Speaker 1: The disease began in various ways, but commonly with chills
Speaker 1: and heats, pressure and pain in the head, soreness of
Speaker 1: throat and hoarseness, some cough, sickness of the stomach, frequent
Speaker 1: vomiting and purging. These symptoms occurred more frequently in children
Speaker 1: and were then very severe in adults. They were less
Speaker 1: emphatically expressed, commonly on the uvula, tonsils, vellum platinum, and
Speaker 1: back part of the pharynx, several whitish or ash colored
Speaker 1: spots appeared scattered up and down, which oftentimes increased very fast,
Speaker 1: soon covering one or both of the tonsils. These eventually
Speaker 1: proved to be the sluffs of superficial ulcers. The tongue,
Speaker 1: at this time, though only white and moist at the top,
Speaker 1: was very foul at the root and covered with a
Speaker 1: thick yellowish or brown coat. The breath also now began
Speaker 1: to be very nauseous. The offensive smell increased hourly, and
Speaker 1: in some instances became quite intolerable even to the patients themselves.
Speaker 1: By the second or third day, the sleuths were much
Speaker 1: enlarged and of a darker color, and the surrounding parts
Speaker 1: tended much more to a livid hue. The breathing became
Speaker 1: more difficult, with a kind of rattling stirter, as if
Speaker 1: the patient was actually strangling, the voice being exceedingly hoarse
Speaker 1: and hollow.
Speaker 2: Wow.
Speaker 1: Yeah, it's pretty intense. So is the sound like to you?
Speaker 2: Sounds like diphtheria.
Speaker 1: That's right, the topic of today's episode.
Speaker 2: All right, Hi, I'm erin Welsh and I'm erin Almond Updyke, and.
Speaker 1: You are listening to this podcast Will Kill You Dip
Speaker 1: Theory Edition.
Speaker 2: Yep, So I'm really excited.
Speaker 1: I am really thrilled.
Speaker 2: You've been talking about this one for a while now,
Speaker 2: I know.
Speaker 1: And there's also there's been something in my part that
Speaker 1: I have been dying to tell you about, and I've
Speaker 1: been keeping it secret and.
Speaker 2: Keeping it safe, keeping it secret, keeping it safe. I
Speaker 2: can't wait to hear it good.
Speaker 1: I guess though, that we should start first.
Speaker 2: With our quarantines.
Speaker 1: So what do we have to drink tonight?
Speaker 2: Tonight we're drinking the Strangling Angel. Oh that sounds menacing.
Speaker 2: It's a little bit, but it's also quite delicious. It's
Speaker 2: actually quite good. It's a kind of a variation on
Speaker 2: a penicillin which who knew that was a real cocktail.
Speaker 1: Maybe we should have We do, now we do.
Speaker 2: It's got what whiskey, lemon bourbon rye and lemon juice,
Speaker 2: ginger liqueur, and a little maple syrup. And in addition
Speaker 2: to our quarantinies, this episode will also be making what
Speaker 2: are we calling them, plus ey burritos, Yeah, plussy burritos. Guys,
Speaker 2: come up with a better name for that. And we'll
Speaker 2: be posting the full recipe for the quarantinies and the
Speaker 2: plussy bo ritos. We'll be posting those non alcoholic versions
Speaker 2: online as well on all of our social media channels.
Speaker 2: You guys can find those and drink along with us.
Speaker 1: Yeah. So, so now that that's out of the way.
Speaker 2: Let's get started. So, diphtheria is caused by a bacterium
Speaker 2: known as Karini bacterium diphtheria. And I did, in fact
Speaker 2: look up how to pronounce that. Oh good, that's like
Speaker 2: the first time for me. Ever, Well, it's a it's
Speaker 2: a strange spelling. Yeah, I looked at it and I
Speaker 2: was like, I'm gonna look this one up. Karini Bacterium diphtheria.
Speaker 2: It's a gram positive rod so it's shaped like a
Speaker 2: little tube, not a.
Speaker 1: Ball, like a little good and plenty.
Speaker 2: Yeah, good and plenty. That's a great one actually. And
Speaker 2: one thing that's interesting about this disease is that the
Speaker 2: disease that we associate with diphtheria is not caused by
Speaker 2: the bacterium itself. It's caused by a toxin. And this
Speaker 2: toxin is produced by a virus, a bacteria phase that
Speaker 2: actually infects the bacterium. What. Yeah, So a lot of
Speaker 2: the toxins we talked about toxins in the MRSA episode,
Speaker 2: A lot of the toxins that bacteria that quote unquote
Speaker 2: bacteria produce are actually produced by viruses. So it's this
Speaker 2: little mutualism or yeah, commensalism I haven't really seen. I mean, presumably,
Speaker 2: at least in the case of humans, which are the
Speaker 2: pretty much only reservoir for diphtheria, you might be getting
Speaker 2: more sick. So I guess if that's beneficial, then you
Speaker 2: could call it a mutualism. But I don't know if
Speaker 2: that actually, like, I don't know that the bacteria survives
Speaker 2: any better with this bacteria phase or not. Okay, so
Speaker 2: maybe someone else who knows can tell us.
Speaker 1: That's really interesting though, yeah.
Speaker 2: So it's not the bacterium itself. So there are strains
Speaker 2: out there that are what are called non toxogenic strains.
Speaker 2: Those can still infect you. They can still cause some disease,
Speaker 2: but they only don't cause as severe of disease and
Speaker 2: not the type of disease that we might associate with diphtheria. Okay,
Speaker 2: so ready, uh huh, so diphtheria, and from now on,
Speaker 2: whenever I talk about it, will just assume that it's
Speaker 2: a toxogenic strain of the bacterium. So it's making toxin,
Speaker 2: it's trying to kill you, gotcha. It's transmitted via aerosols,
Speaker 2: so coughing, spitting, sneezing, et cetera.
Speaker 1: Lovely.
Speaker 2: The incubation period is two to five days, so if
Speaker 2: I cough on you two to five days later, you're
Speaker 2: going to be getting sick most likely. And historically not
Speaker 2: to step on your toes or anything.
Speaker 1: No worse my toes are saying.
Speaker 2: But historically diphtheria has been a disease of childhood, very
Speaker 2: specifically of childhood, meaning babies didn't usually get it and
Speaker 2: adults didn't usually get it. Do you have a guess
Speaker 2: as to why?
Speaker 1: Hmmm, I'm guessing that in babies it would have to
Speaker 1: do with maternal antibodies from breast milk.
Speaker 2: Nailed it.
Speaker 1: And adults, I would assume that most of the adults
Speaker 1: would have had been asymptomatic and been exposed.
Speaker 2: To it and then developed immunity or just had it
Speaker 2: and survived it. Yeah, exactly, So they definitely were exposed
Speaker 2: and either got the infection and survived it, or they
Speaker 2: were asymptomatic carriers, which is very common in diphtheria, meaning
Speaker 2: just because someone looks healthy doesn't mean they are.
Speaker 1: Dun't dun dull.
Speaker 2: All right, So let's get into what actually happens when
Speaker 2: you get infected. Okay, So the first place that diptheria
Speaker 2: tends to colonize is your naso pharynx, so that means
Speaker 2: your nose and your throat.
Speaker 1: Okay.
Speaker 2: It is possible to only infect your nasal passages, in
Speaker 2: which case the disease that it causes is more like
Speaker 2: the common cold. It's not as severe. You get a
Speaker 2: lot of bloody mucus and puss coming out of your nose.
Speaker 1: Yeah, that's pretty gross.
Speaker 2: But it's less common. More commonly, it's actually going to
Speaker 2: kind of go straight to the back of your throat,
Speaker 2: and that's its sort of favorite spot to infect. So
Speaker 2: the progression of the disease I saw described as insidious,
Speaker 2: which is not a good No. You don't want something
Speaker 2: in your body to.
Speaker 1: Be negative connotation to that word canny negative.
Speaker 2: So here's how it begins. You start with a fever,
Speaker 2: but not like a crazy high fever, so maybe not
Speaker 2: one that makes you go, I need to get to
Speaker 2: the doctor. Right, you're running like one hundred maybe one
Speaker 2: hundred and one max. So you're feeling crappy, You're feeling tired,
Speaker 2: maybe weak, You've got just generally like malaise. You're like, God,
Speaker 2: I'm coming down with something. Maybe it's the flu, I
Speaker 2: don't know. And then your throat, like it really hurts.
Speaker 2: It hurts pretty bad. So then because you're feeling crappy
Speaker 2: and your throat hurts, you've got anorexia. Right, You don't
Speaker 2: want to eat anything, you don't want to swallow, and
Speaker 2: you just feel bad.
Speaker 1: So is just just means not wanting to eat anything?
Speaker 2: Yeah, exactly, you're not eating, and so you're like, Wow,
Speaker 2: maybe it's strub throat. Maybe that is that what I've got.
Speaker 2: I don't know. But then within two to three days
Speaker 2: you're not getting better. And at the back of your
Speaker 2: throat you'll see this thing and it starts out white,
Speaker 2: just sort of attached to like the roof of your
Speaker 2: mouth and like back near your tonsils, and then it
Speaker 2: gets bigger.
Speaker 1: I don't like this.
Speaker 2: It just keeps getting bigger and it starts out white,
Speaker 2: but as it grows to cover your entire soft palate,
Speaker 2: it can turn green or gray or black, god black. Yeah,
Speaker 2: And it's not really puss because puss you can kind
Speaker 2: of spit that out right, like mucus. You could sort
Speaker 2: of put your finger back there and scrape it off. Oh,
Speaker 2: you can't do that with this because it's stuck gone.
Speaker 2: And if you try, like if you really really try
Speaker 2: in there, you're just gonna cause yourself to bleed a
Speaker 2: lot because it's stuck on there. Oh. And at this point,
Speaker 2: it might be getting kind of hard for you to breathe.
Speaker 2: So if you finally were to go to the doctor
Speaker 2: and they put a stethoscope up to you, they'd hear
Speaker 2: a sound something like this.
Speaker 1: Was that good? Oh my god, I am feeling like
Speaker 1: the need to breathe very deeply. This is I'm feeling
Speaker 1: very stressed right now.
Speaker 2: Aaron's really I've made her very anxious.
Speaker 1: I am highly anxious.
Speaker 2: So that sound that I mimicked, I'm pretty proud of
Speaker 2: myself for that I practiced. It was excellent, thank you.
Speaker 2: It's called streider. It's not a good sign. It's a
Speaker 2: very very bad sign. So at this point, if you've
Speaker 2: progressed this far, you have two fates. Either you recover
Speaker 2: somehow or you die. It's pretty much a fifty to
Speaker 2: fifty chance the end.
Speaker 1: Just kidding, I'm just letting this sink in because I
Speaker 1: have read obviously, like it's come across my research about
Speaker 1: sort of the membrane and the dying. But it's it's.
Speaker 2: Ugh when you hear the whole When.
Speaker 1: You hear the whole thing, and you just imagine this. Well,
Speaker 1: first of all, I'm going to be terrified for every
Speaker 1: time I get a cold from here on out, I'm
Speaker 1: gonna be constantly checking the back of my throat.
Speaker 2: You don't need to do that, You've been vaccinated here.
Speaker 1: Some of us are just nervous by nature, yeah, not
Speaker 1: naughty by nature.
Speaker 2: So yeah, So this thing that's on the back of
Speaker 2: your throat is called a pseudo membrane. I don't know
Speaker 2: why they call it that, but that's what they call it.
Speaker 2: It seems like a pretty real membrane and not a
Speaker 2: pseudo one, but that's what they're calling it. And basically
Speaker 2: what happens, and one of the very common ways that
Speaker 2: you end up dying from diphtheria is that this thing
Speaker 2: grows so large and then your surrounding lymph nodes will
Speaker 2: also swell up that basically your airway is blocked off
Speaker 2: and you suffocate. Oh now that's not the only way
Speaker 2: that you can die from diptheria. But before we talk
Speaker 2: about the other ways that you can die, will take
Speaker 2: a step back and let's talk about what's actually going
Speaker 2: on inside your body. Why are these specific symptoms happening. So,
Speaker 2: like I said, the primary thing that's actually causing this
Speaker 2: disease is a toxin, diphtheria toxin, not the bacterium itself.
Speaker 2: So what happens is this, this toxin is released from
Speaker 2: the bacterium made by the bacteria phage inside. Released from
Speaker 2: the bacterium into your body, it enters your cells, so
Speaker 2: it can actually attach to certain receptors on your cell
Speaker 2: and get inside of your cell. And once it's in
Speaker 2: your cells of like the epithelium of your throat, right,
Speaker 2: it basically inhibits protein synthesis. One of the main things
Speaker 2: that cells do is make protein. If your cells cannot
Speaker 2: make protein, they will die.
Speaker 1: Yeah, so inhibiting that seems pretty bad.
Speaker 2: It's not good, So it basically causes cell death. So
Speaker 2: this toxin gets into your cells, stops them from doing
Speaker 2: their job, and then results in their death. The pseudo
Speaker 2: membrane that you're actually seeing on the back of somebody's
Speaker 2: throat is a direct result of this toxin. It's made
Speaker 2: up of a whole bunch of dead cells that have
Speaker 2: been infected by this toxin and then killed. And then
Speaker 2: what happens is because the bacteria are also there, right,
Speaker 2: so there are colonies of bacteria. You've got macrophages and neutrophils,
Speaker 2: which are white blood cells that are coming in to
Speaker 2: try and eat the bacteria and also clean up after
Speaker 2: all these dead cells that are now in the back
Speaker 2: of your throat. And when there's dead cells, what they
Speaker 2: do is they lay down this stuff called fibrine, which
Speaker 2: is like scar tissue. And so that's why it's adherent
Speaker 2: to the back of your throat. It's not like when
Speaker 2: you get sick with another like strep throat, for example,
Speaker 2: and you might have a bunch of mucus. That mucus
Speaker 2: is also just white blood cells and bacteria. The difference
Speaker 2: here is that because you have a bunch of cell death,
Speaker 2: you have fibrin being laid down, and that's everything is
Speaker 2: attached still to your healthy, living tissue.
Speaker 1: That makes sense and is also that much more horrifying.
Speaker 2: Yeah, definitely, yeah, because there's no just like, oh, let
Speaker 2: me just hack cough really hard and hack this thing
Speaker 2: up right. You can't. You can't hack it up, and
Speaker 2: it suffocates you, suffocates you.
Speaker 1: I feel claustrophobic.
Speaker 2: I can tell. It's a small room. But like I said,
Speaker 2: asphyxiation is not the only way that you can die.
Speaker 1: Cool.
Speaker 2: So, the toxin is released into your bloodstream, and your
Speaker 2: naso pharynx, especially the back of your throat is just
Speaker 2: rife with blood supply, which means that this toxin can
Speaker 2: make it into your blood supply and then it can
Speaker 2: go to the rest of your body.
Speaker 1: Cool cool, cool, cool cool.
Speaker 2: It can travel to your heart, where it will do
Speaker 2: the same thing that it does in the back of
Speaker 2: your throat, so it's going to infect your heart cells
Speaker 2: cause sell death and then fibrosis or scarring. And what
Speaker 2: happens when you have scarring on the muscles of your
Speaker 2: heart is the conductance, the electrical activity that controls your
Speaker 2: heart is impaired. So you've got a bunch of scars
Speaker 2: from everywhere where. You've got dead cells because this toxin
Speaker 2: killed your cells, and now your heart can't send impulses,
Speaker 2: so it can't pump correctly, so you end up with arrhythmias.
Speaker 2: Your heart's not beating in sync with itself, so you
Speaker 2: can die because your heart stops beating correctly. You can
Speaker 2: also die. There's more.
Speaker 1: You can you can just you can just your heart
Speaker 1: will just stop beating.
Speaker 2: Yeah, you go into like like a like a tachycardia
Speaker 2: or an a arrhythmia where your heart is not beating correctly,
Speaker 2: like maybe you're gonna have atrial fibrillation, which means the
Speaker 2: top part of your heart is like like, say what
Speaker 2: my hands are doing because I can't what do you
Speaker 2: call this? V I don't know.
Speaker 1: I mean that looked like jellyfish tendrils.
Speaker 2: Okay, so it's kind of like that, like like instead
Speaker 2: of being like dunk dunk, dun't dunk. Your heart's like
Speaker 2: it's fluttering. Yeah, exactly, So that can happen, and that'll
Speaker 2: kill you, right, because if your heart's not dunk dunking,
Speaker 2: it's not pushing blood out. That's what dunk dunk is. Right.
Speaker 2: You also could just become paralyzed. Cool, because it can
Speaker 2: infect your nervous tissue. And if it infects your nerve
Speaker 2: cells and then your nerve cells die, then you can't
Speaker 2: transmit electricity. Yeah, so it's pretty gnarly. You also can
Speaker 2: get cutaneous diphtheria, which is basically a giant ulcer on
Speaker 2: your skin. It's pretty it's pretty gnarly looking. We should
Speaker 2: post a picture, but I don't know if we should
Speaker 2: post a picture because I we.
Speaker 1: Can do like a like to see graphic content.
Speaker 2: Yeah, because it's pretty gross.
Speaker 1: Now, is that again with the fibrine.
Speaker 2: No, it's actually usually a non toxogenic strain that infects
Speaker 2: your arms, well, not just arms, but your skin. Not
Speaker 2: exactly sure why, but I have some good news because
Speaker 2: it looks like you could use it.
Speaker 1: Yeah. I'm very tense right now. My arms are folded.
Speaker 1: She's very well. I feel like my heart is a rhythmic.
Speaker 2: Right now, untreated, I guess I have a little more
Speaker 2: bad and then we'll get to the good. Untreated, the
Speaker 2: mortality rate is up to fifty percent, so about half
Speaker 2: of people who get infected and do not have any
Speaker 2: treatment will die from diptherea high. It's pretty high. Treated,
Speaker 2: so we do have a treatment. Treated, the mortality is
Speaker 2: between five and ten percent, which is still kind of high,
Speaker 2: and in young children it's actually as high as twenty percent.
Speaker 2: And the thing that's really sad is this case fatality
Speaker 2: rate has not improved over the last fifty years, so
Speaker 2: we're not any better at treating it now than we
Speaker 2: were in the nineteen forties and fifties. That's scary, yeah,
Speaker 2: but you want to know how we treat it, it's
Speaker 2: kind of cool.
Speaker 1: Yeah. Yeah.
Speaker 2: So there's two things that you have to do. The
Speaker 2: first is give an anti toxin. You do that to
Speaker 2: actually treat the symptoms. The thing about this treatment, the
Speaker 2: anti toxin, is that it only works on toxin that
Speaker 2: is not already bound to your cells, So you have
Speaker 2: to be treated very very early in the course of
Speaker 2: disease because any cells that are already infected with the
Speaker 2: toxin are screwed. And then on top of that, you
Speaker 2: also treat with an antibiotic, and that's both to kill
Speaker 2: the bacterium itself so it stops making more, and to
Speaker 2: protect those around so to make sure that you don't
Speaker 2: spread this disease to anybody else. And the best news
Speaker 2: is that there is a vaccine, but we'll talk more
Speaker 2: about that later. So tell me how did we get here?
Speaker 1: Excellent question? Diph theory? Where to begin? Before I started
Speaker 1: researching this, the word dip theory didn't really mean much
Speaker 1: to me on its own right. It was more just
Speaker 1: like part of a vaccine, lumped in with other diseases
Speaker 1: that you don't really hear much about it anymore, except
Speaker 1: more recently with the whole anti vaccine movement, which I'm
Speaker 1: sure we'll get into a bit later. Yeah. Anyway, but
Speaker 1: as I read more about the history of this disease,
Speaker 1: I found that the mention of diphtheria in a village
Speaker 1: or a city could cause a huge panic.
Speaker 2: Wow, and it was.
Speaker 1: Yeah, it was one of the most feared diseases in
Speaker 1: pre vaccine times for a few reasons. One, it attacked children, primarily,
Speaker 1: so it causes horrible slow suffocating death that you just
Speaker 1: talked about, Yeah, which just sounds so awful.
Speaker 2: Yeah, you just like watch your kid suffocate.
Speaker 1: Yeah, like I cannot imagine.
Speaker 2: Yeah, it's pretty bad.
Speaker 1: And also too it would show up suddenly and tear
Speaker 1: through an entire town or village and nothing seemed to
Speaker 1: stop it. So let's just check off the etymology of
Speaker 1: this disease before going into any more of its gory
Speaker 1: historical details. Diphtheria didn't get its name until eighteen twenty six.
Speaker 2: WHOA, that seems super late.
Speaker 1: Yeah, and so in this year, a French pathologist named
Speaker 1: Pierre Bretoneau came up with diphtherite or something like that,
Speaker 1: which is from the Greek root diphthera, meaning leather, which
Speaker 1: is of course what that tough membrane in the throat resembled.
Speaker 2: Leather, leather, second football.
Speaker 1: Yeah, and apparently it smelled really bad according to the
Speaker 1: first hand account.
Speaker 2: Okay, I really think that was just poor hygiene.
Speaker 1: I saw every like, there were so many first hand
Speaker 1: accounts that I read that were like it smelled discs.
Speaker 2: It does make sense because it's just like a bunch
Speaker 2: of dead stuff in the back of your throat, But
Speaker 2: like some of that description in the first hand account
Speaker 2: was like its tongue was brown. I'm like, bro, that's
Speaker 2: you man.
Speaker 1: Okay, well, fair enough, but it was one of the
Speaker 1: when in reading some of this it seemed like there
Speaker 1: was a characteristic diphtheria smell. Yeah, but the naming itself
Speaker 1: was really important in the history of diphtheria because before this,
Speaker 1: outbreaks of sore throat were called by a bunch of
Speaker 1: different names, which made tracking and monitoring outbreaks difficult, not
Speaker 1: to mention developing any kind of treatment that was reliable
Speaker 1: or consistent. Right, Okay, so the name didn't come about
Speaker 1: until the nineteenth century, but this wasn't a new name
Speaker 1: given to a new disease. This disease has really characteristic
Speaker 1: signs like extreme sore throat, leathery membrane. So you would
Speaker 1: think that tracing the history of diphtheria would be somewhat easy,
Speaker 1: at least compared to diseases like staff, which was much.
Speaker 2: More right, it's like everywhere and everything and causes so
Speaker 2: many different types of disease exactly.
Speaker 1: Yeah, but it actually doesn't have that much of a
Speaker 1: history before the seventeen hundreds.
Speaker 2: What.
Speaker 1: Yeah, at least that I found, and I could be wrong,
Speaker 1: and I could be looking in the wrong places, But
Speaker 1: there were some mentions. In the fifth century BCE, Hippocrates
Speaker 1: writes about a disease that sounds an awful lot like diptheria.
Speaker 1: And there's another mention a few hundred years later by
Speaker 1: Aretaeus the Cappadocian, in which he describes ulcers in the
Speaker 1: throat and warns that quote, if it spreads to the
Speaker 1: thorax by the windpipe, it occasions death by suffocation within
Speaker 1: the space of a day. Yep. And that quote children
Speaker 1: until puberty especially suffer yep.
Speaker 2: So it does sound a lot.
Speaker 1: Like probably, And that's really more or less the last
Speaker 1: mention of the disease until the late fifteen hundreds and
Speaker 1: early sixteen hundred.
Speaker 2: It's weird.
Speaker 1: And so that's when there was a series of epidemics
Speaker 1: of sore throats resulting in suffocation that swept through Spain
Speaker 1: and parts of the New World. This epidemic was referred
Speaker 1: to as Alao de los gartios, essentially meaning the year
Speaker 1: of strangulations. That was one translation I found for that chill.
Speaker 1: But yeah, it sounds terrifying, a year of drangulation. Yeah,
Speaker 1: but it remains a bit of a mystery as to
Speaker 1: why there's no mention of this disease for over a
Speaker 1: thousand years, and so I was starting to wonder, well,
Speaker 1: are we just missing historical accounts or did it not
Speaker 1: really act as an epidemic disease for all that time,
Speaker 1: or were the ancient descriptions of the disease actually something
Speaker 1: else that just happened to resemble diptheria.
Speaker 2: Yeah.
Speaker 1: I couldn't really find a whole lot of information on
Speaker 1: that on this missing puzzle piece, but I did see
Speaker 1: somewhere that the bacterium is thought to have come from
Speaker 1: domestic herbivores, which means it probably has ancient origins, right,
Speaker 1: Maybe the incorporation of the bacteria phase was more recent
Speaker 1: and then the toxin more recent, but.
Speaker 2: I don't know. Yeah, And the thing is that it's
Speaker 2: like humans, from what I read, are the only reservoir,
Speaker 2: so these aren't. It's not like currently a zoonotic disease,
Speaker 2: So that would further point to an ancient origin exactly.
Speaker 1: I don't know. Weird. In any case, diphtheria emerged with
Speaker 1: a vengeance in seventeen thirty five, when outbreaks of the
Speaker 1: illness occurred in New England, Great Britain, France and the
Speaker 1: West Indies. People called it throat distemper. Yeah, and sufferers
Speaker 1: either died from suffocation by the thick grayish membrane covering
Speaker 1: their throat.
Speaker 2: She's gonna say that like one hundred more.
Speaker 1: This is the most horrible thing to me. I don't
Speaker 1: know why or if they survived that they could just
Speaker 1: drop dead a week or two later. Yep, as we've heard, yeah,
Speaker 1: cool cool, cool, cool love it. This outbreak disproportionately affected children,
Speaker 1: and some families lost all of their kids, like entire families,
Speaker 1: just kids all gone. I know.
Speaker 2: It is quite infectious, and so it does make sense
Speaker 2: that if you've got a bunch of kids, it's going
Speaker 2: to go like chicken pox from one to the next
Speaker 2: to the next and then yeah, boom boom boom awful.
Speaker 1: In Kingston, New Hampshire, a third of all children in
Speaker 1: this town died from the disease. Whoa a third of
Speaker 1: all the children and the state itself lost five percent
Speaker 1: of its entire population.
Speaker 2: So that's really crazy because that means it's not just
Speaker 2: like always there. It's like coming into these communities wiping
Speaker 2: them out and then moving on exactly, because if otherwise,
Speaker 2: you would just have like low levels of death all
Speaker 2: the time.
Speaker 1: Right, weird. Never, it's an epidemic disease, it's not an endemic,
Speaker 1: So then.
Speaker 2: It's even weirder that there's not more accounts of it.
Speaker 1: Yes, what I know? Oh sounds like yeah, yeah, it's
Speaker 1: it's bizarre.
Speaker 2: That is super bizarre.
Speaker 1: Obviously, with such a huge loss of life comes people
Speaker 1: seeking answers or at least where they can point fingers,
Speaker 1: and many Puritan ministers said that the people had brought
Speaker 1: it on themselves by straying too far from the religious path,
Speaker 1: which I'm sure is exactly what they needed to hear,
Speaker 1: as they have lost their entire children.
Speaker 2: Oh god, it's your own fault. Mother's right, the wanton mother,
Speaker 2: the wanton mother.
Speaker 1: Ridiculous anyway, So, after this first big diphtheria epidemic in
Speaker 1: seventeen thirty five, outbreaks showed up every twenty five years
Speaker 1: or so, whoa yeah, And it slowly shifted from this
Speaker 1: epidemic rural disease to a more endemic cosmopolitan disease by
Speaker 1: the mid eighteen hundreds, and it seemed to increase in
Speaker 1: virulence the entire time. Yeah, it was during these outbreaks
Speaker 1: in the eighteen hundreds that diptheria got its name, the
Speaker 1: strangling Angel, which is the name of our quarantine if
Speaker 1: you remember. In an outbreak in New York City in
Speaker 1: eighteen fifty seven, the case fatality rate was forty two percent,
Speaker 1: which is I mean, as we know, that's that's just
Speaker 1: what you said, but that's still so hot. Yeah, I
Speaker 1: mean that's almost bubonic plague.
Speaker 2: You And it's children, right, children, So you've got a
Speaker 2: school house with one hundred kids in it, They're all
Speaker 2: going to get infected, right, and like realistically, forty two
Speaker 2: of them are going to die. Yeah, you now have
Speaker 2: fifty eight kids in your class. Yeah, right, that's right,
Speaker 2: thank you, that's what.
Speaker 1: Yeah. And no amount of therapy or supportive treatment could
Speaker 1: save the lives of those suffering, and so they died
Speaker 1: this slow, terrible death. God. So physicians deeply feared diptheria
Speaker 1: because they felt pretty much helpless against it. Yeah, and
Speaker 1: even more helpless than the parents, because the parents would
Speaker 1: take their children to them, expecting this person to try
Speaker 1: to make things better and no, so it was it
Speaker 1: was a parent's absolute nightmare to watch their child suffering
Speaker 1: so horribly, and for this reason, dip theoria played a
Speaker 1: prominent role in the development of germ theory in the
Speaker 1: eighteen hundreds.
Speaker 2: Our fave.
Speaker 1: Oh yes, all right, so it's the mid eighteen hundreds. Okay,
Speaker 1: let's take a minute to consider some of the prevailing
Speaker 1: thoughts on what caused disease.
Speaker 2: Your bad sexual habits. Okay, wait, that's actually true, My bad,
Speaker 2: I'm sorry, let me try that again. Not praying enough.
Speaker 1: Actually I don't really have that in here. I think
Speaker 1: by that time it was not so it wasn't so
Speaker 1: much about the morality. Okay, it was bad air, yes, absolutely,
Speaker 1: so miasma that kind of thinking, which if you remember
Speaker 1: from John Snow and the Cholera Broadstreet.
Speaker 2: Cholera Outbreak, episode four, if you haven't listened to it.
Speaker 1: Yes, that was all thought to be miasthma.
Speaker 2: So.
Speaker 1: And then there's also humorism or humoralism, which we've talked
Speaker 1: about during Tuberculosis episode nine. And then there's germ theory. Yes,
Speaker 1: so the idea that many diseases are caused by microorganisms.
Speaker 1: So this idea was around, but not necessarily widely accepted
Speaker 1: quite yet, because humorism was still kind of the prevailing thought,
Speaker 1: but it pretty quickly fell out of favor as formal
Speaker 1: medical research focused on specific tissues or cells as indicators
Speaker 1: of disease. Importantly, they started asking whether if a specific
Speaker 1: tissue or organ was inflamed, there could be multiple causes
Speaker 1: for the same symptom For instance, diphtherias, scarlet fever, and
Speaker 1: stripped throat all result in inflammation of your throat. Does
Speaker 1: that mean that they are one disease or many. This
Speaker 1: is a big shift in the way that people thought
Speaker 1: about disease, so the answer might be obvious to us now.
Speaker 1: Of course, these are different diseases, they have different symptomology,
Speaker 1: blah blah blah. But back then, before germ theory had
Speaker 1: taken hold, this wasn't straightforward, and the concept of multiple
Speaker 1: causes for the same disease symptoms was really huge, and
Speaker 1: it partially paved the way for germ theory, especially the
Speaker 1: one germ, one disease concept. With dip theory, one thing
Speaker 1: seems certain. It was contagious. If it showed up at
Speaker 1: a school in one kid, it was only a matter
Speaker 1: of time before the entire class, as we illustrated, was
Speaker 1: sick at home or in the hospital or dead. Now
Speaker 1: that we knew it was contagious, it was like, okay, well,
Speaker 1: we need to know which microbe caused a disease, which
Speaker 1: was difficult to do because the mouth and throat normally
Speaker 1: contains this really diverse array of microbes, so being able
Speaker 1: to say that one specific microbe was the cause of
Speaker 1: a disease wasn't simple, but there was at least a
Speaker 1: jumping off point the membrane. By the late eighteen hundreds,
Speaker 1: this dude named Clubs found two types of microbes in
Speaker 1: the membrane.
Speaker 2: Clubs like Clibsiella.
Speaker 1: It might oh exciting, but he didn't know which bacterium
Speaker 1: was responsible. So that question was solved a few years
Speaker 1: later in eighteen eighty four by a dude named Friedrich Loeffler.
Speaker 2: Oh.
Speaker 1: He also discovered that the bacillus was only found in
Speaker 1: the membrane and didn't invade deeper into the body. But
Speaker 1: diphtheria also causes effects in the more distant parts of
Speaker 1: your body, so he figured that the distant effects of
Speaker 1: disease could be caused by a toxin.
Speaker 2: Wow, what a smart guy, right, we.
Speaker 1: Had the causative agent, but there was still the mystery
Speaker 1: of why an outbreak of diph theory would suddenly show
Speaker 1: up without any warning and sweep through a village or school.
Speaker 1: Where did it come from?
Speaker 2: Yeah?
Speaker 1: Well, a couple of years after the causative agent of
Speaker 1: diph theoria was identified, there was an epidemiological survey of
Speaker 1: children in Berlin that showed that five percent of healthy
Speaker 1: children carry the bacterium in their throats. So this was
Speaker 1: the first evidence that carriers of the disease existed. And
Speaker 1: this was a big deal because it helped to explain
Speaker 1: the mystery of these sudden outbreaks. And it also led
Speaker 1: to forced quarantine for people who were suspected to be carriers.
Speaker 2: Yeah.
Speaker 1: People were held for months in isolated hospital units. There
Speaker 1: were quarantine stickers or plaques to put on people's houses
Speaker 1: if there was an outbreak of diptheria in a certain house. Yeah.
Speaker 1: Soon after the discovery of diphtheria carriers, peer Paul email Ru,
Speaker 1: who was Loeffler's assistant, found the diptheria toxin by showing
Speaker 1: that if you passed bits of diphtheria secretions like from
Speaker 1: the membrane, threw a superfine filter that would keep the
Speaker 1: bacteria out in other cells and then injected the filtrate
Speaker 1: into an animal, you could cause diphtheria like symptoms in
Speaker 1: the animal. Wow.
Speaker 2: That's cool. I mean not cool for the animal.
Speaker 1: But it's kind of like boom toxin got it proof
Speaker 1: in hand. When a couple other microbiologists named Emil von
Speaker 1: Behring and Shibasa Burro Kitasato heard about the discovery of
Speaker 1: the diphtheria toxin, they were like, we know what to
Speaker 1: do with this information, because if we can fight the toxin,
Speaker 1: we can fight the disease. So they began working towards
Speaker 1: developing the diptheria antitoxin, which was first used in the
Speaker 1: eighteen nineties. Wow. Yeah, And for this research, Van Bhring
Speaker 1: was awarded the first Nobel Prize for Medicine in nineteen
Speaker 1: oh one.
Speaker 2: What Yeah, for diphtheria antitoxin.
Speaker 1: Oh cool. Dip theoria was a big deal. Yeah.
Speaker 2: I definitely had no idea that it was such a
Speaker 2: big deal.
Speaker 1: Yeah, Like it was.
Speaker 2: It's just the d in in t Depp exactly. It's
Speaker 2: all it was to me. Yeah, it was a lot more,
Speaker 2: and it really left a mark. And it's it's kind
Speaker 2: of funny because it seems like so much of diptheria's
Speaker 2: history is squeezed into just a few decades. It was
Speaker 2: only in the eighteen fifties that the disease became endemic
Speaker 2: in cities, and within fifty years the bacterium had been identified,
Speaker 2: its toxin isolated, and immoderately effective treatment produced.
Speaker 1: Wow boom boom boom. But diphtheria was in no way
Speaker 1: defeated or forgotten. It was still one of the illnesses
Speaker 1: that most terrified parents and racked up a hefty death toll.
Speaker 1: Even with the advent of antiitoxin, it remained the number
Speaker 1: one killer of children in some countries, killing thousands of
Speaker 1: children every year. For instance, in the US, thirteen thousand
Speaker 1: to fifteen thousand children died every year from diphtheria. This
Speaker 1: is in the early nineteen hundreds.
Speaker 2: Oh my god.
Speaker 1: And in January nineteen twenty five it would take the
Speaker 1: front page of so many newspapers in a dramatic race
Speaker 1: against time, race against time. Okay, let's take a quick
Speaker 1: trip to Nome, Alaska. Yes, do you know where this
Speaker 1: is going? No? Okay, great, In nineteen twenty four, Nome
Speaker 1: is still a baby city. It had been founded only
Speaker 1: twenty seven years earlier. By a few gold prospectors, which
Speaker 1: then led the way for hundreds more to rush to
Speaker 1: this extremely remote part of Alaska, which was still just
Speaker 1: a US territory and not a Statenome is just a
Speaker 1: couple of degrees south of the Arctic Circle and extremely
Speaker 1: far west on the Steward Peninsula, and we'll post a map.
Speaker 1: In nineteen twenty four, it was one of the most
Speaker 1: remote cities on Earth. Gnome was closer to Siberia than
Speaker 1: it was to any other major town in Alaska. Whoa.
Speaker 1: Its population had shrunk from around twenty thousand during the
Speaker 1: peak of the gold rush to around fifteen hundred brave
Speaker 1: or crazy people that made it their home in nineteen
Speaker 1: twenty four.
Speaker 2: Wow.
Speaker 1: For most of every year, from around October or November
Speaker 1: to July, Nome was more or less shut off from
Speaker 1: the rest of the world. The port was inaccessible due
Speaker 1: to freezing water. No train reached that far west, and
Speaker 1: planes hadn't yet been designed to withstand the extremely harsh winters.
Speaker 2: Oh my god, yeah until July. Yeah, no, thank you.
Speaker 2: I think that's like when the ice melt was uh uh,
Speaker 2: I'm complaining about fifties over here.
Speaker 1: So that left sled dogs as the only reliable way
Speaker 1: to get around, So before those ships left for the winter,
Speaker 1: you really had to make sure that you had everything
Speaker 1: you needed or wanted for that long winter and spring
Speaker 1: and half of summer ahead of you. In the summer
Speaker 1: of nineteen twenty four, Nome's only doctor, Curtis Welch, sent
Speaker 1: a request from war dip theory antitoxin after he noticed
Speaker 1: that the units that he had were expired. But when
Speaker 1: the last ship of the year came and went without
Speaker 1: any new antiitoxin, he crossed his fingers and hoped for
Speaker 1: the best. Being so isolated might protect them from any
Speaker 1: outbreaks coming their way. And they had been lucky avoiding
Speaker 1: diptheria in previous years, but the nineteen eighteen flu still
Speaker 1: lingered on everyone's minds. I don't know if I mentioned
Speaker 1: this in our flu episode, since it was like one
Speaker 1: hundred years ago.
Speaker 2: Oh, it was about a year ago.
Speaker 1: But this part of the world suffered some of the
Speaker 1: highest death rates during the flu. In Gnome, fifty percent
Speaker 1: of the population of Alaska Natives died.
Speaker 2: You know you did mention that, Okay, I.
Speaker 1: Thought so, because it's such an intense it was such
Speaker 1: a high mortality rate. Yeah, and so. On Christmas Eve
Speaker 1: nineteen twenty four, when doctor Welch heard of a seven
Speaker 1: year old girl who had a very sore throat, he
Speaker 1: worried if this was diphtheria. Gnome was on its own
Speaker 1: with enough expired antiitoxin to help just a handful of people,
Speaker 1: and in particular, he worried about the thousands of Alaska
Speaker 1: Natives living in the area who had lower resistance to diphtheria.
Speaker 2: Oh no.
Speaker 1: A few days later, on December twenty eighth, the girl
Speaker 1: died and several more cases of sore throat began popping up.
Speaker 1: Welch didn't officially diagnose anyone with diphtheria until mid January,
Speaker 1: and by this time at least five children were dead
Speaker 1: of the illness. This isn't a really small, super isolated town. Yeah,
Speaker 1: so now is the time to panic. He sent out
Speaker 1: a telegram to the US Public Health Service pleading for
Speaker 1: antiitoxin some way, get it Tonome please. Getting together that
Speaker 1: much antiitoxin wasn't a problem, but the issue was getting
Speaker 1: it too Gnome by sea was impossible because of ice.
Speaker 1: By plane was considered too dangerous, but by a sled
Speaker 1: dog was another story. Oh my god, this still doesn't
Speaker 1: sound familiar to you. No, okay, wait.
Speaker 2: Wait wait wait is this a book or something.
Speaker 1: Well, it is a book, but it's also a movie.
Speaker 2: It's it Bolto.
Speaker 1: Stop. Yes, this is Balto.
Speaker 2: Yes, Balto's active theory.
Speaker 1: Yeah, that's why I was so thrilled.
Speaker 2: Your face is so happy right now, it's like so satisfying.
Speaker 1: Oh I love it. Well, Balto was so bloodmobile. Who
Speaker 1: provides all the music for this episode and all of
Speaker 1: that episodes is my brother Dan, and we've blown his cover.
Speaker 1: I think we already said that he was obsessed with Balto,
Speaker 1: like we had to watch it over and over and
Speaker 1: over again. So yes, I've always loved it.
Speaker 2: Okay, So she's still so happy.
Speaker 1: And anyway, so officials decided that they would use a
Speaker 1: relay of dog sleds to transport the serum the six
Speaker 1: hundred and seventy four miles or one thousand and eighty
Speaker 1: five kilometers nice from Nanana to Nome. Wow, you're not
Speaker 1: as close to Fairbanks, okay. The heroic efforts of the
Speaker 1: sled dogs and their handlers were on the front page
Speaker 1: of every US newspaper. God and much of the population
Speaker 1: waited anxiously to see whether the antiitoxin would successfully make
Speaker 1: it to Gnome. These handlers, most of whom were Alaska natives,
Speaker 1: and their dogs had to endure extreme winter conditions. Dogs
Speaker 1: lost their lives, people lost their fingers or suffered permanent
Speaker 1: damage from frostbite. But in just five and a half days,
Speaker 1: so an area of six hundred and six hundred and
Speaker 1: seventy four miles.
Speaker 2: Of frozen frozenz.
Speaker 1: This is in January, over ae thousand kilometers in genus in.
Speaker 2: Midge ask, oh my god.
Speaker 1: Yeah, the anti toxin arrived in Nome carried by Gunner
Speaker 1: Cosson and his lead dog, Balto Balto, about whom the
Speaker 1: movie was made. But I want to do my part
Speaker 1: to clear up a historical misrepresentation about Balto and the
Speaker 1: serum race. Even though Balto and Cosson were the ones
Speaker 1: to deliver the serum to Nome, they were only the
Speaker 1: last ones in a long relay which involved many more
Speaker 1: dogs and handlers. Among these is the dog considered the
Speaker 1: true hero of this story, Togo Togo and his handler
Speaker 1: Leonard Seppola. Togo ran more than two hundred and sixty
Speaker 1: one miles.
Speaker 2: Oh my goodness.
Speaker 1: Four hundred and twenty kilometers during this relay, and his
Speaker 1: leg of the relay was ninety one miles one hundred
Speaker 1: and forty six kilometers, which was more than twice any
Speaker 1: other team. He safely led his team through some of
Speaker 1: the worst conditions and across the treacherous Norton Sound, which
Speaker 1: is this frozen inlet of the Bearing Sea, so over
Speaker 1: frozen seawater.
Speaker 2: Oh my god.
Speaker 1: Yeah, but Togo didn't get any of the recognition, or
Speaker 1: at least not nearly as much, especially right after the
Speaker 1: serum got there that Balta received, which like there's a
Speaker 1: statue of Balto in New York City's Central Park and Seppola,
Speaker 1: who was the handler, was super salty about this.
Speaker 2: Well, yeah, I would be too, because he was with him.
Speaker 1: Yeah, I know. The outbreaking gnome was small. Only six
Speaker 1: or seven children died and maybe five hundred to one
Speaker 1: hundred people were infected with diphtheria, but the numbers could
Speaker 1: have climbed a lot higher had the serum race not
Speaker 1: been successful. And maybe Togo will finally get the recognition
Speaker 1: he deserves because apparently there's it's a live action Disney
Speaker 1: movie in the works called Togo Stop It in which
Speaker 1: Willem defote everyone's favorite hero. What we'll play Leonard Ceppala,
Speaker 1: No no Veto.
Speaker 2: Oh well we'll see, sorry Will.
Speaker 1: I'm definitely gonna keep an eye out for that though.
Speaker 1: So I tell this story about Gnome and Togo and
Speaker 1: Balto to underline just how scary this disease was.
Speaker 2: Right, people were willing to go to pretty extreme lengths
Speaker 2: to protect this tiny little town.
Speaker 1: And they were captivated like this was on the cover
Speaker 1: of every newspaper. A few years after the Nome serm race,
Speaker 1: a diph theoria vaccine was created using the toxoid, which
Speaker 1: was the inactivated form of the toxin, and it went
Speaker 1: into wide use in the nineteen thirties and the disease
Speaker 1: really dropped off to where most doctors today have no
Speaker 1: idea what a dip theoria membrane looks like.
Speaker 2: Only in pictures or smells like. I think that's why
Speaker 2: we don't like it's not in a picture.
Speaker 1: Yeah, exactly. We talk scratch and sniff.
Speaker 2: Yeah, there's We talk a lot about smells of some bacteria,
Speaker 2: specifically that that like the bacteria make a smell, right,
Speaker 2: But with this, my guess is that it's just like
Speaker 2: a bunch of dead miss that is making the smell.
Speaker 1: I just want to repeat again what I said about
Speaker 1: a scratch and sniff book.
Speaker 2: Scratch and sniff pseudo membrane.
Speaker 1: Scratch and sniff medical textbook.
Speaker 2: Oh, grody dude.
Speaker 1: Not that I would not buy, No, but somebody would
Speaker 1: buy it for you.
Speaker 2: Yeah, that's true.
Speaker 1: That's basically all I've got.
Speaker 2: So is it.
Speaker 1: Yeah, you're done.
Speaker 2: And then they made a vaccine story over.
Speaker 1: Well, that's because I think that's where you pick it
Speaker 1: up and you tell me about how the anti vaccine
Speaker 1: movement might be a changing thing.
Speaker 2: Okay, let's do it. So just because we invented a
Speaker 2: vaccine doesn't mean we've pulled a smallpox. This has not
Speaker 2: been eliminated from the world. It has not been eliminated
Speaker 2: from the United States. Still exists, but in the United
Speaker 2: States it is actually a pretty huge success story. So,
Speaker 2: for example, in nineteen twenty one in the United States,
Speaker 2: so before there was any kind of vaccine, there were
Speaker 2: two hundred and six thousand cases of diphtheria reported.
Speaker 1: That's a lot.
Speaker 2: Yeah, there were also overted fifteen thousand deaths.
Speaker 1: Oh my, I know, most children games.
Speaker 2: Yeah, But since nineteen eighty. Okay, there have not been
Speaker 2: any double digit year cases, So no double digit cases.
Speaker 2: This is a weird way to say it. A fewer
Speaker 2: than ten. There you go, and in many years, zero
Speaker 2: cases in the United States have been reported. That's great,
Speaker 2: it's very great. It's not so across the globe. So
Speaker 2: the World Health Organization, and I'll actually post this because
Speaker 2: I think I don't think I'm the only one who'll
Speaker 2: find it interesting, has little fact sheets about the number
Speaker 2: of cases of all of the vaccine preventable diseases, of
Speaker 2: which diphtheria is one, and how many or what percentage
Speaker 2: of people are actually vaccinated across the world. So this
Speaker 2: is aggregated all of the countries of the world, how
Speaker 2: many actual case reports there have been of all of
Speaker 2: these diseases. So keep in mind as always that you know,
Speaker 2: it's just the reported cases. There's a lot of underreporting
Speaker 2: and many places who might not report it at all,
Speaker 2: et cetera, et cetera. But the numbers have been generally
Speaker 2: getting better for the most part. In nineteen eighty, worldwide,
Speaker 2: there were over ninety seven thousand cases of diphtheria reported.
Speaker 2: Well hold on nineteen eighty nineteen eighty ninety seven thousand,
Speaker 2: ninety seven thousand, Okay, nineteen ninety that number had dropped
Speaker 2: to twenty three thousand. Holy crap, way to go world.
Speaker 1: Right, that's that's because of the vaccine.
Speaker 2: I mean, the vaccine has been in use since the
Speaker 2: you know, twenties. But sure, but I mean like vaccination
Speaker 2: or rates. Yeah, they went up from thirty one percent
Speaker 2: in nineteen eighty worldwide to eighty eight percent in nineteen ninetyl. Yeah,
Speaker 2: that's for one dose of the vaccine. So one thing
Speaker 2: I will say is that the vaccine for diphtheria, it's
Speaker 2: usually given in combination with tetanus and pertussis. So you
Speaker 2: might hear people say DTP or t DAP or d TAP.
Speaker 2: There's a lot of different versions of it. Yeah, So
Speaker 2: these are all different combinations of diphtheria toxoid, which is
Speaker 2: just a inactivated toxin, tetanus toxoid, inactivated tetnus toxin, and
Speaker 2: pertessis either the whole bacterium or parts of the bacterium.
Speaker 2: And because in all of those cases you're giving a
Speaker 2: killed toxin and not a live bacterium, your immune system
Speaker 2: only mounts a partial response to it. So one dose
Speaker 2: is not enough to actually give you full immunity. So
Speaker 2: in the US, children actually get five doses of d
Speaker 2: TAP okay, up until they're about six years old, and
Speaker 2: then after that it's recommended that you get a booster
Speaker 2: every ten years. Worldwide, one of the biggest challenges is
Speaker 2: making sure that people get all of the recommended doses
Speaker 2: of vaccines like the DTP vaccine, because giving just one
Speaker 2: is good, but giving three or four or five is
Speaker 2: a lot better. So globally, the rates of like giving,
Speaker 2: the rates of children who have received at least one
Speaker 2: DTP vaccine is pretty high, but the rates that have
Speaker 2: received at least three, which is what's recommended by who,
Speaker 2: is a bit lower. Okay, So where were we We
Speaker 2: were in nineteen ninety right, with twenty three thousand cases worldwide? Yeah,
Speaker 2: cut to two thousand, still doing great, only eleven thousand cases,
Speaker 2: right all right? Twenty thirteen, four thousand. What twenty fourteen,
Speaker 2: seven thousand must have been a fluke, twenty fifteen, back
Speaker 2: down to four thousands. What's up twenty sixteen seven thousand? Okay,
Speaker 2: twenty seventeen eighty eight hundred.
Speaker 1: Not a fluke, Not a fluke.
Speaker 2: It's not great. It's hard to say for sure what
Speaker 2: the cause of this is because globally, vaccination rates, at
Speaker 2: least reported vaccination rates have not changed globally, that is
Speaker 2: not true in the United States. But what it basically
Speaker 2: means is that at least over the last five years,
Speaker 2: we haven't really gotten better, right, We haven't made we
Speaker 2: haven't made huge strides in the last few years in
Speaker 2: terms of actually reducing the burden of diphtheria. And it
Speaker 2: definitely still exists. And something that I thought was really
Speaker 2: interesting that I definitely didn't realize is that if you
Speaker 2: were to like randomly screen a whole bunch of people's
Speaker 2: noses or naso pharynxes in the United States, even in
Speaker 2: areas where you have relatively hi or I suppose what
Speaker 2: someone would think would sound relatively high vaccination rates like
Speaker 2: say eighty percent, which sounds high, but for vaccination rates
Speaker 2: is actually not good. Yeah, you can you can find
Speaker 2: a lot of people colonized with diphtheria in the United States.
Speaker 2: So this bacteria still exists here. So even though we
Speaker 2: haven't had a case of diphtheria in the United States
Speaker 2: since in twenty twelve, we had one and before that
Speaker 2: it was two thousand and three. Okay, we had one.
Speaker 2: So even though the case rates of diphtheria in the
Speaker 2: United States are very low, that doesn't mean that it's
Speaker 2: not here. Right, The are not of diphtheria is six
Speaker 2: to seven, which is really highly high. It's second to
Speaker 2: like measles, which we haven't for How have we not
Speaker 2: talked about measles yet.
Speaker 1: Because we had because there are tons.
Speaker 2: Of isis okay, but we need to put But yeah,
Speaker 2: so it's really high. So what that basically means is that, yeah,
Speaker 2: for every one infected kid, you could potentially infect six
Speaker 2: or seven more kids.
Speaker 1: That's crazy.
Speaker 2: It's crazy, It's it's scary. It's really scary. Especially also
Speaker 2: because so the T dep DETAP whatever you call it, vaccine,
Speaker 2: they're different vaccines, but whichever vaccine it is is recommended
Speaker 2: for pregnant women. And that's because since you have this
Speaker 2: waning immunity, you want to make sure that a pregnant
Speaker 2: woman is immune so that she passes on those immunoglobulins
Speaker 2: to her baby. Because babies don't actually get vaccinated until
Speaker 2: two months old, So for those first two months, they're
Speaker 2: super super susceptible.
Speaker 1: Gotcha, if you.
Speaker 2: Don't give a if a woman maybe doesn't have access
Speaker 2: to prenatal care or doesn't have health insurance or things
Speaker 2: like that and doesn't get that, then you can potentially
Speaker 2: have babies that are completely susceptible. And so that's why
Speaker 2: this whole vaccination thing becomes really important, is that it's
Speaker 2: not just about like your individual risk. It's about the
Speaker 2: fact that there are a lot of people in the
Speaker 2: community that either are too young to be vaccinated, are
Speaker 2: very old so they just don't have a good immune
Speaker 2: system left, right, are already immunal compromised, whether it's from
Speaker 2: something like HIV or leukemia or other immune disorders, so
Speaker 2: they can't be vaccinated right. And so those are the
Speaker 2: people who are most at risk when you have low
Speaker 2: levels of vaccination in a population.
Speaker 1: It just it blows my mind, after reading about this
Speaker 1: disease and hearing about this disease from you and the
Speaker 1: progression of disease, that there are people who choose to
Speaker 1: go nah, I'm just gonna take my chances.
Speaker 2: I think the thing is, though, that we don't hear
Speaker 2: about this. It's not on the front stage of our newspapers.
Speaker 2: Because one kid has gotten it since.
Speaker 1: Twenty twenty US.
Speaker 2: But it's also it's not in everyone's face, and it's
Speaker 2: not every day, and it's not everywhere, So it's very
Speaker 2: easy individually to say that problem is elsewhere and it's
Speaker 2: not going to affect me. I mean, I think that's
Speaker 2: why it's it's just about making sure that people are
Speaker 2: aware that these diseases still do exist, and that's why
Speaker 2: these vaccines are important.
Speaker 1: It's scary that the disease itself is scary. What's the
Speaker 1: scariest thing is that there are people who can be
Speaker 1: protected against it and can by doing that, protect other
Speaker 1: people against it, and they're choosing to not do that. Yeah,
Speaker 1: that's the scariest part to me.
Speaker 2: Yeah, yeah, it is.
Speaker 1: It's scary.
Speaker 2: It is scary. Well, I wish I had some happy note.
Speaker 2: I mean, worldwide vaccine coverage is about eighty five to
Speaker 2: ninety percent. She's great. Yeah, that's good old diphtheria. Who
Speaker 2: knew Quite honestly, I didn't know most of this stuff.
Speaker 1: Yeah, yeah, there's I feel like there's there's a lot
Speaker 1: more to diptheria than I knew was going to be
Speaker 1: out there, and I'm really glad that we covered this.
Speaker 2: Yeah, and thanks Balto, I mean Togo, thanks Togo. Sources.
Speaker 1: Yeah, I have a few. Okay, so the story of
Speaker 1: Balto and the whole sled dog race and the race
Speaker 1: for the anti toxin. It's called The Cruelest Miles and
Speaker 1: it's by Gay and Laney Salisbury. And I also used
Speaker 1: the Cambridge World History of Human Disease, The Epidemic Streets
Speaker 1: by Anne Hardy, and a couple of papers. But I
Speaker 1: also wanted to plug I used. I read this book
Speaker 1: in middle school and when it came up in the searches,
Speaker 1: I was like, I definitely recognize that cover and it's
Speaker 1: called Running out of Time by Margaret Peterson Haddocks. It
Speaker 1: is quite dark, so no wonder I loved it. Anyway,
Speaker 1: you should definitely read it Running out of Time.
Speaker 2: I want to read it.
Speaker 1: Yeah you should.
Speaker 2: Also, we'll definitely add that book to our Goodreads list,
Speaker 2: which as a reminder, you can find all of our sources,
Speaker 2: including all of the articles and books that we read
Speaker 2: for each episode, as well as links to our Goodreads
Speaker 2: list on our website This podcast will kill You dot Com.
Speaker 1: Thank you as always to Bloodmobile, also Balta's number one
Speaker 1: fan YEP, and to all of you for listening.
Speaker 2: Also, don't forget if you aren't already to subscribe to
Speaker 2: all of our social media situations, Rate Review, subscribe on iTunes.
Speaker 1: Well, until next time, wash your hands, you filthy animals.
Speaker 2: Bon bon bas bon ba, bon ba bonb