Speaker 1: On March twenty third, nineteen sixty three, at one a m.
Speaker 1: Jerrol Lynn Hilliman woke up with a sore throat. Five
Speaker 1: years old, with penetrating blue eyes and an adorable pixie haircut.
Speaker 1: Jerl quietly tiptoed into her father's bedroom and stood at
Speaker 1: the foot of his bed. Daddy, she whispered. Hillman shook
Speaker 1: himself awake, rose to his full height of six feet
Speaker 1: one inch, bent down, and gently touched the side of
Speaker 1: his daughter's face. There, at the angle of her jaw,
Speaker 1: he felt a lump. Jerrel winced in pain. At the
Speaker 1: time of his daughter's illness, Hilliman was a single father.
Speaker 1: Four months earlier, his wife, Thelma, had died of breast cancer.
Speaker 1: Although he wasn't sure what was happening to Jerrel, Hilliman
Speaker 1: had a pretty good idea. Near his bed was a
Speaker 1: book titled The Murk Manual, a simply written compendium of
Speaker 1: medical information. Thumbing through it, he soon found what he
Speaker 1: was looking for. Oh my god, he said, you've got
Speaker 1: the mumps. Then Hilliman did something that few fathers would
Speaker 1: have done. He walked down the hallway, knocked on the
Speaker 1: housekeeper's door, and told her that he'd be gone for
Speaker 1: a while. Then he went back to his bedroom, picked
Speaker 1: up his daughter and put her back to bed. I'll
Speaker 1: be back in about an hour, he said, Where are
Speaker 1: you going? Daddy asked Jeryl to work, but I won't
Speaker 1: be long. Hileiman got into his car and drove fifteen
Speaker 1: miles to Murk. He rummaged around his laboratory, opening and
Speaker 1: closing drawers until he found cotton swabs and a vial
Speaker 1: of straw colored nutrient broth. By the time he got home,
Speaker 1: Jeryl had fallen back to sleep, so he gently touched
Speaker 1: her shoulder, woke her up, stroked the back of her
Speaker 1: throat with a cotton swab, and inserted it into the
Speaker 1: vial of broth. Then he comforted her, drove back to work,
Speaker 1: put the nutrient broth in a laboratory freezer, and drove home.
Speaker 1: Most parents thought that mumps was a mild, short lived illness,
Speaker 1: but Hilliman knew better. He was scared aird about what
Speaker 1: might happen to his daughter. Although he knew that it
Speaker 1: was too late for gerald, Hillman wanted to find a
Speaker 1: way to prevent mumps. He decided to use his daughter's
Speaker 1: virus to do it.
Speaker 2: It's a level good it's so exciting. It's amazing.
Speaker 1: I also just love what a nerd he was that
Speaker 1: he slept next to the murkmanual like had it on
Speaker 1: his bedside table.
Speaker 2: Maurice, it's amazing. As if you don't do the same thing,
Speaker 2: Aaron coming, I have a.
Speaker 1: Stack of medical books on my bedside table right now.
Speaker 3: See.
Speaker 4: Yeah, I know it's embarrassing. Nerds unite.
Speaker 2: That amazingly written story is true. Story is from the
Speaker 2: book Vaccinated, One Man's Quest to Defeat the World's Deadliest
Speaker 2: Diseases by Paul Offitt, and it is about Maurice Hillman, Yeah,
Speaker 2: who played a big part, a huge part, a crucial part,
Speaker 2: as well as his daughter in the creation of the
Speaker 2: momp's vaccine, which is the subject of today's episode.
Speaker 4: It sure is. Hi.
Speaker 2: I'm Aaron Welsh.
Speaker 4: And I'm Aaron Allman.
Speaker 2: Updyke and this is this podcast will kill you.
Speaker 1: We're really excited to be bringing back yet another of
Speaker 1: the vaccine preventable diseases.
Speaker 2: We sure are. I mean, this is the last of
Speaker 2: the MMR that we needed to cover.
Speaker 4: Mm hmm yeah. The other M. We've got it, the
Speaker 4: other M.
Speaker 2: Yeah, speaking of the other M, what are we drinking
Speaker 2: this week.
Speaker 4: That's what we're drinking the other m M.
Speaker 2: I feel like most people when they think of MMR,
Speaker 2: it's sort of all blurred together, right, it's measles, mumps, rebella.
Speaker 2: You barely take a breath between them or ye apause
Speaker 2: it's just all one word. But I also kind of
Speaker 2: think that maybe measles springs to mind first for most people.
Speaker 1: I think it depends on the generation. I think that
Speaker 1: there's a good chunk of people who remember mumps more
Speaker 1: than anything because of some of its distinctive signs. But yeah,
Speaker 1: measles I think steals the show in that vaccine.
Speaker 2: Yeah, maybe it's because of there have been more recent
Speaker 2: outbreaks of measles, although there have been recent outbreaks of
Speaker 2: mumps done. So, yeah, we are drinking the other m
Speaker 2: in any case, And in the other m it's a
Speaker 2: tasty little concoction with bourbon sage, simple syrup because my
Speaker 2: garden has way too much sage, and some orange tossed
Speaker 2: in there.
Speaker 4: Yeah, delicious, I can't wait. It's very early fall.
Speaker 2: Fantastic and we will post the full recipe for the
Speaker 2: quarantini as well as the non alcoholic plusy Brita on
Speaker 2: our website this podcast will kill you dot com as
Speaker 2: well as on all of our social media channels.
Speaker 1: We sure will on our website this podcast will kill
Speaker 1: you dot Com. You all know how many amazing things
Speaker 1: you can find there. Do we even do this anymore?
Speaker 1: We've skipped it a few times. Check out our website.
Speaker 2: I like it, and I don't think there's any more business.
Speaker 2: So can we dive into the last of the MMR.
Speaker 4: I am really excited to do it.
Speaker 1: Let's take a quick break and then we'll get into it.
Speaker 4: So mumps mumps. Mumps is the disease.
Speaker 1: That's the name of the disease that's caused by a
Speaker 1: virus that is named the same thing, the mumps virus,
Speaker 1: which I think we've covered a number of viruses whose disease.
Speaker 4: Are named the same thing.
Speaker 1: But I don't know why I expected mumps virus to
Speaker 1: be named something different, like something more virus sounding.
Speaker 2: That's a good point.
Speaker 4: Yeah, the mumps virus, it causes mumps.
Speaker 2: What I mean, surely it has like a virus family
Speaker 2: and oh stuff like that. That sounds a little more professional.
Speaker 4: We can do that. Of course.
Speaker 1: It's in the family paramixa Viridae. There we go, which is,
Speaker 1: as it turns out, the same family as the measles virus,
Speaker 1: as well as parainfluenza, canine dis temper rsv a whole
Speaker 1: bunch of other viruses that are pathogenic to humans as
Speaker 1: well as our dogs. Mumps virus has a single stranded
Speaker 1: RNA genome.
Speaker 4: It's an enveloped.
Speaker 1: Virus, so outside its little protein capsid, it has this
Speaker 1: lipid and glycoprotein envelope that helps it evade.
Speaker 4: Our immune response.
Speaker 1: And from what I could tell, there are at least
Speaker 1: twelve different genotypes of this virus that do vary geographically,
Speaker 1: but it's unclear whether these genotypes vary that much in virulence,
Speaker 1: probably not substantially, at least as far as we know
Speaker 1: so far. Zero type wise, If you remember in our
Speaker 1: dosporosis episode, I talked a little bit about the differences
Speaker 1: between like what is this zerotype, et cetera. Right, So,
Speaker 1: zerotypes are things that vary based on their outside surface proteins,
Speaker 1: and so we can categorize them based on different epidemic
Speaker 1: outbreaks and things like that, based on different zerotypes or
Speaker 1: zero VARs. And in the case of mumps, it doesn't
Speaker 1: seem like there are a lot of different zerotypes, but
Speaker 1: there are differences in their genes. So there are different genotypes,
Speaker 1: but it's unclear how much these genetic differences really translate
Speaker 1: to differences in the virus and how it interacts with
Speaker 1: our immune system and causes disease, if that makes sense.
Speaker 2: Yeah, okay. So, for instance, when it comes to different zerotypes,
Speaker 2: you might not have cross protection or as much cross
Speaker 2: protection from one compared to the other because the surface
Speaker 2: protein is different, and your immune system might not recognize
Speaker 2: a different zerotype that you haven't previously been infected with
Speaker 2: different genotypes. You could be infected with one and then
Speaker 2: your immune system would recognize another because of surface proteins
Speaker 2: aren't substantially different.
Speaker 4: Right exactly.
Speaker 1: Yeah, okay, Okay, that's it, more succinct summary than my blathering.
Speaker 2: Yeah. I feel like I went on and on, but
Speaker 2: I think that that makes a lot of sense, and
Speaker 2: I think that's really interesting from both a public health
Speaker 2: perspective as well as an evolutionary perspective.
Speaker 3: Yeah, yeah, exactly, And vaccines and vaccines.
Speaker 1: So, mumps is a human specific virus. It does not
Speaker 1: infect other animals naturally, just humans, and it's a very
Speaker 1: contagious disease the rn not, which we haven't talked about
Speaker 1: for a long time.
Speaker 4: I'm excited to bring it back.
Speaker 1: The rn knot is a number that is used in
Speaker 1: epidemiology to estimate the average number of infections that result
Speaker 1: from a single infection in an entirely susceptible population.
Speaker 2: I feel like we all know are not from COVID now.
Speaker 4: I know.
Speaker 1: Now it's been two and a half years, so people
Speaker 1: might have forgotten, you know what I mean? But yes,
Speaker 1: little refresher, But this is an estimate, so it can vary, right,
Speaker 1: depending on the population and the study that you're doing.
Speaker 1: So four months, the average is estimated at around four
Speaker 1: point four, so every one case results in four and
Speaker 1: a half ish additional cases. But depending on the population,
Speaker 1: that can vary from three to ten. Wow, yeah in
Speaker 1: different studies. So potentially up to one person can infect
Speaker 1: up to ten people in some studies.
Speaker 2: Ah okay, that's very contagious.
Speaker 1: Very contagious. And transmission is by primarily respiratory droplets as
Speaker 1: well as close contact in general, because respiratory droplets are
Speaker 1: generally close content tech transmission as well as potentially foam
Speaker 1: mites or surfaces like door knobs, or pillows or whatever
Speaker 1: that become contaminated.
Speaker 2: And that would be contaminated through your saliva exactly.
Speaker 4: It's very much like influenza.
Speaker 2: And how durable is this virus in the environment?
Speaker 4: Great question.
Speaker 1: I actually didn't see any data on that, so I
Speaker 1: do not know. Okay, yeah, yeah, good question though, But yeah,
Speaker 1: it can be transmitted that way. So it's very much
Speaker 1: like influenza and a lot of other crowd diseases that
Speaker 1: we've covered. And also, like a lot of those diseases,
Speaker 1: people become contagious or infectious at least a day or
Speaker 1: two before their symptoms start. And virus has been isolated
Speaker 1: from saliva and nasal mucosa up to a week before
Speaker 1: symptoms start, w which is terrifying.
Speaker 4: Yeah, h okay.
Speaker 2: Question how long is the incubation period?
Speaker 4: The great question. It's very long.
Speaker 1: It's between fifteen to twenty four days, so like two
Speaker 1: to three weeks.
Speaker 2: That is so interesting. Why is it so long?
Speaker 1: I don't know, arin I have a lot of I
Speaker 1: don't knows about mumps. So once we get exposed to
Speaker 1: the virus, let's say a couple of toddlers at preschool
Speaker 1: breathing on.
Speaker 4: Each other like they do yeap.
Speaker 1: The virus then predominantly infects the cells that line our
Speaker 1: respiratory tract, or at least initially begins to infect those cells,
Speaker 1: especially the upper respiratory tract. Usually doesn't make its way
Speaker 1: into our lungs, not causing like a lower respiratory infection.
Speaker 1: And then one of the primary cell types that it
Speaker 1: infects and begins to replicate within is our parotid glands.
Speaker 1: Our parotid glands are a pair of salivary glands in
Speaker 1: your cheeks, kind of like back near the angle of
Speaker 1: your jaw. And this infection of this glandular epithelium that's
Speaker 1: the cells that are lining the glands like in your
Speaker 1: parodid glands, leads to what's called a paratitis that just
Speaker 1: means inflammation of these glands, and that is what leads
Speaker 1: to one of the hallmark symptoms of Mump's infection, which
Speaker 1: are super super swollen cheeks. But this is not a
Speaker 1: virus that only infects our parodid glands. It can infect
Speaker 1: a variety of glandular epithelial cells. It can infect our
Speaker 1: respiratory epithelium of course, it can infect our central nervous
Speaker 1: system and wherever it goes. What it does is essentially
Speaker 1: replicate a lot, and this replication causes a lot of
Speaker 1: local inflammation infiltrates of our white blood cells trying to
Speaker 1: fight off this virus by killing those infected cells, which
Speaker 1: can then lead to hemorrhage or necrosis of various tissues
Speaker 1: within these organs and significant swelling and potentially increased pressure
Speaker 1: in these various glands. So what we see with infection
Speaker 1: with a mumps virus is both direct damage from the
Speaker 1: virus replicating in ourselves, but also a lot of indirect
Speaker 1: damage from our immune response to such a highly proliferative virus.
Speaker 2: Okay questions, Okay, why does it go where it goes,
Speaker 2: especially like the central nervous system and outside of the
Speaker 2: salivary glands and respiratory tract.
Speaker 4: Great questions.
Speaker 1: So what's very interesting is that one of the papers
Speaker 1: I read suggested that mumps virus actually has a very
Speaker 1: high We've talked on this podcast about tissue tropisms, so
Speaker 1: particular tissue types that viruses are very good at infecting,
Speaker 1: and in animal models, mumps virus actually has a very
Speaker 1: wrong tissue tropism for nervous tissue, so it invades and
Speaker 1: replicates really well in nervous tissue in animal models, but
Speaker 1: in humans we actually don't see very common. It's not
Speaker 1: the hallmark symptom to have neurologic involvement, as we'll talk about,
Speaker 1: you definitely can, but primarily it seems to infect these
Speaker 1: other epithelial cell layers. Why does it have a particular
Speaker 1: tropism for these glandular epithelial cells. I don't have an
Speaker 1: answer for you. And what's very interesting is that it
Speaker 1: really is these parodied glands specifically that are the hallmark
Speaker 1: and other salivary glands. Because our parodids are not our
Speaker 1: only salivary glands. We have others under our mandible and
Speaker 1: under our tongue. Those tend to not be infected at
Speaker 1: least not without also having parodid gland involvement. Like it's
Speaker 1: much less common. Does that make sense?
Speaker 4: Yeah?
Speaker 2: How fascinating.
Speaker 1: Yeah, And I will talk about this isn't restricted to
Speaker 1: that glandular epithelium. It can infect epithelial cells in a
Speaker 1: lot of other organs as well, And I think it
Speaker 1: just as a matter of does it manage to make
Speaker 1: it all the way to those organs evading our immune
Speaker 1: response on its way there and then if it does,
Speaker 1: then it can set up shop and just replicate like
Speaker 1: it does in our parodids.
Speaker 2: One more quick question, Okay, how does infectivity change throughout
Speaker 2: the duration of infection?
Speaker 1: Yeah, you're most infectious those couple of days before symptoms
Speaker 1: start and then for the first week ish after that. Okay, Yeah,
Speaker 1: but we know that virus can be detected for up
Speaker 1: to a week before symptoms, and I think for even
Speaker 1: longer than a week after symptoms begin. But the most
Speaker 1: highly infectious time seems to be that kind of more
Speaker 1: narrow time window of just before symptoms start and for
Speaker 1: a few days maybe up to a week after. Okay, yeah,
Speaker 1: so let's talk about what those symptoms actually look like,
Speaker 1: shall we. Yeah, just talked about this virus itself, talk
Speaker 1: about what's happening to us. So first of all, and
Speaker 1: this kind of like messes up what I just said
Speaker 1: Aaron about the product lands. But thirty percent of the
Speaker 1: time this is an asymptomatic infection, right yeah, yeah, which
Speaker 1: I did not know, and I feel like it makes
Speaker 1: it that much more terrifying considering how long the incubation
Speaker 1: period is, how much you can shed before symptoms even start,
Speaker 1: how much are asymptomatic carriers contributing to spread. Ooh scary,
Speaker 1: but yeah, okay, but that's thirty percent. So let's talk
Speaker 1: about the other seventy shall we? In that seventy ish
Speaker 1: percent of people who become symptomatic, the infection usually starts
Speaker 1: with a little bit of a fever, but not like
Speaker 1: I'm laid out, I'm feverish, I'm so ill. It's just
Speaker 1: like feeling right down, maybe not having much of an appetite,
Speaker 1: often having a headache, feeling sick, and then over two
Speaker 1: to three days is when that hallmark sign of paratitis begins.
Speaker 1: The parotid glands can get so big that they actually
Speaker 1: lift up your ear lobe kind of up and out,
Speaker 1: and you completely lose that angle of the jaw. If
Speaker 1: you look at pictures of people with mumps, it it's
Speaker 1: hard for me to describe well, but you just really
Speaker 1: have two ginormous chipmunk cheeks.
Speaker 2: Also, if you've watched Brooklyn nine to nine, there's an
Speaker 2: episode oh where Jake and Captain Holt get mumps. Yeah,
Speaker 2: I forgot about it, and they name them. They name
Speaker 2: their big swollen lumps.
Speaker 1: That's hilarious. How accurate is it. Well, let me go
Speaker 1: through and you'll tell me.
Speaker 2: I can't. I mean, it's been a long time, but
Speaker 2: it's it's yeah, it's been a long time since I've
Speaker 2: watched it, but yeah.
Speaker 1: And this swelling can persist for up to an entire week,
Speaker 1: and it is incredibly painful. It's a very very inflamed organ.
Speaker 1: It's super tender. Ninety percent of the time, it's bilateral,
Speaker 1: so you're miserable on both sides, and usually it starts
Speaker 1: on one side and then the second side takes a
Speaker 1: couple extra days to come in.
Speaker 2: That part is accurate from Brooklyn nine nine. Oh sure,
Speaker 2: I love that.
Speaker 1: And ninety five percent of people who show symptoms do
Speaker 1: have this paratitis, so it is very, very classic. The
Speaker 1: testes are another very common sight of Mump's infection, especially
Speaker 1: in post pubertal people with testes. Fifteen to thirty percent
Speaker 1: of post pubertal people with testes can get an infection
Speaker 1: that is often an epididymmo orchitis. Oh gosh, it's both
Speaker 1: epididymitis and orchitis.
Speaker 4: So let me tell you what those two things are,
Speaker 4: shall we? Yeah?
Speaker 1: Yeah, So these symptoms often start several days to a
Speaker 1: week after the paratitis.
Speaker 4: It is possible to get it without.
Speaker 1: That parodid gland swelling, but it's much less common and
Speaker 1: it's two different things that can happen. First, it's an orchitis,
Speaker 1: which is inflammation of the testes themselves, the sperm producing
Speaker 1: little oval structures in the scrotum. With that inflammation, think
Speaker 1: of it just like your parodid glands. It's swelling, its warmth,
Speaker 1: its tenderness, extreme tenderness because of all this inflammation. Then
Speaker 1: on top of that, you can also get an epididymitis,
Speaker 1: which is inflammation of the epididymis, which is the tube
Speaker 1: that carries sperm away from the testies themselves and kind
Speaker 1: of stores the sperm as well. And with that you
Speaker 1: usually also see more general constitutional symptoms like a worsen fever, headache, vomiting,
Speaker 1: just overall looking a lot sicker. So that's very miserable.
Speaker 1: In terms of the long term effects of this epididimo orchitis,
Speaker 1: it seems still controversial from what I could tell, whether
Speaker 1: there is a long term association with like infertility or
Speaker 1: subfertility or reduced sperm production. There are some studies that
Speaker 1: do suggest a small decrease in testicular size and or
Speaker 1: abnormalities in spermatograms, whether that be sperm count, sperm morphology,
Speaker 1: or sperm motility. But this is only in a percentage
Speaker 1: of people, and it doesn't seem like we have great
Speaker 1: data on how common this is or what the real
Speaker 1: effects of this are, Like why is this causing.
Speaker 4: More long term effects?
Speaker 1: Ovaries can also be affected, but it tends to be
Speaker 1: much less common. About five percent of post pubertal or
Speaker 1: reproductive AID people with ovaries get oopharitis, So again just inflammation,
Speaker 1: same situation happening, but in the ovaries. You have a question,
Speaker 1: like your face is saying like why and I don't
Speaker 1: know why?
Speaker 2: So, yeah, why is it less common? Is really what
Speaker 2: I was gonna ask.
Speaker 1: I wonder if it has anything to do with like
Speaker 1: differences in body temperature or something like the testes and
Speaker 1: the salivary glands are in a very different place in
Speaker 1: your body, in your abdomen, But I don't know, because
Speaker 1: they can also replicate in your kidneys just fine. So
Speaker 1: maybe it's just that it's a more indirect route to
Speaker 1: try and get there for the virus.
Speaker 4: I don't have an answer for. Yeah, do we just
Speaker 4: diagnose it less. I don't know, I don't know. I
Speaker 4: don't have an answer.
Speaker 1: Interesting now, all of those symptoms are horrible, they're painful.
Speaker 1: They may or may not cause residual symptoms in the
Speaker 1: case of an architis or an epidemitis, but they do
Speaker 1: tend to be self limiting in all those cases. The
Speaker 1: problem with mumps virus is that it can also infect
Speaker 1: the central nervous system, and it can result in a
Speaker 1: meningitis or an encephalitis. It is rare. Most estimates I
Speaker 1: saw suggested that about five to ten percent of cases
Speaker 1: of mumps will cause a meningitis, although one World Health
Speaker 1: Organization articles suggested up to fifteen percent and less than
Speaker 1: half a percent point five percent cause encephalitis, which is
Speaker 1: the worst one.
Speaker 2: Five to ten percent still seems pretty dang high.
Speaker 1: It is absolutely and apparently up to half of the
Speaker 1: time with a meningitis. It can happen even without that
Speaker 1: parodied land swelling and infection, so you might not have
Speaker 1: had that as a preceding symptom. To know that this
Speaker 1: meningitis is likely related to the mumps, if that makes sense,
Speaker 1: and if that's not enough that it can happen without
Speaker 1: even the product land swelling. It can also happen in
Speaker 1: any order, so you can see meningitis that starts before
Speaker 1: salivary gland involvement or after salivary gland involvement. Okay, Now,
Speaker 1: mumps meningitis is a more severe infection. You can see
Speaker 1: things like high high fevers, headaches, vomiting, all the scary
Speaker 1: kind of meningial signs when you have inflammation of these
Speaker 1: mening's lining your nervous system, like stiff neck.
Speaker 4: Like lethargy.
Speaker 1: But in general, very low mortality from mumps meningitis and
Speaker 1: very little long term issues and problems that arise as
Speaker 1: the result of this meningitis, which is really in contrast
Speaker 1: to other causes of meningitis.
Speaker 2: However, there's always a however, there's always a.
Speaker 1: However, there can be a progression to encephalitis, which is
Speaker 1: inflammation happening in the brain itself, in the parankama of
Speaker 1: the brain, and that does lead to the potential for
Speaker 1: severe and lasting damage, including seizures, behavioral changes. Hearing loss
Speaker 1: asterisk Hearing loss is actually a well known complication of
Speaker 1: mumps that happens in about four percent of cases overall,
Speaker 1: so not only in these encephalitis cases, but unlike hearing
Speaker 1: loss as a consequence of other forms of meningitis, it's
Speaker 1: often unilateral rather than bilateral one ear not both. And
Speaker 1: it's often transient, which is good, but it can be permanent,
Speaker 1: which is not good. And despite how rare this encephalitis
Speaker 1: is in a mump's infection, MOMPS was the leading cause
Speaker 1: of viral encephalitis in the United States and many other
Speaker 1: countries until the vaccine was widely available.
Speaker 4: So this is not a.
Speaker 1: Benign disease ease, even though the vast majority of people
Speaker 1: who get it will have a very sort of self
Speaker 1: limited disease course. So yeah, that's kind of the worst
Speaker 1: of the things that can happen. Like I kind of
Speaker 1: alluded to, mumps can infect a lot of other organs.
Speaker 1: It can cause a pancreatitis, which is inflammation in your pancreas.
Speaker 1: It can cause kidney infections, it can infect your heart. Really,
Speaker 1: it can go anywhere, but the ones I talked about
Speaker 1: are kind of the most commonplaces that we see mumps
Speaker 1: infection happening. Overall, the fatality rate is very low, about
Speaker 1: one to three per ten thousand infections, and almost exclusively
Speaker 1: in cases of encephalitis.
Speaker 2: I have a question. Okay, So clearly it can cross
Speaker 2: the blood brain barrier and cause problems in your central
Speaker 2: nervous system. Correct, can't cross the placenta great.
Speaker 1: Question, I believe. So it's not very strong associations. But
Speaker 1: there is some suggestion that mumps can be associated with
Speaker 1: spontaneous abortion early pregnancy loss, even in a few case
Speaker 1: reports that I saw neonatal infection leading to neonatal death
Speaker 1: when someone was infected like very much at the end
Speaker 1: of their pregnancy, like a few days before delivery. So yeah,
Speaker 1: But part of the problem about kind of all of
Speaker 1: these questions is that most of what we know about
Speaker 1: the pathogenesis of mumps comes from animal models, and this
Speaker 1: is a human.
Speaker 4: Specific virus, So all these animal.
Speaker 1: Models are imperfect, and I think it's probably a part
Speaker 1: of why we don't know maybe as much about the
Speaker 1: specific pathogenesis as we do about other viruses.
Speaker 2: Right, Okay, that makes sense.
Speaker 4: But we do have a vaccine.
Speaker 3: We do.
Speaker 1: It's the second m in the MMR vaccine measles, mumps
Speaker 1: and rubella.
Speaker 4: The vaccine for.
Speaker 1: Mumps is a live attenuated vaccine, which means it's a
Speaker 1: live virus that has been grown in laboratory culture to
Speaker 1: not be virulent, so it doesn't cause symptomatic disease, and
Speaker 1: it's available in MMR, but also as like on its own,
Speaker 1: just mumps. And there's actually a lot of different vaccine
Speaker 1: strains that exist out there, and some of them do
Speaker 1: seem to be more effective than others, which is very interesting,
Speaker 1: especially in the context of the fact that we don't
Speaker 1: know that genotypes.
Speaker 4: Are all that different, you know what I mean.
Speaker 1: And what's very interesting, and I'll kind of talk more
Speaker 1: about what has happened as a result of this. Some
Speaker 1: cases of aseptic meningitis, so meningitis that.
Speaker 4: You can't grow anything from, like in.
Speaker 1: Culture, have happened as a result of vaccination with specific
Speaker 1: strains of the vaccine of the mump's vaccine. But this
Speaker 1: vaccine isn't really in use very commonly anymore because of that.
Speaker 1: And importantly, all of the cases of asymptic menindritis that
Speaker 1: happened from this vaccine strain of the virus did not
Speaker 1: result in any kind of long term consequences or any
Speaker 1: deaths as far as everything.
Speaker 4: That I read, Okay, but important to note, Okay.
Speaker 2: I have a question about the disease itself.
Speaker 4: Okay, heps.
Speaker 2: So you mentioned that in infants the disease can be
Speaker 2: very severe. Do we see any other patterns when it
Speaker 2: comes to age, for instance, in terms of whether someone
Speaker 2: has certain symptoms or more likely to have a more
Speaker 2: severe course of infection stuff like that.
Speaker 1: Yeah, great question. It actually tends to be more severe,
Speaker 1: like a lot of childhood illnesses if you get it
Speaker 1: later in life, so as an adolescent or adult, especially
Speaker 1: with testes, because we really don't see that testicular infection
Speaker 1: prior to puberty very commonly at all.
Speaker 2: Right, okay, So then that leads me to a question
Speaker 2: about the vaccines, which is waning immunity. How does the
Speaker 2: vaccine durability change across these different vaccine strains.
Speaker 1: That's a great question, Aaron. The whole waning immunity thing
Speaker 1: is a really important part of vaccination. So in general,
Speaker 1: childhood infection with mumps induces a very persistent, long lasting
Speaker 1: immunity that, as far as we know, is pretty much lifelong.
Speaker 1: But again, infection can also cause meningitis, encephalitis, and death,
Speaker 1: so we vaccinate to avoid those consequences. Vaccination with mumps
Speaker 1: specifically does seem to have a waning immunity.
Speaker 4: Although.
Speaker 1: It's not forevery on average, some studies have found that
Speaker 1: vaccination can lead to twenty seven years or more of
Speaker 1: immunity to mumps, which.
Speaker 4: Is a really long time.
Speaker 1: Yeah, but up to twenty five percent of people might
Speaker 1: lose that protection within just seven or eight years. Okay,
Speaker 1: So the twenty seven years is an average, but that
Speaker 1: average has a really widespread and the question of why
Speaker 1: that is is something that we still.
Speaker 4: Don't really know.
Speaker 1: Okay, And I'll talk a lot more in the current
Speaker 1: event section about what the consequences of that have been
Speaker 1: in terms of outbreaks that we've seen in adolescents and
Speaker 1: young adults especially that likely this waning immunity plays.
Speaker 4: A big role.
Speaker 1: Yeah, of course, So that's a biology of MOMPS.
Speaker 2: What a weird little virus, isn't it. It's interesting though,
Speaker 2: It's really interesting. Yeah, So tell me erin where did
Speaker 2: this weird little guy come from? I won't answer that question,
Speaker 2: but I'll get into more about months and the history
Speaker 2: of this disease right after this break. Months is a classic.
Speaker 2: It's a classic TPWKY topic. Historically, it's been a classic
Speaker 2: childhood illness and now thankfully it's a class vaccine preventable.
Speaker 4: Disease such a classic.
Speaker 2: It's a classic, and most of what I'm going to
Speaker 2: talk about today is the story of the Mump's vaccine,
Speaker 2: as well as the man behind this and many other vaccines,
Speaker 2: Maurice Hillman.
Speaker 4: If you're a listener you know his name.
Speaker 2: You certainly do. But before I get there, I want
Speaker 2: to briefly take you through the early history and prehistory
Speaker 2: of mumps, or at least as far as we know.
Speaker 2: Where the mumps virus came from seems like somewhat of
Speaker 2: a difficult question to answer. It's possible that it's spilled
Speaker 2: over from pigs to humans during the agricultural Revolution, when
Speaker 2: humans first began to domesticate pigs, and that's based on
Speaker 2: the fact that there's a very similar virus found in pigs.
Speaker 2: They seem to be related. Or another option is that
Speaker 2: it's spilled over from humans to pigs.
Speaker 4: Ah maybe.
Speaker 2: And more recently, a virus very similar to the human
Speaker 2: mumps virus has been found in certain bat species, leading
Speaker 2: some researchers to hypothesize that perhaps the mumps virus spilled
Speaker 2: over from bats into humans and maybe also pigs. This
Speaker 2: is kind of my long way of saying that.
Speaker 4: We don't know, we don't know, we don't.
Speaker 2: Know where mumps virus came from and when it first
Speaker 2: started infecting humans, and maybe that information is out there
Speaker 2: and I just didn't search for it well, but I
Speaker 2: couldn't find anything more specific than that. But we do
Speaker 2: have a better sense for when mumps was first written about,
Speaker 2: and that is, of course, from the Hippocratic texts in
Speaker 2: the fifth century BCE. Retrospective diagnosis of any disease can
Speaker 2: be difficult, in a little bit hand wavy, but as
Speaker 2: you described, a typical infection with mumps is pretty distinctive
Speaker 2: thanks to those chipmunk swellings around your jaw. And so
Speaker 2: this quote from the Hippoocratic text describing an outbreak of
Speaker 2: an illness on the island of Thasus seems pretty clearly mumps.
Speaker 2: Tell me if you agree, okay. Quote swelling appeared about
Speaker 2: the ears in many on either side, and in the
Speaker 2: greatest number on both sides. In some instances earlier and
Speaker 2: in others later, inflammations with pain seized, sometimes one of
Speaker 2: the testicles and sometimes both.
Speaker 4: Yep, sound sounds like sounds like mumps.
Speaker 2: Yeah. And in later centuries, historians and physicians recorded outbreaks
Speaker 2: of a disease that sounds pretty similar to mumps, and
Speaker 2: as early as seventeen fifty five people suspected that it
Speaker 2: was contagious.
Speaker 1: I just love I love those stories when people knew
Speaker 1: that it was contagious, before they knew, like what the
Speaker 1: heck a virus or a bacteria or anything was.
Speaker 2: What was the actual contagious agent unit?
Speaker 4: Yeah? Oh yeah, yeah.
Speaker 2: And by the way, I just have to throw and
Speaker 2: hear the etymology of mumps.
Speaker 4: Oh please.
Speaker 2: So the English word for the disease mumps, it's different
Speaker 2: in other languages. The origin of that is a bit
Speaker 2: of a mystery. It could refer to like lumps around
Speaker 2: your face, okay, could refer to the English word mump
Speaker 2: meaning to be sulky. Or it's even been suggested that
Speaker 2: it comes from the difficulty in speaking experienced by people
Speaker 2: who have those salivary glandsucks like mumbum.
Speaker 1: Yeah.
Speaker 2: I don't know, but one of the things I thought
Speaker 2: was really hilarious, especially when you were talking about how
Speaker 2: like why doesn't the mumps virus have a more scientific
Speaker 2: sounding name.
Speaker 4: Yeah.
Speaker 2: So, one of the earliest articles about mumps, like scientific
Speaker 2: articles from seventeen ninety is titled quote an account of
Speaker 2: a distemper by the common people in England vulgarly called
Speaker 2: the mumps. So and the author, like in the text,
Speaker 2: immediately said like, I beg leave to call it not
Speaker 2: mumps but angina maxilaris HM. He was like, we can't
Speaker 2: call it mumps, it's too improper. So mumps is the
Speaker 2: vulgar name for it. I guess who knows hilarious. But
Speaker 2: in anyway, by the late seventeen hundreds, interest in mumps
Speaker 2: had increased, with the result that people began to take
Speaker 2: a closer look at the more severe manifestations of infection,
Speaker 2: like the nervous system involvement that you talked about. They
Speaker 2: also began to recognize its cyclic pattern, so every few years,
Speaker 2: like I don't know, three to seven years or so,
Speaker 2: an epidemic would occur as the number of susceptible individuals
Speaker 2: in a given area increased, which is something that we
Speaker 2: commonly see for crowd diseases, especially prototypically childhood diseases. People
Speaker 2: also started to note its global distribution, which was truly
Speaker 2: seemed to be global, and they also observed how it
Speaker 2: spread rapidly under certain conditions. Things like prisons, boarding schools, ships,
Speaker 2: and of course soldiers at war. The estimate for some
Speaker 2: military populations was as high as six thousand cases per
Speaker 2: one hundred thousand individuals.
Speaker 4: Wow.
Speaker 2: That's pretty high.
Speaker 4: It is.
Speaker 1: And it's interesting that, like they're going to be grown ups.
Speaker 1: It's like there's that many people who were still susceptible
Speaker 1: in that population for that outbreak to happen. Yeah, that's interesting.
Speaker 2: Yeah it is. Yeah, how did they escape it? I mean, yeah,
Speaker 2: they just missed the window.
Speaker 4: They just missed the window.
Speaker 2: Ooh, and unfortunately hit it later on.
Speaker 4: Yeah.
Speaker 2: I mean so during the US Civil War, about eleven thousand,
Speaker 2: two hundred cases of months were reported during the first
Speaker 2: year and over thirteen thousand, four hundred in the second.
Speaker 4: Wow.
Speaker 2: So again these are not these are people who escaped
Speaker 2: it as child children.
Speaker 4: Yeah.
Speaker 2: Mumps also ran rampant during World War Two, with the
Speaker 2: Surgeon General of the US Public Health Service stating in
Speaker 2: nineteen forty that it was quote one of the most
Speaker 2: disabling of the acute infections among armed forces recruits, seated
Speaker 2: only by the venereal diseases.
Speaker 4: Wow.
Speaker 2: Yeah, I had no idea how prevalent. No, this was,
Speaker 2: and I feel like a lot of people, a lot
Speaker 2: of us who were born after the mumps vaccine already existed,
Speaker 2: maybe just didn't realize how widespread it was. It was
Speaker 2: just sort of an inevitability, almost of childhood.
Speaker 1: I feel like mumps has been one of the most
Speaker 1: brushed under the rug, like a vaccine came out, and
Speaker 1: then our collective consciousness like forgot how bad it was
Speaker 1: because I didn't know how bad it was.
Speaker 2: I feel like the same thing. Maybe measles was like
Speaker 2: that too, until measles started increasing and people were reminded
Speaker 2: of just how horrible this disease could be. Maybe yeah,
Speaker 2: so yeah, but I agree, it does sort of seem
Speaker 2: like an afterthought, And it certainly didn't used to be
Speaker 2: just an afterthought. It used to be a hugely important disease,
Speaker 2: and that made it a public health priority to find
Speaker 2: out how it was transmitted and what caused it, what
Speaker 2: was the pathogenic agent. In nineteen thirty four, C. D.
Speaker 2: Johnson and E. W. Goodpasture demonstrated that mumps was caused
Speaker 2: by a filterable transmissible agent aka a virus I love
Speaker 2: it in saliva, and they did this by transmitting the
Speaker 2: disease from humans infected with mumps to reesis monkeys, and
Speaker 2: a little more than ten years after that, the virus
Speaker 2: was first cultivated by k Havel and a few years
Speaker 2: after that, in nineteen forty eight, g Henley and his
Speaker 2: colleagues investigated the relatively high rate of asymptomatic infections. Interesting
Speaker 2: apparently there was an experimental killed virus vaccine that came
Speaker 2: out in the early nineteen fifties, but I don't know
Speaker 2: if it was just if it stayed experimental, you know,
Speaker 2: or if it was ever distributed widely, And I'm kind
Speaker 2: of guessing that it wasn't because there was still such
Speaker 2: a need for months, was still infecting millions of people
Speaker 2: every year, yea. And in order for months to become
Speaker 2: this afterthought, like we talked about simply like one of
Speaker 2: the ms in MMR in many places around the world,
Speaker 2: which it kind of is today, although things are changing,
Speaker 2: that transition would take a more effective vaccine, and for
Speaker 2: that we needed, of course, Maurice Hilleman.
Speaker 4: Let's hear it for Maurice.
Speaker 2: Let's hear it for Maurice. From the start of the
Speaker 2: twentieth century to the end of it, Americans lived thirty
Speaker 2: years longer on average, and that's thanks to an improvement
Speaker 2: in many different technologies and infrastructure, sure from seat belts
Speaker 2: to access to clean drinking water and improved sanitation, antibiotics,
Speaker 2: workplace safety regulations, improved in nutrition, and many other things.
Speaker 2: But the most impactful of all medical advances was certainly vaccines,
Speaker 2: and the person responsible for developing a great number of
Speaker 2: these life saving vaccines was one Maurice Hileman. Like you
Speaker 2: said Erin, if you've listened to the podcast before, Maurice
Speaker 2: Hileman's name probably sounds familiar to you, especially if you've
Speaker 2: listened to our vaccines episodes, where we mention some of
Speaker 2: the incredible work that he did in vaccine research, but
Speaker 2: we didn't talk about him in too much detail. And
Speaker 2: since this month's episode marks the last of the diseases
Speaker 2: covered by the MMR vaccine that we've done on the podcast,
Speaker 2: I thought I'd take just a little bit more time
Speaker 2: to talk about Maurice.
Speaker 4: I can't wait.
Speaker 2: Maurice Hillman was born at his family's home on the
Speaker 2: banks of the Tongue and Yellowstone Rivers near Miles City, Montana,
Speaker 2: on August thirtieth, nineteen nineteen. It's like Eastern Plains Montana,
Speaker 2: just out there. His birth was marked not only by
Speaker 2: global tragedy he was born at the end of the
Speaker 2: influenza pandemic that had killed tens of millions of people
Speaker 2: around the world, but also by personal tragedy. His twin
Speaker 2: sister died at birth, and his mother followed shortly after
Speaker 2: from eclampsia. Yeah. Maurice later said, quote, I always felt
Speaker 2: that I cheated death.
Speaker 4: Wow.
Speaker 2: He spent his childhood living with his aunt and uncle,
Speaker 2: but working during the day at the family farm, the
Speaker 2: Riverview garden, and nursery, and getting into trouble and adventures
Speaker 2: when he wasn't working, nearly drowning in the Yellowstone River
Speaker 2: while floating on a makeshift boat, getting diphtheria, nearly getting
Speaker 2: hit by a freight train while riding his bike across
Speaker 2: a train. Yeah. Rough and tumble childhood. His childhood heroes
Speaker 2: were Charles Darwin he got caught reading on the origin
Speaker 2: of species.
Speaker 4: In church, Oh my God.
Speaker 2: And also Howard Taylor Ricketts, who I talked a lot
Speaker 2: about during our Rocky Mountain Spotted Fever episode. Yeah.
Speaker 4: Ricketts of Ricketzia.
Speaker 2: Ricketts of Ricketsia. He worked in Montana trying to understand
Speaker 2: how Rocky Mountain spotted fever was transmitted and the role
Speaker 2: that the tick played, et cetera, et cetera, and find
Speaker 2: the causative agent. As Maurice got to the end of
Speaker 2: high school, he struggled with what to do next. The
Speaker 2: thought of going to seminary school to become a preacher,
Speaker 2: which was a very common path at that time for
Speaker 2: people in his town, that didn't really appeal to him,
Speaker 2: and so he applied and got a full scholarship from
Speaker 2: Montana State University. He graduated in nineteen forty one, first
Speaker 2: in his class, with a degree in chemistry and microbiology.
Speaker 2: His plans were to go to medical school, but he
Speaker 2: couldn't afford it, so he turned his sights to grad school.
Speaker 2: He applied to microbiology programs all over the country, and
Speaker 2: his top pick was University of Chicago. He got into
Speaker 2: all of them, but he chose Chicago, where he quickly
Speaker 2: made impressive progress on his dissertation, discovering that chlamydio was
Speaker 2: not caused by a virus, as was the prevailing thought
Speaker 2: at the time, but rather a small intracellular bacterium. After
Speaker 2: finishing that up, the expectation from everyone at the university
Speaker 2: was that he would stay in academia, teaching and doing research,
Speaker 2: but that didn't really sound great to him. Didn't sound
Speaker 2: as good as a job at a pharmaceutical company, because
Speaker 2: he wanted to take what he had learned in graduate
Speaker 2: school and apply it to industry. Be Able to scale
Speaker 2: up like vaccine production, be able to quality control stuff
Speaker 2: instead of just one project after the next, half for
Speaker 2: the next Yeah. But the University of Chicago didn't want
Speaker 2: him to go into industry, and so they set up
Speaker 2: various obstacles to make it more difficult, including a French exam,
Speaker 2: and Maurice hadn't studied French, so he spent six months
Speaker 2: learning the language, passed the test, and finally was permitted
Speaker 2: to work at the pharmaceutical company er Squib in New Jersey.
Speaker 1: Wait, I'm sorry, like they wouldn't give him his degree
Speaker 1: or something, until he hoops.
Speaker 2: I don't know if it was like not giving him
Speaker 2: his degree or just I can't remember what the book said,
Speaker 2: but yeah, gosh, I know it's academiah. Yeah. And at
Speaker 2: Squib he worked on the mass production of influenza vaccines.
Speaker 2: After about four years there, he headed to the Walter
Speaker 2: Reed Army Medical Research Institute to try to develop new
Speaker 2: influenza vaccines, and that's something that would serve him very
Speaker 2: well when he led the charge to produce a vaccine
Speaker 2: for the nineteen fifty seven pandemic strain of influenza. The
Speaker 2: nineteen fifty seven flu pandemic doesn't get a whole lot
Speaker 2: of attention, I feel, because maybe it wasn't as severe
Speaker 2: as the nineteen eighteen one, but what it did was
Speaker 2: demonstrate the potential for another influenza strain to sweep through populations,
Speaker 2: especially those that had no previous immunity to a similar strain.
Speaker 2: And Maurice was not only one of the first in
Speaker 2: the US to recognize the potential for pandemic spread, but
Speaker 2: also he was able to get people to take it seriously,
Speaker 2: pushing for vaccine development when others were like, you know what,
Speaker 2: it's not here, We're going to be fine. We don't
Speaker 2: need to worry about it, and he was like, oh,
Speaker 2: we absolutely need to worry about it. And part of
Speaker 2: the reason why the nineteen fifty seven flu pandemic didn't
Speaker 2: turn out to be as deadly as the nineteen eighteen
Speaker 2: one was likely due to the vaccine that Maurice produced
Speaker 2: and pushed.
Speaker 4: Wow.
Speaker 2: After the nineteen fifty seven pandemic, Maurice broadened his scope
Speaker 2: beyond influenza. He left Walter reed to become the Director
Speaker 2: of Virus in cell Biology at Murk Research Laboratories, and
Speaker 2: in his new position, he had one simple, easy goal
Speaker 2: to prevent every viral and bacterial disease that commonly hurt
Speaker 2: or killed children.
Speaker 3: Oh, oh, my goodness, I know, super easy, right, like
Speaker 3: super simple, no problem, doesn't have like big goals or anything.
Speaker 2: No, but honestly he got pretty close. Wow. He created
Speaker 2: and tested more than thirty vaccines over the next thirty
Speaker 2: years of his career, and one of those vaccines was,
Speaker 2: of course, for the subject of this episode, Momps Momps.
Speaker 2: As you heard in the first hand account, the mumps
Speaker 2: vaccine got its start when Jeryl Lynn Hillman, whose father
Speaker 2: was Maurice Hillman, came down with the infection in March
Speaker 2: nineteen sixty three. Maurice took that throat sample that he
Speaker 2: had gotten from Jeryl and brought it into the lab
Speaker 2: where he set to work on trying to make a
Speaker 2: mumps vaccine. Not for Jerl of course, like was mentioned,
Speaker 2: since it wouldn't do her any good at that point.
Speaker 2: But for the rest of the world. During the nineteen sixties,
Speaker 2: about a million people in the US got infected with
Speaker 2: mumps every year. And so when you were talking about
Speaker 2: these numbers arin of oh, well, five to ten percent
Speaker 2: of people get meningitis and then a smaller percentage of
Speaker 2: point get encephalitis, those seem like small numbers, but when
Speaker 2: you have millions of cases every single year, those are
Speaker 2: thousands of lives exactly.
Speaker 4: That's the thing of about months.
Speaker 1: Ninety five to one hundred percent of people will get
Speaker 1: mumps in their lifetime if they are unvaccinated, if the
Speaker 1: entire population is susceptible.
Speaker 4: Yeah, so, like.
Speaker 1: This is not a disease that only affects some people.
Speaker 1: It literally affects everyone in unvaccinated populations. And that's what
Speaker 1: it did until we had a vaccine.
Speaker 2: Yeah. Yeah, those those percentage points can make the risk
Speaker 2: of diseases like this seem low. But when you have
Speaker 2: the number of susceptible people, first of all, the actual
Speaker 2: number of people impacting can be high. Second of all,
Speaker 2: no matter how low the risk is, if you can
Speaker 2: avoid it, why risk it? Just yeah, I know, yeah,
Speaker 2: I mean, I think you know, like we've talked about
Speaker 2: many of us today don't maybe think about mumps all
Speaker 2: that often, especially those born after the vaccine was available,
Speaker 2: And I think our distance from that time period and
Speaker 2: mumps was a persistent childhood threat. Basically, an inevitability means
Speaker 2: that we don't recognize how fortunate we are to not
Speaker 2: have to think about mumps. We don't. We're like, oh,
Speaker 2: we never think about mumps. It's brushed under the rug.
Speaker 2: How amazing is that. It's a wonderful thing. And so
Speaker 2: Maurice was not just thinking, oh, hey, no one's made
Speaker 2: a mumps vaccine yet, Guess I'll give it a go.
Speaker 2: This seems like a solvable problem, something fun. He knew
Speaker 2: that if he could successfully create a vaccine, he could
Speaker 2: save millions of people around the world from this potentially
Speaker 2: harmful infection. And so he took jerald sample to the
Speaker 2: lab and he inoculated it into an incubating hen's egg,
Speaker 2: and then passed the virus into more eggs, and then
Speaker 2: grew the virus in chick cells that he had cultured. Again,
Speaker 2: he transferred the virus from one flask of chick cells
Speaker 2: to the next, seeing the virus get better and better
Speaker 2: At infecting the chick cells with every passage, and Maurice
Speaker 2: took this to mean that the virus was losing its
Speaker 2: ability to infect humans as it was getting better at
Speaker 2: infecting these chicken cells. But perhaps even though it couldn't
Speaker 2: cause disease in humans, maybe it could induce an immune
Speaker 2: response enough for protection. This serial passage process that Maurice
Speaker 2: used had been used and has been used by many
Speaker 2: researchers for decades to make vaccines. It's how Louis Pesture
Speaker 2: made the rabies vaccine, for instance. But how can you
Speaker 2: know for certain that the virus you've created using this
Speaker 2: process for any process, really is actually a effective at
Speaker 2: preventing infection while b not giving you the disease itself
Speaker 2: and c being safe.
Speaker 4: Yeah, you have to test it out.
Speaker 2: And this is where we come to the part of
Speaker 2: the story that is not surprising but still disappointing, frustrating, appalling,
Speaker 2: choose your adjective. But it's important to talk about, and
Speaker 2: that is the testing of vaccines and other medical studies
Speaker 2: in children with developmental disabilities. This was not an uncommon
Speaker 2: practice in the nineteen thirties, nineteen forties, nineteen fifties and
Speaker 2: into the nineteen sixties, including with Maurice Hillman's Moump's vaccine.
Speaker 2: Paul Offitt, in his book Vaccinated, writes that from our
Speaker 2: perspective today, we may think of the scientists heading those
Speaker 2: studies as a moral viewing those children as expendable opportunities
Speaker 2: to conduct their studies, but he argues that these doctors
Speaker 2: really saw the children as more vulnerable, more in need
Speaker 2: of protection, especially those living in crowded and underfunded state
Speaker 2: run facilities where infectious diseases often ran unchecked. And part
Speaker 2: of his reasoning to back that up is that many
Speaker 2: of these researchers, including Maurice Hillman, including Joe and A. Sulk,
Speaker 2: also tested the early versions of their vaccines on their
Speaker 2: own children, So why would they inject their kids with
Speaker 2: something they thought could be unsafe. I'm not sure that
Speaker 2: I agree with that take entirely. I think it's likely
Speaker 2: that some researchers did feel that way, that they had
Speaker 2: good intentions with their studies and who they chose to
Speaker 2: test out those untested products on, but others may not
Speaker 2: have felt that way, may have truly looked at these
Speaker 2: children as less than or as dispensable, And maybe others
Speaker 2: didn't really think that much at all about the ethics
Speaker 2: of this, beyond seeing these children as an opportunity. Administration
Speaker 2: of the vaccine and follow up was easy because they
Speaker 2: were all in one place. Infection rates were high, so
Speaker 2: you could get a good sense of how well these
Speaker 2: vaccines protected, and many of the children were wards of
Speaker 2: the state, so you didn't have to deal with the parents.
Speaker 2: And my point here is not try to decipher what
Speaker 2: these researchers thought about what they did, whether their intentions
Speaker 2: were good or bad, or how they reconciled it with
Speaker 2: their ethics. And I'm also not going to go into
Speaker 2: the history of how we got from there to where
Speaker 2: we are today with much stricter guidelines on how these
Speaker 2: studies are conducted, who gets chosen or who gets asked
Speaker 2: to participate in the study in form consent and so on.
Speaker 2: I'm also not saying, oh, it was a different time,
Speaker 2: everyone did it and no one thought much of it.
Speaker 2: And I'm also not saying progress could only have happened
Speaker 2: at the expense of these non consenting individuals, which is
Speaker 2: certainly not the case. So enough about what I am
Speaker 2: not trying to do. What I do want to do,
Speaker 2: what I want to get across is just that this happened.
Speaker 2: This is a crucial part of the history of the
Speaker 2: mump's vaccines, of polio vaccines, of hepatitis B virus, and
Speaker 2: so many other things. When talking about the history of
Speaker 2: a disease or a medication or medical technology, we need
Speaker 2: to address the cost of progress and acknowledge who actually
Speaker 2: paid for it, which in many cases has been non
Speaker 2: consenting individuals. Where did the earliest data come from that
Speaker 2: showed that the mumps vaccine was safe and effective. It
Speaker 2: came from children whose consent was not or could not
Speaker 2: be given, and that should be a part of the
Speaker 2: story we tell when talking about the history of mumps. Okay,
Speaker 2: so what happened? The first mumps vaccine test was actually
Speaker 2: a pretty small study. Sixteen children at the Trendler School
Speaker 2: in Pennsylvania, which was a home for developmentally delayed children,
Speaker 2: and these sixteen children were injected with Maurice's experimental mumps
Speaker 2: vaccine in June of nineteen sixty five. The results were clear. Fortunately,
Speaker 2: the vaccine was both safe and produced antibodies against mumps,
Speaker 2: and so a second trial was carried out, this time
Speaker 2: on sixty children with developmental delays living at other schools,
Speaker 2: again demonstrating that the vaccine induced the production of antibodies
Speaker 2: against the MOMPS virus. But one thing still had to
Speaker 2: be answered. Did this vaccine actually prevent disease? We saw antibodies,
Speaker 2: but were those antibodies enough to prevent disease from actually
Speaker 2: infection from actually happening? And to answer that they had
Speaker 2: to scale up and for this, Maurice and his colleagues
Speaker 2: thankfully turned away from using these state run schools and instead,
Speaker 2: for several months, Maurice and his colleagues went around to
Speaker 2: preschools and elementary schools in the Philadelphia area and handed
Speaker 2: out flyers to parents telling them about this new vaccine
Speaker 2: and that there would be info sessions held at local churches.
Speaker 2: At these sessions, researchers on the project would describe the vaccine,
Speaker 2: how it was made, a bit about how it worked,
Speaker 2: and then they would open it up to questions. If
Speaker 2: a parent was interest and allowing their kid to get
Speaker 2: the vaccine, they filled out a three by five inch
Speaker 2: card that said I allow my child to get a
Speaker 2: Mump's vaccine and had a signature at the bottom. This
Speaker 2: was this three by five little index card was a
Speaker 2: far cry from the informed consent forms that you see
Speaker 2: today with info about the safety of the vaccine, the
Speaker 2: timeline of the project, a list of the ingredients, what
Speaker 2: the study would entail in terms of tests or follow ups,
Speaker 2: all the things that were known. But I found it
Speaker 2: really funny to read that it did include the home
Speaker 2: and work phone numbers of Robert Wibel, who was one
Speaker 2: of the lead investigators on the project. Who's that call
Speaker 2: anytime you have any questions, any concerns.
Speaker 4: That's good.
Speaker 2: In total, about four hundred children were enlisted in the study,
Speaker 2: with two hundred getting the mumps vaccine and two hundred
Speaker 2: getting a placebo love it. Several months after the study began,
Speaker 2: a mump's epidemics swept through Philadelphia, and when the dust settled,
Speaker 2: sixty three children in the study had gotten mumps, two
Speaker 2: had been given the vaccine, and the remaining sixty one
Speaker 2: had not.
Speaker 4: Wow.
Speaker 2: Wa, pretty pretty good, Pretty clear.
Speaker 4: Yeah yeah.
Speaker 2: And on March thirtieth, nineteen sixty seven, a couple of
Speaker 2: years after this study and four years after jerro Lynn
Speaker 2: came down with mumps, the jerre Lynn mumps vaccine was
Speaker 2: licensed for use in the US, and cases of the
Speaker 2: disease dropped rapidly, and since that time, this vaccine has
Speaker 2: prevented millions, like countless millions of cases of mumps around
Speaker 2: the world. I want to read this quote from a
Speaker 2: reporter that has been widely circulated about the mumps vaccine
Speaker 2: because I think it's hilarious. Quote Jerrel recovered from mumps virus,
Speaker 2: but mumps virus never recovered from infecting Jerrel.
Speaker 4: I love it.
Speaker 2: I love that within a few years, the mumps vaccine
Speaker 2: was combined with the measles vaccine also made by Hillman,
Speaker 2: and the rubella vaccine made by Stanley Platkin to be
Speaker 2: the one shot MMR vaccine we know today, and this
Speaker 2: was simply to reduce the number of injections that a
Speaker 2: child had to get.
Speaker 1: There are more and more combo vaccines coming out because
Speaker 1: there are more and more vaccines.
Speaker 2: More and more vaccines. It's awesome. This combo shot, of course,
Speaker 2: was the same that would later be falsely attacked by
Speaker 2: Andrew Wakefield, who did his best, along with many other people,
Speaker 2: to undermine the efforts of Maurice Hillman and others to
Speaker 2: keep children safe. If you want to hear more about
Speaker 2: the history of the anti vaccine movement and just how
Speaker 2: completely wrong and unethical Andrew Wakefield was is check out
Speaker 2: Our Vaccine's Part two episode. And I'll also recommend the
Speaker 2: books Vaccine Sceanes Did Not Cause Rachel's Autism by Peter Hotez,
Speaker 2: our fave and also Deadly Choices by Paul Offitt. And
Speaker 2: there are many other great books and other resources out there,
Speaker 2: but please be careful where you find your information. Books
Speaker 2: aren't peer reviewed, and anyone can write a book and
Speaker 2: claim anything they want to in it. And even though
Speaker 2: they aren't peer reviewed, there are reviews of non fiction
Speaker 2: scientific books that can often be found in academic journals,
Speaker 2: so it's a bit more homework, but I will recommend
Speaker 2: plugging a book title into Google scholar seeing if a
Speaker 2: review pops up, read the review to see whether it's
Speaker 2: good or not. I love that, Yeah, recommend anyway. Back
Speaker 2: to Mumps and Maurice. Over the course of his career,
Speaker 2: Maurice Hillman and his team created tens of vaccines, including
Speaker 2: eight of the fourteen routinely used in US vaccination schedules measles, mumps, hepatitis,
Speaker 2: hepatitis B, chicken pox, niceria, meningititus, Streptoccus pneumonia, and Hemophilus influenzae.
Speaker 2: His vaccines have saved the lives of I don't even
Speaker 2: know if we have a number like countless people around
Speaker 2: the world and continue to prevent death and illness in
Speaker 2: millions annually. His name and work really should be more
Speaker 2: widely known, at least as well known as someone like
Speaker 2: Louis Pasturer or Jonas Salk or Alexander Fleming. And that's
Speaker 2: a part of the reason why I wanted to spend
Speaker 2: a little time talking about his life and what led
Speaker 2: up to the creation of the mumps vaccine. Unfortunately, several
Speaker 2: of the diseases for which Maurice developed these vaccines have
Speaker 2: been making a comeback over the last few decades due
Speaker 2: to a lack of access to vaccines, vaccine hesitancy or
Speaker 2: anti vaccine sentiment and waning immunity, and mumps is no exception.
Speaker 2: I so wish it were the case that the last
Speaker 2: chapter in the book of Monps was here's this life
Speaker 2: saving vaccine, everyone used it and Momps went away forever.
Speaker 2: Sadly that's not the case, So Aaron, tell me where
Speaker 2: we actually stand. What the most up to date chapter
Speaker 2: is on months today and what college campuses have to
Speaker 2: do with it.
Speaker 4: I can't wait.
Speaker 1: We'll take a quick break and then I'll let you know.
Speaker 1: Turns out, Aaron, college campuses have a lot to do
Speaker 1: with it.
Speaker 2: We're being honest, I thought, so.
Speaker 4: Yeah.
Speaker 1: While we've had a vaccine for MOMPS since, like you said,
Speaker 1: the nineteen sixties, MOMPS is not quite as common of
Speaker 1: a vaccine included in national immanization programs worldwide as things
Speaker 1: like measles, rubella, even polio. About fifty to sixty percent
Speaker 1: of countries, depending on which paper I read, include mumps
Speaker 1: in their national vaccine schedules. But in places where it
Speaker 1: has been very highly uptaken, I guess the effect was dramatic.
Speaker 1: Finland actually eliminated mumps entirely in the country for a
Speaker 1: while and only had imported cases here and there.
Speaker 2: It's so awesome. But also, your verb tenses are worrying.
Speaker 4: I know, yeah, they're they're valid.
Speaker 1: The US had a decline of like ninety nine percent.
Speaker 1: We were down in two thousand and one to less
Speaker 1: than point one case per one hundred thousand people. Like wow,
Speaker 1: from a million cases per year to less than point
Speaker 1: one per one hundred thousand people.
Speaker 2: That is, it's so great and I hate where this
Speaker 2: is going.
Speaker 1: Okay, Yeah, Since those numbers, which really I would say
Speaker 1: probably like peaked in the early two thousands in terms
Speaker 1: of overall effectiveness and decline of months cases, probably peak
Speaker 1: early two thousands, two thousand and one, et cetera. Since then,
Speaker 1: we have seen increasing numbers and an increase in sporadic
Speaker 1: outbreaks in the US, in Europe, which is highly vaccinated,
Speaker 1: and across the globe. The reasons for this are very multifactory,
Speaker 1: and what's interesting about these outbreaks, especially in the US,
Speaker 1: is that they tend to actually be among vaccinated individuals
Speaker 1: and not unvaccinated individuals as we saw with measles outbreaks
Speaker 1: several years ago.
Speaker 4: So it's likely that this.
Speaker 1: Idea of waning immunity that we talked about in the
Speaker 1: biology section likely plays a really big role when it
Speaker 1: comes to months that it plays less of a role
Speaker 1: as we see with other infections. So think more like protessis,
Speaker 1: which is another one we've already covered. Waning immunity leading
Speaker 1: to segments of populations that are now newly immune and
Speaker 1: therefore you.
Speaker 4: Can have an outbreak.
Speaker 1: This has happened on college campuses because nothing's wrong with
Speaker 1: college campuses, but it's just a place where all of
Speaker 1: this huge group of people all got vaccinated at around
Speaker 1: the same time, some proportion of them had waning immunity
Speaker 1: at around the same time, and they're in close quarters
Speaker 1: sharing saliva.
Speaker 4: And et cetera.
Speaker 1: Now you have an outbreak, right for an outbreak. So
Speaker 1: in the US we had outbreaks in two thousand and six,
Speaker 1: twenty sixteen, twenty seventeen, in twenty nineteen that were.
Speaker 4: All pretty big.
Speaker 1: Most of those had case numbers of over six thousand
Speaker 1: in these outbreaks twenty it's a lot, And in twenty
Speaker 1: nineteen the outbreak was over three thousand.
Speaker 2: Wow.
Speaker 4: Not all of this was college campuses.
Speaker 1: But a number of these outbreaks were associated with college campuses.
Speaker 1: Do you remember Aaron twenty sixteen Illinois.
Speaker 2: I was living in Panama that whole year.
Speaker 1: Oh well, it was University of Illinois and they were
Speaker 1: recommending MMR boosters for everyone.
Speaker 2: I think I do remember that vaguely, remember the emails
Speaker 2: at least.
Speaker 4: Yeah.
Speaker 1: Worldwide, it's hard to get great numbers. There have been
Speaker 1: outbreaks like this that number in the thousands in the UK,
Speaker 1: in other countries, in Europe, in Australia. It's hard to
Speaker 1: get a number globally, but one paper that I read
Speaker 1: estimated an global annual average of more than five hundred
Speaker 1: thousand cases between twenty five and twenty ten.
Speaker 2: Huh okay.
Speaker 1: So it's not like this is a virus that we
Speaker 1: have even come close to eliminating by any means.
Speaker 2: And it's human specific, so in.
Speaker 1: Theory, in theory, in theory. Arin part of the issue
Speaker 1: I think has been, in addition to perhaps issues of
Speaker 1: vaccine access which always come up, a number of countries
Speaker 1: had initially implemented national vaccine campaigns and then made them
Speaker 1: more like a volunteer and not as part of the
Speaker 1: national vaccine program.
Speaker 4: And part of.
Speaker 1: This had to do with these cases of aseptic meningitis.
Speaker 1: And so I want to kind of get into this
Speaker 1: a little bit more, especially because there has been polio
Speaker 1: in the news recently and this kind of relates to
Speaker 1: what we have seen with polio as well. So let
Speaker 1: me get into this idea that viruses can cause infection.
Speaker 1: If you have listened to our polio episode, we talked
Speaker 1: a lot about the fact that there are two different
Speaker 1: polio vaccines in the US. We used to use an
Speaker 1: oral polio vaccine across the globe. We used to use
Speaker 1: this exclusively an oral polio vaccine, and this is a
Speaker 1: live attenuated vaccine, highly effective. It was an oral vaccine,
Speaker 1: so easy to administer, and it replicated in our guts,
Speaker 1: which is how polio is transmitted its fecal oral So
Speaker 1: this oral vaccine conferred really good protection. And it was
Speaker 1: also possible for people to shed this live virus through
Speaker 1: their feces, which meant you could have passive immunization of say,
Speaker 1: household contacts through this fecal oral root of a non
Speaker 1: virulent strain of this virus.
Speaker 2: It's awesome.
Speaker 4: It's awesome.
Speaker 1: However, this non virulent strain can mutate potentially to become
Speaker 1: more virulent and actually cause disease, and so over time,
Speaker 1: as we massively decrease the number of polio cases, the
Speaker 1: risk benefit analysis of using this live attenuated vaccine shifted
Speaker 1: into the other direction, and so we no longer use
Speaker 1: the oral polio vaccine in the US and in a
Speaker 1: lot of other countries that have eliminated or greatly reduced polio.
Speaker 1: We now use an inactivated, injected polio virus vaccine. That's
Speaker 1: what we use in most of the world now when
Speaker 1: it comes to mumps, this exact of events has not
Speaker 1: been shown to happen. We don't have things like passive
Speaker 1: immunization and that.
Speaker 4: Sort of thing.
Speaker 1: We haven't seen outbreaks from the viral strain the way
Speaker 1: that we have in cases of polio. However, there have
Speaker 1: been case reports of aseptic meningitis, so inflammation occurring in
Speaker 1: the me ninja's importantly, not encephalitis, not inflammation in the
Speaker 1: brain itself, but aseptic meningitis from some strains of the vaccine.
Speaker 1: And so understandably this caused a lot of concern and
Speaker 1: led to the withdrawal of some of these vaccine strains
Speaker 1: and in some cases stopping vaccination for months entirely, or
Speaker 1: making it voluntary rather than part of a national immunization campaign,
Speaker 1: which has implications not only for like vaccine uptake and acceptance,
Speaker 1: but also a lot of times for funding. Countries don't
Speaker 1: fund it if it's not part of the national campaign.
Speaker 2: Yeah.
Speaker 1: One country where this happened, where these cases happened because
Speaker 1: of the particular vaccine strain that was used and then
Speaker 1: the national vaccine program stopped, was in Japan, and Japan
Speaker 1: now has one of the highest rates of months among
Speaker 1: high income countries, with over a million cases reported annually.
Speaker 4: As of twenty fifteen. So that's a huge issue. Yeah yeah, WHOA,
Speaker 4: I know.
Speaker 1: So I feel like what this comes down to, it's
Speaker 1: several different things. One, there are other strains of this vaccine,
Speaker 1: like the one that we use here in the US,
Speaker 1: that are not associated with aseptic meningeritis. I want to
Speaker 1: emphasize that the vast majority of strains that are used
Speaker 1: for this have not been associated with this and are very,
Speaker 1: very safe and well studied vaccines. The strains that have
Speaker 1: caused this generally are not used, and the cases all were,
Speaker 1: while scary, self limiting. But I do feel like this
Speaker 1: kind of touches on something that I think is important
Speaker 1: when it comes to a disease like mumps and a
Speaker 1: vaccine like the mumps vaccine that was developed many years ago.
Speaker 1: I think that this is a good example of why
Speaker 1: we can't be complacent, both in terms of like, we
Speaker 1: can't assume that a disease is gone just because we
Speaker 1: have a vaccine for it, right, Like, we don't know
Speaker 1: how long immunity is going to last when we come
Speaker 1: up with a vaccine, so it's quite possible that this
Speaker 1: could re emerge at a later date, so we shouldn't
Speaker 1: be complacent in that way. But we also shouldn't be
Speaker 1: complacent in terms of the vaccine itself. We have a vaccine,
Speaker 1: it's very effective, though the immunity might not last as
Speaker 1: long as we'd like, and it can prevent morbidity and mortality.
Speaker 1: But can we make it better? Can we make it
Speaker 1: we're safe? Can we make it more effective, especially as
Speaker 1: we are doing such a good job of reducing the
Speaker 1: population disease incidents overall? Can we make a more effective
Speaker 1: vaccine with less potential for side effects? So I think
Speaker 1: that that is kind of the place I'm most excited
Speaker 1: to see mumps research go in the future is towards
Speaker 1: maybe new vaccine research.
Speaker 4: Yeah, but I don't have an update on where we're
Speaker 4: at with it.
Speaker 2: No, But I agree that was really well put about complacency,
Speaker 2: Like there's yeah, we can still look forward. We don't
Speaker 2: have to be like, okay, like, yeah, our hands we're done.
Speaker 1: When we can't forget where we came from and why
Speaker 1: it was so important to begin with, and why it's
Speaker 1: still so important to get this vaccine. The full picture,
Speaker 1: the full picture, so that Aaron is the mumm ups
Speaker 1: the momps.
Speaker 2: Should we do sources?
Speaker 4: We should? We should do some sources.
Speaker 2: Okay, I have several, but I'm only going to shout
Speaker 2: out to. One is the Cambridge World History of Human Disease,
Speaker 2: the Months chapter, and the other is of course Vaccinated
Speaker 2: by Paul Offitt, which was also the source for our
Speaker 2: first hand account recommend great read.
Speaker 1: I had one particular favorite paper for the biology section
Speaker 1: and that was titled Months Got eleven Yeah, from the
Speaker 1: Lancet in two thousand and eight. I had a couple
Speaker 1: of others for more details on the pathogenesis, and then
Speaker 1: a number of papers on the epidemiology of months, especially
Speaker 1: in the era post vaccines. So you can find the
Speaker 1: list of our sources from this episode and all of
Speaker 1: our episodes on our website did we tell you about it?
Speaker 1: This podcast will kill you dot Com.
Speaker 2: Thank you toub Bloodmobile for providing the music for this
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Speaker 4: Thank you to the Exactly Right Network, and thank you
Speaker 4: to you listeners.
Speaker 2: We hope you liked this one. We hope you thought
Speaker 2: it was interesting. Yeah, did you learn more about Months
Speaker 2: than you ever thought you would?
Speaker 1: More than you wanted to, but you're so happy you did.
Speaker 4: And it's special. Thank you, as always to.
Speaker 1: Our patrons, thank you so so so much for your support.
Speaker 4: Yeah.
Speaker 2: Absolutely, Okay, Well, until next time, wash your hands
Speaker 4: You filthy animals.