Rabies from Organ Transplant, Screwworm Threat, & Hep B Vax Rollback | Dr Jay Varma & Dr Jon Epstein

In this episode of Inside Outbreaks from ThermometerHQ, Dr. Jay Varma and Dr. Jon Epstein unpack a series of events that show how infectious disease threats are never truly behind us. From a tragic rabies transmission through organ transplantation, to a growing parasitic threat to North American cattle, to a politically driven rollback in childhood vaccination policy, this week’s discussion highlights how science, surveillance, and public health decisions intersect. And what that means for your health and our health systems.

Dr. Varma, a physician and public health expert, and Dr. Epstein, a veterinarian, virologist, and disease ecologist, begin with an unusual but alarming case of rabies transmitted via a kidney transplant. They explain how rabies, though rare in humans in the United States, remains 100% fatal once symptoms appear, why even minor animal scratches can be dangerous, and how this case exposes limits in our current screening and surveillance systems.

The conversation then turns to screwworm, a destructive parasitic fly affecting livestock in Central America and Mexico. The hosts describe why screwworm poses a serious economic and animal health threat to US beef producers, how a coordinated One Health response is working to slow its northward spread through sterile insect techniques and emergency veterinary tools, and what this means for agriculture, trade, and global health.

Finally, they examine the recent overhaul of CDC’s Advisory Committee on Immunization Practices (ACIP) and the decision to roll back the long-standing recommendation for universal hepatitis B vaccination at birth. Dr. Varma and Dr. Epstein review what hepatitis B is, how it spreads, why newborn vaccination has been so effective, and how politicized attacks on vaccines and public health infrastructure undermine decades of progress in infectious disease prevention and surveillance.

Topics Discussed This Week
1. How a single rabies-infected organ donor led to a fatal transplant case and what it reveals about the limits of current screening systems.
2. Why even seemingly minor animal scratches—from skunks, bats, or other mammals—can pose a serious rabies risk and require careful medical evaluation.
3. The biology of screwworm, how its larvae damage cattle, and why its spread in Latin America threatens US beef production and food security.
4. The One Health, multi-agency response involving USDA, CDC, and international partners to deploy sterile insect releases and emergency treatments against screwworm.
5. The role of hepatitis B in chronic liver disease and cancer, and why universal birth-dose vaccination became a cornerstone of US public health.
6. How changes to ACIP membership and the rollback of hepatitis B birth-dose recommendations reflect broader political attacks on vaccines, infectious disease control, and public health expertise.
7. Why maintaining trusted, evidence-based voices—like ThermometerHQ’s Inside Outbreaks with Dr. Jay Varma and Dr. Jon Epstein—is essential for navigating future outbreaks and global health crises.

Inside Outbreaks is part of ThermometerHQ: your trusted source for expert insights on infectious diseases and public health.

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🌐Find Dr. Jay Varma at https://drjayvarma.com

🌐Find Dr. Jon Epstein at https://onehealthscience.com

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