WEBVTT - Ep 64 Rubella: Timing is Everything 0:00:01.040 --> 0:00:04.200 On her second day of life, Kimberly Cowley had congestive 0:00:04.200 --> 0:00:07.440 heart failure. Considering the vast array of health issues she 0:00:07.480 --> 0:00:10.280 had been born with hearing in vision loss, a rare 0:00:10.280 --> 0:00:13.640 condition known as tetrology of fullow caused by a combination 0:00:13.720 --> 0:00:16.200 of four heart defects, any one of which is a killer. 0:00:16.680 --> 0:00:21.160 Expectations of survival were low. Against all odds, Kimberly survived, 0:00:21.320 --> 0:00:24.639 but the road has been long and often painful. Born 0:00:24.680 --> 0:00:27.720 in Hamilton, Canada, in nineteen sixty four, Kimberly spent the 0:00:27.720 --> 0:00:30.080 first two months of her life in the hospital. Her 0:00:30.120 --> 0:00:33.120 parents were young and shortly after marriage. Her mother became sick. 0:00:33.520 --> 0:00:35.640 She thought it might be a bout of flu, and 0:00:35.680 --> 0:00:38.440 then once she learned she was pregnant, she thought maybe 0:00:38.479 --> 0:00:42.040 that was why she felt unwell. It was neither. Her 0:00:42.040 --> 0:00:44.720 mother later learned that it had been rubella, having come 0:00:44.760 --> 0:00:47.640 into contact with an infected relative in her first trimester 0:00:48.440 --> 0:00:51.120 in nineteen sixty four. The rubella vaccine was still five 0:00:51.200 --> 0:00:54.400 years away from being available when Kimberly was diagnosed with 0:00:54.440 --> 0:00:57.200 congestive heart failure. That second day in the hospital, her 0:00:57.240 --> 0:00:59.880 parents realized the problems were much bigger than they had thought. 0:01:00.360 --> 0:01:03.400 Those first two months were a whirlwind of tests. All 0:01:03.520 --> 0:01:05.560 Kimberly's parents were told was that they would have to 0:01:05.600 --> 0:01:08.360 wait until later in life to see how this translated 0:01:08.400 --> 0:01:12.480 in reality. Like most children, Kimberly started school at age five, 0:01:12.880 --> 0:01:15.520 but in all other ways, she was profoundly different from 0:01:15.520 --> 0:01:18.319 the other kids in her class. Physically, she was the 0:01:18.360 --> 0:01:20.400 size of a small three year old, and school was 0:01:20.440 --> 0:01:23.880 an immense challenge. Given no special tools, Kimberly was expected 0:01:23.920 --> 0:01:25.880 to learn at the same rate as her classmates while 0:01:25.920 --> 0:01:29.119 missing most of two of her senses. After eight hours 0:01:29.120 --> 0:01:32.120 of concentrating to hear, see, and keep up, she craved 0:01:32.160 --> 0:01:35.080 silence and to be left alone, meaning after school friends 0:01:35.160 --> 0:01:38.120 were few and far between, often lonely. She grew up 0:01:38.160 --> 0:01:41.840 being bullied and picked on for her differences. Kimberly's parents 0:01:41.840 --> 0:01:44.039 were at a loss, not knowing what to do or 0:01:44.040 --> 0:01:47.279 how to cope. I needed advocates, and they just weren't. 0:01:47.360 --> 0:01:49.760 She said. My mother had been a bully at school 0:01:49.760 --> 0:01:52.880 herself and continued that behavior with me. She was unable 0:01:52.920 --> 0:01:55.560 to relate to my disability. It was hard to get 0:01:55.560 --> 0:01:58.040 close to my father or brothers too, because they didn't 0:01:58.040 --> 0:02:01.120 try to get close to me. Things became much worse 0:02:01.160 --> 0:02:03.840 emotionally for eleven year old Kimberly. When she was scheduled 0:02:03.840 --> 0:02:07.200 to have heart surgery. Her classmates taunted her, telling her 0:02:07.200 --> 0:02:09.840 she was going to die. One parent was allowed to 0:02:09.840 --> 0:02:12.400 go into the operating room with Kimberly while anesthesia was 0:02:12.440 --> 0:02:15.400 being administered, but neither of her parents chose to provide 0:02:15.400 --> 0:02:19.080 this comfort. She went in alone. When she woke up, 0:02:19.160 --> 0:02:22.560 she smiled despite the incredible pain, knowing she was alive, 0:02:22.760 --> 0:02:26.240 proving her schoolmates and the unfeeling world around her wrong. 0:02:26.760 --> 0:02:31.320 Her surgeon called her a wilful, stubborn survivor. These days, 0:02:31.360 --> 0:02:34.200 Kimberly lives quietly. She has worked in the past, but 0:02:34.360 --> 0:02:38.800 seldom full time. She exercises daily or risks losing her mobility, 0:02:38.840 --> 0:02:41.680 and is a passionate archer. When she ventures out of 0:02:41.720 --> 0:02:46.040 her home, it's an exercise and extreme concentration. Kimberly uses 0:02:46.080 --> 0:02:48.760 a long cane to help her get around. Her life 0:02:48.800 --> 0:02:52.799 is also about tools. Her laptop has magnification, her Kindle 0:02:52.840 --> 0:02:55.400 reader is on the second largest font, and she paints 0:02:55.400 --> 0:02:58.040 her nails with a magnifying glass clipped to her glasses. 0:02:58.680 --> 0:03:01.480 You get used to being stared at Kimberly said, the 0:03:01.520 --> 0:03:03.920 only difference between now and when I was a child 0:03:04.080 --> 0:03:06.840 is that now I don't care. I just smile. I 0:03:06.960 --> 0:03:08.960 like who I am and how far I have come. 0:03:09.720 --> 0:03:12.120 I'm looking forward to the next adventures in my life. 0:03:12.440 --> 0:03:16.000 She said, I'm a vaccination crusader. If I can save 0:03:16.200 --> 0:03:19.880 just one life by telling, teaching, and pushing for vaccination, 0:03:20.280 --> 0:03:33.600 that I know it's all been worth it. 0:04:05.560 --> 0:04:08.440 Oh, Aaron, that got me, I know, I know. 0:04:09.680 --> 0:04:15.080 It's a Yeah. That firsthand was from Kimberly Cowley and 0:04:15.160 --> 0:04:19.000 I found it on a website called Measlesubella Initiative dot 0:04:19.080 --> 0:04:22.279 org and I will post a link to the full account. 0:04:22.360 --> 0:04:25.280 So that was excerpts. And also, according to this website, 0:04:25.360 --> 0:04:28.520 Kimberly is working on a book, so that would be 0:04:28.560 --> 0:04:34.800 awesome to check out. Yeah, yeah, Hi, I'm Aaron Welsh. 0:04:34.279 --> 0:04:36.120 And I'm Erin Alman Update and. 0:04:36.000 --> 0:04:39.240 This is this podcast will kill you Today. 0:04:39.400 --> 0:04:43.000 I'm already crying. It's gonna be a great episode. 0:04:43.080 --> 0:04:48.760 Setting the stage, setting the tone for this episode today. Yeah, yes, 0:04:48.839 --> 0:04:53.480 today we are covering rubella also known as German measles, 0:04:53.520 --> 0:04:55.600 although I don't know how many people still call it 0:04:55.640 --> 0:04:56.520 that nowadays. 0:04:56.720 --> 0:04:59.159 In like textbooks. I feel like you still hear it. 0:04:59.480 --> 0:05:04.120 Yeah, yeah, well, we'll be mostly calling it rubella Rubella, 0:05:04.360 --> 0:05:10.960 that's what it's called. Yeah ah well, I guess to 0:05:11.000 --> 0:05:13.920 start us off, it's quarantiny time. 0:05:14.040 --> 0:05:16.480 It's definitely definitely quarantiny time. 0:05:18.240 --> 0:05:20.080 What are we drinking this week? 0:05:20.400 --> 0:05:22.800 We're drinking choo rubella. 0:05:25.360 --> 0:05:28.520 Very well done, air, thank you? And what is in 0:05:28.560 --> 0:05:33.800 the chow Rebella? I don't know, Okay, I can tell 0:05:33.839 --> 0:05:39.719 you gin cherry juice, grenadine, a splash of soda water, 0:05:39.880 --> 0:05:44.000 and also a fancy liqueur that's like a raspberry liqueur 0:05:44.160 --> 0:05:50.200 called chambourd Chambard. Yeah, I liked the bottle was really pretty. 0:05:50.160 --> 0:05:53.760 A very ruby rubella drink. I feel like that's appropriate 0:05:54.000 --> 0:05:54.760 Ruby Rebella. 0:05:55.080 --> 0:05:59.839 Yeah exactly. We will post the full recipe to the 0:06:00.120 --> 0:06:02.800 chow Rebella on our website. This podcast will kill you 0:06:02.839 --> 0:06:05.920 dot Com as well as all of our social media channels, 0:06:05.960 --> 0:06:07.719 and that is also where you will be able to 0:06:07.800 --> 0:06:09.880 find the non alcoholic Placybrita. 0:06:10.200 --> 0:06:12.640 Oh yeah, we got you covered. 0:06:12.600 --> 0:06:16.760 We got you all right? Is there some there's some business? 0:06:16.800 --> 0:06:19.279 I guess we should run down the list of usual 0:06:19.320 --> 0:06:20.800 suspects before we dive in. 0:06:21.200 --> 0:06:26.520 For example, we have incredible merch for sale on our 0:06:26.520 --> 0:06:28.640 website This podcast will kill You dot com. Just click 0:06:28.640 --> 0:06:32.120 on merch you can find it. We have incredible offerings 0:06:32.160 --> 0:06:36.400 by the artists Abigail Irvin Penner as well as Hollysullivan. 0:06:36.640 --> 0:06:39.400 Really truly, I just got some of the Holly Sullivan's 0:06:39.440 --> 0:06:42.239 Framed Prince and I am obsessed with them. They're so cute, 0:06:42.680 --> 0:06:43.320 my gosh. 0:06:43.360 --> 0:06:47.480 And there are stickers of both which like, if you're 0:06:47.520 --> 0:06:50.880 running out of wall space for pictures, which I definitely am, you. 0:06:51.120 --> 0:06:52.520 Have water bottle space. 0:06:55.800 --> 0:06:59.279 We also have a good Reads list if you want 0:06:59.320 --> 0:07:01.480 to read more on any of the subjects that we 0:07:01.520 --> 0:07:05.880 talk about, in addition to a bookshop affiliate account, and 0:07:06.080 --> 0:07:09.920 when we post the references to all of these episodes, 0:07:09.960 --> 0:07:12.840 we will also post links, when available, to the books 0:07:12.880 --> 0:07:14.560 that we mentioned on the podcast. 0:07:14.920 --> 0:07:17.720 Yep is that all of our business? 0:07:18.000 --> 0:07:22.160 I think that's it. Okay, let's dive in. 0:07:22.680 --> 0:07:25.920 Let's this is going to be a big fun not fun, 0:07:26.120 --> 0:07:28.040 a big episode. 0:07:28.240 --> 0:07:29.760 It's going to be a big one. It's going to 0:07:29.840 --> 0:07:33.560 be very interesting. There's a lot I feel like to 0:07:33.760 --> 0:07:38.040 uncover that I had no idea about before diving in. 0:07:38.320 --> 0:07:40.400 Oh, I can't wait to hear the history. But we'll 0:07:40.400 --> 0:07:43.920 start where we always do, with the biology right after 0:07:43.960 --> 0:08:24.160 this break. Obviously, we have two major points to talk 0:08:24.200 --> 0:08:28.520 about today in the biology, and that is rubella infection 0:08:29.600 --> 0:08:34.680 like in children and adults, and of course congenital rubella syndrome, 0:08:35.160 --> 0:08:38.280 which I think most people listening probably know already. The 0:08:38.360 --> 0:08:42.880 major complication of rubella infection is the effects that it 0:08:42.880 --> 0:08:46.320 can have on a fetus if someone is infected during pregnancy, 0:08:46.520 --> 0:08:51.320 especially and specifically early in pregnancy. When we did our 0:08:51.440 --> 0:08:55.840 Triple E episode Eastern equine encephalitis like back in season three, 0:08:56.559 --> 0:08:59.760 I said during that episode that rubella was another and 0:08:59.880 --> 0:09:03.160 one of the only non arthropod born alpha viruses in 0:09:03.200 --> 0:09:08.400 the family Togaviridae. But apparently in twenty eighteen that was 0:09:08.520 --> 0:09:14.000 changed and Rubella was reclassified. So it's not really anymore 0:09:14.080 --> 0:09:18.080 a toga virus. It's in its whole own family called Motonaviridae, 0:09:18.280 --> 0:09:22.719 in the genus Rubavirus. Huh okay, I know. So this 0:09:22.800 --> 0:09:25.960 is a self correction, because nobody has corrected me on 0:09:26.000 --> 0:09:30.199 that yet. I'm shocked. In any case, we are talking 0:09:30.200 --> 0:09:33.760 today about a virus. It is a single stranded positive 0:09:34.080 --> 0:09:37.880 RNA virus. Unlike a lot of other RNA viruses that 0:09:37.920 --> 0:09:42.040 we've talked about, it's pretty stable antigenically, so that's a 0:09:42.120 --> 0:09:49.760 large part of why we have a pretty effective vaccine spoilers. So, 0:09:50.400 --> 0:09:56.040 in general, Rubella virus is transmitted via aerosols, much like measles, 0:09:56.360 --> 0:09:59.400 which I feel like rubella and measles often go hand 0:09:59.440 --> 0:10:02.600 in hand in terms of our conversations, even though they're 0:10:02.600 --> 0:10:06.760 really not that similar. But in this case Rubella, it's 0:10:06.880 --> 0:10:09.760 really large particle aerosols, so it doesn't linger in the 0:10:09.800 --> 0:10:11.720 air the way that measles does. 0:10:11.960 --> 0:10:14.480 Okay, So that explains the lower are not. 0:10:15.880 --> 0:10:19.840 Exactly right. So it is a respiratory virus, and like 0:10:19.960 --> 0:10:22.960 every virus on the planet, it has to infect a 0:10:23.120 --> 0:10:27.679 cell in order to replicate. In the case of rubella, 0:10:27.760 --> 0:10:31.319 it generally first infects the cells of our respiratory tract 0:10:31.600 --> 0:10:34.360 and then the lymph tissue, which it's very easy to 0:10:34.400 --> 0:10:39.600 access from like our nose and nasal passages, but very 0:10:39.760 --> 0:10:44.280 very quickly. Within five to seven days after exposure, Rubella 0:10:44.360 --> 0:10:47.600 is able to disseminate throughout our blood stream, so it 0:10:47.679 --> 0:10:50.960 causes a viremia, meaning you can detect virus in our 0:10:50.960 --> 0:10:53.680 blood if you took a sample, and it leads to 0:10:53.760 --> 0:10:59.120 a pretty widespread systemic infection. What that means is that, 0:10:59.240 --> 0:11:02.880 unlike some other viruses and pathogens that we've discussed, rubella 0:11:02.960 --> 0:11:06.720 has a very wide tropism, meaning it can infect a 0:11:06.960 --> 0:11:10.120 huge range of our cell types, not just a few 0:11:10.240 --> 0:11:11.040 types of cells. 0:11:11.960 --> 0:11:14.320 That's very interesting. 0:11:14.040 --> 0:11:19.160 It really is. We don't still know exactly what receptor 0:11:19.240 --> 0:11:22.840 it uses on our cells to gain entry into our cells, 0:11:23.920 --> 0:11:25.960 but we know that it must be something that's present 0:11:26.000 --> 0:11:29.640 on like almost every cell type, if that makes sense. 0:11:29.800 --> 0:11:35.400 So that makes me wonder about other species. So, like, 0:11:35.640 --> 0:11:39.040 I know that rubella is human specific, it is, but 0:11:39.880 --> 0:11:42.520 if it infects all like, what is it then about 0:11:42.760 --> 0:11:44.920 all of these human cells? 0:11:45.280 --> 0:11:45.480 Right? 0:11:45.600 --> 0:11:47.880 Makes it not able to infect other animals? 0:11:48.200 --> 0:11:50.560 Right? It's a really good question. So what is it 0:11:50.720 --> 0:11:54.800 using in our bodies to be able to infect almost 0:11:54.800 --> 0:11:58.920 all of our cells? But really just humans? I mean, experimentally, 0:11:59.000 --> 0:12:01.240 you can infect other animals. So it's not that it's 0:12:01.280 --> 0:12:04.880 impossible for other animals to become infected. It's just that 0:12:05.000 --> 0:12:08.880 in general, other animals, they're not good reservoirs. They're not 0:12:09.000 --> 0:12:12.840 like walking around in the world infected with Rubella virus. 0:12:13.280 --> 0:12:17.560 Ooh, so I wonder whether it's like just the transmission 0:12:17.640 --> 0:12:22.280 dynamics and like human behavior, and or maybe like it 0:12:22.360 --> 0:12:25.880 just doesn't cause disease the way that it doesn't. That's 0:12:25.880 --> 0:12:28.280 so interesting, so interesting. 0:12:28.000 --> 0:12:33.679 Right, yeah, I know it gets even more interesting, quite honestly, 0:12:34.160 --> 0:12:36.280 But keep that in mind, right, Like, this is a 0:12:36.320 --> 0:12:40.079 virus that can infect pretty much any cell type. Additionally, 0:12:40.240 --> 0:12:43.960 we know that, like many many viruses, at least part 0:12:44.200 --> 0:12:49.760 of the pathogenic effect of rubella is by directly killing cells. Essentially, 0:12:49.840 --> 0:12:53.040 so whind cells get infected with virus and the virus 0:12:53.080 --> 0:12:57.920 replicates inside those cells, that cell will undergo apoptosis, meaning 0:12:58.120 --> 0:13:01.840 that cell will die. So at least in part that 0:13:02.000 --> 0:13:05.160 is responsible for the damage. That means it's not just 0:13:05.320 --> 0:13:08.600 our immune reaction or our immune response that's causing the 0:13:08.600 --> 0:13:11.520 symptoms that we see. But we'll put a pin in 0:13:11.520 --> 0:13:15.520 that because that's not the whole story, and we'll move 0:13:15.559 --> 0:13:21.280 on to the symptoms at least in grown humans. I 0:13:21.320 --> 0:13:25.960 want to skip ahead. Okay, okay, in general, in children 0:13:26.160 --> 0:13:29.760 or adults who get infected, we are talking with Rebella 0:13:30.120 --> 0:13:34.320 about a very very mild self limited illness. If you 0:13:34.400 --> 0:13:39.800 have symptoms at all. In general, it starts with a rash, 0:13:39.840 --> 0:13:40.360 not a fever. 0:13:40.679 --> 0:13:45.199 Oh that's the other podcast. 0:13:45.960 --> 0:13:48.640 It's starting with a fever asterisk. Unless it starts with 0:13:48.640 --> 0:13:52.040 the rash, we there go perfect. So in the case 0:13:52.040 --> 0:13:54.840 of rebella, it generally starts with a rash. This rash 0:13:55.000 --> 0:13:57.720 is very similar actually to the one that we see 0:13:57.800 --> 0:14:00.360 with measles, which I think is a large part of 0:14:00.400 --> 0:14:05.400 why there's this overlap. It starts on the face. It 0:14:05.440 --> 0:14:10.000 generally spreads downwards towards the feet, encompassing almost your whole body. 0:14:10.679 --> 0:14:14.320 They're just the rash looks like small red spots, maybe 0:14:14.320 --> 0:14:18.480 with some bumps. But differences between the rubella rash and 0:14:18.520 --> 0:14:21.640 measles are that it spreads much more quickly, like within 0:14:21.720 --> 0:14:25.760 twenty four hours. It generally lasts only a couple of days, 0:14:25.800 --> 0:14:29.720 like two to three days, and the rash doesn't coalesque 0:14:29.960 --> 0:14:32.600 or darken the way that measles rashes tend to do. 0:14:32.920 --> 0:14:36.400 Okay, I also read somewhere it was tingly. 0:14:37.200 --> 0:14:40.880 Oh interesting. I took the cares that, oh, you can 0:14:40.960 --> 0:14:41.960 feel it tingling. 0:14:42.320 --> 0:14:45.240 That's ad tingly rash, I mean. Granted, this description was 0:14:45.280 --> 0:14:49.200 from the mid mid eighteen hundred so, like, you know, I. 0:14:49.240 --> 0:14:51.800 Wonder is that a description of how the rash feels 0:14:51.960 --> 0:14:54.520 or is it something about like is that how you 0:14:54.560 --> 0:14:58.760 describe rashes like a tingly rash versus a lacy rash? 0:14:58.840 --> 0:14:59.320 I don't know. 0:15:00.880 --> 0:15:04.840 I assumed it was it tingles, but well, because does 0:15:05.080 --> 0:15:07.560 does measles tingle? I can't remember, or does it like 0:15:07.640 --> 0:15:08.520 itch or burn? 0:15:09.000 --> 0:15:10.120 I don't think so. 0:15:10.560 --> 0:15:12.280 I didn't think so. So I thought that was one 0:15:12.280 --> 0:15:16.760 of the designating like interesting or differentiating characteristics. 0:15:16.800 --> 0:15:20.680 Really, yeah, really, I didn't read it. Doesn't mean it's 0:15:20.680 --> 0:15:26.880 not possible, but very differently from measles that rash is 0:15:26.920 --> 0:15:31.480 often it okay in terms of the symptoms of rubella 0:15:31.640 --> 0:15:34.240 if you have that at all, maybe you might also 0:15:34.360 --> 0:15:38.000 have a slight fever, maybe you might have some swollen 0:15:38.080 --> 0:15:42.600 lymph nodes, but really that's about it. It's a very 0:15:42.640 --> 0:15:45.880 mild illness. And again that's if you even have symptoms. 0:15:47.160 --> 0:15:49.440 The older that you are when you get infected, the 0:15:49.520 --> 0:15:53.480 more likely that you'll have symptoms beyond the rash. But 0:15:54.240 --> 0:15:57.320 kids are more likely to like have the rash for sure, 0:15:57.440 --> 0:16:00.280 like have any symptoms whatsoever. And if you have symptoms, 0:16:00.640 --> 0:16:03.520 number one is going to be the rash okay. In 0:16:03.560 --> 0:16:07.480 some cases you can have things like arthralgias or joint pain, 0:16:07.920 --> 0:16:11.400 which can last for several weeks, but it's really rare, 0:16:11.760 --> 0:16:16.480 and even more rare are severe manifestations like encephalitis the 0:16:16.520 --> 0:16:19.440 way that we do see with measles. We're talking though, 0:16:19.520 --> 0:16:23.960 like one to three per six thousand cases, so this 0:16:24.000 --> 0:16:29.040 is a very rare complication. But also other complications that 0:16:29.080 --> 0:16:32.040 you can get from a wide variety of viral and 0:16:32.120 --> 0:16:36.280 other infections, things like yon beret myocarditis, which is when 0:16:36.320 --> 0:16:39.600 the virus infects your heart, optic neuritis if it affects 0:16:39.640 --> 0:16:42.480 your eyes. These things are all possible, but they're not 0:16:42.560 --> 0:16:45.680 specific to rubella, and they're very very unlikely with a 0:16:45.760 --> 0:16:50.960 rubella infection specifically gotcha, but that's not the big story 0:16:51.040 --> 0:16:54.520 when it comes to rubella. The big story is congenital 0:16:54.640 --> 0:16:58.720 Rubella syndrome or CRS. This is what happens when a 0:16:58.760 --> 0:17:03.120 person gets infected with rubella, and usually this has to 0:17:03.160 --> 0:17:06.439 be a primary infection, so someone is being exposed and 0:17:06.480 --> 0:17:09.600 infected for the first time in their life while they 0:17:09.600 --> 0:17:13.840 are pregnant, specifically during the first trimester, which is the 0:17:13.880 --> 0:17:18.120 first twelve weeks of pregnancy. Now, if we remember back 0:17:18.160 --> 0:17:21.480 to our philidamide episode, when I talked about the embryologic 0:17:21.560 --> 0:17:24.000 period of development, the first like ten weeks or so, 0:17:25.400 --> 0:17:28.800 I talked a lot about how anything that has effects 0:17:28.840 --> 0:17:32.639 on a developing fetus during this period when it's an embrya, 0:17:32.800 --> 0:17:39.000 not even a fetus, has huge downstream developmental effects. Rubella 0:17:39.200 --> 0:17:41.840 is one of those infections that can infect a fetus, 0:17:41.960 --> 0:17:47.320 especially at this early early stage. Essentially, what happens is 0:17:47.560 --> 0:17:50.800 when a pregnant person gets infected with rubella. As we 0:17:50.880 --> 0:17:55.720 already talked about, that virus spreads really rapidly throughout our bodies, 0:17:56.280 --> 0:17:58.400 and one of the places that it spreads and can 0:17:58.440 --> 0:18:01.320 infect is the placenta in the place central tissue, and 0:18:01.359 --> 0:18:03.919 then it can travel through that placenta and go on 0:18:04.000 --> 0:18:07.840 to infect pretty much any cell in that developing embryo 0:18:07.960 --> 0:18:14.320 or fetus. Now, what exactly happens inside an infected fetus 0:18:14.560 --> 0:18:18.280 is still not entirely clear, which I think is fascinating. 0:18:18.600 --> 0:18:22.119 So yeah, I'm so surprised by. 0:18:22.000 --> 0:18:25.000 That, me too. But we do know some things, and 0:18:25.040 --> 0:18:29.840 they're really interesting. There's kind of three main ways that 0:18:29.960 --> 0:18:35.840 rubella has effects. We know that in grown humans. One 0:18:35.840 --> 0:18:39.399 of the main effects of rebella that causes symptoms is 0:18:39.560 --> 0:18:43.639 direct cell death, right, But in the case of the 0:18:43.680 --> 0:18:48.080 developing fetus, that doesn't seem to be a main mechanism 0:18:48.359 --> 0:18:53.119 by which damage is induced. Isn't that weird? 0:18:53.640 --> 0:18:57.080 I wonder does this have something to do with the 0:18:57.119 --> 0:19:00.240 fact that we still don't know the receptor and that 0:19:00.400 --> 0:19:04.080 like maybe I don't know, I mean it does is 0:19:04.119 --> 0:19:07.040 it cell death? Okay? So if rubella virus can infect 0:19:07.160 --> 0:19:10.520 all those different cells that we have, does it cause 0:19:10.640 --> 0:19:14.320 cell death in all of those cells or is it 0:19:14.480 --> 0:19:15.640 just a subset? 0:19:16.080 --> 0:19:19.720 Very good question. I don't know. And here's an on 0:19:19.800 --> 0:19:23.679 top of that. We think that at least part of 0:19:23.800 --> 0:19:26.680 the reason that a fetus is susceptible when it is, 0:19:26.800 --> 0:19:29.679 and part of why. So this is an interesting I 0:19:29.720 --> 0:19:31.080 was gonna say this later, but I'm going to say 0:19:31.080 --> 0:19:34.760 it now. If a baby is born with congenital rubella syndrome, 0:19:35.040 --> 0:19:39.240 they still harbor rubella virus for months, if not years, 0:19:39.520 --> 0:19:44.040 And so in a fetus and a newborn rubella is 0:19:44.080 --> 0:19:48.920 not an acute infection. It's a chronic infection. So it's 0:19:49.000 --> 0:19:52.639 acting very differently in a fetus than it is in 0:19:53.400 --> 0:19:56.800 a person. Yes, so how much does that have to 0:19:56.880 --> 0:19:59.560 do with the fact that the immune system is still 0:19:59.640 --> 0:20:05.680 under development? Gosh, who knows, right, Like, what are those 0:20:05.720 --> 0:20:09.000 mechanisms and what's the interaction with a you know, well 0:20:09.040 --> 0:20:13.600 developed immune system versus a fetal immune system. It gets complicated, 0:20:13.600 --> 0:20:15.480 but erin, it's about to get more complicated. So I 0:20:15.520 --> 0:20:16.359 have to keep going. 0:20:16.560 --> 0:20:19.560 Wait, but can I ask two questions before try. 0:20:21.600 --> 0:20:21.679 So? 0:20:22.160 --> 0:20:26.719 Okay? My first question is if it can infect all 0:20:26.760 --> 0:20:28.160 these different types of cells? 0:20:28.920 --> 0:20:29.479 Uh huh? 0:20:29.640 --> 0:20:33.359 Can it also be transmitted through means other than respiratory? 0:20:33.440 --> 0:20:35.439 Is respiratory just the primary way? 0:20:35.800 --> 0:20:38.840 Great question? And yes, yeah, so you can culture virus 0:20:38.880 --> 0:20:42.159 from a whole bunch of different bodily fluids poop pe 0:20:43.359 --> 0:20:48.679 i conjunctive fluid, even by scraping off the skin. Like 0:20:48.960 --> 0:20:51.679 the virus is in your skin, especially when you have 0:20:51.720 --> 0:20:54.760 a rash, it's actually in the rash and in non 0:20:54.880 --> 0:20:57.879 rashy skin. So the virus is definitely everywhere. It's in 0:20:57.920 --> 0:21:01.960 your blood, but it's at highest level in the respiratory tract. 0:21:02.240 --> 0:21:05.840 Okay, that makes sense. Yeah, And my other question is 0:21:06.800 --> 0:21:10.920 in later trimesters or later on in the pregnancy, if 0:21:10.960 --> 0:21:15.639 someone becomes infected, does the fetus have an immunity, like, 0:21:15.680 --> 0:21:16.760 are there any effects? 0:21:17.000 --> 0:21:19.280 Pause that question, Okay, I'll answer that. 0:21:19.440 --> 0:21:20.159 I'll address that. 0:21:20.240 --> 0:21:25.000 Thank you, We will get there erin, let's not jump 0:21:25.040 --> 0:21:25.600 our guns. 0:21:25.680 --> 0:21:27.040 Sorry, I got really excited. 0:21:27.200 --> 0:21:30.280 I know you did. So all I told you was 0:21:30.359 --> 0:21:35.359 what is not the main cause of the effects that 0:21:35.400 --> 0:21:37.440 we see in a developing fetus. I want to tell 0:21:37.440 --> 0:21:41.600 you what we think are okay, because we know something okay, 0:21:41.800 --> 0:21:45.240 and because it gets even weirder. Infection in the fetus 0:21:45.600 --> 0:21:52.160 results in decreased cell growth and division. So even if 0:21:52.160 --> 0:21:57.320 it's not killing cells directly, it's stopping cells from dividing. 0:21:57.640 --> 0:22:03.000 That's what a fetus does, divide cells. But I mean 0:22:03.119 --> 0:22:06.160 that what that means is that in a developing fetus 0:22:06.160 --> 0:22:09.520 you have a reduction in cell mass, and that can 0:22:09.560 --> 0:22:14.399 result in not enough cells recruited to shape embryologic parts 0:22:14.560 --> 0:22:16.639 the way that they should be developed. 0:22:17.000 --> 0:22:20.040 Okay, So that it's just a non it's almost a 0:22:20.080 --> 0:22:25.840 side effect of Like, there are so many downstream effects 0:22:26.280 --> 0:22:29.480 from a rebella infection that's not just oh, the rebella 0:22:29.640 --> 0:22:31.320 virus targets those. 0:22:32.200 --> 0:22:37.960 Cells, and there's more talk about downstream effects another cell type. 0:22:38.040 --> 0:22:40.000 Even though we know that rebella can infect a lot 0:22:40.080 --> 0:22:43.080 of different cells. One of the big problems is when 0:22:43.200 --> 0:22:47.199 rubella in a developing fetus infects the endothelial cells of 0:22:47.240 --> 0:22:50.480 the blood vessels. Those are the cells that line blood vessels. 0:22:50.520 --> 0:22:52.840 We end up talking about those a lot on this podcast. 0:22:53.240 --> 0:22:57.680 Interesting infection of those cells causes damage to fetal blood vessels, 0:22:58.119 --> 0:23:03.879 which can downstream cause damage enough that they cause ischemia 0:23:04.040 --> 0:23:07.280 or tissue death in organs that are supplied by those 0:23:07.320 --> 0:23:11.000 blood vessels. So you can have downstream effects of damage 0:23:11.000 --> 0:23:14.359 to organs because of damage to these blood vessels in 0:23:14.400 --> 0:23:14.920 the fetus. 0:23:16.760 --> 0:23:23.280 Okay, I have a question. Okay, does the timing of 0:23:23.359 --> 0:23:26.560 infection during the first trimester matter or is it just 0:23:26.600 --> 0:23:27.600 sort of any time. 0:23:27.720 --> 0:23:32.400 Absolutely, the timing matters. So the timing matt The timing 0:23:32.640 --> 0:23:37.480 is everything in terms of the effects that you see, 0:23:37.520 --> 0:23:42.000 in terms of the severity everything. So there's a lot 0:23:42.040 --> 0:23:45.000 of details in a lot of the papers that I 0:23:45.040 --> 0:23:47.879 will post in terms of like the exact number of 0:23:47.960 --> 0:23:51.679 weeks for when you have this effect versus that effect. 0:23:52.600 --> 0:23:56.159 But in general, it goes like this infection within the 0:23:56.200 --> 0:24:01.000 first twelve weeks almost always is going to result in 0:24:01.000 --> 0:24:04.000 infection of the fetus. So infection of a pregnant person 0:24:04.119 --> 0:24:06.600 during the first twelve weeks of pregnancy for the first 0:24:06.600 --> 0:24:10.840 time with Rebella is going to end up infecting the fetus. 0:24:11.520 --> 0:24:15.040 In those first twelve weeks. Almost all of those infections, 0:24:15.280 --> 0:24:18.080 or a large proportion of those infections, are going to 0:24:18.119 --> 0:24:22.200 result in some kind of fetal malformation or problem down 0:24:22.240 --> 0:24:28.159 the line after like sixteen eighteen weeks especially. It's not 0:24:28.200 --> 0:24:31.240 that infection doesn't occur, it just doesn't have those long, 0:24:31.560 --> 0:24:37.760 long term effects or downstream effects. And this is really weird. 0:24:37.840 --> 0:24:40.320 There's like a period of time in the second trimester 0:24:40.440 --> 0:24:44.680 where infection itself tends to be like lowest, and then 0:24:44.720 --> 0:24:48.560 in the third trimester the fetus could become infected, but 0:24:49.040 --> 0:24:51.439 the most that you might see would be like some 0:24:51.600 --> 0:24:57.040 growth restriction. Okay, but at almost any point in pregnancy 0:24:57.560 --> 0:25:00.760 a fetus could become infected. It's just that only in 0:25:00.840 --> 0:25:03.320 that early period of time are you going to see 0:25:03.359 --> 0:25:06.080 the effects. So let's talk a little bit more specifically 0:25:06.119 --> 0:25:08.600 about what you see, because then we can talk about 0:25:09.160 --> 0:25:13.040 even more specifically about the timing. Okay, So, because this 0:25:13.119 --> 0:25:18.240 is a virus that can affect almost every cell, really 0:25:18.480 --> 0:25:24.120 almost any part can be affected almost any organ really everything, 0:25:24.200 --> 0:25:28.040 but classically there are kind of three large scale ways 0:25:28.119 --> 0:25:31.639