GERM
00:00:09.360 – 00:00:11.120
Lolma! My name is Germ.

WORM
00:00:11.200 – 00:00:12.080
I’m Worm.

GERM
00:00:12.320 – 00:00:25.840
Welcome to episode 112 of the Germ and Worm Travel Health podcast, Breathing Easy in Wildfire Season. It’s a big planet. See it in Good Health. I’m Dr. Paul Pottinger, also called Germ. I’m an infectious diseases specialist at the University of Washington.

WORM
00:00:26.190 – 00:00:31.630
I’m Dr. Chris Sanford, also known as Worm, family medicine doctor, also at the University of Washington.

GERM
00:00:32.030 – 00:01:34.790
This is a podcast where we answer great questions from people across the country and around the world about travel health. Here are a few that we will consider today.

Earplug Recommendations for Noisy Sporting Events When I travel, how can I deal with wildfire smoke in the American West? Flying when I’m pregnant? What are the rules? And will I catch brucellosis from bison at Yellowstone?

These questions and others a reminder to our listeners. Please contact us with your travel health questions. We would love to hear from you.

Germandworm.com or drop us an email germandworm@gmail.com

As always, our medical Disclaimer this podcast is designed to inform, inspire and entertain, but before you travel, please see a qualified healthcare professional for recommendations specific to you and to your itinerary.

So Chris, let’s talk about earplugs.

We want people to listen to us, but we don’t want them to get overwhelmed by the sounds of our voice or sounds at sporting events. And we do have a question from someone who says I’m planning to travel to Europe, can plan to attend some sporting events. What are the best earplugs I can use to protect my hearing?

WORM
00:01:34.950 – 00:03:51.530
Oh, that’s a great question. And it has a rather complex answer which I’ll get into a little bit.

So there’s more than one reason to take some sort of noise canceling earplugs or other type of earplugs abroad when you travel.

One, of course is if you go to a noisy place because if you go to too many loud concerts it can affect your hearing permanently and once your hearing is gone, there’s not a medical way of bringing it back other than wearing a hearing aid. However, what I use them for, I don’t go to that many concerts when I travel, but just noise and sleep.

I’m a light sleeper and so I always travel with some sort of earplug just so I don’t hear cars or other things. My neighbors in the next house over having their house party so I can sleep.

You’ve got several options and basically four categories are foam, wax, noise canceling and specially fitted tailor made for you by an audiologist between foam and wax, I prefer wax, but when I research them, I see that they’re pretty similar. And a lot of people even say that foam are better in terms of absolute noise reduction, but they’re better at different things.

The foam ones are better at low frequencies, so like the low rumble of a jet, the wax ones are good for light traffic and snoring, more intermittent sounds, but they’re not so good for the low frequency sounds. Noise canceling, like foam are better for low frequency.

And in fact, I saw a display once for noise canceling headphones and they had a thing where you can turn on a jet sound and then do that, listen to it with and without the headphones. And the reason they chose that is that’s what it’s particularly good for.

And the last category is where you see an audiologist and you get custom fit ones. The custom fit are probably the best. You have to see the audiologist, but in terms of absolute noise reduction, that’s going to be your best bet.

So if you’re a musician or a person who goes to a lot of concerts, the custom fit are the best. They all have pros and cons and frankly experiment, like between foam and wax. I know people who love the foam and hate the wax and vice versa.

But I’ll tell you, when I travel abroad, if I only take a small number of things, my wax earplugs are always very high on my list. Paul, what’s your take? What’s your preference?

GERM
00:03:52.410 – 00:05:27.620
You know, when I travel, it’s foam earplugs. I just find them to be more comfortable. But you’ve mentioned the wax before. I need to get back into that.

I feel like the foam may, may breathe a little bit better, but I’ve got an open mind to this idea of the wax. My usual daily routine, yeah, it’s the Apple AirPods. So that noise canceling earbud, that’s my typical thing.

And I got to tell you, I had a good experience with them here in Seattle for World cup when the United States played Belgium, I shouldn’t say played, when they were destroyed and dismembered by, by Belgium. Mad respect to our American soccer team. They were great, but it was, it was not even close, I have to say.

But what a great experience to be there for so many reasons. One of the things about it that struck me was the noise.

Now, for those who don’t understand this or know already, the Seattle Stadium, which is usually called Lumen Stadium, that’s where typically our American football Team, the Seattle Seahawks play. This was renamed as Seattle Stadium, but it’s notorious.

And they’re very proud of the fact that it’s the loudest public space in America, if not the world. And they have a decibel meter that’s there when they get you psyched up at the beginning of the game.

You know, my apple watch that I wear will give an alarm when we hit 90 decibels. You know, flee. You’re going to damage your hearing within 20 minutes. 90 Decibels is the alarm in Seattle Stadium that day. It was 140. 140 Decibels.

And I just thought, this is insane. It was so flipping loud. That’s the beginning of the game.

Towards the end of the match, when we were being completely dismembered by Belgium, it was much quieter and better for the ears in Seattle Stadium. So I do like that idea. I did ask some of the other people there in the stadium what they were using. This is just anecdotal and I’m not sponsored by this company, but a lot of them said they favor a company called Loop L O O P. Loop Earplugs is something that is designed for concerts where you can still hear things. It’s just quieter. They try to get away from this idea that you were talking about, Chris, of cutting out low versus high frequencies.

It’s supposed to cut out both. I haven’t used them personally, but that’s something that people have found to be as a passive form of hearing protection. Rather popular.

WORM
00:05:55.700 – 00:06:14.180
140 Decibels is incredible. A jackhammer which hurts my ears is 130 decibels. And a jet taking off is between 120 and 150 decibels.

So 140 would at a minimum, leave your ears ringing for days, if not potentially cause permanent damage.

GERM
00:06:14.340 – 00:06:16.020
Yeah, I do not recommend.

WORM
00:06:19.300 – 00:06:38.110
All right, Paul, this next question is for you. And this comes from Chad, a person, not the country. I’m scheduled to visit Nairobi next month.

Mostly work, but also I’m going on safari for about three nights and I worry about cholera. I read that there’s an outbreak in Sudan. Is this close enough to kim you to be a threat? What do you recommend? Thanks much.

GERM
00:06:38.190 – 00:09:41.100
Yeah, thanks. So Chad, you’re. You’re correct. There is outbreak in Sudan which is recently announced by the World Health Organization. An outbreak of cholera.

Quick answer is no. I think you should go ahead with your trip to Kenya. The chance of this coming to you in Kenya through Sudan is essentially zero.

But let’s talk about that. Cholera is a very serious condition.

It’s a bacterial infection which we get when we drink the water that is infected with a bacteria called vibrio cholerae. And vibrio cholerae comes to us when the water is befouled by people who have this infection in their own diarrhea.

It’s a disaster because yes, it causes diarrhea. Let’s face it, there are other bacteria that do this.

But in the case of cholera, it’s much, much worse because it really perverts and hijacks the way that the body transports salt and water across the bowel so that instead of resorbing water from our diet and what we eat and drink, the reverse happens. We end up losing a ton of water this way, at least temporarily, While that toxin that’s made by the bacteria works through.

Our people can die within a day of this condition. It’s not septic shock. They are just literally dehydrated. It’s like wringing someone out, like they’re wringing out a sponge.

And if we keep up with the water and the salt requirements that go with that, these patients can survive with that simple supportive care. Antibiotics are not the mainstay of treatment. Rather it is hydration. This can be done with oral rehydration.

That’s something that is well established scientifically, but it takes a lot of care and attention these patients cannot take care of.

And so it’s a classic issue that comes up in complex humanitarian emergencies when ordinary people are basically neglected and abused by their own governments. War, famine, political corruption and ineptitude.

It’s always the common people who end up with these issues because they just don’t have clean water to drink because they don’t have a place to deposit their waste.

And one person who’s even carrying a low amount of this in their diarrhea can end up, if they crap upstream in the river, can end up putting a whole population at risk. That is happening currently in Sudan. We have 114 people who recently documented as infected and potentially more than a thousand others.

As usual, the numbers that we get look like they are under counting. There is an approach to this. World Health Organization is doing what they can. But you should not worry about this Chad.

If you’re going to Kenya, that’s a different country.

And this really is at risk for people who are living in complex humanitarian emergency situations, either as refugees, asylees, or as the people who are trying to take care of them. You sound like you’re going on a business trip with some vacation I have. If you have great experience.

I would not consider you to be at high risk of cholera. But Chris, what if I’m wrong? What if Chad is someone who’s going to volunteer to try to help out?

Is there anything that they can do to provide a countermeasure and reduce their risk of catching cholera?

WORM
00:09:41.660 – 00:10:34.639
You bet. There is a vaccine, but actually we don’t recommend it for that many people.

If you’re just a routine tourist going on safari, or a business traveler, or a researcher or a student, your risk is very low.

But suppose you’re a medical worker and you’re going to a refugee camp where there’s cholera, or you’re going to another known outbreak of cholera, or you are working with water, you’re a sewage worker in an area where there’s cholera, then indeed you’re at risk. And I would consider the vaccine. It’s available in the U.S. it’s called Vax Cora. It’s one dose, it’s oral.

You taking it must be observed by a medical person, such as the pharmacist who gives it to you. The protection is not super high. It’s nowhere near 100%. And also it’s only lasting for a few months. So again, we don’t give it to many people.

But, yeah, if you’re at risk, especially a healthcare worker, then I would get this vaccine before you go to a place where there’s an ongoing outbreak.

GERM
00:10:34.960 – 00:10:51.660
Amen.

Chris, here’s a question from an anonymous listener. When is it safe to fly during pregnancy? And when will the airlines permit me to fl as my due date approaches?

WORM
00:10:52.300 – 00:12:39.310
Yeah, great question. This comes up. And first let me just say that I’ve never delivered a baby on a jet and I really never want to.

I’ve been called a number of times, as I. Sure, I’m sure you have been. Also, Paul, you know, is there a doctor on board? And a few months ago I helped a woman stop a nosebleed.

And I’ve done some things for chest pain or passing out while I’ve been on jets over the years, have never delivered a baby. It would be really difficult. I mean, it’s done. I’ve read reports about it.

And usually baby and mom and the helping person all do well, but delivering is. You need a lot of space. And it’s a very wet procedure with amniotic fluid and sometimes blood.

And so the idea of doing that in that little narrow space between the bathrooms or elsewhere just kind of fills me with dread. So, anyway, I don’t want to deliver a baby and probably the Woman doesn’t want to deliver on a jet either.

She’d rather deliver in a hospital or, or elsewhere. So in terms of rules, you gotta call the airlines. They’re all different. As a general rule, most airlines are okay until the 36th week of pregnancy.

Normal pregnancy last 40 weeks. So months zero through eight, usually you can fly starting the 36th week. A lot of airlines flatly say that you can’t fly at all.

But look up the airlines, just for example, United Airlines wants a doctor’s note within 72 hours of departure if you are in your ninth month of pregnancy. So after 36 months. But Delta, Southwest, they all have different rules online, so look it up before you go.

But also I’ll note that you’re at the discretion of the gate agent. So basically, if that tummy is protruding such that the person at the gate doesn’t want you to get on the jet, they’re the final decider.

And this actually ties into an interesting anecdote and into the World cup, which Paul will address.

GERM
00:12:39.710 – 00:14:06.500
It’s so funny. I mean, one of the amazing world class athletes I saw play here in Seattle, of course, is Balogan.

Balogan is somebody who’s a wonderful soccer, AKA football player playing for the United States. Why? Because he was born in the United States. Why?

Because his parents, who were Nigerian, were denied boarding to return home to Nigeria to deliver him.

Mom describes being about seven months pregnant, if I’m not mistaken, and was denied boarding and so had to stay in the United States and deliver her baby in Brooklyn. That was not her intention. In fact, she wasn’t even permitted, I think, to stay at that time.

But what a wonderful thing, because out of that we have a US citizen who is one of the world’s greatest soccer players. And that wouldn’t have happened, no doubt. He would have played for Nigeria, Right, if they’d actually been able to get back on that plane.

So sometimes these, these rules work out. Well, the arc of justice bends slowly towards wonderful soccer players. I guess it’s possible, but there are examples where this happens.

Look, every time I get that call, I hear that overhead. I’m just praying that it’s a heart attack or a stroke or a seizure. Something I can handle a little bit. For God’s sakes, make it not be a baby.

I mean, unlike you, Chris, I’m not really fully trained to do this. I’ve caught maybe a dozen kids in my life. You’re a family medicine doctor. You know how to actually deliver these kids much better than I do.

So the fact that you don’t want to deliver one on the plane. That makes me feel even better about my own fear of having to do that.

WORM
00:14:13.050 – 00:14:23.770
Paul, this question is to you. Last year you mentioned that an outbreak of Legionella in New York City seemed pretty small. Now I’m reading that it’s back or it never went away.

What gives?

GERM
00:14:24.250 – 00:18:57.500
Yeah. So Legionnaires disease is a bacterial infection.

It’s caused by a germ called Legionella pneumophila was originally described, you know, in Philadelphia, where a bunch of foreign legionnaires were coming together for a convention at a hotel. That hotel ended up making those people sick. Some of them died. It was the first time that that infection had been described.

It was discovered in that context. So to honor the memory of the people who did the work and also those, of course, who did not survive, we now call it Legionnaires disease.

In the world, what’s happening is that there is pond scum and waterborne amoeba. We talked about this actually on a very recent episode here of germ and worm. Sometimes these amoeba in the water can cause brain infections.

But what they normally do is they’re just eating bacteria to try to survive in fresh water. Legionnaires, the Legionella bacteria has evolved a defense around being consumed by those amoeba. They can survive inside amoeba.

And so they have a certain toughness that allows them to do this.

Well, that’s fine in nature, but if those Legionnaires bacteria get inside you, they don’t realize where they are and they try to survive inside your very macrophage cells, the warrior cells that help to consume bacteria that we breathe in or that we consume. And so that’s a problem because these intracellular bacteria, they can be very tough, tough for our immune system to clear away.

And especially for people with an underlying reduced immune system due to age or immune suppression, this can cause a very severe case of pneumonia. It’s actually a body wide illness where the liver is involved, the lungs are involved.

They can be in the bloodstream, of course, and these patients can become very, very sick. Not every case of Legionnaires disease is fatal by any means.

It is treatable with antibiotics and some people will get better on their own, but it’s a big deal because, number one, it’s tough to diagnose, number two, tough to treat. Number three. Yeah, you can catch it just breathing the air.

Especially cooling towers, large buildings like hotels, apartment buildings, how do they, you know, cool there, the air inside the building? They use the natural cooling ability of water to Create cooling towers, cooling the air by dripping water through it, basically.

And those turn out to be, unfortunately, great breeding grounds for Legionella pneumophila, the bacteria that causes this.

So if you’re even walking near one of these buildings, even on the sidewalk, and some of those microscopically small water droplets are drifting through the air, you can breathe them in and catch a case of Legionnaires disease, which can be very serious indeed. That was part of what happened in the original case series. It’s true today as well.

We did learn recently about New York City having an outbreak of this more than they are accustomed to seeing. That does seem to be happening again this season. We’re recording this conversation mid July 2026.

And so as the temperatures get warmer, the need to cool those buildings goes up. People are outside more as well. It does seem to be a problem. So what do we have?

36 Cases in New York City that are confirmed to be Legionnaires disease. And those confirmations, you know, this may actually be only the tip of the iceberg or a part of what is actually happening out there.

This is a real issue. And it turns out that we try to find out where it’s coming from.

So public health workers, epidemiologists, investigators have gone around New York City to try to find out where it’s coming from. And they have found it everywhere, or so it seems.

Dozens upon dozens of buildings in New York City that have cooling towers that are contaminated with this particular bacteria. There’s a lot of it out there.

That does not mean that they have found this single point source for these 36 infections, but rather, it’s a reminder to us that as we build the environment to try to make it comfortable for ourselves and livable and habitable, we’re not the only people, we’re not the only creatures that find these buildings to be habitable. The bacteria do too. So it’s an ongoing threat. It’s a risk. Look, what do you do about this?

You clean out those tanks, you chlorinate the water, you scrub the hell out of them, you deal with it, and you do the routine maintenance that we should always do in the built environment. That’s the wake up call in New York City. I would still be happy to visit New York if I get the opportunity. I’ll. I’ll do that.

I don’t have it on my dance card now, but I’d be happy to go. I wouldn’t recommend against going, but I would say it’s a chance for us.

I hope Leadership in New York City will pay attention and really do routine maintenance and insist that building managers and property managers do what they’re supposed to do to keep their residents safe.

WORM
00:18:58.780 – 00:19:41.770
Yeah, I’m glad they’re doing the surveillance. That’s the first step in this.

The New York City Department of Health and Mental Hygiene released a statement earlier this week and they said that on the Upper east side they actually found 76 buildings where the water tower is tested positive for bacteria. And that can be controlled in part by, as Paul said, chlorination and cleaning.

Ideally you tear these things down if it was economically feasible, which it isn’t, and you put up new sterile ones and chlorinate that. Bottom line is you can reduce the risk, but we can’t bring it down to zero. I don’t think the risk is huge for the average person in good health.

And as Paul said, this is not a reason not to go to New York is just something to continue the surveillance on.

GERM
00:19:51.530 – 00:20:04.890
Well Chris, you know, here we are in wildfire season. Are there any suggestions that you would have for someone with asthma who may not be able to avoid visiting their relatives in Colorado?

This comes to us from someone who self identifies as “Smokey” and is asking for a friend.

WORM
00:20:07.070 – 00:21:48.770
Hey Smokey, thanks for the question.

Fortunately for you, the big current ongoing horrendous smoke in the us most of it coming down from Canada, the focus is really the Great Lakes region, you know, Chicago and the surrounding area and this stretches to the northeast of the U.S. and New York City suffering as well. And there it’s really bad.

I just read a day or two ago in Chicago it was one of the worst if not the worst city air pollution wise in in the world with an AQI of over 650 which is just horrendous. I just checked a map and at least as I speak today, mid July, no, Colorado is not seeing a lot of wildfires, not a lot of smoke.

But this changes week to week. Certainly Colorado has been hit in the past, as has our town Seattle.

So I would just look up AQI air quality and where you’re going to in Colorado on a regular basis. Indeed, the folks who do worse with air pollution are those with pre existing respiratory conditions.

And this would be copd, Chronic Obstructive Pulmonary Disease and your thing, asthma. Some things to do. Suppose it changes. Suppose you’re in Colorado, you go there and then there’s a fire nearby and the smoke gets bad.

What should you do?

A few things I would even before you go, take a N95 respirator, a properly fitted N95 respirator will block up to 95% of the particulates, which is most of the problem from a forest fire. Also, the worst thing to do would be to exercise outdoors in the heat of the day.

So to the extent you can do the opposite of that, stay indoors, use an air purifier if you have access to one. Consider wearing a mask and maybe leave town. Again. Go online, check maps and if you have the capability, go to a place with better air.

GERM
00:21:50.130 – 00:22:38.310
You know, my son happens to be a wildland firefighter, so I’m thinking a lot about this. Colorado has been very bad this season. We had three wildland firefighters die fighting fires on the Colorado Utah border just a couple weeks ago.

If you want to understand what’s happening with those fire patterns, looking at the air quality is one way. The other is the same app that I use looking after my own family. It’s called Watch Duty. There may be others out there, but watch duty is free.

There are paid add ons you can get, but I do recommend watch duty. Just type in the county that you’re thinking of visiting and you’ll get all the updates you could want.

Having your own home in there is also good because that way you can get alerts if there are rising unexpected threats for wildfires in your own neighborhood, when is it time to evacuate, etc. That’s a good way to stay on top of things at Watch Duty.

WORM
00:22:39.350 – 00:23:17.010
One factor that may be contributing is the extreme heat. There’s also some extreme heat going on in the US and Canada. Now it’s a good thing that global warming is a myth.

But you might have trouble convincing the people of Salt Lake City of that. A few days ago they saw their all time ever over 100 years record. It hit 109 degrees Fahrenheit, which is 42.8 centigrade.

Despite their being at altitude, they’re not at sea level. They’re at about 4300ft which is a little over 1300 meters. Nonetheless, they hit 109 degrees Fahrenheit.

So this extreme heat can predispose to a bad fire season.

GERM
00:23:17.490 – 00:23:18.610
No kidding.

WORM
00:23:23.410 – 00:23:42.100
Paul, question for you. So I see that a person was gored and thrown into the air by a bison in Yellowstone recently.

Now aside from trauma, bison, which is the same as a buffalo, they have brucellosis. When will people learn not to bother these animals?

GERM
00:23:42.820 – 00:27:02.810
Yeah, so there’s a number of reasons not to mess with bison. Actually brucellosis is only one of those. The main is just not to get Gored and tossed in the air.

So this has been a social media sensation that came across my feeds as well.

Some innocent bystander, a nice person enjoying their time at Yellowstone and attacked by a bison and pitched like a rag doll 20 plus feet into the air.

That person, I think, has suffered very serious fractures of their leg, but is expected to survive at least as the time we’re recording this mid July 2026. So this is an issue, you know, in this particular case, I do not understand what happened with that male bison, why it got so upset.

It’s an unusual one in that it was not right on the roadside. It was not something someone just taking a selfie next to them. We see this every single season, right?

And the poor park rangers at Yellowstone are constantly having to deal with the aftermath of people behaving foolishly, driving through the park, getting out of their car and trying to ride or touch or play with a bison. These are wild animals. They look fluffy and adorable, but they will kill you if you mess up.

And so please, for God’s sakes, don’t do this because they can trample you to death, gore you to death. Again, in this particular case, it’s a little bit different. This bison went into a picnic area.

The person who was tossed in the air was not even involved. They were an innocent bystander. So that part is a little bit concerning as well. This questioner asked about brucellosis. What is that?

So Brucella abortis is a bacteria that is pretty common in bison. A substantial fraction of the Yellowstone bison actually have this bacteria in them.

It’s a big deal because it can cause pregnancy loss, it can impact the population of the bison herds, and we do not have a very effective countermeasure. There are vaccines. They’re not good enough to deploy broadly, unfortunately, no.

Once this particular bacteria gets into, for example, domestic cattle herds, that entire herd has to be destroyed because it’s considered to be something that can threaten the entire health of the herd. So Yellowstone knows very well about this. There is a plan to try to gradually get rid of it from the population.

But the bottom line is that can it be spread to human beings? It’s very uncommon. There’s a related bacteria called Brucella melitensis, originally described in Malta.

That’s why they call it Melitensis and that we usually get from unpasteurized goat products that does come to human beings. It can go to your spine. It can cause chronic smoldering infections. The American experience with Brucella abortis is different.

It can cause an undulant fever, but that’s uncommonly spread from bison to person. Look, you wouldn’t get it by getting gored by a bison. Not. Not really. The bigger concern is that you got gored by a bison.

Could you actually catch this from an unpasteurized bison jerky or bison cheese? I mean. Yeah, but how did you milk that bison cow in the first place? It just. The whole thing does make a lick of sense. I’m not too worried.

In spite of your good question about brucellosis in the American B. From a human illness perspective, that really is more of an animal concern. And it’s a very real one too, folks.

If you have not yet been to Yellowstone, you must go. It is undescribably beautiful. It is amazing. It’s also crowded with people.

And some of those people are idiots. So please take good care of yourself and your family. And if you see the bison, snap a picture from behind the glass of the inside of your car.

Do not get out and mess with the bison. Yeah.

WORM
00:27:15.570 – 00:27:35.650
If, as Paul said, if a bison grounds you into paste, your issue is not brucellosis. Sort of like if a lion eats you, your issue is not rabies. So the first issue that comes up is really is not an infectious one in general. Yeah, take.

Stay in the vehicle. Have you seen, Paul, that movie Grizzly Man?

GERM
00:27:36.210 – 00:27:42.550
It says this is a Werner Herzog movie. I do recommend Grizzly man. And there are some. Some. Some similarities, I suppose.

WORM
00:27:42.950 – 00:27:59.270
Yeah. Unless your goal in life is to be written about in that book that talks about the Darwin Awards, where people died in particularly unwise ways.

The big animals have their space. We have our space. Let’s just leave them be and take photos from afar.

GERM
00:27:59.350 – 00:28:02.390
From your lips to the tourist’s ears.

WORM
00:28:04.150 – 00:28:17.020
Paul, we talked just recently about Ebola in East Africa. Now I read there’s been a case of Marburg virus, the first since 2017. Can you tell us a little bit about that?

GERM
00:28:17.260 – 00:30:40.790
Marburg virus detected in Uganda for the first time in a long time? That’s correct. We’ve talked about Marburg before. This is another filovirus, or thread virus. So it is related, for example, to Ebola Bundabugio.

It can cause a very serious and potentially fatal hemorrhagic illness. The name doesn’t sound right, does it? Marburg.

Well, there was a missionary who was working in Africa who returned home to Germany and was being cared for in Marburg, Germany. That’s where the discovery of the virus was made. That’s where the name comes from. What we think is that in life it is probably carried by bats.

As is true with a number of viral infections. The theory is that bats, especially bats living in caves for shelter, may be the natural reservoir of this infection.

Exactly how it gets from bats to people is not always clear. And there may be other animal reservoirs too. That’s possible.

There is indeed a case that was described, a single lab confirmed case of Marburg virus disease in a person late June 2026 in Uganda. All the contact tracing you can imagine is underway, the investigation and the care of that individual. We do not have details on any of this.

This is not a surprise. This is not alarming to me. This would not be a reason to avoid visiting Uganda. Them. It’s a beautiful, interesting country. Please go.

Occasionally people will get in trouble.

Either direct contacts with bats or with some other animal reservoir through intimate contact that way, for example, butchering bush meat or actually going after trying to capture a bat directly. That sort of animal to human contact is probably the source here, although I’m just guessing, we don’t have that information yet.

So there is no specific treatment, there is no specific prevention except to please, when you do go to Uganda and please do, please do not go into caves for a whole bunch of reasons. I don’t want you in there. And please avoid direct contact with bats during your upcoming trip.

I think if you’re a healthcare worker who’s planning to volunteer in these areas of Uganda or elsewhere where there could be other filovirus disease, you just need to be prepared. You need to understand what you’re doing. Don’t just go fly by night.

You need to work with an organization that is well prepared to do the work of caring for these patients. And you personally should be prepared as well.

Probably the biggest risk factor for catching Marburg would be unsafe practices in the delivery of healthcare to someone who’s suffering from Marburg disease.

WORM
00:30:41.030 – 00:31:01.140
Yeah, agree.

If it was me and I had reason to go to Uganda now, say to go on safari or to be a doctor, I would still go, but I wouldn’t go into a cave, I wouldn’t handle a bat.

And certainly with anybody with potential Marburg symptoms, you know, I might get into that entire moon suit that we became familiar with during the Ebola epidemic.

GERM
00:31:01.220 – 00:31:58.800
Yeah. And what’s so interesting about the moon suit, and we’ve mentioned this before, you don’t catch it by breathing the air.

We don’t think it should not be transmissible person to person that way, but it is through direct contact. Why the moon suit? Because it’s so hot and sweaty doing this difficult work while you’re wearing a plastic gown.

The PAPR is basically a personal air conditioner, so it helps make it cool and more sustainable to do this very difficult, heroic work. Everyone, thanks so much for joining us here on episode 112 of Germ and Worm. As always, we would welcome your questions on travel health.

Just send them to us or tips for travel success.

Suggested corrections Drop us a line germandworm gmail.com or visit our website germanworm.com if you’ve enjoyed what you’ve heard, 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.

WORM
00:31:58.800 – 00:32:01.400
I’m Worm. It’s a big planet. See it in good health.

GERM
00:32:01.560 – 00:32:23.010
We hope to see you next time.

This podcast is designed to inform, inspire and entertain, but it does not establish a doctor patient relationship and so 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. Sanfords and Dr. Pottinger’s alone and do not necessarily represent the opinions of the University of Washington or UW Medicine.