment with antibiotics. However, appendicitis in the movies, it’s easy to diagnose. In the real life, it’s not notoriously difficult to diagnose.

Typically you get a fever and diffuse abdominal pain with nausea, which classically then locates to the lower right abdomen.

But in the real world, it’s really hard to tell appendicitis from a variety of other causes, such as gallbladder disease or even viral gastroenteritis without diagnostic testing. And this includes ultrasound or some other imaging, which you don’t tend to have on a sailboat.

So although this is all true that antibiotics are a treatment, if you get mild abdominal pain, then do whatever. If you get severe abdominal pain, seek medical care.

Because really, even a doc cannot diagnose appendicitis accurately without diagnostic tools and imaging. And even with all of that, there’s still a significant error rate.

Speaker A
00:20:18.180 – 00:23:37.460
Chris, I want to do another callback in the context of the Caribbean. This is to episode 72, and our loyal German worm nation will remember 72.

Right away we talked about riptides and rip currents and what to do if you get caught in a rip current.

This occurred to me because I was walking on the beach just yesterday here in beautiful Puerto Vallarta, and there are signs on the beach or warning people that rip currents can happen. And as we talked about in episode 72, that if you are caught in a rip current, that you should swim parallel to shore. This is a big deal.

It’s one of the deadliest issues for beaches in the world. And more than 100 people die worldwide caught in rip currents, swept away from shore and out to sea.

And the way they typically die, of course, is by drowning after they become exhausted, trying desperately, understandably, to swim back to shore. We know that doesn’t work. The human body cannot compete with these currents. So current guidelines for the current, I.e.

rIP, is to swim parallel to the beach and eventually you’ll leave that rip current and then be able to swim back to shore. We’ve talked about this, and indeed that’s what the signs here in Puerto Vallarta and everywhere around the world show. Thus, therefore.

And so I was really surprised recently to read in Outside magazine’s Digital Format, outside online.com, an article that grabbed my attention because of its sensationalistic headline. And the headline is, everything you know about surviving rip currents is wrong.

That’s not true, by the way, but that was the sensationalistic headline. So I read this article in Outside. I think everyone should look it up. It’s a good article. It’s dated August 21, 2025.

Somehow it just came across my feed. But if you haven’t seen the this, basically the journalist did a good job identifying people in Australia.

Australia, which is they do have a lot of beach life, a lot of surfing, and a lot of experience working with people who have figured out that actually we may be able to do things a bit differently instead of Swimming parallel to the current. This particular group of experts say you should just do nothing. You should just sit there passively and get swept out to sea.

It’ll be the most terrifying five minutes of your life.

But then the rip current will dissipate and you will almost always be scooted off to the side and come right back to shore along with everything else that comes in, crashing with the waves. The recommendation in this article is to just relax, float, and let the current do its thing. So I wouldn’t say that everything we know is wrong.

We know that fighting the current is incorrect.

And I think the concern is that if you swim parallel to shore, going one direction may be very helpful, but going the wrong direction may be counterproductive. And you don’t know which way to go, left versus right. Thus this recommendation.

I would say that there are cases in which swimming parallel to shore makes sense. I would try that. I mean, if it’s me, if I go swimming today in the Bay of Banderas and I get swept away, I will try swimming parallel to shore.

But if I find that that too fails, I now feel empowered with this knowledge, Chris, that I can relax, focus on floating, giving myself a little bit of time. You’re not going to end up in Japan. You’re not going to go across the entire ocean.

You’re going to scoot out for a matter of hundreds of meters, and then having marshaled your energy, then you can swim parallel and come back. What’s your thought about this, please?

Speaker B
00:23:37.460 – 00:24:25.040
Yeah, I agree. This is a case of where it’s more important to know what not to do.

And the key point is don’t swim directly towards shore, which may be your first impulse. That’s the worst thing to do.

And my second point, and this may be so simplistic, I don’t need to say it, but either know how to swim or wear a personal flotation device. And you can learn to swim at any age. If you didn’t learn as a kid, take a few lessons as an adult. It’s also really good exercise.

I just learned for the first time two years ago how to swim.

And so I think that in addition to this technique, just knowing how to swim in general, especially if you’re in the developing world a lot, often boats, usually boats don’t have personal flotation devices. If the whole thing abruptly sinks, it’s really good to know how to swim.

Speaker A
00:24:25.360 – 00:25:13.430
I totally agree. And you’re such an inspiration that you did that. I think it’s so cool.

And acknowledging the idea that learning to swim In a swimming pool or indoor controlled setting, it is different from ocean and open water. And getting, you know, a little bit of training and experience in those other environments that can also be a huge part of staying safe.

Okay, Chris, here’s a question I have for you related to the Caribbean, and it’s because of measles, right? So in the United States we’ve got measles.

In my city of Seattle, we actually have people with measles today because someone from South Carolina came and visited and they got sick that way. But what about the Caribbean? Is there measles in the Caribbean? And if someone is exposed, what should they do?

Speaker B
00:25:13.510 – 00:27:32.560
Ooh, thank you for the question.

First, just to note, unfortunately, the rate of this entirely vaccine preventable disease is going up in the U.S. as you say, and I worry it’s going to go up even further as vaccine rates fall.

In terms of around the world, it’s most common in Indonesia, it’s common in several countries in Africa, and it appears to be going up in incidence again because of the falling vaccine rate. It’s not common in the Caribbean, but there is a significant amount in Mexico.

So basically, regardless of where you’re going in the world, including the Caribbean, I think it is very important to be current on your measles vaccine. It’s real simple. Most people just need two doses.

Paul, you can go through the different age specific rules if you want to, but in answer to your question, no, it’s not common in the Caribbean, but it’s common enough to where you want to be vaccinated for it. And also, do recall that you’re not just going to be in the Caribbean, but presumably you’re going through an airport at some point.

And these crowded places always have some low risk of transmissible things like measles. In terms of what to do. Suppose you’ve been through an airport and then you receive an email.

Hey, there was a person at this airport near you with active measles. What should you do? The first thing to do is check your vaccination status. And if you’ve had two shots, most people are protected for life.

And really all you need to do then is wait and see if you get any symptoms such as fever and rash and typical symptoms of fever. Also you can get a cough and a runny nose.

And then a few days after that you get this very characteristic red rash, which actually is what the disease is named after. This starts at the mouth and the hairline and then it kind of works its way down the body.

If you get symptoms consistent with measles, such as fever and or rash. Don’t just show up at your doctor’s office. Measles is super transmissible.

So if you’re in a waiting room with measles and somebody else has never had it, you’re probably going to give it to them.

So just like in the COVID days, you want to call ahead, call the egg ER or the urgent care wherever you’re going to show up and say, hey, I was exposed to measles. I’ve now got this funky rash.

And they will not direct you to sit in the waiting room, but they will whisk you into an exam room where you’re relatively isolated.

Speaker A
00:27:32.720 – 00:30:24.330
Yeah, well said. And this is a nasty disease. We’ve talked about it many times here on good old Germ and Worm.

It’s something that will definitely ruin your entire week and it can in fact be life threatening and certain cases too. So we hate this disease.

It is present in Mexico in the last year, if I’m not mistaken, they had about 3,000 cases reported to public health authorities there. That’s not very different from the United States where we have more than 2,000 cases.

So I don’t care if you go into Mexico, elsewhere, in the Caribbean or just staying home in the US you need to be protected against this stupid infection because we really lack a specific effective treatment. It’s all about prevention. And as you said, Chris, yes, it’s true.

If someone in our germ and worm nation is not sure whether they are immune to measles, they should talk with their physician and that doctor will ask you when you’re born. A lot of our guidelines relate to your year of birth. For example, in the United States, if you were born before 1957, you probably had measles.

Even if you don’t remember, you may have had a mild case, which would be great. It’s so incredibly contagious that virtually all the Americans born before 1957 are assumed to have had it. There are exceptions.

If you’re a healthcare worker or someone who will be heavily exposed. We do want to make sure that we know what your immune status is.

So if you’re a healthcare worker, you may get a blood test or even just get a vaccine. Even if you were born before 57. If you’re born from around 59 to 63, you probably missed that vaccine.

It was licensed in 63, but it was really improved in 68. So if you’re, you know, an early 1960s person, you need to get vaccination with two good vaccine shots.

If you’re born from 63 to 89, you probably got a dose of the measles shot, which is great. That gives you about a 93% coverage. But we know that with a second shot that protectivity of 93% increases to 97%.

Everybody basically needs to have two shots of measles vaccine if they were born after 1957. That’s the simple answer.

If you were born in 1990 to the present, you really almost certainly have received two doses of the MMR, measles, mumps and rubella vaccine. But again, if you’re not sure, talk with your doctors. And if there’s any uncertainty, you have two options.

You can get a blood test to see if your body has the antibodies, the protection level that you need, and if you don’t want to do that, you can always get another shot. It’s a very safe vaccine to use in spite of all the nonsense you’re hearing from our federal health leaders, which is just a tragedy and an outrage.

And by the way, Chris, you and I recently wrote an op ed article on this topic in the Seattle Times. And so our suggestion is if you’re interested in this topic, please take a look at Seattle Times.

You can search for our names, I’ll just put a link in the show notes and people are encouraged to take a look at that op ed piece.

Speaker B
00:30:24.330 – 00:30:34.410
Yeah, we share our opinions and you can imagine our conclusions concerning recent CDC changes in the recommended pediatric vaccine schedule.

Speaker A
00:30:50.740 – 00:31:20.990
Everyone. That’s a wrap for episode 87 of German Worm Notes from the Field on the Caribbean. As always, we welcome your questions on travel health.

Please send them to us or if you have tips for success or suggested corrections, we would look forward to hearing from you. Just send us an email germandwormmail@gmail.com or visit us online, Germandworm.com if you have enjoyed this episode, 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 Jerm.

Speaker B
00:31:20.990 – 00:31:24.350
I’m Worm. It’s a big planet. See it in good health and we’ll.

Speaker A
00:31:24.350 – 00:31:45.920
See you next time. This podcast is designed to inform, inspire and entertain.

However, this podcast does not 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.