GERM
00:00:00.240 – 00:00:00.560
Kumusta ka! My name is Germ

WORM
00:00:11.840 – 00:00:12.800
I’m Worm.

GERM
00:00:13.040 – 00:00:28.000
Welcome to episode 102 of the Germ and Worm travel health podcast. Tick tock ticks in 2026. 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
00:00:28.140 – 00:00:35.970
Professor I’m Dr. Chris Sanford, also known as Worm, Associate professor in the departments of family medicine and Global health, also at the University of Washington.

GERM
00:00:36.290 – 00:01:47.850
You know, some people say we don’t have a presence in TikTok, but they’re wrong because we’re talking ticks all day long. This is our annual TikTok talking about ticks and how it relates to travel health and travel wellness for our listeners.

Some of the questions we’ve received from our TikTok nation, well, I guess I should say German Worm Nation, include can I really become allergic to meat after I get bitten by a tick? What’s the best way to avoid tick bites in the first place? What’s up with the new vaccine for Lyme disease?

And is there a difference in Lyme disease if you catch it in Europe compared to the United States? These questions and many more. A friendly reminder to our listeners.

Please contact us with your travel health questions, your stories, and your tips for success. Or if you want a clarification on something we say here on the podcast, we’d love to hear from you.

Just get us on our website, germandworm.com or send us an email germandworm@gmail.com before we jump in. As always, 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 to your itinerary. Now, here we are.

I’m coming to us from Germ and Worm world headquarters in Seattle. Chris, where are you today?

WORM
00:01:48.090 – 00:01:53.050
Hey, I am in Palermo on the island of Sicily, where the gelato is good.

GERM
00:01:53.370 – 00:02:09.780
Where the gelato is good and when the gelato is afraid of. Chris, I’m sure you’re eating everything you can possibly get your hands on. I’m very envious of you.

I’ve never been to Palermo and put it on the list, that long list of places that we definitely need to check out personally before we recommend to our listeners.

WORM
00:02:10.420 – 00:02:23.220
Well, you know, I’m going to Bhutan and doing a little high altitude hiking and right now I’m in the phase not of training but of carbo loading. So I’m Trying to pack extra calories on just in case I get a reduced appetite at altitude.

GERM
00:02:23.540 – 00:02:33.940
We appreciate your sacrifice and thank you for loading up. Let us know if you have any issues. I’ll gladly take care of you if you come back with pancreatitis or something like that.

But very happy for you, Chris. That’s great.

WORM
00:02:34.270 – 00:02:49.150
Well, hey, first tick question. Question came in. Someone wrote. Hey, my social feeds are full of stories about a new Lyme disease vaccine. Is this for real? Didn’t we used to have one?

What happened to the old one? And is there a new one? And if not, when’s it coming out?

GERM
00:02:49.630 – 00:06:51.830
Yeah, thanks.

All the vaccine questions, it’s so interesting to me because we have so many vaccines for not enough, by the way, but so many vaccines for so many other infections. Why not Lyme disease? And the answer is, this is good news.

It looks like we are probably on the verge of FDA approval of what looks like a very safe and also quite effective vaccine to reduce the chance of catching Lyme disease. So this is a vaccine that’s made by Pfizer and another company called Valneva, and they have a vaccine.

This is a vaccine that shows an efficacy, meaning impact or success rate with 73% fewer cases of Lyme disease among those who received this vaccine in a phase 3 placebo controlled trial compared to those who received the placebo. So this is really exciting. And we are waiting with bated breath. I don’t know about your breath. Mine is highly bated.

Waiting to see if this actually gets approved. It’s possible by the time our listeners hear this story in the next week or two that it will be approved by FDA.

If FDA’s process is on track, it should be happy news to us soon. At least we really hope so. Unless there’s a tick in the ointment during that scrutiny and review at fda. But how does this vaccine work? Look, it goes.

Remember, Lyme disease is caused by bacteria called Borrelia burgdorferi.

Borrelia burgdorferi has certain proteins on its surface, these outer surface proteins, especially one called outer surface protein, a letter A because it’s the first of the Alphabet, because that’s the biggest protein that we focus on.

And in fact, the vaccine targets outer surface protein A in six different flavors, including the ones that are predominant currently here in the United States and others that are more predominant in Europe as well. It’s exciting. That is different from the previous Lyme disease vaccine the listener was asking about.

What about the old Lyme vaccine called Lymerix Lymerix was around in the 1990s, but it only went to one OSPA, not the six that we have in this current so called hexavalent vaccine. So the spectrum and the coverage was less. It was actually pretty well tolerated and safe, but it just didn’t succeed.

The efficacy that we’re getting in this particular vaccine, again, at a 73% reduction in cases of Lyme disease, that’s not perfect, but it’s really good. And we hope that it’s going to be plenty good enough to get people excited about actually getting the vaccine. So the vaccine was very well tolerated.

There were no major safety concerns or signals. So as study, this is a very inconvenient shot to get right, Chris, because the primary schedule is three doses.

You get your first shot, then one at two months later, and then one between five and nine months later. And then ideally you get a booster dose as you go into the next Lyme disease season.

So four shots is a lot, and that’s more than we would typically expect. What do we do with yellow fever? It’s one and done. For example, Japanese encephalitis.

So for many of the vaccines that we reach for, where you get permanent high level immunity after a single slug, this is different. And who knows, that might change over time.

But it really looks like, unfortunately, to mount a good immune response, Chris, you really need this series of immunizations, a series of injections. That’s going to be a barrier for some people. We don’t know the cost. The cost may also be a barrier.

My sense is that travelers may be excited about this if they’re heading to a highly endemic area, either within the contiguous US or in Europe. We’ll talk about European Lyme disease as well in a moment.

But it’s also an exciting one because it does have a role for people who just live in these endemic areas. It’s not just a travel vaccine. This is about quality of life.

And for folks playing in the backyard, going hiking on a trail in their own neighborhood and feeling, feeling more confident going out that they can partially if not fully reduce the chance of catch and Lyme disease. What’s your hot take on this one?

WORM
00:06:52.790 – 00:07:40.180
Yeah, it looks good and I’m really glad to see it come back. You know, we had this. The listener asked about previous Lyme disease vaccine. We had one that had similar efficacy, as you say, called Lime Ryx.

But there were some alleged side effects and they involved autoimmune arthritis. And word got out and there was a big hullabaloo.

It’s unfortunate that subsequent studies showed that the incidence of this side effect was identical in people who both did and didn’t receive the vaccine, which means the vaccine had no effect on it. But because of sort of the media wrap, people stopped getting it and the company stopped making money from producing it. So production was stopped.

So from 2002 to now is a long time. So I’m very glad to see the return of this vaccine. I’m looking forward to it being released.

GERM
00:07:41.280 – 00:07:48.960
Let’s hope that it passes Musterable C this is what the FDA process is supposed to be about. We’ll see if there’s going to be a tick in the ointment as they do that.

WORM
00:07:49.520 – 00:08:10.610
Well, you know, I think they’ll make more money this time because this disease is expanding. And I think. I don’t know if their biggest market is going to be travelers, but it may be people, as you mentioned, who live in endemic areas.

I mean, if I lived in Massachusetts or some other state like that where there was a lot of Lyme disease, if I had much outdoor exposure, I would get this new vaccine asap.

GERM
00:08:11.250 – 00:08:59.749
I mean, coming from me, somebody who’s had Lyme disease, what a hassle. That was my first day of medical school. I did totally fine, but man, that doxycycline made me barf because I didn’t take it with food.

Never, never do this. Yeah, it’s.

It’s a huge issue for up and down the eastern seaboard and elsewhere in the US So it’s a tough time to bring vaccines to market in this weird environment. We have weird regulators, weird cultural movements of nonsense, etc. So I’m actually a little nervous about this one. Let’s see how it plays out.

Stay tuned here to germ and worm and we’ll let you know. So, Chris, let’s talk about that. What if someone is traveling to Europe? Can they catch Lyme disease there?

And if so, is it the same as what we get here in the United States?

WORM
00:09:00.549 – 00:10:11.370
In brief, yes and no. Yes, they can certainly get it. There’s a lot of Lyme in the forested areas in Europe, and it’s a different Lyme disease.

It’s still called Lyme disease because it’s caused by a similar bacteria. The genus is Borrelia in both places, the U.S. and Europe. But there’s different species of this bacteria.

And in US you get the characteristic bullseye rash and neurologic and cardiac and arthritis symptoms. In Europe, it’s different.

You don’t get the bullseye rash, but you get an entirely different type of rash, it’s more like little nodules, like little bluish reddish nodules which can be on the earlobes or on the nipples. And also there’s this Europe specific slowly progressing skin rash. It’s like an atrophy, a thinning that affects the hands and the feet.

Also the neurologic symptoms are different.

In the US you often get what’s called a facial palsy, a Bell’s palsy, where half of your face goes slack, whereas in Europe you get more, a painful nerve inflammation. So these are related but different.

So long way of saying that the symptoms are entirely different even though the bacteria are pretty closely related, you know.

GERM
00:10:11.370 – 00:10:49.270
And we’ve seen that in our travel, post travel clinic here at uw. The acrodermatitis chronica atrophicans, that thinning of the skin, it’s a thing, it’s not mythological.

We’ve seen that it’s helped us make a diagnosis and it can gradually improve over time. It’s a risk and you need to protect yourself when you go to Europe as best you can. We talked a moment ago about a vaccine.

That vaccine, vaccine should have activity not only for the American flavor, but also the European flavors of Lyme disease. That’s exciting. You’re still going to need to do that. All those other stylish things that we can to keep them off our body.

We’ll talk about that here shortly.

WORM
00:10:55.750 – 00:11:09.250
Taking us to the next question, Paul.

Suppose you’re bitten by a tick in an area that’s endemic for Lyme disease and of course you don’t know if that tick has Lyme and is going to spread it to you or not. What should you do?

GERM
00:11:09.490 – 00:13:36.640
Well, it’s a good question because tick bites are common, right? We know that in the United States.

According to the Centers for Disease Control and Prevention, we have, you know, about 31 million people bitten by a tick every year. There’s about 310 of us, million of us who live in the U.S. about 1 in 10Americans going to report a tick bite every single year. So it’s a lot.

And so I appreciate this.

Now the, the trick is that although we’re going to talk a lot about infections and other envenomations, toxicities with tick bites, most people who are bitten by tick will not have a side effect or an infection or a problem. They’re usually benign, but once in a while they can be a problem. Take it from me, my good old Lyme disease.

So the question is, can you take a dose of antibiotic to prevent Illness. And the answer is yes, you can. The guidance from ID Society of America I think is very good.

And that says that if you are bitten with a high risk t tick bite, you can consider taking a dose of antibiotics. What’s a high risk tick bite? You should live or be bitten in an area that’s known to be high risk for Lyme.

The tick should be known to be the one that can give you Lyme disease. Right. That’s the Ixodes tick. Ixodes scapularis is the most common one out here. Out west we have Ixodes pacificus.

There’s a few Ixodes ticks that can do this. So you’re in a high risk area, you’re bit by high risk tick and that tick has been on you for at least 36 hours. Why 36 hours?

It takes that long for the tick to get its head down, up in your skin, up in your business, and then start injecting saliva and sucking the blood. If you remove these ticks, even in a high risk area, even a high risk tick, within 36 hours, they have not yet had that blood meal.

And so you don’t need any antibiotics. But if you meet those criteria, high risk area, high risk tick, it’s been on longer than 36 hours, then yes, you, number one, remove the tick.

Number two, take a single dose of doxycycline at 200 milligrams and that can dramatically reduce the chance of getting Lyme disease. So it’s exceptional. But there are occasions when we do recommend doing this.

Oh, and by the way, if you’re not paranoid enough already, check out the CDC’s website, CDC tick bite data tracker. You can see all the bites that are reported to CDC in a nice graphical form. Chris, pop quiz to you. What’s the.

What month of the year is reliably the highest risk for people presenting to care complaining of a tick bite?

WORM
00:13:37.040 – 00:13:38.720
You know, I’m going to say April.

GERM
00:13:39.040 – 00:14:08.140
Oh, you’re so good. It turns out it’s April and May, so I was going to say August because that’s when I’m outside. Totally wrong. Yeah, you’re right. It’s the spring.

So right now, as we record this in the month of May, May is actually the highest risk month. So folks, it’s. You may not be hot and sultry where you are, but you can still be bitten by the ticks.

Now, they’re coming out of their winter dormancy, they’re hungry as hell and they’re mad and they want your very living blood. So this is a High risk time if you’re hiking outside to take some precautions.

WORM
00:14:08.780 – 00:14:12.060
And we’ll talk in a minute about specifics for precautions.

GERM
00:14:19.020 – 00:14:31.300
CHRIS before we get to precautions, here’s another listener who says, what the hell is going on with tick transmitted meat allergy? Can I really die of a meat allergy if I’m bitten by a tick?

WORM
00:14:31.620 – 00:17:05.920
You know, I wish it was just an Internet myth, and it sounds like an Internet myth, but no, it’s totally legit and real and kind of crummy for those who get it.

So the deal is there’s this thing, this syndrome called Alpha Gal syndrome, and Alpha Gal is a sugar, and it’s found in all mammals, except not humans and other primates.

But it’s not present also in fish and reptiles and birds, but it’s in all the meats you carnivores like to eat, including pork, beef, rabbit, lamb, venison, and of course, products made from mammals. And that would include gelatin and cow’s milk and other milk products.

The vector of this bad thing is the Lone Star tick, and it’s common in the US it’s primarily in the southeast, but in the 12 year period 2010 to 2022, there were over 100,000 cases of this identified. And CDC says there were as many as half a million cases of this.

And what happens is you’re bitten by a tick, you’re exposed to this, and then you are allergic to meat. And interestingly, you don’t get immediate symptoms, but it tends to be delayed. So it’s not like you have a peanut allergy and you get symptoms asap.

But a few hours, hours, maybe two to six hours after exposure, people get hives and an itchy rash and nausea or vomiting and heartburn and diarrhea and cough and shortness of breath. And you can see why it took a while for this to be diagnosed, and it took many years for this to be linked to meat allergy and then to the ticks.

People were just getting random symptoms in the Southeast and they didn’t really know what was going on. The diagnosis is by a blood test, but also just by the history.

Basically, if you eat beef and two to six hours later, you get hives reliably and repeatedly. That’s probably what’s going on. There’s no specific treatment for it.

It tends to be just the usual allergy treatment of epinephrine and antihistamines. And if it’s severe, corticosteroids treatment, I’m afraid, is avoidance of meat. And if you’re like me and Paul and you enjoy a good sirloin.

This is a real drag. However, it’s. It often goes away. It often doesn’t go away.

But a lot of people, if they don’t eat meat for a year or two, this will spontaneously resolve. And a related question comes up. Can you, as you can for a bee sting, just get a bunch of desensitization shots?

There’s research on this and there’s some small trials, but there’s no standardized protocol. So the way not to get this is to not get bit by ticks, especially in the US and Southeast.

GERM
00:17:07.200 – 00:18:25.090
And it’s not all ticks that will do this. Right. It’s primarily going to be that Lone Star tick. The Amblyomma americanum is the typical one.

I think there are links to other ticks, including the black legged Ixodes tick. Apparently this can happen, but it’s mostly that Lone Star tick. And unlike the name, you don’t have to be in the Lone Star state to get it.

And we’re seeing more and more of those Amblyoma ticks moving elsewhere. There is a report in the, in the press of someone who died of what the medical examiner or coroner has determined to be ags. Alpha Gal syndrome.

By the way, I still think Alpha Gal is got to be a great name for a pop rock band or some singer or something. Just sounds so cool. The disease not cool.

And we have reports of someone who apparently did not know that they had a meat allergy and kept eating meat and ultimately apparently succumbed to, died of, of anaphylaxis due to this meat exposure. So I mean, I’m a plant based guy, but I’ll have, I do have some animal meat in my diet. I would hate this.

If you’re looking for an excuse to go vegan, here’s yet another one, I would say, but this is something that’s of concern and thanks for thinking about this. We do not have a vaccine for this. I don’t think we ever will.

This is about prevention of just common sense things, trying to stay away from those, those ticks.

WORM
00:18:25.250 – 00:18:42.690
Yeah, this wouldn’t be a thing that I would think would happen until I read about it and it was proved to be linked. So it’s really weird, but it’s a real thing. Speaking of tick weird things, here’s a question for you, Paul.

What’s up with something called tick paralysis?

GERM
00:18:43.970 – 00:21:33.000
Yeah, tick paralysis. So tick paralysis is.

It’s similar in a way to the Alpha Gal you talked about a moment ago, because it’s not an Infection, it’s something from the tick itself. So I want to emphasize that ticks, they can carry bacteria or viruses. They can spread those to us when they take a blood meal.

Lyme disease is a classic cancer example of that. Ehrlichiosis is one of those.

Example Babesia, they’re sucking your blood and they, they vomit, you know, germs into your body and they then take over in your body. Alpha Gal is different, right? That’s something in the saliva of that. We think that’s probably a saliva protein that makes that happen.

And, and same probably here in the case of tick paralysis.

Tick paralysis, you’re bitten by a tick, the tick is feasting on your blood, and during that blood meal, it’s not a bacteria, but it’s a protein that comes out through the saliva of the tick. In this case, the protein is a neurotoxin and it will lead to an ascending paralysis.

People will present with the inability to walk, an imbalanced, disordered sense of balance, and then they lose the ability to, you know, to stand up entirely. It’s what we call an ascending paralysis, usually starting at the tip of the toes and moving its way up.

This can be evocative of Guillain Barre syndrome, for example. And so it’s terrifying. Now, the cure is easy. You make the diagnosis by looking for a tic.

So if someone comes in with unexplained paralysis, we’re thinking Guillain Barre, for example, other demyelinating processes. But we always get that history. Have you been in the woods? Have you been exposed to ticks?

And even for a patient who’s fully paralyzed and not even able to speak any longer, that’s part of the protocol. We search the entire body for ticks. And these things are small, right? You have to actually part the hair. Look in the entire body.

All the body folds between the legs, under the arms. We’re looking for a tick. Because if you find that tick and remove it carefully, that cures the patient, alright?

As soon as that saliva, the neurotoxin goes away, these people wake up. And like I said, not that they’re asleep, they gave their power of motor function back and walk out of the hospital a day or two later.

So if you don’t do this and you don’t support them, then they can die of respiratory failure, right? I mean, even the muscles that help us breathe will no longer work.

So it’s serious disease, very rare, and one that all doctors are excited to look for. I have never made this diagnosis. I’m always looking and who knows, maybe someday you could save the day.

Right, Chris, if you’re thinking about this, to our listeners, if you hear about a case like this, please raise that with your physician. This is rare as hell, and so a lot of doctors may not think about this.

It is worth sharing that tick exposure history, woodland hiking history, because you might someday be able to solve the case.

WORM
00:21:33.830 – 00:22:33.610
Yeah, this is somewhat rare or very rare in the US Although it is present at a low level in the Pacific Northwest, the Rocky Mountain states and the southeastern U.S. here in Washington state, where Paul and I live, there’s only between about zero and two cases per year. However, in Australia, you may be familiar with this, it tends to be more on the coast to the east.

It’s also present at a low level in South Africa, Africa and Asia and Europe. And as Paul said, it’s the treatment couldn’t be simpler. You take the tick off and symptoms slowly go away.

If you don’t, if this is not diagnosed, people have actually died from this because their breathing muscles stop working. So it’s rare, but it’s very bad.

And like you said, Paul, it’s like the tick paralysis in that it’s not or, excuse me, it’s like the alpha gal allergy in that it’s not an infectious thing, it’s the injection of a neurotoxin. So I’m glad this is rare, but this is yet another reason to try not to get bitten by a tick in the first place.

GERM
00:22:40.730 – 00:22:56.460
All right, Chris, with all of these rotten things that can happen with ticks, how do we advise our listeners? What can, what can people do to not get bitten by tick, aside from not going outside?

I mean, I think if you stay inside, you’re probably not going to get bitten by a tick. But if people want to be outdoors, what should they do?

WORM
00:22:56.860 – 00:24:28.570
Well, you know, I wouldn’t recommend to stay indoors, and I don’t think you would either. There’s so much mental health benefits and physical benefits with going outside. So a few measures.

We talked about this in TikTok 1 a year ago, so I won’t go into great detail. One is bug repellent. Usual stuff, same stuff as you would do for mosquitoes.

So that is the D to picaridin to exposed skin and putting permethrin on your clothes.

But I will say that while those measures work very well for mosquitoes, they don’t have zero efficacy for ticks, but they have reduced efficacy for ticks. So you can get tremendous, like reduction in risk of dengue fever from those measures. You’ll get a modest benefit in tick bite reduction.

Other things you can do, wear long pants, wear socks, tuck your trousers into your socks, and that will reduce the risk as you tend to brush against things and then the tick will leap from the leaf or the branch onto your clothing and then find its way to your skin fairly quickly. They tend to like crevices like your groin or your ear.

And so after you’ve been out for a day hiking, even if you’ve done all of these tick avoidant measures, strip into your birthday suit and either with a mirror or a close friend, go over every square inch of your body and look for little dots. And these things can be tiny, they can be as small as a sesame seed.

But with a lot of the illnesses they spread, if you can pull the tick off within a few hours, you won’t get whichever illness. So again, a tick check after a day in the woods is a really good idea.

GERM
00:24:28.890 – 00:25:51.820
Yeah, totally agree. And by the way, that move of tuck in your, your trousers into your socks, that’s a high fashion statement.

I walk around like that in the city all the time. No, just kidding. But it’s, who cares what look like? What you don’t want to do is catch one of these infections. So I think that’s, that’s very wise.

But you’re right, there’s no substitute for actually just getting out of those clothes when you’re done and looking.

You know, I’ve seen on the socials, people taking a lint roller, one of those masking tape rollers, and coming out of the woods and then rolling up and down their trousers, their shirt, and you can see all these little ticks stuck to the tape. I don’t know if those are real or not. It might actually work. Work to pull the ticks off your clothing.

I don’t care if there’s ticks on my clothing, I don’t want them on my skin. So you cannot, unfortunately, that is not good enough unless you’re going to do that on your very living skin and flesh, which I do not recommend.

Even if you’ve seen people take one of these lint rollers to their clothing. I mean, you can do that if you want to. That you still need to get naked. Not naked, but naked. Right. You have to get naked.

If you come out of the woods, it’s not nakedness, it’s naked. And really look carefully for those ticks because if you find one, it may not even yet have started to sink its jaws into your flesh. You can just.

Well, then I would do something to get it off my skin. You may also find one that’s started its feast. And that’s a different story, isn’t it?

WORM
00:25:57.740 – 00:26:07.220
Now suppose one of our listeners gets naked after a day in the woods and finds a ticket on their person. Paul, what’s the best way to remove the tick?

GERM
00:26:07.380 – 00:30:16.320
Yeah, there’s so many myths out there. Take a match to it, put some kerosene on it, smear it with Vaseline. Don’t do anything.

I’m surprised we haven’t been asked about tasing or should I tase my tick? Don’t do any of this stuff, for the love of God. You just want to get it off your body. And so, no, there’s no substitute.

You just need to remove the tick mechanically with a pair of tweezers. There’s tweezers and there’s tweezers. This is one.

I mean, anybody who lives on the east coast needs at least one high quality pair of fine tipped tweezers that is reserved for this purpose. Because if the tweezers don’t have a fine point, it’s going to be really hard.

These, these little animals are small and what you do not want to do is break it during the removal process. So it’s simple, but it does require focus. And that is high quality pair of tweezers in a brightly lit area.

And if you need to like me, if you need to wear your reading glasses or something to get good magnification and good view, do that. And then you want to get those tweezers right up as close to the head as you can.

Remember the body of the tick that’s, you know, that’s expanding and that’s there because it’s full of your own blood. You don’t want to squeeze on that because that’s going to just regurgitate blood and saliva, which may or may not be infected, back into the body.

So you want to go to the head, get right up onto that head, grasp it and then firmly, but not too firmly, because if you squeeze it too hard, you’re just going to kill it on the spot, break it apart and then you’ll never get the little mouth parts out. But if you grasp the head and then pull straight out slowly, you’ll have success. The mouth parts go in and then they lock.

They have a little bit of a hinge, if you will.

So if you just yank the thing out, which you might be tempted to do, because these are nasty and gross, you might, might want to just get it off me, get it off me. No, you got to be diligent. You got to be slow and methodical about it.

Grasp it with a fine pair of tweezers at the head and pull directly in line with the way the tick head has gone in in the first place. No twisting, no yanking, no jerking, just gentle removal. The process should take less than a minute, but it shouldn’t take two seconds.

You need to be a little bit patient and then inspect it, both the hole that it left behind and the tick itself. You’re looking for any broken mouth parts or things that are left behind. I cannot advise people to go digging in their own skin.

So if the thing does break, the head is left behind. Please don’t go digging after it. I know you’re going to do this anyway, but don’t do that because we shouldn’t do self surgery at home.

Do as I say, not as I do. But you shouldn’t do self surgery at home. If you do leave a head behind, honestly, it will usually be ejected by the. By the body anyway.

That might be one of those cases where you’d want to get in with a physician or healthcare provider to try to get the whatever’s left behind removed. That should be unnecessary if you’re really careful about this.

And then again, if it’s been less than 36 hours like we talked about at the top of this episode, you don’t need to save it, bring it into an emergency department or something. If you’ve removed it, then you’re done, you can just chuck it and be through.

If it’s very much engorged and you think it may have been longer than two or three days that it’s been there, you know, when you went hiking, you had that exposure, you know, you walk away and then three days later you finally find the damn thing, then that’s different. It might indeed be helpful to be able to identify it and figure out if it’s one of our higher risk ticks as well.

So that would be one exception to that rule. I’ve done that myself when I went hiking in my backyard, Westchester county, my folks place.

Came back to Seattle four days later, finally saw the damn thing. It was big enough, plump enough, I was able to remove it, took it right to the lab. I can do that because I’m an ID doctor. They said, yep, it’s an.

I had my dose of doxycycline. That was a controversial one because I was just on the cusp of. You really want to take your doxy within 72 hours.

I think I was right on on the edge of that, come to think of it, I may have even been longer than 72 hours. But sometimes you do need to identify these to know what else to do about them.

Chris, do you have any tips for what to do or what not to do when removing a tick from the body?

WORM
00:30:17.120 – 00:31:05.430
Some people seem to enjoy torturing the tick by jamming a lit match into it or dumping kerosene on it. I would pass on that. As you say, your tool is tweezers.

And this is why in my little travel kit, which I have with me now, I have a pair of fine tipped tweezers which docs call forceps. And admittedly, I’ve used this more often to pull a splinter out their main reason I carry than to pull ticks out. But that’s really it.

You grab it, you pull straight out. No noxious chemicals. Don’t torture the thing. Once you pull it out, you can squish it or do whatever you want with it, but it’s a pretty simple thing.

And as you say, if you leave a little bit of it in the skin, if you go digging, you could cause a skin infection. And the skin is very good at spitting out little foreign bodies. So I would just tend to leave it alone.

GERM
00:31:05.750 – 00:31:33.440
Yeah, yeah. A little bit of cleaning of the wound is fine. Alcohol or water with soap and something that’s that you shouldn’t have to do more than that.

I think that’s exactly right. Chris, what’s up with tularemia? There’s so many infections we’ve talked about that can be spread by ticks. We didn’t cover 1/10 of them today.

One infection of interest right now. Tularemia, what is that?

WORM
00:31:33.600 – 00:33:34.880
Yeah, people may have heard the phrase rabbit fever, and that’s tularemia. It’s not that rare in the US It’s a bacterial illness and it can be spread several different ways. But one is ticks.

The dog tick, the wood tick, the Lone star tick, all can spread to, but it can be spread by the deer fly. It’s often spread by skin contact with infected animals. So for example, a taxidermist would be at risk. Or somebody who’s skinning and eating rabbits.

It’s associated with rabbits and muskrats and prairie dogs and other rodents. You can also get it by drinking contaminated water. And it’s all over the US it’s in all states except Hawaii. Case count is coming down a little bit.

There’s still a few hundred cases per year. Symptoms depend on how you contract it. So, for example, if you get a Bite from a tick or a deer fly, you get this type called glandular.

You get big lymph nodes. You get an ulcer at the bite site. If you get it in through your eye, you get symptoms such as the light sensitivity and a lot of tearing.

If you eat it, you get throat pain and a really bad sore throat. Maybe tonsillitis if you breathe it in. This is really bad. And this can happen.

Suppose you’re on a tractor and you essentially aerosolize a rabbit, which of course you could do on a, on a big tractor. And then you breathe in this bacteria. You get a cough and tightness. But this can be fatal very quickly unless you get antibiotics.

Quick fatalities 30 to 60%. So again, symptoms depend on the route of spread. Once it’s diagnosed, it’s treatable with antibiotics.

And in terms of bringing risk down, use insect repellent so you don’t get the tick bite or other bites. Be careful when you’re handling dead animals. A don’t or wear gloves.

And also, to the extent that, you know there’s dead animals, don’t mow them, because if you spread them into the air and aerosolize them, it’s a bad thing. You can breathe it in. And like I said, that’s fairly horrible.

GERM
00:33:35.200 – 00:34:33.430
This is one of those that is. It’s a tough to treat infection. Some of these, you know, just give doxycycline, just doxy for Lyme disease, doxydoxydoxy, and you’re good and done.

Tularemia is different. It really does require these. Well, doxy is part of it, but we also give other antibiotics to try to keep people alive.

If it happens to be the mnemonic form, it can be very dangerous. Dangerous, tough to treat. So I’m not making you paranoid about going outside. You said it right. You got to get out. You got to be in the woods.

It’s therapeutic. It’s great. Just tuck in your damn socks and into the, into the trousers, into the socks and do what you can.

And if you end up with an area on your body that looks like a sore, like you said, that ulcero glandular form. Do not sit on that. Get in with the doctor, tell them what you’ve done.

The testing is actually challenging, but you need to raise that possibility so your physician has a chance to get you with an infectious disease. Doctor will make the diagnosis quickly and get you on the right treatment.

WORM
00:34:33.990 – 00:36:33.130
Right. And actually, because the mnemonic form particularly is so fatal, this is considered a potential biowarfare weapon.

And there was a case a couple decades ago where there was suspicion this had been used in a war.

So Kosovo, part of the former Yugoslavia, they were in the early post post war period, 1999 to 2000, and all of a sudden in a rural area, there were over 900 cases of suspected tularemia. Over 300 confirmed positive, which was way higher than baseline. And so all these national alarms went off. Was this bioterrorism?

A group went in and investigated and no it wasn’t. But here’s how it happened. Because of the war, the grain in the fields was not harvested. So there was were more mice because there were more mice.

There were more ticks on the mice because there were more ticks, there were more ticks biting people. So a lot more people got tularemia, especially given that people were living in substandard housing given the war.

So again, this thing is a potential biowarfare agent, but to my knowledge it has been not been used in that way.

And let’s certainly hope and trust that that continues to be the case. It would be such a nasty one to use like that.

Everyone, thanks so much for joining us on episode 102 of Germ and Worm.

As always, we do welcome your questions on travel health. Just send them along or tips for success.

If you just want to let us know what’s on your mind, send us an email germandwormmail.com or visit our website germandworm.com and we hope you’ll join us next week for episode 103, Tales from Dr. Pottinger’s Post Travel Infectious Disease Clinic. If you’ve enjoyed this episode, please subscribe. Rate us favorably on your device and spread the word with friends, family and on the socials.

Those are free ways to support this podcast. I’m Germ. I’m Worm. It’s a big planet. See it in good health.

GERM
00:36:34.090 – 00:36:39.540
We look forward to seeing you next time. This podcast is designed to inform, inspire and entertain. However, it does not establish 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.

WORM
00:36:39.780 – 00:36:56.500