GERM
00:00:00.160 – 00:00:11.680
Guten tag! My name is Germ. I’m

WORM
00:00:11.680 – 00:00:12.240
I’m Worm.

GERM
00:00:12.400 – 00:00:27.120
Welcome to episode 93 of the Germ and Worm Travel Health Podcast. Polio in Europe. WTF? 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
00:00:27.770 – 00:00:35.530
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
00:00:35.610 – 00:01:32.520
Well Chris, wtf indeed. Here we have great questions from our listeners across the country and around the world.

We’ll tackle a bunch of them today, including Are you at risk for leishmaniasis in the continental United States for the hajj? What vaccines should I receive?

What vaccine preventable infections do you predict are likely to be on the rise in coming years and state versus Federal vaccine recommend? Which should I trust? A reminder to our listeners, please contact us with your travel health questions, your stories, and your tips for success.

Or if you have a request for clarification about something you’ve heard on a previous episode, just let us know.

Find us online germandworm.com or send us an email germandworm@gmail.com

Before we jump in today, 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. Please see a qualified healthcare professional for recommendations specific to you and your itinerary.

WORM
00:01:33.640 – 00:01:45.240
Paul, on your recent travels, you spent a bit of time in Singapore. Suppose somebody just had a brief layover there. What would be your top pick for or top picks for activities?

GERM
00:01:46.040 – 00:04:38.129
Yeah, I was lucky to spend a few days in Singapore as my wife’s plus-one. She had work and so together we had some work obligations which were wonderful, but also some downtime.

Number one, it’s hot as hell. I mean it’s on the equator so it’s hot and humid. Be ready for that.

Number two, there’s plenty to do in Singapore even if you just have a layover of a day or two. The things that we did that I enjoyed the most was very classical tourist associated stuff. We didn’t go far afield.

Well, first of all because it’s a tiny island and you can’t go far afield. But second of all, because they really have curated some activities for tourists.

So if you’re just there for a short time, the things that I enjoyed Number one, I love Botanic Gardens and they have world class, maybe unsurpass past Botanic Garden, both outdoor and they have these huge indoor domes they have to do this because it’s so flipping hot that in the middle of the day you just can’t be outside in the tropical sun. You go indoors and the plants are happy. It’s relatively cool. And you’ll have a great experience with that too. To me, that was a lot of fun.

For food, please check out the hawker alleys. The food hawkers are these. Well, it’s like street food, but it’s regulated. So they have center. Think of a food court at a mall in the United States. But it’s dedicated just for this purpose. There is no mall, it’s just for the food. And every stall is inspected and regulated very carefully by food safety experts. So I would be very surprised if anybody got sick eating any of this food. And it’s highly multicultural. Singapore is known for its food because it has influence from China and India and Malaysia. And so I really do recommend you visit one of these food hawker areas. There are many. We went to the Amoy hawker center, but there are others too. All really good.

And then you know, at nighttime when it is a little bit cooler comparatively, they have also embraced the suck of their humidity by creating an entire zoo. If you’re into the zoo scene, I love animals. If you’re into zoos, they have a night zoo. It’s just a nighttime zoo.

It’s all these nocturnal animals you normally don’t see. The whole zoo is built for nighttime. It’s a self guided thing. You walk around or you could even ride a tram.

If you’ve got mobility issues, you can do this too. My God. All these animals you don’t normally see, they’re going ape, they’re going wild. They’re just swinging from branch to branch.

They’re running around through the jungle floor. It’s a very nice zoo scene. For me personally. It was very emotional to do this because of course the palm civet was there on big display.

And I think about the palm civet with respect to SARS 1, that was what we think started the first SARS outbreak. So it was very auspicious for me to be like, oh wow, that animal almost killed a lot of people back in the day. And they’re adorable little creatures.

Anyway, I do recommend the night zoo. Very touristy and, and very fun.

WORM
00:04:38.369 – 00:05:13.220
Oh, super. Thank you. All right, first question for you.

And this comes from Carl in Seattle and he says, hey, I just read a good book titled the Lost City of the Monkey, A true story by Douglas Preston. And that was published in 2017. And in this Book, which is nonfiction.

A bunch of scientists and archaeologists were in Honduras looking at some ancient structures and they got leishmaniasis, this kind of flesh eating disease. Does that disease happen in the United States?

GERM
00:05:14.630 – 00:10:12.360
Oh, Carl, thanks. So I gotta read that. That sounds like a great title of a book. Lost City, the Monkey God. I haven’t read that.

So first of all, thanks for the recommendation on that. And second of all, leishmaniasis or leshmaniasis, you’ll hear us use the term, the pronunciation both ways. What is it?

Does it happen in the United States?

Quick answer is it’s very rare in the contiguous U.S. although as you get down towards the Mexican border, it can happen, especially the state of Texas. What is leishmaniasis?

I call it leishmaniasis because, well, when I trained in London, everybody looked back at Dr. Leishman, who was the first person to describe this back in the day related to British colonial expansion. And so in that person’s honor, the disease is often called leishmaniasis. So who was Leishman?

A physician who was describing skin boils and illnesses that had gone by other names previously. But he’d started to understand what was really going on with this.

Other names for this condition include the oriental sore is a bunch of names back to antiquity. We call it leishmaniasis. This is a parasitic infection. You catch it when you’re bitten by a phlebotoman sand fly.

In other words, a sand fly that, that sucks your blood kind of like a mosquito, honestly. But inside that fly is this single celled parasite of the leishmaniasis family.

And during the blood meal, some of those parasite cells can get into your body. Once they get inside you, a number of different things are possible. Spoiler alert. Leishmaniasis is hyper complicated.

This is not one of those simple ones. In fact, I think it’s the single most complicated disease that I teach in medical school or in tropical medicine.

But for our listeners here, our brave, intrepid listeners, let me boil it down to you. Several things are possible. First of all, you may have no infection, whatever.

Your immune system may clear it away, but you may also end up with an infection that can be either vexing and miserable or potentially life threatening. What happens is you can end up with either a skin infection or an internal infection.

Some species of the parasite can live at core temperature and get into your very living guts, like your liver, your spleen. But most of them don’t. Most of them get killed by our body temperature. So they stay on the skin where it’s Comparatively cool.

But even then when they’re on the skin, they can cause wounds, sores, these very ugly and difficult to heal wounds, which you know, to a trained eye and someone who looks at this, as a physician and knows your travel history, we should not miss this diagnosis. But Chris, I gotta tell you, I don’t know about your experience.

I have been so humbled by this because as a referral specialist, people send patients to me from all around the region when they can’t figure out what’s going on.

And that’s because this is a rare infection in the contiguous U.S. so I have seen cases of people who have a, what’s pretty obviously a leishmaniasis infection, but their travel history was missed by the physician or healthcare provider who initially saw that person. And so these people can suffer with a sore, an open wound for weeks and months before they finally get a diagnosis. It’s very regrettable.

So the answer is we do have treatment. The treatment is very difficult, although it’s gotten better. There are certain medications that work for some species.

There are other medications that work for other species. This is a bad infection. It is treatable.

But the single most important thing is, number one, protect yourself against fly bites when you’re in one of these high risk areas. I’m thinking about Latin America, I’m thinking about Africa and parts of Asia. You don’t want to be bitten by a mosquito.

You also don’t want to be bitten by a fly. Personal bug avoidance measures work because we don’t have a vaccine for this, unfortunately.

And number two, if you do come home from one of those beautiful, exciting places and you have a sore on your skin, you need to get with a doctor and tell them, hey, I, I was in a place where there might be something called leishmaniasis from the lost city of the monkey God, could this be? That’s what this is. Most doctors won’t think of this because it’s not something we see in this country in our everyday experience.

What I try to teach our physician colleagues is, hey, when it comes to leishmaniasis, you need to know, was it acquired in the Americas or the so called old world? Is it visceral or cutaneous?

And if it’s cutaneous, could it be a species that could cause something called mucocutaneous disease, which goes by other names such as espundia and what’s the immune system of the patient? So that’s where all this is complicated. It comes together.

You do need to see an expert doctor about this is not something Your primary care doc would be expected to know. So does it happen in the US To Carl? Yep, it does, especially in Texas. There have been close to 100 cases of Texas leishmaniasis, but it’s uncommon.

Even in the great state of Texas. You’re not likely to catch it, but when you go south of the border or some other fun place, it’s something to think about.

Chris, would you share your experience with leishmaniasis, please?

WORM
00:10:12.720 – 00:11:12.540
Yeah, you bet.

When I’ve seen people returning from abroad with this, and I’ve never seen a person who acquired this in the US But I have seen a few people who got this abroad. Most of them, because I practiced in Seattle, were in Central America. Now, that begs the question, should you avoid Central America because of this?

I would say no. Getting this or not getting this is very related to your exposure to insects, and you can control that.

So if you want your skin to break out in all sorts of interesting things, including leishmaniasis and hot fly, just spend the night in the jungle wearing nothing but short pants and don’t use any insect repellent. What I do, like, on my recent trip to Belize and elsewhere, I do bug repellent.

I do the, you know, picaritin to my skin, permethrin to clothing, and that markedly reduces risk. So, yeah, it happens.

Most of it that we see in the US Is from Central America, but you can make your risk fairly minuscule just by doing the usual bug repellent stuff.

GERM
00:11:13.260 – 00:12:41.900
I agree with you.

And just in my own clinical experience here in Seattle, where I live and work, just as a pro tip, the experiences that my patients tell me about is going to a yoga retreat or some kind of ayahuasca spiritual experience where they’re not focused on personal protection. They just want to have a fun time, and they don’t think about keeping these flies off of them.

That or going to a mangrove swamp or any place where there’s a bunch of biting flies, please do your best to avoid the bites of these little flies. And if you do end up with a little sore when you come home, don’t ignore it. Come see us and we’ll take care of you. So, Chris, is a question to you.

I want to get your opinion about this because, you know, you and I have been railing and probably raging against all the outrageous disassembly of public trust in vaccine safety and technology, especially with the onset of the current administration. This drives us crazy, right?

Because we know that vaccines are generally well tested, generally safe, and generally save a lot of lives and generally everybody should get all their vaccines. And yet we have this consistent assault on that obvious time worn truth from the current administration.

So I wanted to get your take on some recent information that the American Medical association, the ama, is now advising people not to go to CDC for vaccine advice, but instead to look to, to the American Academy of Pediatrics and other professional societies. What’s your take on this news, please?

WORM
00:12:42.220 – 00:13:53.380
Well, this is bizarre as compared to recent years. First AMA, American Medical association, it’s the biggest collection of physicians in the United States.

And it’s not some fringe group, it’s entirely mainstream. It has people from all over the political spectrum and traditionally it’s been non political.

And of course, until recently, the first place they recommended that people look for the best vaccine recommendations was the CDC, Centers for Disease Control and Prevention, which is under Health and Human Services.

But in their most recent recommendations, they say, hey, if you want the very best vaccine recommendations, and this came out in a what is called an internal medicine patient page, they say look to places like aap, the American Academy of Pediatrics, and something that sort of screams by its absence is they do not mention the cdc. And I’ve never seen that before. I think they’re smart, smart to do that now that the CDC recommendations are corrupt from political influence.

But now even the AMA, the old stodgy AMA, is saying, no, don’t look at the CDC, look at physicians, professional groups instead.

GERM
00:13:54.100 – 00:16:21.290
Yeah, it’s unprecedented and but it is important. So thanks for that perspective.

You know, in late 2025, November 2025, the Pew Charitable Trusts published a survey that they had conducted independently, talking to Americans across the political spectrum, across geography, about their beliefs and opinions on vaccine safety. And it’s really quite interesting thinking about new versus old vaccines. I think people want to do the right thing. They’re just confused.

I’ll give you an example. MMR is the measles, mumps and rubella vaccine.

An overwhelming majority of people who in that survey self identified as Democrat, 92% felt that the benefits outweighed any potential risks. Among Republicans, it was similar, although a little bit less.

But Even among Republicans, 78% of respondents said that they believed that the MMR vaccine was safe and that the benefits outweighed the risk. On the other hand, for other questions, let’s say global safety confidence.

How confident are you that childhood vaccines have undergone sufficient safety testing?

It was only 53%, meaning almost half of Americans did not feel that they were extremely or very confident that childhood vaccines had undergone safety testing. So the point is it’s not monolithic and it’s not that people are treating all these vaccines the same way.

Now is not the time for us to divide the American people and give them all these multiple sources of information. That one of the great benefits of cdc, and I hope you agree, Chris, is that it’s a single place. It is the highest authority in the land.

We’ve always been able to point to them and that’s no longer the case.

My own professional society called the ID Society of America, like American Academy of Pediatrics, we are leaders in trying to create evidence based, clear information for people to go and find information about this. But we have always said remains true. If you have questions about vaccines, talk to your physician.

A board certified physician is a great resource for any of these questions.

And I’m just sorry and outraged, befuddled and frankly currently exhausted that we have lost that confidence and ability in our, in our Centers for Disease Control. I’ll say it again, like we said before, the rank and file servants at cdc, the experts in public health, I think they’re still great.

It’s the leadership structure over there. That’s what needs to change in my opinion and I don’t think there’s any other way to say it.

WORM
00:16:22.970 – 00:16:36.100
And Paul, related question. There’s been some news recently about measles outbreaks in the United States. But what are some other illnesses that are going to become more common as vaccine rates drop?

GERM
00:16:37.220 – 00:19:25.900
Vaccine rates are dropping and this is regrettable for this exact reason. Let’s take one example. A moment ago we talked about mmr, the measles mumps rubella vaccine.

Rubella sounds like somebody’s name from the 1950s or something. “Come here, Rubella!” No, I mean what are these strange things we don’t think of? Well, this is a true effing thing.

It’s not only measles that’s on the rise, but it’s the most contagious infection known to man. So no, no surprise that measles rates are going up as vaccine rates go down. But what about mumps? Mumps? It just sounds like such a downer of a thing.

And it is. Mumps is a viral infection. It’s been with us forever and remains so. It’s much less catchy than measles.

But it’s also something that I’m glad is part of the MMR vaccine because it’s a miserable infection.

People can have perit, the parotid glands up on your cheeks can end up the lymphatics also of the cheeks and the neck can end up getting very swollen. It’s a miserable experience. But this can also actually be more serious than that.

There’s the risk of harm to the neurological system, including reduced ability for hearing and also for reproduction. I mean, the classic thing with mumps is that in boys and men, but usually boys who get this, it can have testicular infection involvement too.

This causes inflammation of the testes that may have permanent, irreversible fertility implications, where the testes get so inflamed that their ability to create sperm is reduced. So the point is, mumps is a rotten thing. It’s been with us forever.

It is not as preventable by vaccine as is measles, but it is still largely preventable. So the fact that we now have reduced MMR vaccine coverage. Yep, there’s increases in mumps.

There’s a significant increase in mumps reported by various states.

For example, in Maryland recently, public health department there reported 26 cases, which is a five fold increase in a certain time frame compared to what they had seen previously. This is not an American thing, this is global.

We have similar reports in Canada, in the United Kingdom, in Australia, where all these different countries with good surveillance processes for public health are reporting in increased numbers of mumps. So that’s one example. But if you think about it, if we look at an erosion of confidence in vaccine safety, it’s no surprise.

We all predict that any number of these vaccine preventable infections, Chris, they’re all going to go on the rise. I’m thinking about chickenpox, I’m thinking about influenza, I’m thinking about COVID. Everything is a risk out there.

The germs don’t care what your confidence level is. They simply are, they simply exist. They simply threaten us.

And, and if we don’t trust in science and medical progress, all of us will be at risk of seeing an increase in these infections. What’s your thoughts about this, please?

WORM
00:19:26.460 – 00:21:02.110
Yeah, I agree with all of that. And just to give an example first, measles, as you’ve probably read, is at a 35 year high in the United States.

Last year, 2025, there were over 2,200 cases. And unfortunately, the vaccination rate is going down over recent years. And I can quantify that for you.

In between 2019 and 2020, a little over 95% of U.S. infants had at least one shot of MMR, measles, mumps, rubella, by age 2. But in when that was most recently checked, a year ago, that was down to about 90.6%. So about a 5% drop. And an important number is 95%.

To maintain herd immunity for measles, you need to have 95% of children vaccinated or there’s going to be outbreaks. And so measles is going to get bigger, mumps is going to get bigger. Heck, maybe polio will come back with all of this anti vaccine talk.

So Paul and I feel a little bit like Cassandra. Do you know your Greek mythology, Cassandra was the priestess and her curse, I think it was put on her by her father, Apollo, was that she would correctly predict the future but never be believed.

And so Paul and I keep saying, oh, measles is going to get more common a vaccine rates drop, you know, as do all physicians who know about infectious diseases.

And apparently the federal government currently is tone deaf to what we’re saying, which is inordinately frustrating and ultimately I would say tragic.

GERM
00:21:02.510 – 00:21:46.240
Thanks to all of our loyal listeners. We know that you get this.

We’re trying to provide you with this information so that as you have discussions with friends, family, on the social media, just getting you some high quality evidence based information coming from us, people who really care about you and the entire community.

Let’s have these conversations in the most civil way that we can so that we can try to get everybody their vaccines and thus protect all of us together. Yee haw.

And Chris, speaking of vaccine protections, it occurs to me that we’re getting close to the time for Hajj Umrah which scheduled this year for late May of 2026. And so the question is, for listeners who may be planning to attend Hajj and Umrah, what should they do for vaccine safety before they travel?

WORM
00:21:47.280 – 00:23:03.660
Yeah. Thank you. First, Hajj and Umrah are Muslim pilgrimages in the country of Saudi Arabia.

And the Saudi Arabian government I think very wisely mandates certain vaccinations for people coming into the country at this time. The first thing I would do is go to the Kingdom of Saudi Arabia website.

They have a very nice website on Hajj and Umrah and what they require vaccine wise.

And it’s important because if you show up in Saudi Arabia all ready to go to the Hajj, if you don’t have the right vaccinations, they will not let you into the country. Prior to these rules, there were some very large outbreaks of meningococcal meningitis and other diseases. So I think these are good rules.

So check out the website. Depends what country you’re coming from. But a few general things.

Everyone, regardless of where they’re from has to be vaccinated for meningococcal disease and also for Covid. They also recommend influenza. And then there’s a couple others that are dependent on what country you’re from.

So depending on where you’re from, you may be required to be vaccinated for polio and yellow fever. So I won’t go through all the regulations. It’s long.

But the bottom line is don’t just show up, but both to get in legally and for your own safety, read the sheet, go online, and then see a doc and get up to speed on the right vaccines.

GERM
00:23:04.140 – 00:23:40.790
Can we just pause for a moment and reflect on this? I see this. I’m not a member of Islamic faith, but if I were, I would be so grateful that I could both celebrate my faith and do it safely.

Here’s an example. Religion and vaccines, they can coexist so often in our country. I feel like it’s a philosophical or religious concern about vaccines.

People using this as an excuse not to get their Covid shot, which is unfortunate, to say the very least. So props to the government in Saudi Arabia for making this happen and doing it safely.

And for those who make the pilgrimage, we hope you have a safe experience.

WORM
00:23:47.110 – 00:24:12.930
All right, Paul, question for you. What’s up? A bunch of states in the west of the US have gotten together in some sort of group and they are issuing their own vaccine recommendations. And also Washington State is trying to issue its own guidance for vaccines that insurers may cover. And this is going to be different than federal guidelines. So what’s going on with suddenly the states becoming activist in this topic?

GERM
00:24:14.370 – 00:27:01.240
This is just a clear response by necessity, which is almost unprecedented. There may be a precedent for this. Chris. It just. I can’t put my finger on that.

In which states and regions have decided that they’re going to do their own thing. It gets back to what we were talking about before. Who do you trust? What do you believe to be true with respect to vaccine safety?

So, yep, here in we have a number of Western states that have gotten together to say that they would create their own vaccine guidelines.

From a public health perspective, that’s important not only because it makes it confusing for people to know who to trust, but also because it has implications for insurance coverage and reimbursement. Right. When it comes to this question of vaccines, it’s not just about what you believe. It’s also about who’s going to pay for it. So you’re right.

We have recent news that the state of Washington, where you And I Live has come out with its own guidelines based on its Western states connection, saying that by law, in the law of the state of Washington, recommendations and guidelines for vaccines now exist.

And that means that insurers, including private insurance companies that may cover people’s health and safety who live here in the state of Washington, the hope is that those insurers will now start to, well, that they’ll have to continue to abide by those guidelines. The guidelines coming from Washington state should be the same as they were before the current administration came in. There’s no change here.

This is a legal maneuver in order to protect the health, safety and lives of people who live here by saying that no matter what federal government says, because if you do business here as an insurer, you gotta follow the rules. The rules being vaccine recommendations as they always have been. This is just a way to codify what we know to be true.

And it’s crazy and it’s outrageous.

One of the interesting secrets about this, I don’t know if it’s a secret, but my suspicion is that actually the insurance companies are all good about this. If you’re an insurer, what do you not want to do? You don’t want to have somebody who’s sick.

You don’t want to cover someone with, let’s say hepatitis B infection because that’s a lifelong incurable infection. It’s going to cost an umpteen millions of dollars to cover a life. Whereas if you give a shot, it’s basically free.

In other words, these vaccines, from the perspective of the insurance companies, they really are cost effective. This is an easy story to tell to the insurance companies.

Nevertheless, out of fear that the insurance companies may start to try to do something that’s cheap in the short term and avoid the right thing to do for the people who live here. Yeah, that’s where these laws have come from. So it’s crazy, but it’s, but it’s true.

And I’m grateful to our legislative process here in Washington State that they’ve done this.

WORM
00:27:01.960 – 00:27:08.920
Yeah, I agree. I’m glad. Sort of in the expertise vacuum that the feds are creating that the states are stepping up on this one.

GERM
00:27:14.790 – 00:27:25.830
Chris, here’s a question to you.

If someone wants to have good information that they can rely upon regarding their upcoming trip, where do you recommend that they go online to do a little more research?

WORM
00:27:26.630 – 00:28:36.440
Yeah, this one site that was just set up recently I think is super high quality information and actually it’s put on by istm, the International Society of Travel Medicine, which is A society for health providers that are into travel medicine like me and Paul, and just go to ISTM and click on their online resources. One thing they have that’s super helpful is a global clinic directory.

So this is a list of clinicians who see people basically in countries around the world. So if you’re in country X and you get a fever, it’s sort of a list of pre vetted physicians and other professionals who can see you.

So that’s a real handy resource. Also they have a number of fact sheets and you don’t need to be a member. There’s no password for this.

They have one on altitude illness, one on insect bite avoidance, one on malaria, several other topics including traveler’s diarrhea.

So again, just go to the ISTM website, International Society of Travel Medicine, and it’s a large amount of free, high quality info designed not for professionals but for the lay traveler.

GERM
00:28:37.010 – 00:28:48.530
It’s a great resource. And if you do check this out and you have a good experience or you have questions about how the ISTM website works, let us know. Shoot us an email. Germandworm@gmail.com we’d love to hear from you,

WORM
00:28:54.610 – 00:29:04.610
Paul. This comes from Irl in Seattle and Irl says, Hey, I’m going to Barcelona on Sunday. I’m reading something about needing a polio booster. What’s the deal with that?

GERM
00:29:05.620 – 00:34:20.540
Yeah, thanks Irl.

So this is the super interesting topic and it’s true, we do have a recent travel Advisory from early March 2026 from Centers for Disease Control that children and adults be up to date on routine polio vaccines before any international travel to anywhere in the world.

But that there’s also an increased signal based on surveillance of polio virus, both wild type poliovirus and and vaccine derived polio virus in wastewater in a number of different countries, including in Europe, where they actually have the ability to do some good wastewater surveillance. So polio virus, it’s a virus that we get when we consume water or food, but usually water that’s befouled with the polio virus itself.

So it’s a fecal oral infection. It can do any number of things in the body.

But the classic and most feared complication, of course, is is myelitis, meaning inflammation of the spinal cord.

When that happens, there may be permanent problems with paralysis or reduced use of the arms and legs because of irreversible damage to the spinal cord.

This is one of the great fears that every parent had here in the continental United States every summer when their kids would be out of school and go play or go to a camp, jump into a lake, and end up getting a fever and then getting poliomyelitis. It’s part of our history. It’s a shared suffering that reached the highest level of the land. Right.

Fdr, one of our previous presidents, actually contracted this as an adult. So no one was safe from poliomyelitis until it came to Jonas Salk and his colleagues, including Dr. Sabin, who created the first polio vaccines.

And you’ll see those photographs. Everybody’s seen them from 1950s people lining up around the corner and down the street to get their polio shot.

And parents could finally start to breathe a sigh of relief that their children were protected. It’s one of the great achievements in modern medicine is the development of polio vaccines, which we still benefit from today.

And so the recommendation is that every human being alive on planet Earth should be immediate, immune to polio. If we do that, then the chance of getting this complication is dramatically, dramatically, dramatically reduced. There is no animal reservoir.

Theoretically, if every human being alive had a good response to the vaccine, the infection would disappear from planet Earth. We’re not there for a variety of geopolitical, sociocultural problems.

So currently we have wild type polio being transmitted in a very small number of areas. Afghanistan, Pakistan.

There are certain areas with reduced wastewater treatment where this is a problem and people who just don’t have good access to sanitary facilities when they use the toilet.

So it’s a bit of a surprise and bit newsworthy when people say, hey, if you look in the wastewater of other parts of the world, including Spain, including Germany, very industrialized societies, that they’re seeing this virus in those wastewater flows as well.

You know, some of that is related to people who have been immunized with the oral polio vaccine and that oral polio virus is actually in the wastewater stream. But some of this apparently also seems to be wild type polio virus as well. So do you need to get a polio booster before you go to Europe?

The most important thing for all of us is to be immunized as soon as we possibly can in childhood. That immunity is thought to last a lifetime. So I recommend that people get a booster before travel.

Number one, if their immune system is reduced, you’ve had B cell depletion, you’ve been treated for cancer, for example, a stem cell transplant. We then restart and give you all those childhood immunizations after that transplant.

Number two, if you’re going to an area of very high risk, very high risk would be an austere setting where Public sanitation is reduced, et cetera.

And then number three, this current and potentially very confusing recommendation from CDC which says that if you’re going to go to Europe as well, not only should you be immunized, but talk to your doctor and that you quote, unquote, may receive, end quote, a single once in a lifetime booster for polio in the United States.

Our rates here are extraordinarily low and the only polio that we see currently is actually related to the the old fashioned oral polio vaccine which can on very rare occasions actually cause some disease. We don’t use that here routinely anymore. We use the killed vaccine and that does not carry such a risk.

So should you get this to Earl’s question, going to Spain, going to Barcelona on Sunday, do you need to get a booster? You can, and I think it’s something that you can talk with your doctor about. It’s probably unnecessary.

It is most certainly harmless and I think when it comes to vaccines in general, more vaccines are better. So I have no problem with people talking to their doctor to find out if they should get a booster.

It’s almost certainly unnecessary based on the low risk and based on your previous immunization. Nevertheless, CDC says that you may receive one. And so certainly if someone wants to get this booster, no problem. It is safe to do.

Chris, what’s your philosophy about this current situation?

WORM
00:34:21.180 – 00:34:49.880
Yeah, I agree. This is one of those topics that we can’t give a definite thumbs up or thumbs down to. The risk is minuscule.

But you can get a shot if you want to for even additional protection. Certainly if you go to a high risk area, then it’s a good idea getting one after age 18 on top of the series you had as a kid.

But for an extremely low risk destination like Europe, talk with your doc. And it’s a personal decision, so I’m not going to say yes or no on that one. I’m going to hedge.

GERM
00:34:50.600 – 00:35:37.890
I recently went to Paris for a lovely time and had no hesitation about going without getting a polio virus booster. That was my own personal choice. Your decision was may be different. Everyone, thank you so much for joining us here on episode 93 of Germ and Worm.

As always, we welcome your questions on Travel Health. Just send them to us@germ germandworm gmail.com or visit our website germandworm.com if you’ve enjoyed what you’ve heard today, please subscribe, give us a thumbs up and spread the word with friends, family and on social media.

I’m Germ.

WORM
00:35:38.210 – 00:35:40.850
I’m worm. It’s a big planet, Seed and good health.

GERM
00:35:41.570 – 00:36:04.380
We look forward to seeing you next time.

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