WEBVTT - Ep 49 Eastern Equine Encephalitis: Triple EEEk! 0:00:01.240 --> 0:00:03.760 On the seventh of September, my boy took her from 0:00:03.800 --> 0:00:07.160 the pasture a little before sunset and harnessed her. While 0:00:07.160 --> 0:00:10.119 standing at the door, I observed she slavered freely and 0:00:10.240 --> 0:00:14.240 was stupid and downcast in her appearance. I observed that 0:00:14.280 --> 0:00:16.479 she was loath to go faster than the walk, and, 0:00:16.520 --> 0:00:20.160 although repeatedly urged forward by the whip, would shortly resume 0:00:20.160 --> 0:00:23.959 the walk. Once or twice, on ascending a hill she 0:00:24.040 --> 0:00:26.600 stopped for a second as if fatigued or in pain, 0:00:26.760 --> 0:00:29.680 and several times in descending small pitches she appeared in 0:00:29.760 --> 0:00:32.280 great danger of falling from the very bungling manner of 0:00:32.360 --> 0:00:36.040 using her fore feet. I continued my ride without discovering 0:00:36.080 --> 0:00:39.040 anything farther till the latter part of the evening, except 0:00:39.159 --> 0:00:41.960 that whenever the whip was applied, a distinct interval was 0:00:42.000 --> 0:00:44.280 obvious between the time I struck her and the time 0:00:44.320 --> 0:00:47.120 she perceived the blow. When she did perceive it, the 0:00:47.159 --> 0:00:50.040 effect was greater than expected, for she started off as 0:00:50.080 --> 0:00:52.600 if surprise had been added to the usual effects of 0:00:52.600 --> 0:00:55.520 the lash. On my return home in the latter part 0:00:55.560 --> 0:00:58.560 of the evening, I experienced great difficulty in keeping her 0:00:58.560 --> 0:01:01.520 in the road on account of an obstinate and constant 0:01:01.560 --> 0:01:05.160 tendency to the left that required strong effort to counteract. 0:01:05.720 --> 0:01:08.000 She could scarcely be urged out of a walk, and 0:01:08.080 --> 0:01:10.600 it was perfectly evident that she was laboring under some 0:01:10.640 --> 0:01:15.600 alarming disease. I now made a careful examination and found 0:01:15.600 --> 0:01:19.160 the whole surface of the body cold and tremulous, countenance 0:01:19.200 --> 0:01:22.160 dull and listless, a leaning and stepping to the left, 0:01:22.440 --> 0:01:25.280 with so much appearance of general weakness as to induce 0:01:25.319 --> 0:01:27.880 the fear that she would fall in the harness. With 0:01:27.959 --> 0:01:30.560 much ado, I got her home, which was then but 0:01:30.600 --> 0:01:34.600 a short distance. She, however, grew worse very fast, and 0:01:34.640 --> 0:01:37.560 when she arrived home, did not recognize her own stable. 0:01:38.840 --> 0:01:41.000 She was now well rubbed and a gallon of blood 0:01:41.040 --> 0:01:44.720 taken from the neck. While this was doing, and afterwards 0:01:44.840 --> 0:01:48.360 she often kicked violently with her left foot. About eleven 0:01:48.400 --> 0:01:50.480 p m. I was called from home and did not 0:01:50.520 --> 0:01:53.120 return until the next day, about two pm. When she 0:01:53.240 --> 0:01:56.480 was down and incapable of rising. She was left in 0:01:56.560 --> 0:01:59.000 care of a farrier, who had her blood again and 0:01:59.080 --> 0:02:03.400 given her several cathartic medicines without effect. She lay stretched 0:02:03.400 --> 0:02:05.920 out upon the floor with her head drawn back and 0:02:05.960 --> 0:02:09.440 the muscles of the neck, abdomen and limbs frequently convulsed. 0:02:10.120 --> 0:02:13.079 At short intervals. She would revive or attempt to get up, 0:02:13.240 --> 0:02:15.600 but could only get upon her hind feet, for her 0:02:15.639 --> 0:02:19.720 fore legs appeared to be completely paralyzed. She would, however, 0:02:19.840 --> 0:02:23.079 make a powerful exertion to rise forwards and throw herself 0:02:23.160 --> 0:02:25.720 several feet ahead, without regard to anything that might be 0:02:25.760 --> 0:02:29.799 in her way. No material alteration took place till next morning, 0:02:29.960 --> 0:02:35.400 except gradual diminution of strength and exertion. In the morning, 0:02:35.480 --> 0:02:38.880 she commenced moving her legs backwards and forwards, was generally 0:02:38.880 --> 0:02:42.920 convulsed and apparently in greatest distress. This state of things 0:02:42.960 --> 0:03:31.680 continued till nine am when she expired. Oh, I know, 0:03:32.600 --> 0:03:36.800 it's really sad. Also, that was about a. 0:03:36.760 --> 0:03:40.000 Horse, that was Yeah, it wasn't. 0:03:40.120 --> 0:03:43.200 It wasn't obviously clear right the firsthand. 0:03:43.320 --> 0:03:46.000 But that was about a horse like taking her from 0:03:46.040 --> 0:03:51.720 the pasture. Yeah, we four feet four feet. 0:03:53.800 --> 0:03:57.520 So that was an account of the eighteen thirty one 0:03:58.120 --> 0:04:03.040 Eastern equine encephalitis outbreak in Massachusetts, written by Gardner M. Peck, 0:04:03.280 --> 0:04:06.000 and it was from a nineteen fifty seven article titled 0:04:06.000 --> 0:04:08.920 in an Epizootic of Equine and Cephalomyelitis by RP. 0:04:09.080 --> 0:04:09.480 Hanson. 0:04:11.000 --> 0:04:13.000 Hi, I'm Aaron. 0:04:12.760 --> 0:04:15.320 Welsh and I'm Erin omen Updyke. 0:04:15.280 --> 0:04:17.320 And this is this podcast will kill you. 0:04:18.120 --> 0:04:20.760 And they were talking about triple. 0:04:20.400 --> 0:04:23.560 A triple A Eastern equine encephalitis. 0:04:24.080 --> 0:04:27.040 Yes, that's very exciting. 0:04:27.800 --> 0:04:32.040 It is so we actually this is similar to our 0:04:32.240 --> 0:04:37.680 Dangay episode. We have done this already in person at 0:04:37.680 --> 0:04:38.840 the University of Michigan. 0:04:39.160 --> 0:04:39.719 Whoop whoop. 0:04:40.320 --> 0:04:40.719 Yeah. 0:04:41.400 --> 0:04:41.640 Uh. 0:04:41.680 --> 0:04:45.000 But just like Dangay, I've forgotten everything. 0:04:45.040 --> 0:04:48.000 I don't remember. I didn't even remember Erin like my 0:04:48.080 --> 0:04:50.080 own part of this. So when I went back to 0:04:50.120 --> 0:04:53.120 my notes, I was like, oh, this is depressing. 0:04:54.000 --> 0:04:58.679 Oh yeah it is. And I yeah, I didn't remember 0:04:58.720 --> 0:05:02.000 any part of a mind, which definitely means I remember 0:05:02.120 --> 0:05:03.279 zero part of yours. 0:05:03.360 --> 0:05:05.360 Oh no, I don't know the history of this, like 0:05:05.440 --> 0:05:06.200 in the slightest. 0:05:06.360 --> 0:05:10.200 So I feel like it's kind of alarming how hotly 0:05:10.320 --> 0:05:14.760 we forget. Yes, but that was but it was super 0:05:14.800 --> 0:05:17.799 fun to be in Michigan and we really liked hanging 0:05:17.839 --> 0:05:20.880 out with Laura, So we wanted to give Laura and 0:05:20.920 --> 0:05:24.080 that group a huge shout out to having us and 0:05:24.120 --> 0:05:25.039 inviting us. 0:05:25.279 --> 0:05:27.039 That was so fun. That was when we did like 0:05:27.120 --> 0:05:28.960 actual chemistry. Remember that. 0:05:29.360 --> 0:05:32.560 Oh my gosh, it was like such an action packed 0:05:32.560 --> 0:05:33.080 fun day. 0:05:33.320 --> 0:05:34.159 It really was. 0:05:34.279 --> 0:05:38.560 We enjoyed meeting everyone and talking to everyone, and yes. 0:05:38.839 --> 0:05:40.560 It was super fun. It was great. 0:05:41.160 --> 0:05:41.920 Is so cute? 0:05:42.240 --> 0:05:45.640 Yeah, I know, I wish we got more time there. Yeah, 0:05:45.680 --> 0:05:49.080 maybe someday in the future we can go back. Yeah, 0:05:49.960 --> 0:05:56.560 someday someday. All right, to be business to attend to, Aaron. 0:05:57.160 --> 0:05:59.600 I mean, we could just do the usual suspects one 0:05:59.640 --> 0:06:03.760 more time. So we've got alcohol free episodes. You can 0:06:03.760 --> 0:06:06.320 find them on this podcast will Kill You dot com 0:06:06.400 --> 0:06:11.960 under the episodes tab. And we also have two things 0:06:11.960 --> 0:06:15.800 related to books. One is a Goodreads list, so we 0:06:15.839 --> 0:06:17.919 have a link to that on our website under the 0:06:17.920 --> 0:06:20.560 books tab. And we also have an affiliate page on 0:06:20.800 --> 0:06:25.719 bookshop dot org that is an online bookseller that works 0:06:25.720 --> 0:06:26.880 with independent bookstores. 0:06:27.440 --> 0:06:30.400 All right, now for the most important business of all, 0:06:32.560 --> 0:06:33.760 it's quarantiny time. 0:06:34.120 --> 0:06:35.919 It's quarantiney time. 0:06:37.400 --> 0:06:39.440 What are we drinking today, Aaron? 0:06:39.880 --> 0:06:42.320 We are drinking the Triple E Shot. 0:06:43.080 --> 0:06:46.640 That's it's a straightforward name. 0:06:47.160 --> 0:06:50.240 Yeah, I know, I feel like I think at the 0:06:50.279 --> 0:06:51.880 time we were like, oh, we'll come up with a 0:06:51.920 --> 0:06:55.440 better one when the episode comes out, and then here 0:06:55.520 --> 0:06:58.119 our creative juicies have just been dried up. I think 0:06:58.440 --> 0:06:59.200 we're used up. 0:06:59.240 --> 0:07:02.440 I don't know both maybe, Well, what's in the triple 0:07:02.440 --> 0:07:03.000 E shot? 0:07:03.360 --> 0:07:07.279 The triple E shot has three things, of course, a 0:07:07.320 --> 0:07:11.800 half an ounce of coffee tequila okay, delicious even on 0:07:11.840 --> 0:07:15.520 its own, A half an ounce of hazel nut liqueur, 0:07:16.080 --> 0:07:18.880 and a half an ounce of half and half fab 0:07:19.320 --> 0:07:21.840 It's it's delicious, it's simple, it's easy. 0:07:23.480 --> 0:07:28.400 There you go, all right, fabulous. Anything else that we 0:07:28.400 --> 0:07:30.600 should cover or should we just jump straight into this 0:07:30.800 --> 0:07:32.960 depressing episode? 0:07:34.240 --> 0:07:37.920 I mean, I think it's just let's just do it, Aaron, 0:07:38.000 --> 0:07:39.000 Let's just let's just. 0:07:39.000 --> 0:07:42.240 Dive right in. It's actually it's going to be very interesting. Okay. 0:07:42.680 --> 0:07:45.720 Well, I'm excited to relearn everything that I've forgotten. 0:07:46.160 --> 0:07:47.160 Yeah, me too. 0:07:47.800 --> 0:07:51.640 Right, well, we will start doing that right after this break. 0:08:16.760 --> 0:08:23.840 Eastern equine encephalitis aka triple E aka also sometimes called 0:08:23.840 --> 0:08:27.680 sleeping sickness, but not to be confused with African sleeping 0:08:27.680 --> 0:08:30.280 sickness or trepanasamiasis okay. 0:08:30.120 --> 0:08:32.800 Or encephalitis lethargica, because I think at the time it 0:08:32.840 --> 0:08:36.640 was also confused with that disease for at least the 0:08:36.679 --> 0:08:37.400 early years. 0:08:37.840 --> 0:08:41.760 Fascinating. Huh yeah, all right, well, this. 0:08:41.800 --> 0:08:42.400 Is not that. 0:08:44.800 --> 0:08:51.480 Eastern equine encephalitis is a viral infection. It is an 0:08:51.559 --> 0:08:54.800 alpha virus, which I don't believe that we've covered any 0:08:54.800 --> 0:08:59.680 alpha viruses thus far in this series. Triple E virus. 0:08:59.720 --> 0:09:04.160 It's an RNA virus. It is round in shape, so 0:09:04.200 --> 0:09:06.840 it's very kind of adorable when you look at it 0:09:06.960 --> 0:09:13.040 under scanning electron microscopes. There are four major lineages of 0:09:13.080 --> 0:09:17.600 this virus, so four major strains. But group one, which 0:09:17.640 --> 0:09:20.800 is the one that's most common in North America, is 0:09:20.840 --> 0:09:24.840 also the most virulent and the most common cause of 0:09:24.880 --> 0:09:27.959 disease in humans. So that's the one that we'll focus 0:09:28.000 --> 0:09:30.960 on just because that's the one that makes people sick. Okay, 0:09:31.160 --> 0:09:34.120 uh huh, all right. So I'm not going to talk 0:09:34.160 --> 0:09:38.640 a lot about the evolutionary history or the ecological cycle 0:09:38.800 --> 0:09:40.559 of this virus, because you're. 0:09:40.400 --> 0:09:43.679 Going to do that right erin, I hope, so excellent. 0:09:44.040 --> 0:09:46.640 But I will say, because we have to understand how 0:09:46.679 --> 0:09:51.160 this virus is transmitted. Trips E. That's what I wrote 0:09:51.200 --> 0:09:52.719 down is the name for it. 0:09:53.120 --> 0:09:54.640 That's not going to be confusing at all. 0:09:56.640 --> 0:10:01.360 Triply virus, it's mostly a bird virus, okay, So it 0:10:01.480 --> 0:10:06.440 circulates enzootically among a number of different bird species, but 0:10:06.920 --> 0:10:11.199 it can cause both epizootics, So that is an epidemic 0:10:11.320 --> 0:10:15.560 in animals when it jumps from bird populations into for example, 0:10:15.760 --> 0:10:22.080 horse populations equine populations, hence the name. And it can 0:10:22.120 --> 0:10:26.640 also cause zoonotic outbreaks in humans if it jumps from 0:10:27.000 --> 0:10:31.880 birds into humans. Okay, all right, So among birds, it's 0:10:31.920 --> 0:10:35.480 primarily transmitted by mosquitos in the genus Cula seta, but 0:10:36.280 --> 0:10:40.559 it can be transmitted by a number of different genera 0:10:40.640 --> 0:10:44.480 of mosquitoes, including eighties mosquitoes and others. 0:10:44.679 --> 0:10:47.400 Okay, there's an asterisk to that statement that I'll go into. 0:10:47.559 --> 0:10:51.280 Oh I can't wait to hear about it. I want 0:10:51.280 --> 0:10:51.520 to know. 0:10:52.000 --> 0:10:53.360 Okay, do you know right now? 0:10:53.480 --> 0:10:54.080 Yeah? Kind of. 0:10:54.720 --> 0:10:58.439 So basically they call these other mosquito species the bridge vectors. 0:10:58.520 --> 0:11:01.800 Uh huh, okay, So, jumping a little bit into the 0:11:01.800 --> 0:11:05.880 ecology side of things, Quelo seta, which is the genus well, 0:11:05.960 --> 0:11:08.720 Kulo seta melanera, which is the main species that seems 0:11:08.760 --> 0:11:13.320 to perpetuate this infection cycle in like, you know, birds, 0:11:14.200 --> 0:11:18.480 they are not mammal biers or human biers, like very 0:11:18.600 --> 0:11:21.719 very little, and so researchers are like, well, it might 0:11:21.760 --> 0:11:25.640 be that there's either they occasionally bite humans and that's 0:11:25.640 --> 0:11:29.240 how these things happen, or it's bridge vectors. But in 0:11:29.360 --> 0:11:33.920 one study that looked at the like viral load of 0:11:35.160 --> 0:11:39.760 other species of mosquito, some of the the proposed bridge 0:11:39.800 --> 0:11:45.080 vector species, none of them had viral loads that were 0:11:45.360 --> 0:11:50.439 high enough to actually cause infection. Fascinating, So it might 0:11:50.480 --> 0:11:53.200 be that you can detect the virus because that mosquito 0:11:53.280 --> 0:11:56.400 fed on an infected bird, but the virus might not 0:11:56.440 --> 0:12:00.400 be able to replicate within that mosquito. But there's still 0:12:00.440 --> 0:12:03.000 a lot of like question mark, question mark, question mark, right, 0:12:03.000 --> 0:12:04.880 this sort of thing. So it's like that aspect of 0:12:04.880 --> 0:12:09.720 the ecology is pretty not very well clarified yet in 0:12:09.800 --> 0:12:13.080 terms of like the contributions of this mosquito species versus 0:12:13.160 --> 0:12:17.360 this mosquito species species, and also geographically because that can 0:12:17.440 --> 0:12:18.240 play a huge role. 0:12:18.720 --> 0:12:21.440 So then it's like unclear exactly which mosquitoes might be 0:12:21.440 --> 0:12:23.079 infecting humans. 0:12:23.000 --> 0:12:25.000 Right, So basically, I think the takeaway that I got 0:12:25.040 --> 0:12:28.000 from that article was that if even if you detect 0:12:28.120 --> 0:12:32.520 this virus in a mosquito, it doesn't necessarily mean that 0:12:32.559 --> 0:12:37.240 it's going to be infected and able to transmit. 0:12:37.120 --> 0:12:40.960 Right, because these viruses have to be able to replicate 0:12:41.040 --> 0:12:44.040 within the mosquito and then leave the mosquito's gut and 0:12:44.120 --> 0:12:47.000 travel to their salivary glands and then be there in 0:12:47.040 --> 0:12:50.360 high enough concentration that when the mosquito bites its next host, 0:12:50.600 --> 0:12:53.840 it's injecting enough virus to actually get that host sick. 0:12:54.440 --> 0:12:58.120 So there, these are very complicated cycles within the mosquito. 0:12:58.240 --> 0:13:00.679 So it makes sense that not every mosquito is going 0:13:00.720 --> 0:13:04.400 to be able to transmit every virus, right. So, right, 0:13:04.520 --> 0:13:07.120 even if you can detect it just when you smush 0:13:07.160 --> 0:13:09.959 that mosquito, like, yeah, you found some virus, but where 0:13:10.080 --> 0:13:12.520 was that virus within the mosquito and how much of 0:13:12.559 --> 0:13:18.160 it was there? Cool? How interesting? All right, So we've 0:13:18.200 --> 0:13:21.040 covered now that this is a disease transmitted by mosquitoes. 0:13:21.080 --> 0:13:24.720 Will ignore the details of which mosquito it is for now, 0:13:26.600 --> 0:13:29.520 So let's talk about how this virus makes you sick 0:13:29.760 --> 0:13:35.360 once it gets inside you. Okay, So, like many arboviral diseases, 0:13:35.440 --> 0:13:40.280 so virus is transmitted by arthropods like mosquitoes. When a 0:13:40.360 --> 0:13:43.280 mosquito bites you, the first place that it spits that 0:13:43.520 --> 0:13:47.959 virus is kind of towards your lymphatic system, right, so 0:13:48.000 --> 0:13:49.800 it's kind of right under your skin. They don't spit 0:13:49.840 --> 0:13:53.080 it necessarily directly into your bloodstream, but they spit it 0:13:53.160 --> 0:13:57.640 under your skin, and that virus goes into your lymphatic system. 0:13:58.240 --> 0:14:01.480 From there, it travels to you lymph nodes, and in 0:14:01.520 --> 0:14:06.280 the case of eastern equine and stephalitis virus, it infects 0:14:06.320 --> 0:14:10.000 our white blood cells. Okay, so those are the cells 0:14:10.000 --> 0:14:13.880 that it goes into, and that's where it replicates. Remember 0:14:13.920 --> 0:14:17.079 that viruses have to replicate inside of our cells. They 0:14:17.080 --> 0:14:19.840 don't replicate on their own. So it turns out that 0:14:20.120 --> 0:14:24.240 triple E replicates inside of our white blood cells. White 0:14:24.240 --> 0:14:28.480 blood cells can travel pretty much anywhere in our body, 0:14:29.160 --> 0:14:33.160 including crossing the blood brain barrier and making it into 0:14:33.240 --> 0:14:38.440 our nervous system. All right, so let's go through kind 0:14:38.480 --> 0:14:42.000 of how this makes you sick. This is a bit 0:14:42.040 --> 0:14:46.800 of a spoiler, but this is a horrible, horrible disease. 0:14:47.080 --> 0:14:51.440 Okay, So that much I do remember, yes, from Michigan, if. 0:14:51.320 --> 0:14:53.560 You if you had like a magic eight ball, and 0:14:53.600 --> 0:14:58.080 you shook it, it would say, outlook not so good? Yeah, okay. 0:14:58.880 --> 0:15:00.400 One of the questions that I like to try and 0:15:00.440 --> 0:15:03.120 answer when we look at a disease that causes such 0:15:03.400 --> 0:15:08.520 terrible outcomes is how does it do that? We are 0:15:08.680 --> 0:15:12.280 usually very good at fighting off infections, So how can 0:15:12.360 --> 0:15:16.000 this virus kind of beat our own immune system? 0:15:16.120 --> 0:15:16.440 Right? Like? 0:15:16.520 --> 0:15:19.720 How can it make us so very sick? M okay? 0:15:20.200 --> 0:15:20.280 So. 0:15:22.080 --> 0:15:24.560 The other reason that it's important to understand how this 0:15:24.720 --> 0:15:27.680 virus makes us so sick is because, in theory, if 0:15:27.680 --> 0:15:30.200 we can understand how it makes us so sick, we 0:15:30.240 --> 0:15:33.000 could maybe try and do something about it, right, We 0:15:33.040 --> 0:15:36.320 can try and counteract that. Okay. So I found a 0:15:36.320 --> 0:15:38.520 few different studies that tried to shed some light on 0:15:38.600 --> 0:15:41.880 exactly how this virus makes us so sick. One of 0:15:41.880 --> 0:15:45.440 the important things is that this virus is very good 0:15:45.520 --> 0:15:49.960 at evating our immune system. Specifically, it seems to do 0:15:50.040 --> 0:15:53.360 a very good job of inhibiting one of our major 0:15:53.600 --> 0:15:58.520 responses to viral infections, and that is something called interferon. 0:16:00.040 --> 0:16:04.960 Talked about in like the hepatitis episode. Probably I don't remember, 0:16:06.000 --> 0:16:09.800 but anyways, Interferon is a protein that we make that 0:16:09.880 --> 0:16:13.520 helps to stimulate our immune response specifically to target and 0:16:13.640 --> 0:16:16.280 kill viruses and virallly infected cells. 0:16:16.840 --> 0:16:17.240 Gotcha. 0:16:17.680 --> 0:16:22.120 So Triple E, like many other viruses and a lot 0:16:22.160 --> 0:16:28.320 of arboviruses, specifically targets and shuts down the production of interferon, 0:16:28.520 --> 0:16:34.440 it seems like in us. And what's really interesting is 0:16:34.440 --> 0:16:37.440 that there have been some other studies I found that 0:16:37.520 --> 0:16:43.560 compared the effectiveness of interferon on actually killing virus infected cells. 0:16:43.760 --> 0:16:47.520 So like, even if you gave someone a bunch of interferon, like, 0:16:47.560 --> 0:16:50.560 if that's the problem the virus is blocking this production, 0:16:51.160 --> 0:16:56.680 give them interfer on. This virus actually like inhibits the 0:16:56.720 --> 0:16:58.119 action of interferon. 0:16:58.560 --> 0:16:59.480 That's wild. 0:17:00.880 --> 0:17:02.920 And here's where it gets even cooler. This is why 0:17:02.920 --> 0:17:05.719 I get excited about this. Remember I said, there are 0:17:05.720 --> 0:17:08.440 many different strains of this virus, like at least four, 0:17:09.440 --> 0:17:11.720 and it's only the North American strain that tends to 0:17:11.720 --> 0:17:15.520 be the most virulent and cause infection in humans. So 0:17:16.320 --> 0:17:20.800 this one study compared North American strains to South American strains, 0:17:21.080 --> 0:17:25.240 and what they found was that across the board, all 0:17:25.240 --> 0:17:28.960 cells infected with Triple E viruses North American or South 0:17:28.960 --> 0:17:32.520 American had very low levels of interferon so they blocked 0:17:32.520 --> 0:17:36.760 the production of interferon. But on top of that, the 0:17:36.800 --> 0:17:40.280 North American strains were the ones that were also resistant 0:17:40.320 --> 0:17:45.760 to the effects of interferon. Ah, So, like, no matter 0:17:45.800 --> 0:17:47.879 how much interferre on you had in your body, it 0:17:47.960 --> 0:17:50.919 was going to be lower within triple E infection than 0:17:50.960 --> 0:17:54.080 with other viral infections. But the interfere on that you 0:17:54.160 --> 0:17:57.679 do have works to kill that South American virus but 0:17:57.760 --> 0:17:59.280 not the North American strains. 0:18:00.400 --> 0:18:02.440 Wow, that's very interesting. 0:18:02.040 --> 0:18:02.359 I know. 0:18:04.640 --> 0:18:08.800 Okay, so that's how it causes disease and why at 0:18:08.920 --> 0:18:11.880 least part of the reason why it probably causes such 0:18:11.960 --> 0:18:16.439 severe disease. Okay, now let's start to talk about the 0:18:16.480 --> 0:18:20.320 really depressing part, which is the actual symptoms. Okay, the 0:18:20.359 --> 0:18:25.520 one good news I have this is it it's estimated 0:18:25.560 --> 0:18:29.440 that only about four to five percent of human infections 0:18:29.560 --> 0:18:32.960 actually result in symptomatic disease. So, like I'm just about 0:18:32.960 --> 0:18:37.520 to ask that, oh good, I preempted you. Ninety six 0:18:37.560 --> 0:18:42.280 percent of people who get infected with triple E virus 0:18:42.680 --> 0:18:46.639 will never have symptomatic disease. They're going to be just fine. Okay, 0:18:47.240 --> 0:18:47.640 that's the. 0:18:47.680 --> 0:18:50.000 Estimates, But that's I feel like that's a trend that 0:18:50.040 --> 0:18:52.880 we see a lot in rble viral diseases, that there's 0:18:52.920 --> 0:18:58.479 a huge rate of asymptomatic individuals. Yeah, do these people 0:18:58.800 --> 0:19:03.200 have immunity? Do they develop immunity to treat question? 0:19:03.520 --> 0:19:06.040 I did see in several review papers just sort of 0:19:06.040 --> 0:19:10.440 talking about the symptoms in general, that it is thought that, yes, 0:19:10.600 --> 0:19:13.080 when you are exposed to this virus, you develop long 0:19:13.160 --> 0:19:17.320 lasting immunity. Remember that point because it will become very 0:19:17.320 --> 0:19:21.800 interesting when we talk about the vaccine. Yes, okay, but yes, 0:19:21.880 --> 0:19:24.360 it is thought that if you get infected with this virus, 0:19:24.480 --> 0:19:29.439 whether you're symptomatic or not, you do generate long lasting immunity. Okayes, 0:19:29.880 --> 0:19:30.480 that's the thought. 0:19:30.880 --> 0:19:31.639 That's good news. 0:19:31.800 --> 0:19:34.320 It is good news. That's the end of the good news. Okay. 0:19:35.160 --> 0:19:37.680 So let's talk about the symptoms of this virus. It's 0:19:37.720 --> 0:19:43.399 called Eastern equine encephalitis. Encephalitis. We've talked about this before, right, 0:19:43.560 --> 0:19:49.119 This is inflammation in your actual brain. It's not good news. 0:19:50.119 --> 0:19:54.920 So this causes a viral encephalitis. In theory, almost any 0:19:55.040 --> 0:19:59.280 virus could potentially cause an encephalitis if it gets into 0:19:59.320 --> 0:20:04.040 your brain causes infection there. For most viruses, that's a 0:20:04.160 --> 0:20:10.000 very uncommon manifestation, but for some reason, a lot of arboviruses, 0:20:10.280 --> 0:20:16.200 so mosquito born viruses do cause viral encephalitis. And we've 0:20:16.240 --> 0:20:18.960 also talked on this podcast about one of the most 0:20:18.960 --> 0:20:21.520 famous causes of viral encephalitis, that is. 0:20:23.119 --> 0:20:26.320 Rabies. Oh I saw. 0:20:26.160 --> 0:20:28.280 Your face just being completely blank, and I was like, 0:20:28.440 --> 0:20:33.160 don't worry. So rabies is like the most probably famous 0:20:33.280 --> 0:20:38.280 viral encephalitis I think. So let's talk about the characteristic 0:20:38.320 --> 0:20:44.560 symptoms of viral encephalitis. There's three Number one fever. This 0:20:44.600 --> 0:20:47.040 fever tends to be quite high and it tends to 0:20:47.040 --> 0:20:51.679 come on very rapidly. Number two headache because your brain 0:20:51.760 --> 0:20:58.720 is inflamed. Number three altered level of consciousness. Now, that 0:20:58.760 --> 0:21:03.520 doesn't necessarily mean that you will go unconscious, although as 0:21:03.560 --> 0:21:06.120 you'll see, it often leads to that, but it does 0:21:06.200 --> 0:21:10.080 mean that, like overall, you can have fluctuating levels of 0:21:10.200 --> 0:21:15.560 consciousness okay, and kind of awareness. And then, because viral 0:21:15.680 --> 0:21:19.760 encephalitis is a viral infection of your brain, you will 0:21:19.800 --> 0:21:24.240 often have specific neurological symptoms that can be very varied, 0:21:24.760 --> 0:21:28.919 and they tend to depend. The specific symptoms you see 0:21:29.119 --> 0:21:31.359 tend to depend on what part of your brain is 0:21:31.400 --> 0:21:37.920 the most infected. Okay, so let's talk about triple E specifically. 0:21:39.400 --> 0:21:41.960 If you have symptomatic infection with triple E, which again 0:21:42.000 --> 0:21:44.040 it is only four to five percent of people, so 0:21:44.080 --> 0:21:48.120 that's the good news. The symptoms begin with a prodrome, 0:21:48.960 --> 0:21:53.639 which essentially means nonspecific symptoms before the real bad symptoms. 0:21:54.840 --> 0:21:59.520 This is like that fever, maybe headache, maybe even some 0:21:59.600 --> 0:22:03.280 abdom o pain, just very non specific symptoms. And then 0:22:03.320 --> 0:22:08.280 about five days later is when the neurologic symptoms begin. 0:22:09.960 --> 0:22:12.639 And in the case of triple E, this can be 0:22:12.760 --> 0:22:17.879 anything from a mild confusion to maybe some focal weakness, 0:22:17.920 --> 0:22:22.439 like your arm feels weak or your leg feels weak. Okay, 0:22:22.960 --> 0:22:27.480 you might have seizures. Seizures are actually very common in 0:22:28.359 --> 0:22:33.440 triply Okay. You might have peristigias, so like weird tingling 0:22:33.560 --> 0:22:38.360 feelings or just like sort of sensory things that aren't normal. 0:22:38.880 --> 0:22:41.480 Is this just because your brain is inflamed? 0:22:41.760 --> 0:22:47.320 Yes, absolutely, okay, yep. But in the case of triple E, 0:22:47.440 --> 0:22:51.480 once any of these neurologic symptoms tend to start, even 0:22:51.640 --> 0:22:55.639 just sort of confusion and maybe like coming in and 0:22:55.680 --> 0:22:59.040 out of being very aware, you know, like not being 0:22:59.040 --> 0:23:03.359 able to focus, that kind of thing, very rapidly. In 0:23:03.400 --> 0:23:06.280 the case of Tripoli, people progress to coma. 0:23:07.080 --> 0:23:08.960 Okay, what's the timeline of this. 0:23:09.000 --> 0:23:11.240 Like hours to a couple of days. 0:23:11.720 --> 0:23:13.040 Oh wow, yeah. 0:23:13.119 --> 0:23:16.399 So once people develop these neurologic symptoms, after this like 0:23:16.520 --> 0:23:19.480 five day prodrome of kind of feeling cruddy, having a fever, 0:23:19.600 --> 0:23:25.240 having a headache, people deteriorate very, very rapidly, and then 0:23:26.160 --> 0:23:30.359 once they're in a coma. The mortality rate is between 0:23:30.400 --> 0:23:31.399 thirty and forty percent. 0:23:33.520 --> 0:23:36.879 Okay, So what proportion of people go into a coma 0:23:36.960 --> 0:23:39.159 like develop these severe neurological symptoms. 0:23:39.520 --> 0:23:46.439 So almost everyone. So if you become symptomatic, almost certainly 0:23:46.440 --> 0:23:50.080 you're going to go into a coma. Of those that survive, 0:23:50.520 --> 0:23:54.879 about a third of them will have significant neurologic impairment 0:23:55.080 --> 0:23:56.919 permanently as a result of this infection. 0:23:57.520 --> 0:24:06.360 Oh yeah, I have a question. Okay, these unlucky four percent. 0:24:07.480 --> 0:24:11.240 Why such a good question, Aaron, I have no idea, 0:24:12.480 --> 0:24:17.560 and I think part of the reason that so okay, 0:24:17.680 --> 0:24:21.560 some of the literature says children under age fifteen and 0:24:21.800 --> 0:24:26.000 adults over age fifty they are more likely to actually 0:24:26.000 --> 0:24:29.800 get the encephalitis form of triple E. That's the most 0:24:29.880 --> 0:24:32.560 that I've seen in terms of like who is it 0:24:32.720 --> 0:24:36.760 that ends up getting triple E versus just getting infected 0:24:36.760 --> 0:24:40.040 and not showing symptoms. I think we have to remember 0:24:40.080 --> 0:24:44.520 that this is a very very rare infection, so it's 0:24:44.640 --> 0:24:47.920 really hard to understand exactly who is the most at 0:24:47.960 --> 0:24:50.719 risk and why, Like, what is it about the characteristics 0:24:50.720 --> 0:24:53.160 of these people that make them more likely to have 0:24:53.280 --> 0:24:56.360 this neurologic manifestation versus never having symptoms? 0:24:57.280 --> 0:24:58.000 Right, exactly. 0:24:58.200 --> 0:25:02.600 Yeah, So of all the ARBA viral encephalitis viruses in 0:25:02.640 --> 0:25:07.800 the United States, this is by far the worst one, Like, yeah, 0:25:07.920 --> 0:25:11.600 mortality rate is so much higher. It's possibly even worse 0:25:11.640 --> 0:25:16.199 than Japanese encephalitis, although that's more common. That's not in 0:25:16.240 --> 0:25:19.760