WEBVTT - Ep 105 Down in the Mumps 0:00:03.080 --> 0:00:06.080 On March twenty third, nineteen sixty three, at one a m. 0:00:06.280 --> 0:00:09.520 Jerrol Lynn Hilliman woke up with a sore throat. Five 0:00:09.600 --> 0:00:13.640 years old, with penetrating blue eyes and an adorable pixie haircut. 0:00:14.120 --> 0:00:17.400 Jerl quietly tiptoed into her father's bedroom and stood at 0:00:17.400 --> 0:00:21.639 the foot of his bed. Daddy, she whispered. Hillman shook 0:00:21.680 --> 0:00:25.040 himself awake, rose to his full height of six feet 0:00:25.079 --> 0:00:28.159 one inch, bent down, and gently touched the side of 0:00:28.200 --> 0:00:31.520 his daughter's face. There, at the angle of her jaw, 0:00:31.640 --> 0:00:35.280 he felt a lump. Jerrel winced in pain. At the 0:00:35.280 --> 0:00:38.200 time of his daughter's illness, Hilliman was a single father. 0:00:38.880 --> 0:00:42.120 Four months earlier, his wife, Thelma, had died of breast cancer. 0:00:42.760 --> 0:00:45.960 Although he wasn't sure what was happening to Jerrel, Hilliman 0:00:46.120 --> 0:00:49.000 had a pretty good idea. Near his bed was a 0:00:49.040 --> 0:00:52.879 book titled The Murk Manual, a simply written compendium of 0:00:52.960 --> 0:00:56.680 medical information. Thumbing through it, he soon found what he 0:00:56.720 --> 0:00:59.959 was looking for. Oh my god, he said, you've got 0:01:00.080 --> 0:01:03.960 the mumps. Then Hilliman did something that few fathers would 0:01:04.000 --> 0:01:06.920 have done. He walked down the hallway, knocked on the 0:01:06.920 --> 0:01:09.520 housekeeper's door, and told her that he'd be gone for 0:01:09.560 --> 0:01:12.679 a while. Then he went back to his bedroom, picked 0:01:12.760 --> 0:01:15.280 up his daughter and put her back to bed. I'll 0:01:15.280 --> 0:01:17.959 be back in about an hour, he said, Where are 0:01:18.000 --> 0:01:21.360 you going? Daddy asked Jeryl to work, but I won't 0:01:21.360 --> 0:01:25.120 be long. Hileiman got into his car and drove fifteen 0:01:25.120 --> 0:01:28.840 miles to Murk. He rummaged around his laboratory, opening and 0:01:28.880 --> 0:01:32.280 closing drawers until he found cotton swabs and a vial 0:01:32.360 --> 0:01:36.039 of straw colored nutrient broth. By the time he got home, 0:01:36.120 --> 0:01:39.080 Jeryl had fallen back to sleep, so he gently touched 0:01:39.080 --> 0:01:41.920 her shoulder, woke her up, stroked the back of her 0:01:41.959 --> 0:01:44.720 throat with a cotton swab, and inserted it into the 0:01:44.800 --> 0:01:48.800 vial of broth. Then he comforted her, drove back to work, 0:01:49.120 --> 0:01:52.480 put the nutrient broth in a laboratory freezer, and drove home. 0:01:53.320 --> 0:01:57.200 Most parents thought that mumps was a mild, short lived illness, 0:01:57.480 --> 0:02:00.640 but Hilliman knew better. He was scared aird about what 0:02:00.720 --> 0:02:03.840 might happen to his daughter. Although he knew that it 0:02:03.920 --> 0:02:06.880 was too late for gerald, Hillman wanted to find a 0:02:06.920 --> 0:02:10.520 way to prevent mumps. He decided to use his daughter's 0:02:10.639 --> 0:02:58.880 virus to do it. 0:02:58.880 --> 0:03:03.960 It's a level good it's so exciting. It's amazing. 0:03:04.520 --> 0:03:07.280 I also just love what a nerd he was that 0:03:07.400 --> 0:03:10.680 he slept next to the murkmanual like had it on 0:03:10.720 --> 0:03:11.800 his bedside table. 0:03:12.240 --> 0:03:15.519 Maurice, it's amazing. As if you don't do the same thing, 0:03:15.560 --> 0:03:16.800 Aaron coming, I have a. 0:03:16.720 --> 0:03:20.240 Stack of medical books on my bedside table right now. 0:03:20.400 --> 0:03:20.880 See. 0:03:21.160 --> 0:03:23.480 Yeah, I know it's embarrassing. Nerds unite. 0:03:25.800 --> 0:03:31.720 That amazingly written story is true. Story is from the 0:03:31.720 --> 0:03:36.120 book Vaccinated, One Man's Quest to Defeat the World's Deadliest 0:03:36.120 --> 0:03:42.080 Diseases by Paul Offitt, and it is about Maurice Hillman, Yeah, 0:03:42.320 --> 0:03:46.000 who played a big part, a huge part, a crucial part, 0:03:46.400 --> 0:03:49.240 as well as his daughter in the creation of the 0:03:49.520 --> 0:03:53.080 momp's vaccine, which is the subject of today's episode. 0:03:53.200 --> 0:03:54.320 It sure is. Hi. 0:03:54.640 --> 0:03:56.040 I'm Aaron Welsh. 0:03:55.760 --> 0:03:56.800 And I'm Aaron Allman. 0:03:56.920 --> 0:04:00.000 Updyke and this is this podcast will kill you. 0:04:00.080 --> 0:04:04.800 We're really excited to be bringing back yet another of 0:04:05.000 --> 0:04:07.160 the vaccine preventable diseases. 0:04:07.720 --> 0:04:10.760 We sure are. I mean, this is the last of 0:04:11.000 --> 0:04:13.640 the MMR that we needed to cover. 0:04:13.960 --> 0:04:16.320 Mm hmm yeah. The other M. We've got it, the 0:04:16.360 --> 0:04:17.120 other M. 0:04:17.440 --> 0:04:22.279 Yeah, speaking of the other M, what are we drinking 0:04:22.320 --> 0:04:22.799 this week. 0:04:23.000 --> 0:04:26.480 That's what we're drinking the other m M. 0:04:27.200 --> 0:04:31.320 I feel like most people when they think of MMR, 0:04:31.520 --> 0:04:34.560 it's sort of all blurred together, right, it's measles, mumps, rebella. 0:04:34.720 --> 0:04:38.040 You barely take a breath between them or ye apause 0:04:38.320 --> 0:04:41.240 it's just all one word. But I also kind of 0:04:41.240 --> 0:04:45.240 think that maybe measles springs to mind first for most people. 0:04:46.160 --> 0:04:48.279 I think it depends on the generation. I think that 0:04:48.320 --> 0:04:52.080 there's a good chunk of people who remember mumps more 0:04:52.120 --> 0:04:56.200 than anything because of some of its distinctive signs. But yeah, 0:04:56.240 --> 0:04:58.839 measles I think steals the show in that vaccine. 0:04:59.200 --> 0:05:02.200 Yeah, maybe it's because of there have been more recent 0:05:02.279 --> 0:05:05.440 outbreaks of measles, although there have been recent outbreaks of 0:05:05.560 --> 0:05:11.120 mumps done. So, yeah, we are drinking the other m 0:05:11.200 --> 0:05:14.159 in any case, And in the other m it's a 0:05:14.160 --> 0:05:18.359 tasty little concoction with bourbon sage, simple syrup because my 0:05:18.400 --> 0:05:22.440 garden has way too much sage, and some orange tossed 0:05:22.480 --> 0:05:22.839 in there. 0:05:23.200 --> 0:05:26.320 Yeah, delicious, I can't wait. It's very early fall. 0:05:26.480 --> 0:05:30.080 Fantastic and we will post the full recipe for the 0:05:30.200 --> 0:05:33.760 quarantini as well as the non alcoholic plusy Brita on 0:05:33.800 --> 0:05:36.240 our website this podcast will kill you dot com as 0:05:36.279 --> 0:05:38.480 well as on all of our social media channels. 0:05:38.800 --> 0:05:41.920 We sure will on our website this podcast will kill 0:05:41.960 --> 0:05:44.560 you dot Com. You all know how many amazing things 0:05:44.560 --> 0:05:46.920 you can find there. Do we even do this anymore? 0:05:47.000 --> 0:05:50.120 We've skipped it a few times. Check out our website. 0:05:51.240 --> 0:05:54.279 I like it, and I don't think there's any more business. 0:05:54.320 --> 0:05:58.360 So can we dive into the last of the MMR. 0:05:58.360 --> 0:05:59.960 I am really excited to do it. 0:06:00.200 --> 0:06:28.840 Let's take a quick break and then we'll get into it. 0:06:29.400 --> 0:06:34.600 So mumps mumps. Mumps is the disease. 0:06:34.720 --> 0:06:37.440 That's the name of the disease that's caused by a 0:06:37.560 --> 0:06:41.120 virus that is named the same thing, the mumps virus, 0:06:42.000 --> 0:06:46.400 which I think we've covered a number of viruses whose disease. 0:06:46.240 --> 0:06:47.280 Are named the same thing. 0:06:47.360 --> 0:06:50.840 But I don't know why I expected mumps virus to 0:06:50.839 --> 0:06:54.400 be named something different, like something more virus sounding. 0:06:55.040 --> 0:06:55.880 That's a good point. 0:06:56.240 --> 0:06:59.640 Yeah, the mumps virus, it causes mumps. 0:07:00.240 --> 0:07:03.160 What I mean, surely it has like a virus family 0:07:03.200 --> 0:07:06.320 and oh stuff like that. That sounds a little more professional. 0:07:06.560 --> 0:07:07.679 We can do that. Of course. 0:07:07.720 --> 0:07:11.960 It's in the family paramixa Viridae. There we go, which is, 0:07:12.240 --> 0:07:15.240 as it turns out, the same family as the measles virus, 0:07:15.440 --> 0:07:19.280 as well as parainfluenza, canine dis temper rsv a whole 0:07:19.320 --> 0:07:22.440 bunch of other viruses that are pathogenic to humans as 0:07:22.480 --> 0:07:26.680 well as our dogs. Mumps virus has a single stranded 0:07:26.960 --> 0:07:27.880 RNA genome. 0:07:28.400 --> 0:07:30.200 It's an enveloped. 0:07:29.840 --> 0:07:33.080 Virus, so outside its little protein capsid, it has this 0:07:33.280 --> 0:07:36.920 lipid and glycoprotein envelope that helps it evade. 0:07:36.560 --> 0:07:37.640 Our immune response. 0:07:38.520 --> 0:07:40.520 And from what I could tell, there are at least 0:07:40.800 --> 0:07:45.920 twelve different genotypes of this virus that do vary geographically, 0:07:46.640 --> 0:07:52.080 but it's unclear whether these genotypes vary that much in virulence, 0:07:53.120 --> 0:07:55.560 probably not substantially, at least as far as we know 0:07:55.680 --> 0:07:59.680 so far. Zero type wise, If you remember in our 0:08:00.040 --> 0:08:03.160 dosporosis episode, I talked a little bit about the differences 0:08:03.240 --> 0:08:07.200 between like what is this zerotype, et cetera. Right, So, 0:08:07.360 --> 0:08:12.240 zerotypes are things that vary based on their outside surface proteins, 0:08:13.160 --> 0:08:16.640 and so we can categorize them based on different epidemic 0:08:16.720 --> 0:08:20.280 outbreaks and things like that, based on different zerotypes or 0:08:20.360 --> 0:08:24.520 zero VARs. And in the case of mumps, it doesn't 0:08:24.520 --> 0:08:26.960 seem like there are a lot of different zerotypes, but 0:08:27.000 --> 0:08:31.320 there are differences in their genes. So there are different genotypes, 0:08:31.600 --> 0:08:35.319 but it's unclear how much these genetic differences really translate 0:08:35.360 --> 0:08:38.440 to differences in the virus and how it interacts with 0:08:38.480 --> 0:08:41.200 our immune system and causes disease, if that makes sense. 0:08:41.480 --> 0:08:45.679 Yeah, okay. So, for instance, when it comes to different zerotypes, 0:08:45.840 --> 0:08:48.880 you might not have cross protection or as much cross 0:08:48.920 --> 0:08:52.200 protection from one compared to the other because the surface 0:08:52.240 --> 0:08:56.040 protein is different, and your immune system might not recognize 0:08:56.120 --> 0:08:59.520 a different zerotype that you haven't previously been infected with 0:09:00.280 --> 0:09:03.920 different genotypes. You could be infected with one and then 0:09:03.960 --> 0:09:07.160 your immune system would recognize another because of surface proteins 0:09:07.200 --> 0:09:08.720 aren't substantially different. 0:09:08.640 --> 0:09:09.439 Right exactly. 0:09:09.520 --> 0:09:14.040 Yeah, okay, Okay, that's it, more succinct summary than my blathering. 0:09:14.160 --> 0:09:17.320 Yeah. I feel like I went on and on, but 0:09:17.440 --> 0:09:19.280 I think that that makes a lot of sense, and 0:09:19.320 --> 0:09:22.520 I think that's really interesting from both a public health 0:09:22.520 --> 0:09:24.640 perspective as well as an evolutionary perspective. 0:09:25.200 --> 0:09:28.840 Yeah, yeah, exactly, And vaccines and vaccines. 0:09:29.320 --> 0:09:33.280 So, mumps is a human specific virus. It does not 0:09:33.360 --> 0:09:38.080 infect other animals naturally, just humans, and it's a very 0:09:38.120 --> 0:09:43.120 contagious disease the rn not, which we haven't talked about 0:09:43.240 --> 0:09:44.120 for a long time. 0:09:44.520 --> 0:09:45.880 I'm excited to bring it back. 0:09:46.880 --> 0:09:49.280 The rn knot is a number that is used in 0:09:49.360 --> 0:09:55.920 epidemiology to estimate the average number of infections that result 0:09:56.080 --> 0:10:01.360 from a single infection in an entirely susceptible population. 0:10:01.960 --> 0:10:04.720 I feel like we all know are not from COVID now. 0:10:04.800 --> 0:10:05.199 I know. 0:10:06.160 --> 0:10:07.959 Now it's been two and a half years, so people 0:10:08.040 --> 0:10:13.720 might have forgotten, you know what I mean? But yes, 0:10:13.960 --> 0:10:17.600 little refresher, But this is an estimate, so it can vary, right, 0:10:17.679 --> 0:10:20.640 depending on the population and the study that you're doing. 0:10:20.960 --> 0:10:24.800 So four months, the average is estimated at around four 0:10:24.840 --> 0:10:28.920 point four, so every one case results in four and 0:10:28.920 --> 0:10:33.599 a half ish additional cases. But depending on the population, 0:10:34.120 --> 0:10:39.240 that can vary from three to ten. Wow, yeah in 0:10:39.240 --> 0:10:42.720 different studies. So potentially up to one person can infect 0:10:43.080 --> 0:10:45.360 up to ten people in some studies. 0:10:45.880 --> 0:10:48.520 Ah okay, that's very contagious. 0:10:48.679 --> 0:10:54.240 Very contagious. And transmission is by primarily respiratory droplets as 0:10:54.320 --> 0:10:58.520 well as close contact in general, because respiratory droplets are 0:10:58.760 --> 0:11:02.880 generally close content tech transmission as well as potentially foam 0:11:02.880 --> 0:11:06.000 mites or surfaces like door knobs, or pillows or whatever 0:11:06.040 --> 0:11:08.040 that become contaminated. 0:11:07.720 --> 0:11:10.920 And that would be contaminated through your saliva exactly. 0:11:11.000 --> 0:11:12.719 It's very much like influenza. 0:11:13.280 --> 0:11:17.160 And how durable is this virus in the environment? 0:11:17.440 --> 0:11:18.160 Great question. 0:11:18.240 --> 0:11:21.640 I actually didn't see any data on that, so I 0:11:21.679 --> 0:11:26.679 do not know. Okay, yeah, yeah, good question though, But yeah, 0:11:26.720 --> 0:11:29.560 it can be transmitted that way. So it's very much 0:11:29.640 --> 0:11:33.520 like influenza and a lot of other crowd diseases that 0:11:33.559 --> 0:11:37.160 we've covered. And also, like a lot of those diseases, 0:11:37.600 --> 0:11:41.719 people become contagious or infectious at least a day or 0:11:41.720 --> 0:11:47.400 two before their symptoms start. And virus has been isolated 0:11:47.480 --> 0:11:52.280 from saliva and nasal mucosa up to a week before 0:11:52.320 --> 0:11:55.400 symptoms start, w which is terrifying. 0:11:55.520 --> 0:11:56.880 Yeah, h okay. 0:11:57.760 --> 0:11:59.960 Question how long is the incubation period? 0:12:00.040 --> 0:12:02.920 The great question. It's very long. 0:12:03.200 --> 0:12:06.120 It's between fifteen to twenty four days, so like two 0:12:06.120 --> 0:12:07.160 to three weeks. 0:12:07.440 --> 0:12:11.000 That is so interesting. Why is it so long? 0:12:11.160 --> 0:12:13.200 I don't know, arin I have a lot of I 0:12:13.240 --> 0:12:18.640 don't knows about mumps. So once we get exposed to 0:12:18.720 --> 0:12:22.640 the virus, let's say a couple of toddlers at preschool 0:12:23.080 --> 0:12:23.800 breathing on. 0:12:23.720 --> 0:12:26.000 Each other like they do yeap. 0:12:26.720 --> 0:12:30.360 The virus then predominantly infects the cells that line our 0:12:30.440 --> 0:12:34.240 respiratory tract, or at least initially begins to infect those cells, 0:12:34.440 --> 0:12:37.920 especially the upper respiratory tract. Usually doesn't make its way 0:12:37.960 --> 0:12:41.280 into our lungs, not causing like a lower respiratory infection. 0:12:42.400 --> 0:12:45.320 And then one of the primary cell types that it 0:12:45.480 --> 0:12:49.840 infects and begins to replicate within is our parotid glands. 0:12:50.520 --> 0:12:53.080 Our parotid glands are a pair of salivary glands in 0:12:53.120 --> 0:12:55.440 your cheeks, kind of like back near the angle of 0:12:55.480 --> 0:13:02.640 your jaw. And this infection of this glandular epithelium that's 0:13:02.679 --> 0:13:06.559 the cells that are lining the glands like in your 0:13:06.559 --> 0:13:10.320 parodid glands, leads to what's called a paratitis that just 0:13:10.360 --> 0:13:14.360 means inflammation of these glands, and that is what leads 0:13:14.400 --> 0:13:18.720 to one of the hallmark symptoms of Mump's infection, which 0:13:18.800 --> 0:13:24.640 are super super swollen cheeks. But this is not a 0:13:24.720 --> 0:13:29.760 virus that only infects our parodid glands. It can infect 0:13:29.800 --> 0:13:34.360 a variety of glandular epithelial cells. It can infect our 0:13:34.480 --> 0:13:38.280 respiratory epithelium of course, it can infect our central nervous 0:13:38.320 --> 0:13:42.960 system and wherever it goes. What it does is essentially 0:13:43.240 --> 0:13:47.960 replicate a lot, and this replication causes a lot of 0:13:48.040 --> 0:13:52.640 local inflammation infiltrates of our white blood cells trying to 0:13:52.679 --> 0:13:56.880 fight off this virus by killing those infected cells, which 0:13:56.920 --> 0:14:01.199 can then lead to hemorrhage or necrosis of various tissues 0:14:01.320 --> 0:14:07.800 within these organs and significant swelling and potentially increased pressure 0:14:08.320 --> 0:14:13.520 in these various glands. So what we see with infection 0:14:13.679 --> 0:14:16.440 with a mumps virus is both direct damage from the 0:14:16.559 --> 0:14:19.720 virus replicating in ourselves, but also a lot of indirect 0:14:19.800 --> 0:14:24.120 damage from our immune response to such a highly proliferative virus. 0:14:24.520 --> 0:14:31.080 Okay questions, Okay, why does it go where it goes, 0:14:32.040 --> 0:14:35.120 especially like the central nervous system and outside of the 0:14:35.120 --> 0:14:37.200 salivary glands and respiratory tract. 0:14:37.640 --> 0:14:38.480 Great questions. 0:14:39.000 --> 0:14:41.960 So what's very interesting is that one of the papers 0:14:42.000 --> 0:14:45.120 I read suggested that mumps virus actually has a very 0:14:45.240 --> 0:14:49.000 high We've talked on this podcast about tissue tropisms, so 0:14:49.320 --> 0:14:54.480 particular tissue types that viruses are very good at infecting, 0:14:55.560 --> 0:14:59.760 and in animal models, mumps virus actually has a very 0:15:00.080 --> 0:15:04.200 wrong tissue tropism for nervous tissue, so it invades and 0:15:04.240 --> 0:15:07.960 replicates really well in nervous tissue in animal models, but 0:15:08.240 --> 0:15:12.680 in humans we actually don't see very common. It's not 0:15:12.760 --> 0:15:17.160 the hallmark symptom to have neurologic involvement, as we'll talk about, 0:15:17.200 --> 0:15:21.320 you definitely can, but primarily it seems to infect these 0:15:21.640 --> 0:15:26.600 other epithelial cell layers. Why does it have a particular 0:15:26.640 --> 0:15:30.360 tropism for these glandular epithelial cells. I don't have an 0:15:30.400 --> 0:15:34.360 answer for you. And what's very interesting is that it 0:15:34.440 --> 0:15:39.440 really is these parodied glands specifically that are the hallmark 0:15:40.080 --> 0:15:42.600 and other salivary glands. Because our parodids are not our 0:15:42.600 --> 0:15:45.560 only salivary glands. We have others under our mandible and 0:15:45.680 --> 0:15:50.600 under our tongue. Those tend to not be infected at 0:15:50.680 --> 0:15:56.520 least not without also having parodid gland involvement. Like it's 0:15:56.560 --> 0:15:58.080 much less common. Does that make sense? 0:15:58.280 --> 0:15:58.720 Yeah? 0:15:58.760 --> 0:15:59.920 How fascinating. 0:16:00.280 --> 0:16:03.920 Yeah, And I will talk about this isn't restricted to 0:16:03.960 --> 0:16:06.800 that glandular epithelium. It can infect epithelial cells in a 0:16:06.880 --> 0:16:09.560 lot of other organs as well, And I think it 0:16:09.680 --> 0:16:12.480 just as a matter of does it manage to make 0:16:12.520 --> 0:16:15.280 it all the way to those organs evading our immune 0:16:15.320 --> 0:16:18.000 response on its way there and then if it does, 0:16:18.080 --> 0:16:20.280 then it can set up shop and just replicate like 0:16:20.320 --> 0:16:21.680 it does in our parodids. 0:16:22.160 --> 0:16:28.600 One more quick question, Okay, how does infectivity change throughout 0:16:28.600 --> 0:16:30.320 the duration of infection? 0:16:30.800 --> 0:16:34.920 Yeah, you're most infectious those couple of days before symptoms 0:16:34.960 --> 0:16:42.040 start and then for the first week ish after that. Okay, Yeah, 0:16:42.080 --> 0:16:44.800 but we know that virus can be detected for up 0:16:44.800 --> 0:16:47.440 to a week before symptoms, and I think for even 0:16:47.520 --> 0:16:51.280 longer than a week after symptoms begin. But the most 0:16:51.480 --> 0:16:53.800 highly infectious time seems to be that kind of more 0:16:53.920 --> 0:16:56.600 narrow time window of just before symptoms start and for 0:16:57.040 --> 0:17:00.680 a few days maybe up to a week after. Okay, yeah, 0:17:00.960 --> 0:17:03.200 so let's talk about what those symptoms actually look like, 0:17:03.200 --> 0:17:07.520 shall we. Yeah, just talked about this virus itself, talk 0:17:07.560 --> 0:17:11.359 about what's happening to us. So first of all, and 0:17:11.440 --> 0:17:13.879 this kind of like messes up what I just said 0:17:13.920 --> 0:17:17.679 Aaron about the product lands. But thirty percent of the 0:17:17.760 --> 0:17:22.639 time this is an asymptomatic infection, right yeah, yeah, which 0:17:22.680 --> 0:17:26.360 I did not know, and I feel like it makes 0:17:26.400 --> 0:17:29.320 it that much more terrifying considering how long the incubation 0:17:29.400 --> 0:17:33.560 period is, how much you can shed before symptoms even start, 0:17:33.600 --> 0:17:39.240 how much are asymptomatic carriers contributing to spread. Ooh scary, 0:17:39.520 --> 0:17:43.080 but yeah, okay, but that's thirty percent. So let's talk 0:17:43.080 --> 0:17:46.959 about the other seventy shall we? In that seventy ish 0:17:46.960 --> 0:17:51.000 percent of people who become symptomatic, the infection usually starts 0:17:51.040 --> 0:17:55.119 with a little bit of a fever, but not like 0:17:55.960 --> 0:17:59.199 I'm laid out, I'm feverish, I'm so ill. It's just 0:17:59.240 --> 0:18:03.919 like feeling right down, maybe not having much of an appetite, 0:18:03.960 --> 0:18:08.960 often having a headache, feeling sick, and then over two 0:18:09.080 --> 0:18:13.600 to three days is when that hallmark sign of paratitis begins. 0:18:14.600 --> 0:18:19.640 The parotid glands can get so big that they actually 0:18:19.840 --> 0:18:22.920 lift up your ear lobe kind of up and out, 0:18:22.960 --> 0:18:25.840 and you completely lose that angle of the jaw. If 0:18:25.880 --> 0:18:30.600 you look at pictures of people with mumps, it it's 0:18:30.640 --> 0:18:33.159 hard for me to describe well, but you just really 0:18:34.640 --> 0:18:37.040 have two ginormous chipmunk cheeks. 0:18:37.760 --> 0:18:39.959 Also, if you've watched Brooklyn nine to nine, there's an 0:18:40.000 --> 0:18:44.960 episode oh where Jake and Captain Holt get mumps. Yeah, 0:18:45.000 --> 0:18:47.720 I forgot about it, and they name them. They name 0:18:47.840 --> 0:18:49.960 their big swollen lumps. 0:18:50.080 --> 0:18:52.359 That's hilarious. How accurate is it. Well, let me go 0:18:52.400 --> 0:18:53.199 through and you'll tell me. 0:18:53.440 --> 0:18:55.320 I can't. I mean, it's been a long time, but 0:18:55.400 --> 0:18:57.560 it's it's yeah, it's been a long time since I've 0:18:57.560 --> 0:18:59.840 watched it, but yeah. 0:19:00.080 --> 0:19:02.920 And this swelling can persist for up to an entire week, 0:19:03.440 --> 0:19:08.520 and it is incredibly painful. It's a very very inflamed organ. 0:19:08.640 --> 0:19:13.040 It's super tender. Ninety percent of the time, it's bilateral, 0:19:13.200 --> 0:19:17.119 so you're miserable on both sides, and usually it starts 0:19:17.160 --> 0:19:19.119 on one side and then the second side takes a 0:19:19.119 --> 0:19:20.560 couple extra days to come in. 0:19:21.119 --> 0:19:23.840 That part is accurate from Brooklyn nine nine. Oh sure, 0:19:24.000 --> 0:19:24.600 I love that. 0:19:26.040 --> 0:19:29.840 And ninety five percent of people who show symptoms do 0:19:30.200 --> 0:19:34.600 have this paratitis, so it is very, very classic. The 0:19:35.000 --> 0:19:39.679 testes are another very common sight of Mump's infection, especially 0:19:39.800 --> 0:19:45.119 in post pubertal people with testes. Fifteen to thirty percent 0:19:45.400 --> 0:19:48.800 of post pubertal people with testes can get an infection 0:19:49.280 --> 0:19:55.560 that is often an epididymmo orchitis. Oh gosh, it's both 0:19:55.600 --> 0:19:57.720 epididymitis and orchitis. 0:19:57.960 --> 0:19:59.600 So let me tell you what those two things are, 0:19:59.640 --> 0:20:00.520 shall we? Yeah? 0:20:00.680 --> 0:20:04.240 Yeah, So these symptoms often start several days to a 0:20:04.320 --> 0:20:06.560 week after the paratitis. 0:20:08.000 --> 0:20:10.720 It is possible to get it without. 0:20:10.160 --> 0:20:14.400 That parodid gland swelling, but it's much less common and 0:20:14.680 --> 0:20:18.000 it's two different things that can happen. First, it's an orchitis, 0:20:18.119 --> 0:20:22.360 which is inflammation of the testes themselves, the sperm producing 0:20:22.400 --> 0:20:27.840 little oval structures in the scrotum. With that inflammation, think 0:20:27.880 --> 0:20:31.760 of it just like your parodid glands. It's swelling, its warmth, 0:20:32.080 --> 0:20:37.920 its tenderness, extreme tenderness because of all this inflammation. Then 0:20:38.000 --> 0:20:40.560 on top of that, you can also get an epididymitis, 0:20:40.640 --> 0:20:44.000 which is inflammation of the epididymis, which is the tube 0:20:44.040 --> 0:20:48.560 that carries sperm away from the testies themselves and kind 0:20:48.600 --> 0:20:52.399 of stores the sperm as well. And with that you 0:20:52.600 --> 0:21:00.720 usually also see more general constitutional symptoms like a worsen fever, headache, vomiting, 0:21:00.840 --> 0:21:06.359 just overall looking a lot sicker. So that's very miserable. 0:21:07.080 --> 0:21:11.800 In terms of the long term effects of this epididimo orchitis, 0:21:12.840 --> 0:21:16.320 it seems still controversial from what I could tell, whether 0:21:16.440 --> 0:21:21.199 there is a long term association with like infertility or 0:21:21.240 --> 0:21:25.600 subfertility or reduced sperm production. There are some studies that 0:21:25.760 --> 0:21:31.760 do suggest a small decrease in testicular size and or 0:21:31.920 --> 0:21:36.760 abnormalities in spermatograms, whether that be sperm count, sperm morphology, 0:21:36.880 --> 0:21:40.960 or sperm motility. But this is only in a percentage 0:21:41.000 --> 0:21:43.040 of people, and it doesn't seem like we have great 0:21:43.119 --> 0:21:45.680 data on how common this is or what the real 0:21:45.680 --> 0:21:48.160 effects of this are, Like why is this causing. 0:21:47.920 --> 0:21:49.320 More long term effects? 0:21:50.520 --> 0:21:53.639 Ovaries can also be affected, but it tends to be 0:21:53.720 --> 0:21:59.280 much less common. About five percent of post pubertal or 0:21:59.320 --> 0:22:05.040 reproductive AID people with ovaries get oopharitis, So again just inflammation, 0:22:05.400 --> 0:22:09.480 same situation happening, but in the ovaries. You have a question, 0:22:09.680 --> 0:22:11.520 like your face is saying like why and I don't 0:22:11.520 --> 0:22:11.880 know why? 0:22:11.960 --> 0:22:14.359 So, yeah, why is it less common? Is really what 0:22:14.400 --> 0:22:15.120 I was gonna ask. 0:22:15.240 --> 0:22:18.280 I wonder if it has anything to do with like 0:22:18.400 --> 0:22:22.719 differences in body temperature or something like the testes and 0:22:22.800 --> 0:22:25.600 the salivary glands are in a very different place in 0:22:25.640 --> 0:22:27.960 your body, in your abdomen, But I don't know, because 0:22:27.960 --> 0:22:30.639 they can also replicate in your kidneys just fine. So 0:22:30.720 --> 0:22:33.280 maybe it's just that it's a more indirect route to 0:22:33.280 --> 0:22:35.840 try and get there for the virus. 0:22:36.160 --> 0:22:38.280 I don't have an answer for. Yeah, do we just 0:22:38.520 --> 0:22:43.040 diagnose it less. I don't know, I don't know. I 0:22:43.040 --> 0:22:43.879 don't have an answer. 0:22:45.320 --> 0:22:51.520 Interesting now, all of those symptoms are horrible, they're painful. 0:22:52.880 --> 0:22:56.719 They may or may not cause residual symptoms in the 0:22:56.720 --> 0:23:00.159 case of an architis or an epidemitis, but they do 0:23:00.280 --> 0:23:04.760 tend to be self limiting in all those cases. The 0:23:04.920 --> 0:23:08.080 problem with mumps virus is that it can also infect 0:23:08.160 --> 0:23:10.480 the central nervous system, and it can result in a 0:23:10.520 --> 0:23:16.119 meningitis or an encephalitis. It is rare. Most estimates I 0:23:16.160 --> 0:23:20.280 saw suggested that about five to ten percent of cases 0:23:20.280 --> 0:23:24.000 of mumps will cause a meningitis, although one World Health 0:23:24.080 --> 0:23:28.480 Organization articles suggested up to fifteen percent and less than 0:23:28.640 --> 0:23:33.359 half a percent point five percent cause encephalitis, which is 0:23:33.800 --> 0:23:34.600 the worst one. 0:23:34.960 --> 0:23:38.320 Five to ten percent still seems pretty dang high. 0:23:38.400 --> 0:23:44.159 It is absolutely and apparently up to half of the 0:23:44.240 --> 0:23:47.159 time with a meningitis. It can happen even without that 0:23:47.240 --> 0:23:50.560 parodied land swelling and infection, so you might not have 0:23:50.680 --> 0:23:53.639 had that as a preceding symptom. To know that this 0:23:53.720 --> 0:23:56.879 meningitis is likely related to the mumps, if that makes sense, 0:23:58.160 --> 0:24:01.280 and if that's not enough that it can happen without 0:24:01.400 --> 0:24:04.119 even the product land swelling. It can also happen in 0:24:04.160 --> 0:24:07.240 any order, so you can see meningitis that starts before 0:24:07.359 --> 0:24:13.160 salivary gland involvement or after salivary gland involvement. Okay, Now, 0:24:13.400 --> 0:24:18.320 mumps meningitis is a more severe infection. You can see 0:24:18.359 --> 0:24:23.440 things like high high fevers, headaches, vomiting, all the scary 0:24:23.600 --> 0:24:27.280 kind of meningial signs when you have inflammation of these 0:24:27.359 --> 0:24:31.360 mening's lining your nervous system, like stiff neck. 0:24:31.320 --> 0:24:32.119 Like lethargy. 0:24:32.840 --> 0:24:39.359 But in general, very low mortality from mumps meningitis and 0:24:39.600 --> 0:24:44.160 very little long term issues and problems that arise as 0:24:44.200 --> 0:24:47.200 the result of this meningitis, which is really in contrast 0:24:47.240 --> 0:24:49.959 to other causes of meningitis. 0:24:51.160 --> 0:24:54.520 However, there's always a however, there's always a. 0:24:54.480 --> 0:24:59.399 However, there can be a progression to encephalitis, which is 0:24:59.440 --> 0:25:03.280 inflammation happening in the brain itself, in the parankama of 0:25:03.320 --> 0:25:06.520 the brain, and that does lead to the potential for 0:25:06.640 --> 0:25:12.520 severe and lasting damage, including seizures, behavioral changes. Hearing loss 0:25:13.600 --> 0:25:17.720 asterisk Hearing loss is actually a well known complication of 0:25:17.800 --> 0:25:21.400 mumps that happens in about four percent of cases overall, 0:25:21.440 --> 0:25:26.520