WEBVTT - Ep 76 Chickenpox: There's always a 'but' 0:00:02.040 --> 0:00:05.040 We were having hat day at school, and I'm not 0:00:05.240 --> 0:00:08.719 normally a hat person. I had this like numb spot 0:00:09.039 --> 0:00:12.400 on my head all day long and it just was 0:00:12.440 --> 0:00:16.040 like like a not scratchable itch. It was all day, 0:00:16.079 --> 0:00:18.599 all day, all day. But I thought like at first, 0:00:18.640 --> 0:00:21.000 I was like, oh, it's just hat day. Like I'm 0:00:21.079 --> 0:00:24.680 just not comfortable wearing this ridiculous Christmas tree hat at school. 0:00:26.960 --> 0:00:30.360 By the weekend, so that like started midweek. By that weekend, 0:00:30.560 --> 0:00:34.479 it had started to move down my forehead to like 0:00:34.640 --> 0:00:39.280 my eyebrow area, and that's when it just became this 0:00:40.800 --> 0:00:47.440 burning itchy, couldn't really make it go away thing. A 0:00:47.479 --> 0:00:51.839 few days went by, and so this is all at 0:00:51.880 --> 0:00:56.639 Christmas time. That's when we were driving from where we 0:00:56.680 --> 0:01:00.440 live in Buffalo down to my parents on Law Island, 0:01:01.000 --> 0:01:05.280 and that drive, my forehead felt like someone had a 0:01:05.319 --> 0:01:08.319 match to it. I think I kind of lucked out 0:01:08.360 --> 0:01:11.240 with shingles because it was a really small patch that 0:01:11.319 --> 0:01:15.160 I had, But it just feel like someone had a 0:01:15.240 --> 0:01:17.920 lighter on my forehead for as long as it did. 0:01:18.080 --> 0:01:21.760 Was just the craziest thing. I had no idea what 0:01:21.800 --> 0:01:25.199 it was though, So I started doing like the web 0:01:25.360 --> 0:01:30.080 MD thing and I was searching for like, what's a 0:01:30.200 --> 0:01:33.560 large red spot, red spot with blisters, because it started 0:01:33.600 --> 0:01:39.920 to get these really small spots over time. And that's 0:01:40.000 --> 0:01:42.800 kind of when I started to see other pictures of 0:01:42.840 --> 0:01:45.160 people who had the same thing, and people were saying, 0:01:45.160 --> 0:01:48.800 its shingles, shingles at shingles. So I finally called my 0:01:48.880 --> 0:01:52.480 doctor and I said, hey, I have all these symptoms, 0:01:52.560 --> 0:01:56.400 but like, I don't know what this is. And they 0:01:56.480 --> 0:01:58.880 said that sounds like shingles. You need to get to 0:01:59.280 --> 0:02:01.360 you need to come see us right away. But we 0:02:01.360 --> 0:02:05.400 were traveling for Christmas. By the time I kind of 0:02:05.440 --> 0:02:09.440 got all that together, we were already en route from 0:02:09.639 --> 0:02:13.280 Long Island up to r Island for the weekend. So 0:02:13.360 --> 0:02:15.720 that's when I ended up at an out of state 0:02:15.919 --> 0:02:20.520 urgent care and I walked in. The receptionist looked at 0:02:20.520 --> 0:02:22.640 me and she's like, oh, look at that. You have shingles. 0:02:22.800 --> 0:02:27.280 And it was just as fast. And then as soon 0:02:27.320 --> 0:02:31.519 as they saw that, they were able to prescribe medication 0:02:31.600 --> 0:02:35.120 and get it under wraps. So by the time I 0:02:35.160 --> 0:02:37.800 got that, they were like, it's probably too late because 0:02:37.800 --> 0:02:40.680 it had been a week since I started showing the 0:02:40.720 --> 0:02:45.520 first symptom. But the really scary thing that they kept 0:02:45.600 --> 0:02:48.520 sounding the alarm on was this is really close to 0:02:48.560 --> 0:02:51.280 your eye, This is really close to your eye. So 0:02:52.320 --> 0:02:54.160 when I came home, I had follow ups with my 0:02:54.240 --> 0:02:56.680 eye doctors. I had to go back to my primary 0:02:56.680 --> 0:02:59.920 care just to continue watching it to make sure that 0:03:00.080 --> 0:03:04.720 at whatever it was wasn't going to affect the optical 0:03:04.760 --> 0:03:10.680 nerves and all of those forehead things. But like I said, 0:03:10.720 --> 0:03:13.800 it was just the craziest thing because I didn't know 0:03:13.840 --> 0:03:17.240 anybody who had ever had it. I didn't know like, 0:03:17.600 --> 0:03:19.400 was I going to pass this on to my mom? 0:03:19.600 --> 0:03:21.680 Was my sister going to get it? I think everybody 0:03:21.760 --> 0:03:25.120 here is you get shingles from chicken pox, and of 0:03:25.240 --> 0:03:27.400 my generation, like I think I was the end of 0:03:27.480 --> 0:03:30.400 like the chicken pox party. So I was just so 0:03:30.440 --> 0:03:32.240 afraid that I was going to pass this on to 0:03:32.280 --> 0:03:34.600 all of my family members, and they were just kind 0:03:34.600 --> 0:03:37.160 of like, no, You're everything's going to be fine, like 0:03:37.920 --> 0:03:41.840 just kind of cover it up then go about your day. 0:03:42.840 --> 0:03:47.960 So that was my That was my shingles experience, I guess. 0:04:31.920 --> 0:04:35.080 Thank you so much for taking the time to chat 0:04:35.080 --> 0:04:37.359 with us and for being willing to share your story. 0:04:37.800 --> 0:04:42.480 Thanks Hi, I'm Erin Welsh and I'm Aaron Oman Updike, 0:04:42.839 --> 0:04:47.720 and this is this podcast will kill you. Welcome, Welcome, 0:04:49.320 --> 0:04:51.840 this is a fun one. 0:04:52.240 --> 0:04:56.559 I'm honestly thrilled. I don't know. I don't know exactly why, 0:04:56.720 --> 0:04:59.599 but I have been looking forward to covering this for 0:04:59.680 --> 0:05:00.680 a really long time. 0:05:01.640 --> 0:05:05.600 I have two and I've been kind of like daunted 0:05:05.720 --> 0:05:08.880 because I don't I didn't know anything about the history, 0:05:08.920 --> 0:05:11.320 and it turns out there's like kind of not that 0:05:11.440 --> 0:05:14.120 much to it. So I hope you don't fall asleep, 0:05:14.279 --> 0:05:18.080 I'm sure, or if you're listening to this podcast to 0:05:18.160 --> 0:05:23.680 fall asleep, I hope you do fall asleep. But yeah, 0:05:23.720 --> 0:05:26.760 I think it's like it's one of like we all 0:05:27.120 --> 0:05:29.719 have experienced it or know someone that's experienced it. And 0:05:29.800 --> 0:05:31.839 I think Aaron, you and I are part of the 0:05:31.920 --> 0:05:36.599 generation like the last remnants that didn't get the vaccine exactly. 0:05:36.720 --> 0:05:42.520 We definitely are the last cohort that just got chicken pox, 0:05:42.560 --> 0:05:44.720 which is the subject of today's episode. 0:05:44.800 --> 0:05:49.000 There we go plus shingles, slash zoster whatever you want 0:05:49.000 --> 0:05:52.640 to call it, exactly, Yeah, basically the vercella zoster virus. 0:05:52.920 --> 0:05:53.680 Yeah. 0:05:54.120 --> 0:05:56.400 Uh, Erin, when did you get chicken pox? 0:05:56.920 --> 0:05:59.560 I don't remember exactly how old I was, but it 0:05:59.640 --> 0:06:03.839 had to have been after nineteen ninety four or five, 0:06:04.040 --> 0:06:06.400 and we all four got it in a row. It 0:06:06.440 --> 0:06:09.200 went boom boom, boom boom, like down the row of 0:06:09.360 --> 0:06:11.280 older brother than me, than my younger brother, than the 0:06:11.320 --> 0:06:15.640 baby brother. We all got it in age order. And 0:06:15.720 --> 0:06:20.800 I have a very distinct memory of my first poc oh. 0:06:20.880 --> 0:06:24.240 I had my very first chicken pox was on my 0:06:24.360 --> 0:06:26.400 left side, like right on my ribs, on my left side, 0:06:26.480 --> 0:06:28.760 and obviously, like my brother was already sick with it, 0:06:28.839 --> 0:06:31.520 so I knew this is chicken pox. And I showed 0:06:31.560 --> 0:06:34.040 my mom and I was like, Mom, I found this 0:06:34.279 --> 0:06:37.640 is this chicken pox? And she was like, uh, yeah, 0:06:37.680 --> 0:06:41.039 it's chicken pox. And I was like, okay, but can 0:06:41.080 --> 0:06:43.880 I still go to gymnastics? 0:06:45.720 --> 0:06:46.159 Did you go? 0:06:46.640 --> 0:06:48.760 I did? As far as I can remember. Maybe my 0:06:48.880 --> 0:06:51.679 memory is off, but my mom was like, you've already 0:06:51.720 --> 0:06:54.279 exposed everyone. Just keep it covered. 0:06:55.560 --> 0:06:56.719 That's hilarious. 0:06:56.880 --> 0:07:00.440 She might dispute that memory of it. We'll see, mom, 0:07:00.680 --> 0:07:02.320 is that what happened? That's how I remember it. I 0:07:02.360 --> 0:07:04.400 have the scar that I know that that was my 0:07:04.480 --> 0:07:05.000 first pop. 0:07:06.320 --> 0:07:08.360 I really should have called my mom to ask her 0:07:08.560 --> 0:07:11.520 my chicken pox story, because I don't remember, and I 0:07:11.520 --> 0:07:13.080 don't even know if I think I might have been 0:07:13.120 --> 0:07:16.600 too young like to actually remember, but I think it 0:07:16.680 --> 0:07:18.680 was my older sister and I at the same time 0:07:18.760 --> 0:07:21.880 got it, and then my two younger brothers got it, 0:07:22.000 --> 0:07:24.679 and then I honestly don't know about my younger sister 0:07:24.800 --> 0:07:32.240 whether she got it or whether she got vaccine. Yeah. Yeah, anyway, should. 0:07:32.040 --> 0:07:37.360 We should we move on to like actual podcasts, actual 0:07:37.400 --> 0:07:38.640 business of our podcast? 0:07:38.840 --> 0:07:42.200 Maybe is it quarantiny time? 0:07:42.360 --> 0:07:44.920 I think it's definitely quarantin any time. What are we 0:07:45.000 --> 0:07:48.280 drinking this week, Aaron, We're drinking chicken scratch. 0:07:48.720 --> 0:07:51.360 I love this. It works on so many levels. It's 0:07:51.400 --> 0:07:55.520 like people always complain about how doctors have chicken scratch handwriting. 0:07:55.640 --> 0:07:58.160 It's true and also if you have chicken pox, you're 0:07:58.200 --> 0:07:59.360 definitely gonna be scratching. 0:08:00.760 --> 0:08:03.520 Yeah, and what's in a chicken scratch? 0:08:04.120 --> 0:08:07.760 There is tequila, there is kiwi, there is ginger, and 0:08:07.800 --> 0:08:08.440 there is mint. 0:08:09.000 --> 0:08:11.200 Kind of just a fun summary, bev. 0:08:11.680 --> 0:08:12.200 Yeah. 0:08:12.280 --> 0:08:15.120 We'll post the full recipe for that quarantiney as well 0:08:15.160 --> 0:08:18.080 as our non alcoholic plusy Burta on our website. This 0:08:18.120 --> 0:08:21.760 podcast will kill you dot com and our social media. 0:08:22.640 --> 0:08:26.360 And on our website. You can find so many different things, 0:08:27.160 --> 0:08:33.080 like transcripts, like alcohol free episodes, like promo codes for 0:08:33.160 --> 0:08:37.160 all of the ads that we do, like the links 0:08:37.200 --> 0:08:41.000 to Bloodmobile, who does the music for all of our episodes. 0:08:41.760 --> 0:08:44.480 We've also got a Patreon. I mean, it's endless. Just 0:08:44.640 --> 0:08:47.480 go in there, explore it, and I'm sure we'll come 0:08:47.520 --> 0:08:48.400 up with something interesting. 0:08:49.040 --> 0:08:53.400 Definitely. All right, that was the longer intro than we 0:08:53.520 --> 0:08:55.120 usually do. Yeah, it was. 0:08:55.200 --> 0:08:56.640 It was kind of fun, though, it was. 0:08:56.800 --> 0:09:02.640 That's fun getting to relive my chicken pox story. Anyways, 0:09:02.920 --> 0:09:04.600 should we dive into the biology of. 0:09:04.559 --> 0:09:06.080 This thing, let's do it. 0:09:06.600 --> 0:09:33.600 We'll take a quick break first, so vercella zoster or 0:09:34.120 --> 0:09:37.840 herpes zaster or if you want to be very official, 0:09:38.200 --> 0:09:43.520 human alpha herpes virus three. So this virus that we're 0:09:43.520 --> 0:09:46.959 dealing with is a herpes virus, which I think some 0:09:47.000 --> 0:09:51.760 people might not realize because it's called chicken pox. People 0:09:51.840 --> 0:09:55.800 might think it's a pox virus. It's a herpes virus, 0:09:55.840 --> 0:10:00.200 and in fact it's very closely related to herpes simplex one, 0:10:00.240 --> 0:10:03.360 which is a common cause of oral herpes, can also 0:10:03.400 --> 0:10:06.840 cause genital herpes. Check out our herpes virus episode for 0:10:06.920 --> 0:10:13.359 more on that. And so, like all of the herpes viruses, 0:10:13.480 --> 0:10:17.199 this is a DNA virus. It has a double stranded 0:10:17.480 --> 0:10:22.599 genome blah blah blah. Like many of the human herpes viruses, 0:10:22.720 --> 0:10:26.280 this is a very human specific virus. It doesn't infect 0:10:26.320 --> 0:10:30.680 any other animals, which, as we'll see, is part of 0:10:30.720 --> 0:10:34.400 why we don't have a lot of answers about some 0:10:34.480 --> 0:10:38.440 of the specifics of the diseases that this virus causes 0:10:38.920 --> 0:10:41.360 because we don't have great animal models in which to 0:10:41.400 --> 0:10:41.880 study it. 0:10:42.240 --> 0:10:43.520 That makes sense, Yeah. 0:10:43.400 --> 0:10:49.479 Yeah, this particular virus doesn't have a lot of variability. 0:10:49.480 --> 0:10:52.760 There aren't a lot of different strains of varicella. There 0:10:52.760 --> 0:10:55.040 doesn't seem to be a lot of variation in the 0:10:55.160 --> 0:10:58.760 virulence across outbreaks or over time. It's a pretty stable 0:10:58.960 --> 0:11:03.320 virus and aarin. You asked me something before we started 0:11:03.360 --> 0:11:06.520 researching this, which is why is chicken pox often called 0:11:06.720 --> 0:11:11.760 vericella zoster and shingles is called herpes disaster? Yeah, did 0:11:11.840 --> 0:11:13.080 you find an answer to that? 0:11:13.600 --> 0:11:16.760 Well, so, the only thing I could think of is 0:11:17.080 --> 0:11:21.120 the etymology of it. So vericella is another word for 0:11:21.320 --> 0:11:24.640 chicken pox, like that rash that happens for that initial infection, 0:11:25.400 --> 0:11:28.360 and in a lot of other languages besides English, it 0:11:28.400 --> 0:11:31.480 tends to be not like the equivalent of chicken pox, 0:11:31.559 --> 0:11:35.120 but some sort of variation of vericella, right, And the 0:11:35.160 --> 0:11:40.640 word veriicella might come from like the diminutive form of variola, 0:11:40.760 --> 0:11:43.679 which is the word for smallpox, and so it might 0:11:43.800 --> 0:11:48.320 just be like, you know, there's it's analogous where chicken 0:11:48.320 --> 0:11:54.120 pox is to smallpox as veriicella is to variola. Etymologically, 0:11:54.320 --> 0:11:55.040 does that makes sense? 0:11:55.080 --> 0:11:57.760 Yeah, it totally makes sense. No, I genuinely makes sense. 0:11:58.200 --> 0:12:02.520 And then herpe'saster herpees from herpes is like the old 0:12:03.200 --> 0:12:06.080 you know, word that was used by ancient Greeks like 0:12:06.160 --> 0:12:09.040 Hippocrates and whatnot to describe those rashes. 0:12:09.720 --> 0:12:11.800 So it seems to just boil down to the fact 0:12:11.880 --> 0:12:16.280 that even though we're talking about one single pathogen, we're 0:12:16.320 --> 0:12:21.800 talking about two completely different clinical diseases exactly. Yeah, So 0:12:21.840 --> 0:12:23.920 I think that that's something that's interesting. I feel like 0:12:23.960 --> 0:12:28.240 we've covered a lot of pathogens that just cause like 0:12:28.480 --> 0:12:31.560 one disease, where we're like, here's the disease we're talking about, 0:12:31.640 --> 0:12:35.240 and here's the pathogen that causes it, and then we've 0:12:35.240 --> 0:12:40.120 talked about some things like staph oreas, for example, that 0:12:40.160 --> 0:12:42.880 can cause any number of diseases. 0:12:43.160 --> 0:12:46.559 Yeah, or strip piogenies exactly, right. 0:12:47.280 --> 0:12:49.120 So yeah, I don't know. I just feel like that's 0:12:49.160 --> 0:12:52.640 an interesting aspect of this, that there's this big distinction 0:12:52.760 --> 0:12:57.600 between the pathogen and the diseases or the illnesses that 0:12:57.640 --> 0:13:02.199 they might cause. Yeah, well, let's get into the pathogen 0:13:02.720 --> 0:13:06.120 and both of these diseases, shall we. 0:13:06.559 --> 0:13:07.160 Let's do it. 0:13:07.600 --> 0:13:12.600 So I talked about how similar already this human herpes 0:13:12.640 --> 0:13:15.640 viruses to other herpes viruses. Let's start to talk about 0:13:15.679 --> 0:13:19.000 how it's a little different. Unlike many other herpes viruses, 0:13:19.480 --> 0:13:24.560 Viicella is transmitted primarily via the respiratory route. 0:13:24.880 --> 0:13:25.160 What. 0:13:25.880 --> 0:13:27.560 Yeah, isn't that interesting? 0:13:28.240 --> 0:13:32.079 I want to know? And I didn't find the evolutionary history, 0:13:32.160 --> 0:13:34.520 Like what about it? How did that happen? 0:13:34.760 --> 0:13:40.240 It's a really good question that I still don't fully understand, 0:13:41.080 --> 0:13:44.040 aside from the fact that we've talked on this podcast 0:13:44.040 --> 0:13:49.160 a number of times about the tropism of different viruses. Right, So, viruses, 0:13:49.400 --> 0:13:52.600 because they are dependent on host cells to be able 0:13:52.600 --> 0:13:58.840 to replicate. Oftentimes, specific viruses can only infect a limited 0:13:58.960 --> 0:14:03.240 range of cell type popes. It seems like vericella can 0:14:03.280 --> 0:14:07.880 infect a pretty wide range of cell types. So is 0:14:07.920 --> 0:14:11.280 it just that that's a really easy route of transmission, 0:14:11.520 --> 0:14:14.920 and it happens to be good at invading and replicating 0:14:14.960 --> 0:14:19.600 within not just our respiratory epithelium, but also it's very 0:14:19.640 --> 0:14:24.160 good at invading and replicating in our white blood cells, 0:14:24.160 --> 0:14:28.160 in lymph nodes, and so a big thing where it 0:14:28.240 --> 0:14:30.560 replicates is in the lymph nodes in our chest and 0:14:30.600 --> 0:14:31.200 things like that. 0:14:31.720 --> 0:14:35.880 Oh, that's very interesting because I thought that like it 0:14:36.440 --> 0:14:40.720 also though, does have a tropism towards nerves or is 0:14:40.760 --> 0:14:41.800 that just later? 0:14:42.280 --> 0:14:46.360 Oh? Certainly, certainly, let's let's get into all of this. 0:14:46.720 --> 0:14:47.160 Okay. 0:14:48.760 --> 0:14:50.880 Basically, I think the bottom line is that it can 0:14:50.920 --> 0:14:52.680 infect all of those cell types. 0:14:53.040 --> 0:14:55.600 Interesting, okay, cool, yeah, all right. 0:14:56.280 --> 0:15:01.080 But primarily the way that people become exposed via respiratory. 0:15:01.160 --> 0:15:04.560 So a kid, because it's usually kids who are infected, 0:15:04.720 --> 0:15:07.000 comes up and it's like I don't feel good, and 0:15:07.080 --> 0:15:10.440 like breathes right on your face and you inhale those 0:15:10.520 --> 0:15:15.840 viral particles. They you speak from experience, I guess I 0:15:15.920 --> 0:15:20.160 do it, uh, And they travel, those viral particles travel 0:15:20.240 --> 0:15:23.360 to those regional lymph nodes and they replicate. And what's 0:15:23.760 --> 0:15:26.240 really important about the fact that they can infect these 0:15:26.240 --> 0:15:29.359 white blood cells is from there they can travel anywhere 0:15:29.400 --> 0:15:32.920 and everywhere, right, So they travel throughout our body and 0:15:32.960 --> 0:15:36.120 they're able to continue replicating as they invade different cells. 0:15:37.280 --> 0:15:41.800 In general, the incubation period is about two weeks. It 0:15:41.800 --> 0:15:45.240 can be from ten to twenty days after exposure to 0:15:45.320 --> 0:15:48.880 when you first start to show symptoms. But what's important, 0:15:49.680 --> 0:15:54.240 especially for a respiratory virus, is that you become infectious 0:15:54.440 --> 0:15:57.560 and able to infect others at least two days before 0:15:57.600 --> 0:15:58.800 those first symptoms start. 0:15:59.400 --> 0:16:00.360 Aha. 0:16:00.760 --> 0:16:05.080 And this is quite an infectious pathogen. It's pretty contagious. 0:16:05.640 --> 0:16:10.359 I've seen anywhere from sixty to ninety percent of susceptible 0:16:10.400 --> 0:16:13.119 household contacts are likely to become infected. 0:16:13.720 --> 0:16:15.360 What is the estimated are not? 0:16:16.280 --> 0:16:19.920 According to a lecture from Johns Hopkins School of Public Health, 0:16:20.240 --> 0:16:23.040 the r NOT for chicken pox is nine to ten. 0:16:24.760 --> 0:16:27.120 Oh that's a lot higher than I realized. 0:16:27.280 --> 0:16:32.600 Goodness, So when you say respiratory transmission, is it respiratory 0:16:32.680 --> 0:16:35.800 droplets or is it like aerosolt like air? 0:16:36.080 --> 0:16:40.280 Good question. I didn't find this specific answer to that. 0:16:40.360 --> 0:16:43.400 They just say respiratory route, So I don't know how 0:16:43.480 --> 0:16:45.720 long it can hang out in the air. I don't 0:16:45.760 --> 0:16:48.080 think that it's quite as bad as something like measles 0:16:48.120 --> 0:16:50.480 that can stay airborne for like hours at a time. 0:16:51.360 --> 0:16:53.520 But with an attack rate that's so high, I would 0:16:53.520 --> 0:16:58.120 guess that it's probably pretty well airborne. Like it's aerosolizing 0:16:58.160 --> 0:17:02.480 pretty well. Okay, those chicken pox parties that people used 0:17:02.480 --> 0:17:06.200 to have, those are probably pretty effective. It's spreading disease. 0:17:06.760 --> 0:17:10.520 Oh yes, not a good idea. Let's talk about why 0:17:11.000 --> 0:17:11.320 should we? 0:17:11.880 --> 0:17:12.560 Let's do it. 0:17:13.440 --> 0:17:19.280 So, once this virus has disseminated throughout our body, one 0:17:19.320 --> 0:17:22.920 of the main cells that they tend to infect are 0:17:22.960 --> 0:17:27.480 our epidermal cells, our skin cells. Inside of our skin cells, 0:17:27.520 --> 0:17:30.520 it begins to replicate, and this is what causes the 0:17:30.560 --> 0:17:34.880 typical chicken pox rash that we all know and don't love. 0:17:35.960 --> 0:17:38.560 So what's really common is that one to two days, 0:17:38.600 --> 0:17:43.160 like twenty four to forty eight hours before this rash kids, 0:17:43.280 --> 0:17:46.119 I say kids. Of course this affects adults too, but 0:17:46.480 --> 0:17:49.679 most often kids will have like they'll feel kind of 0:17:49.800 --> 0:17:53.200 cruddy for a day or so beforehand, maybe a headache, 0:17:53.320 --> 0:17:56.680 maybe a little tummy ache, maybe like a fever probably, 0:17:57.960 --> 0:18:01.919 But then comes the rash, which is very characteristic and 0:18:02.000 --> 0:18:06.320 kind of what we call chicken pox. The rash starts, 0:18:06.400 --> 0:18:11.719 for anyone who hasn't experienced this, starts as very very itchy, 0:18:12.080 --> 0:18:17.879 red flat patches, and then these patches become raised or 0:18:17.880 --> 0:18:20.880 get little bumps within them, and then those little bumps 0:18:20.920 --> 0:18:26.760 develop into small fluid filled vesicles, tiny little blisters, and 0:18:26.800 --> 0:18:30.000 these tiny little blisters are chock full of virus. So 0:18:30.080 --> 0:18:33.320 this is not only a respiratory pathogen, but it can 0:18:33.400 --> 0:18:35.520 also be transmitted by direct contact. 0:18:36.359 --> 0:18:38.360 Okay, it's just covering all the bases. 0:18:38.400 --> 0:18:41.960 It's covering all the bases exactly. This rash can also 0:18:42.080 --> 0:18:45.080 be present on mucous membranes like in the mouth or 0:18:45.119 --> 0:18:49.159 even the eyes, and there the lesions can kind of 0:18:49.320 --> 0:18:52.919 ulsterrate a bit more and be really quite painful. Not 0:18:53.119 --> 0:18:56.480 unlike the lesions that we see with Herpes simplex. These 0:18:56.520 --> 0:19:01.679 all cause a very similar looking lesion. And these this 0:19:01.800 --> 0:19:05.760 rash spreads anywhere and everywhere. It's pretty common that they 0:19:05.840 --> 0:19:08.680 might start on the head or face, or like centrally 0:19:08.760 --> 0:19:12.000 on the trunk, but will pretty quickly spread across the 0:19:12.160 --> 0:19:17.199 entire body and new lesions this rash essentially continues to 0:19:17.240 --> 0:19:20.920 develop over the course of three to five days, although 0:19:20.960 --> 0:19:23.840 the range can be anywhere from one to seven days, 0:19:24.160 --> 0:19:27.800 where you're continually getting more and more little pox. 0:19:28.480 --> 0:19:31.080 Oh yeah, I mean, I don't remember any of this, 0:19:31.280 --> 0:19:33.480 but sounds obnoxious. 0:19:33.640 --> 0:19:38.800 It's not great, and of course they're incredibly itchy if 0:19:38.800 --> 0:19:42.480 you don't scratch the heck out of them. Then eventually, 0:19:43.080 --> 0:19:45.920 after a few days, these vesicles kind of cloud over, 0:19:46.080 --> 0:19:48.960 so it's not like a clear fluid anymore, and then 0:19:49.000 --> 0:19:53.439 they'll encrust usually if you don't scratch them off. This 0:19:53.480 --> 0:19:57.080 will only take about a day or two per blister, 0:19:57.520 --> 0:20:02.280 kind of and once every vessel is crusted over, that's 0:20:02.320 --> 0:20:05.560 when someone is no longer infectious. So you're able to 0:20:05.680 --> 0:20:09.240 spread this disease from about two days before you got 0:20:09.240 --> 0:20:13.000 that fever and headache, so up to four days potentially 0:20:13.040 --> 0:20:18.600 before the rash, until every blister is crusted over. Now, 0:20:19.240 --> 0:20:24.160 chicken pox is generally considered a very benign childhood disease. 0:20:24.240 --> 0:20:27.560 That's why people had things like chicken pox parties because 0:20:27.600 --> 0:20:31.280 it was generally considered, you know, a pretty benign. Yes, 0:20:31.640 --> 0:20:35.000 your kid is miserable for a week, maybe, but they 0:20:35.040 --> 0:20:38.840 get over it, and most of the time that's true. 0:20:38.920 --> 0:20:42.800 Chicken pox is an annoying but self limited disease. 0:20:44.520 --> 0:20:46.400 But I knew there was a butt. 0:20:46.720 --> 0:20:50.760 If there's always a butt. There are a number of 0:20:50.800 --> 0:20:55.720 potential complications associated with veriicella, and that's before we're even 0:20:55.760 --> 0:20:59.560 going to talk about shingles. Okay, mm hmm, let's just 0:20:59.600 --> 0:21:06.600 focus on this primary infection with Varislla virus aka chicken pox. So, 0:21:06.880 --> 0:21:11.240 first of all, these lesions are itchy, itchy, itchy, itchy, itchy, 0:21:11.520 --> 0:21:15.160 and especially for kids, it's very difficult to not scratch 0:21:15.240 --> 0:21:19.359 at an inch, so this inevitably leads to open wounds 0:21:19.440 --> 0:21:21.800 all over the skin, which can lead to a very 0:21:21.840 --> 0:21:26.800 easy route for a secondary bacterial infection to establish. Our 0:21:26.840 --> 0:21:30.359 bodies are covered in bacteria, especially all over our skin, 0:21:30.680 --> 0:21:35.399 and bacteria like Strep Pyogenes and staff aureus can both 0:21:35.440 --> 0:21:39.640 invade deeper tissues and cause very serious and potentially fatal infections. 0:21:40.480 --> 0:21:43.200 So that's one probably the most common complication. 0:21:44.160 --> 0:21:44.640 Number two. 0:21:45.480 --> 0:21:49.960 Veriicella, like we've talked a lot about, is this respiratory pathogen, right, 0:21:50.880 --> 0:21:54.440 except that for most people who are infected, it doesn't 0:21:54.440 --> 0:22:01.560 actually cause any respiratory symptoms. However, it's certain can and 0:22:01.600 --> 0:22:05.200 in kids who are immuno compromised, especially, but also in 0:22:05.320 --> 0:22:08.679 older teens and adults who are exposed to veriicella for 0:22:08.720 --> 0:22:13.800 the first time, infection tends to be more severe and 0:22:14.200 --> 0:22:17.960 primary infection. This first time being exposed to varicella virus 0:22:18.040 --> 0:22:21.200 can cause a viral pneumonia which can be very severe 0:22:21.640 --> 0:22:22.439 or even fatal. 0:22:22.960 --> 0:22:23.440 Wow. 0:22:23.840 --> 0:22:28.280 Yeah, So the numbers that I saw were that of 0:22:28.640 --> 0:22:33.960 otherwise healthy seeming people who were infected with vericella. Up 0:22:33.960 --> 0:22:39.240 to sixteen percent of those people had radiographic evidence, so 0:22:39.280 --> 0:22:41.280 if you took an X ray of their chest, you 0:22:41.359 --> 0:22:43.600 saw that something was going on in their lungs. So 0:22:43.720 --> 0:22:46.600 even in people who maybe don't have respiratory symptoms, this 0:22:46.720 --> 0:22:51.120 virus is still doing stuff in their lungs. But only 0:22:51.160 --> 0:22:55.520 about a third of those would have any respiratory symptoms. Okay, 0:22:56.840 --> 0:23:00.760 but before the advent of antivirals, so before we had 0:23:00.800 --> 0:23:05.399 any kind of antiviral therapy, mortality from varicella pneumonia was 0:23:05.440 --> 0:23:10.040 as high as thirty percent, and even today with treatment, 0:23:10.200 --> 0:23:12.879 it's still around ten percent. So even though this is 0:23:13.440 --> 0:23:16.720 a small, a very small proportion of people who would 0:23:16.720 --> 0:23:21.360 go on to develop vercella pneumonia. It's pretty serious when 0:23:21.400 --> 0:23:21.959 it doesn't. Right. 0:23:22.680 --> 0:23:25.399 I feel like I have heard, you know, a lot 0:23:25.440 --> 0:23:28.040 of people be like chicken pox vaccine, Like why do 0:23:28.080 --> 0:23:30.720 we need a chicken pox vaccine? Everyone gets it, It's 0:23:30.800 --> 0:23:34.560 totally fine. And I mean I was kind of like, well, 0:23:34.600 --> 0:23:36.960 I had the chicken pox, should I have gotten the 0:23:37.040 --> 0:23:40.080 vaccine somehow? But it totally makes sense. 0:23:40.520 --> 0:23:42.480 Yeah, So I think that's one thing I hope that 0:23:42.520 --> 0:23:46.120 everyone can learn, especially in talking about all these complications 0:23:46.240 --> 0:23:49.399 of veriicella as well as shingles, which we'll get to 0:23:49.560 --> 0:23:53.560 in a little bit. Even though all of these complications 0:23:53.600 --> 0:23:58.520 are very very rare, because vericeella is such or was 0:23:58.760 --> 0:24:03.000 such a wide spread pathogen. Literally almost one hundred percent 0:24:03.040 --> 0:24:05.560 of adults in the US, for example, and in most 0:24:05.600 --> 0:24:09.280 temperate regions across the world were exposed and infected by 0:24:09.320 --> 0:24:12.560 the time they reached adulthood, almost like ninety nine percent 0:24:12.600 --> 0:24:16.480 of the population. And so when you have that large 0:24:16.480 --> 0:24:20.359 of a population that's exposed, even these small numbers like 0:24:20.480 --> 0:24:25.000 proportionally lead to pretty severe morbidity and mortality. 0:24:25.640 --> 0:24:27.159 Yeah, right, because. 0:24:26.880 --> 0:24:30.280 Again it's not just death, there's other complications. So speaking 0:24:30.280 --> 0:24:34.480 of other complications. We haven't even really talked about it, 0:24:35.400 --> 0:24:37.280 but we'll talk about it in more detail. That this 0:24:37.359 --> 0:24:41.480 is a virus that is good at infiltrating our nervous system. Right, 0:24:42.560 --> 0:24:45.280 All herpes viruses are good at kind of getting into 0:24:45.280 --> 0:24:49.440 our nervous system and lying latent. So it's not surprising 0:24:49.520 --> 0:24:55.760 then that neurologic complications are another potential serious complication of 0:24:55.840 --> 0:25:02.879 verricilla infection. Overall, the incidence of neurologic complications is low. 0:25:03.080 --> 0:25:06.840 It's estimated at about one to three per ten thousand 0:25:06.960 --> 0:25:11.720 cases have some kind of neurologic involvement, whether that's encephalitis 0:25:12.520 --> 0:25:16.240 or inflammation of the cerebellum which leads to a taxia 0:25:16.280 --> 0:25:18.720 that kind of wobbly, not being able to walk and 0:25:18.840 --> 0:25:24.440 move normally. And so it's low incidents one to three 0:25:24.480 --> 0:25:29.040