Speaker 1: The real and terrible consequence could be seen on CT scans,
Speaker 1: MRIs and ultrasounds. Those tiny heads contain shrunken brains. Sometimes
Speaker 1: just the funnel lobes, the seat of decision making, of speech,
Speaker 1: of intelligence, of humor were atrophied, showing abnormally large dark ventricles,
Speaker 1: the hollow internal spaces that are supposed to appear smaller
Speaker 1: and smaller as the brain grows. Sometimes all that was
Speaker 1: left was the bulb above the brain stem, where the
Speaker 1: most basic functions like breathing and digestion reside. Around it
Speaker 1: would be blank space filled with cerebrospinal fluid. Usually the
Speaker 1: skull had not completely collapsed, but neither had it pushed
Speaker 1: out to its full size by the growing brain, and
Speaker 1: the brain would be smooth, looking more like a small liver,
Speaker 1: with none of the deep folds and fissures that every
Speaker 1: growing brain should develop as it folds in upon itself
Speaker 1: to pack more thinking power into a small space. That
Speaker 1: smooth brain baby might be more than comatose. Maybe it
Speaker 1: could breathe, could blink, could digest, could live, But maybe
Speaker 1: that baby could not chew food or see the spoon
Speaker 1: or the breast coming toward its mouth, certainly it would
Speaker 1: never walk, probably never crawl, or maybe would never do
Speaker 1: more than roll from side to side, unable to control
Speaker 1: its contorted arms and legs enough to even turn over.
Speaker 1: Hospital hallways doctors remembered in Brazil were lined with mothers
Speaker 1: who resembled ghosts. They were in shock, mute, expressionless, bleak.
Speaker 1: Some were just teenagers. Some had ridden buses for hours
Speaker 1: and were too poor to buy food. As the hours
Speaker 1: waiting to be seen stretched on, and there were so
Speaker 1: many of them, one mother looked up from her son's
Speaker 1: face to ask doctor, his head is going to grow right?
Speaker 2: Jeez.
Speaker 3: Yeah, it was really intense, but that's also the reality. Yeah, Itzica,
Speaker 3: it's dang.
Speaker 2: Yeah, it's awful, It's really awful.
Speaker 3: Yeah.
Speaker 1: So that firsthand, that really horrible, sad description is from
Speaker 1: a book called Zeka by Donald Neil.
Speaker 3: Okay, well, hi, hi, we always managed to start on
Speaker 3: really great notes.
Speaker 2: I mean, this podcast, what's this podcast about?
Speaker 1: Oh?
Speaker 3: Yes, yeah, I'm Aaron Welsh and I'm Erin Almond Updyke
Speaker 3: and this is this podcast will kill You And today
Speaker 3: we're talking about none other than zeca virus heavy.
Speaker 1: Yeah, well they all kind of are.
Speaker 2: Really it's true.
Speaker 1: Okay, Well, so before we move on to hear more
Speaker 1: about just how awful zekea is, let's arm ourselves with
Speaker 1: a stiff drink. Let's do that or a placey berita.
Speaker 1: So it's quarantining time.
Speaker 3: I believe it is definitely quarantine time. So this week
Speaker 3: we're drinking the Pink Eye of the Tiger.
Speaker 2: And why is it called that?
Speaker 3: Well, in part as we'll discuss in the biology because
Speaker 3: zeka is transmitted by the tiger mosquito, and in part
Speaker 3: because one of the symptoms is conjunctividis a haha, pany
Speaker 3: as heck today erin just wonderful. So what is in
Speaker 3: Pink Eye of the Tiger?
Speaker 2: Okay?
Speaker 1: So it is a little bit of raspberry sorbet, a
Speaker 1: little bit of mango and passion fruit infused.
Speaker 3: Vodka thanks to my brother Josh, who can't hear this,
Speaker 3: but I'll thank him anyways for that.
Speaker 1: Gift, and then you top it up with some champagne.
Speaker 3: Yum.
Speaker 2: Yeah, it's actually quite delicious.
Speaker 3: And as always, we'll post the recipe for our quarantini
Speaker 3: as well as the non alcoholic version our placey ba
Speaker 3: Rita on all of our social media channels. So TPWKY
Speaker 3: on Twitter and this podcast will kill You on Facebook
Speaker 3: and Instagram as well as our website.
Speaker 2: Cool.
Speaker 1: I want to hear about Zica. I want to hear
Speaker 1: about this is. This is a bizarre little virus.
Speaker 3: It's very bizarre, and it's new for many of us.
Speaker 3: So let's get into it. I'm excited to tell you
Speaker 3: about the biology.
Speaker 2: So we've actually.
Speaker 3: Gotten a fair number of requests for zica, which is exciting.
Speaker 3: And what I think is so interesting and I can't
Speaker 3: wait aron to hear about the history of it, is
Speaker 3: that if we had talked about I mean, if we
Speaker 3: had started this podcast a few years ago, I don't
Speaker 3: even think we would have proposed doing zeica virus because
Speaker 3: I don't even know that I heard of it before,
Speaker 3: like twenty fifteen.
Speaker 2: No, yeah, definitely not.
Speaker 3: It was not on almost anyone's radar.
Speaker 2: Yeah.
Speaker 3: So it's in that way, it's really exciting because so
Speaker 3: much of zica is just brand spanking new.
Speaker 2: Yeah.
Speaker 3: I mean, it's still happening, right, But I don't want
Speaker 3: to steal your thunder of oh the history though you
Speaker 3: Let's just talk about the virus itself and how it
Speaker 3: makes you sick. Okay, So Zeca virus is a virus
Speaker 3: that very obvious it is. You know, we could go crazy,
Speaker 3: you know, call something Zeka virus and have it be
Speaker 3: a No, it's a virus. It's in the family Flavivii.
Speaker 3: Day and so perhaps some really deep listeners or recent
Speaker 3: binge listeners might remember another disease we've covered that's in
Speaker 3: this same family. Aaron, do you remember this.
Speaker 1: Is gonna be embarrassing? Is it yellow fever?
Speaker 3: It's a yellow fever?
Speaker 1: Okay, good, thank great, Yes, I was like, the amount
Speaker 1: of stuff I can forget is impressive.
Speaker 3: Oh, same, But you got it right. It's related to
Speaker 3: yellow fever, also to Dangay, Japanese encephalitis, West Nile, bunch
Speaker 3: of other viruses. So it's an RNA virus, and like
Speaker 3: all of those other viruses that I mentioned, it's transmitted
Speaker 3: by mosquitoes. Zeka happens to be transmitted by the same
Speaker 3: mosquitoes that transmit yellow fever and Dangay virus and chicken gunya.
Speaker 3: But those are all different stories. And that's eighties a
Speaker 3: jypdi and eighties albapictus, So that's the yellow fever mosquito
Speaker 3: and the tiger mosquito, both of which if you live
Speaker 3: in a place where they exist, then you've definitely noticed
Speaker 3: them because they're gnarly bitters. They bite humans like prolifically.
Speaker 3: They love humans and they bite hard and it hurts.
Speaker 3: And they're big and black with white stripes on their legs.
Speaker 2: Oh yeah, and they bite often.
Speaker 3: They bite often, and they also are like daytime biers,
Speaker 3: so they'll bite you all day long. They're not like
Speaker 3: other mosquitoes that will only bite at like dawn or dusk.
Speaker 2: Or crepuscular one of my favorite words.
Speaker 3: It's a good word. And so diseases that are spread
Speaker 3: by these mosquitoes, like yellow fever dangay zica, they're especially
Speaker 3: difficult problems to deal with, in part because of how
Speaker 3: well adapted these two species of mosquito are to the
Speaker 3: urban and peri urban environment and how much they love
Speaker 3: humans and the environments that we create for them. So
Speaker 3: it's really fun when you combine that with climate change
Speaker 3: and how they're expanding their range. It's these diseases aren't
Speaker 3: going to stop being an issue anytime soon.
Speaker 1: And urbanization and change and clear the things, all the things.
Speaker 3: It's just so fun.
Speaker 1: Good news from our corner, everyone right, job security?
Speaker 2: Okay.
Speaker 3: So one of the things though, although ZEKA is transmitted
Speaker 3: primarily by mosquitoes, one of the things that we discovered
Speaker 3: relatively early on during the most recent outbreak that's pretty
Speaker 3: novel and very scary, is that it can also be
Speaker 3: transmitted sexually.
Speaker 2: Oh yeah, so the.
Speaker 3: Virus somehow seems to be able to live in especially
Speaker 3: the male reproductive tract. I don't know exactly where. I
Speaker 3: don't think we know as science exactly where in the
Speaker 3: reproductive tract of humans it happens to live, but it
Speaker 3: can live there and be transmitted weeks or even months
Speaker 3: after a person was infected. And most of the cases
Speaker 3: of sexual transmission have been from symptomatic people, and usually
Speaker 3: it's transmitted via semen, But you can also transmit it
Speaker 3: to your partner even if you've been asymptomatic, which is
Speaker 3: really scary because it means that you could potentially be
Speaker 3: a carrier, never know that you're infected, and then end
Speaker 3: up transmitting it to a partner. Yeah, and this is Yeah,
Speaker 3: it's something that's pretty novel and quite frankly scary in
Speaker 3: looking at something that's normally a vector born disease because
Speaker 3: It really adds a whole nother layer of complexity to
Speaker 3: control efforts, right, which are already really difficult when you're
Speaker 3: dealing with vector born diseases.
Speaker 2: Yeah, I can't believe how long it lives.
Speaker 1: I've read something about someone who it was circulating. They
Speaker 1: found traces of the virus in their semen sixty two
Speaker 1: days after exposure or something like that, or after first
Speaker 1: being positive.
Speaker 3: And the thing is that since we don't know, like
Speaker 3: there's so much that we don't know about this virus.
Speaker 3: We don't know, like, is sixty two days the average
Speaker 3: or is that the maximum? Right, we don't know, or
Speaker 3: is that just like maybe on the low end, maybe
Speaker 3: it could live for six months or a year, who knows.
Speaker 3: We don't know at this point.
Speaker 2: Oh man.
Speaker 3: And there's one other way that zica can be transmitted,
Speaker 3: and that's vertically. So vertical transmission is from mother to baby,
Speaker 3: and so in this case, Zica can actually cross the
Speaker 3: placenta and be transmitted to the fetus during gestation. And
Speaker 3: while this is not uncommon for viruses in general, there's
Speaker 3: a number of infections, viral and bacterial that can cross
Speaker 3: the placenta, it wasn't known at all that zica could
Speaker 3: be transmitted this way until very recently, and as far
Speaker 3: as I know, it's not that common for mosquito or
Speaker 3: vector born diseases to be able to cross the placenta.
Speaker 2: Yeah, I don't think so.
Speaker 3: Yeah, but it's not it's not that out there. Just
Speaker 3: in terms of a biology perspective, there's a number of
Speaker 3: viruses and bacteria that can that can cross the placenta.
Speaker 3: So those are all the ways that you can get
Speaker 3: infected with ZICCA.
Speaker 2: Fantastic.
Speaker 3: So the question is what happens once you get in affected?
Speaker 2: Yeah?
Speaker 3: Yeah, so okay, So the most common way that you
Speaker 3: get infected, right is via mosquito. So if you get
Speaker 3: bitten with an infected mosquito, the incubation period, which is
Speaker 3: again the time from when the mosquito bites you and
Speaker 3: dumps a bunch of virus into your bloodstream until the
Speaker 3: time that you show symptoms. That time period is usually
Speaker 3: between three and fourteen days. So usually within two weeks
Speaker 3: you'll start to show symptoms. It's again a long span,
Speaker 3: it's a pretty long span. Yeah, but again that has
Speaker 3: to do in part with just your immune system and
Speaker 3: then in part with how many viruses was the mosquito
Speaker 3: infected with.
Speaker 2: And how much how long it was feeding on you? Yeah,
Speaker 2: it's all this, all the things.
Speaker 3: So the symptoms in this case are actually very mild fever, rash,
Speaker 3: and the rash is one of the features that seems
Speaker 3: pretty prominent in zecavirus compared to other flavaviruses, Like most
Speaker 3: of the time, if you're going to have someymptoms with ZICA,
Speaker 3: you'll probably have a rash. Also conjunctivitis, hence the.
Speaker 2: Name of our quarantine pink guy.
Speaker 3: Pink iy raise your head if you had pink eye
Speaker 3: as a kid. Who didn't, Oh yeah, everyone did, right,
Speaker 3: It wasn't We weren't just filthy. I don't know, let
Speaker 3: us know people, Okay, So those are really common. Also,
Speaker 3: muscle and joint pain and that's something that's really common
Speaker 3: with a lot of flavaviruses, malaise, headache, These are all
Speaker 3: things that are pretty typical if you get any kind
Speaker 3: of viral infection, and they're also very nondescript, which you
Speaker 3: can imagine makes it very difficult to diagnose yep, right,
Speaker 3: sure does. And symptoms are pretty self limited. They usually
Speaker 3: only last between two and seven days, so we're talking
Speaker 3: like the flu length, but not even as severe as
Speaker 3: the flu, probably, right. But what's really important is that
Speaker 3: up to eighty percent of people who are infected with
Speaker 3: zeca virus don't ever develop any symptoms.
Speaker 1: That's yeah, I've read that. That's amazing.
Speaker 3: Yeah, yeah, and it means that, I mean, it just
Speaker 3: makes it so so difficult to try and get a
Speaker 3: handle on how many people have been infected and everything,
Speaker 3: because if you've got eighty percent of people never showing
Speaker 3: symptoms ooof it makes it tough. And so in general,
Speaker 3: this infection happens in a very similar way as any
Speaker 3: other flava virus or really any other virus or mosquito
Speaker 3: born virus, and that is, the virus gets into your
Speaker 3: skin because the mosquito pokes a hole in it. It
Speaker 3: goes into your lymph nodes and then into your bloodstream
Speaker 3: and it replicates and it invades cells. So how exactly
Speaker 3: zecavirus infects your specific cells and causes damage we don't
Speaker 3: entirely know. So we don't know the exact path of
Speaker 3: physiology of zica virus yet.
Speaker 1: That it makes it a little bit harder to target
Speaker 1: and its acts differently or it's suspected to act differently
Speaker 1: than other flavaviruses.
Speaker 3: I don't know the answer to that question, okay, But
Speaker 3: Zica virus particles can be found in almost every bodily
Speaker 3: fluid that we have tested so far. So if you
Speaker 3: test the blood of someone who's been infected with Zica,
Speaker 3: you'll probably find Zeca virus. If you test their semen,
Speaker 3: if you test vaginal secretions, if you test their eye fluid,
Speaker 3: if you test their saliva, if you test almost any
Speaker 3: bodily fluid or almost any organ you'll probably find Zeca
Speaker 3: virus particles.
Speaker 2: I have a question about bodily fluids. Okay. Do boogers
Speaker 2: and snot count totes? Yeah? Okay?
Speaker 3: And so on top of this sort of general nondescript symptoms,
Speaker 3: there are a number of different complications that can arise
Speaker 3: as a result of Zica infection. So there's an increased
Speaker 3: risk for future neurologic complications like gion beret syndrome, myelitis,
Speaker 3: general nerve issues, and also things like meningitis are possible
Speaker 3: as a result of Zeica virus infection. Right, But the
Speaker 3: biggest complication that we mentioned in our first hand account
Speaker 3: and that people has probably become. The most famous is
Speaker 3: that five to fifteen percent of infants born to pregnant
Speaker 3: women who are infected with ZICA during their pregnancy have
Speaker 3: evidence of complications directly related to Zica virus infection. These
Speaker 3: complications include intra uterine growth restriction, which means the baby's
Speaker 3: not able to grow as big as it should, early
Speaker 3: pregnancy loss also known as spontaneous abortion, and microcephaly, which
Speaker 3: is a small brain that's inadequately developed and in some
Speaker 3: cases can be incompatible with life. So this is sort
Speaker 3: of the most extreme complication and the most devastating complication
Speaker 3: that has come from ZICA. The exact mechanism of how
Speaker 3: this happens is not clear.
Speaker 2: Are their thoughts as to what it might be well.
Speaker 3: So shortly after the connections between zecavirus and microcephaly were
Speaker 3: sort of brought to light, there was a lot of
Speaker 3: pushback because it's only five to fifteen percent of cases,
Speaker 3: and that seems pretty low, and in some areas the
Speaker 3: baseline levels of microcephaly weren't necessarily known at the time,
Speaker 3: But since then, multiple different animal models have shown that
Speaker 3: ZEKA is capable of crossing the placenta and in mouse
Speaker 3: models can cause fetal defects. I believe in monkey models
Speaker 3: non human primate models as well. So at this point
Speaker 3: the link is pretty clear, but we don't really know
Speaker 3: exactly what is happening. Besides that Zica is able to
Speaker 3: invade across the placenta and then infect the fetus.
Speaker 1: Okay, yeah, you might have said this, but I don't
Speaker 1: remember any trimester. Is it any trimester for infection? That's dangerous,
Speaker 1: great question.
Speaker 3: So the number or the percentage of birth's effects is
Speaker 3: highest in women infected during the first trimester, but it
Speaker 3: is possible to end up having a baby born with
Speaker 3: congenital malformation if you're infected at any point in the pregnancy.
Speaker 2: Okay, but what I think is.
Speaker 3: Scary is that when you combine this complication with the
Speaker 3: fact that Zica can be transmitted sexually, that's a pretty
Speaker 3: sinister picture of a disease. Yet me, it's pretty depressing.
Speaker 3: That's all I've got. That's zeka virus.
Speaker 1: It's a scary and really tragic one.
Speaker 2: It really is. It really is.
Speaker 3: Yeah, So what the heck, Aaron, what's going on? How
Speaker 3: do we get here? Where did this thing come from?
Speaker 3: How did it just pop up in twenty sixteen, nonet
Speaker 3: even heard of it? Is it brand new?
Speaker 1: Well? The Romans called it just kidding, Okay. I feel
Speaker 1: like we all know the history of Zica, or at
Speaker 1: least a big part of it. I mean, we've we've
Speaker 1: lived it more or less like we've been there for it.
Speaker 1: Maybe not in the epicenter, but we remember the headlines
Speaker 1: at least. And I can remember the panic and headlines
Speaker 1: of twenty fifteen and twenty sixteen, and I'm sure you
Speaker 1: do too. I was living in Panama for much of
Speaker 1: the peak of media hysteria, and I remember all sorts
Speaker 1: of rumors, just among you know, in in Gamboa about
Speaker 1: the danger of Zica and how pregnant female researchers weren't
Speaker 1: going to be allowed to conduct research in Panama. And
Speaker 1: I think that the week I was visiting sam Blos,
Speaker 1: there was an outbreak of zica declared there like that
Speaker 1: was oh Zeca and plam Blas, And I was like, oh, okay,
Speaker 1: at least it's mild, you know, something like that stupid
Speaker 1: that I was thinking.
Speaker 3: Oh yeah, that's I was the same way. I was like, man,
Speaker 3: maybe I should just try and get Zeka now. So
Speaker 3: then then I've had it.
Speaker 1: Yeah, I mean, I really wonder if we tested antibodies
Speaker 1: whether we would have been show exposure.
Speaker 3: Actually I was tested because if you give blood in
Speaker 3: the US now, they test you for zica and they
Speaker 3: call you if it's positive. And mine was negative. So
Speaker 3: I didn't get zica.
Speaker 2: Okay, so you never got zeka.
Speaker 3: Yeah.
Speaker 2: So for every disease or.
Speaker 1: Topic that we cover, I try to ask myself the question,
Speaker 1: what does this specific disease or outbreak teach us about
Speaker 1: epidemic response or the nature of disease, or often humanity itself.
Speaker 1: And I think in this way, Zeka is one of
Speaker 1: the first epidemics to show us how fast information and
Speaker 1: especially misinformation can spread. In many ways, though that just
Speaker 1: kind of shows us how little things change, rumors and
Speaker 1: conspiracies thrive during epidemics. Someone's always wanting to go against
Speaker 1: quote conventional wisdom. Sometimes they're right, times they're not, and
Speaker 1: it just moves at a faster pace and with a
Speaker 1: higher turnover in this Internet.
Speaker 3: Age, Yeah, thanks Twitter as.
Speaker 1: Age of Twitter, and so does the virus itself thanks
Speaker 1: to global travel.
Speaker 3: Yeah.
Speaker 1: Even though the first time that many of us heard
Speaker 1: the word zica was probably in twenty fifteen in connection
Speaker 1: with the words Microcephae and Brazil.
Speaker 2: The Zeica virus had.
Speaker 1: Actually been known for almost seventy years.
Speaker 3: Amazing. I didn't know it was seventy years. I knew
Speaker 3: it was a long time, but dang.
Speaker 2: Yeah, oh it's really Yeah.
Speaker 1: Did you come across the meeting of Zica and any
Speaker 1: of your readings?
Speaker 2: No? Okay, My favorite.
Speaker 1: Part it actually means overgrown what and is Yeah, So
Speaker 1: it's taken from Zeica forest and Uganda, which is close
Speaker 1: to and Tebbi, where the Rockefeller found established its virus
Speaker 1: research Institute in the nineteen thirties. The swampy hot Zekea
Speaker 1: forest was the perfect place to accomplish some of the
Speaker 1: goals the research institute had laid out, including understanding mesquito ecology,
Speaker 1: exploring which animals are susceptible to different viruses, and the
Speaker 1: big one, discovering new viruses.
Speaker 2: And this is a common theme in so many.
Speaker 1: Early quote global health institutes. The primary focus was research,
Speaker 1: not intervention. That brings with it a whole other set
Speaker 1: of issues about the ethics of early global health research books. Anyway,
Speaker 1: So to conduct this research, scientists suspended cages containing sentinel
Speaker 1: monkeys of various species in the forest.
Speaker 2: Can't be.
Speaker 1: Then they would pull them down occasionally for inspection and
Speaker 1: temperature taking. Sounds like a really wonderful way to live alife.
Speaker 3: Right, My God has to be a monkey in the
Speaker 3: forest so you can like see your friends and you're
Speaker 3: in a cage your whole life.
Speaker 1: Well, and some weren't from Uganda, some were from various
Speaker 1: Asian countries, so extra cool, even better. Yeah, one day,
Speaker 1: April nineteenth, nineteen forty seven, to be exact, because you
Speaker 1: know how I like to be exact, of course, a
Speaker 1: monkey with the charming name of Rees's seven sixty six
Speaker 1: was observed to have a high fever one hundred and
Speaker 1: four degrees fahrenheit forty degrees celsius now that I'm in Finland.
Speaker 1: But blood was drawn and processed, and in it scientists
Speaker 1: found what they called a filterable transmissible agent, which back
Speaker 1: then often meant it was a virus, something they couldn't
Speaker 1: easily culture. But this still left many questions. First, was
Speaker 1: it a new virus meaning undiscovered? And was it mosquito born?
Speaker 1: To answer the second question, they had to collect many
Speaker 1: mosquitoes from the same areas that Reese's seven sixty six
Speaker 1: had been kept, and then test whether these mosquitoes carried
Speaker 1: anything resembling this virus, which meant grinding up and filtering
Speaker 1: the mosquitoes and injecting the slurry into the mice or
Speaker 1: monkeys they had on hand, and then comparing that to
Speaker 1: the infection caused by the filterable transmissible agent that had
Speaker 1: originally come from Riese's seven sixty six.
Speaker 3: Man, that just sounds like because so you can have coinfections.
Speaker 3: It sounds like a messy way to try and figure
Speaker 3: out what's going on.
Speaker 1: I think they just didn't know any other better way
Speaker 1: to do it, for sure.
Speaker 3: Yeah, I don't know if.
Speaker 1: I would have had the patience to be in microbiologists
Speaker 1: back then.
Speaker 3: I don't even have the patients for it now. Yeah,
Speaker 3: fair point, Fair points why I do this podcast instead.
Speaker 2: Uh.
Speaker 1: Finally, they would test this new mosquito derived slurry on
Speaker 1: a monkey that had recovered from an infection with the
Speaker 1: original virus. Huh yeah, full circle, and the results of
Speaker 1: those experiments confirmed their hunch the virus was mosquito born
Speaker 1: transmitted specifically by the species, in this case eighties Africanus.
Speaker 1: But still they didn't know whether this was a new
Speaker 1: virus or one that was already known. Since it was
Speaker 1: nineteen forty seven, they couldn't test for specific genetic material,
Speaker 1: but they could see whether the virus could be neutralized
Speaker 1: by antibodies against known viruses, and they found, as you
Speaker 1: can guess, that this was a brand new virus. So
Speaker 1: they named it Zika, because why wouldn't you.
Speaker 2: Name it after a geographical place? Just kidding, And then
Speaker 2: it all but dropped off the face of the earth.
Speaker 1: Yeah, from nineteen forty seven to two thousand and seven,
Speaker 1: sixty years.
Speaker 3: Nineteen forty seven, they discover it, They're like, cool, we
Speaker 3: got a new virus. Nobody cares to two thousand and seven.
Speaker 3: Tell me what happened?
Speaker 1: Well, I should have maybe kept going, Sorry, just keep going.
Speaker 1: From nineteen forty seven to two thousand and seven, sixty years,
Speaker 1: only fourteen cases of active human infections with CICCA were described.
Speaker 1: Fourteen so in sixty years.
Speaker 3: And were those all in Uganda?
Speaker 1: No, So they were in various places. Sometimes they were specified,
Speaker 1: sometimes that they weren't so, but they weren't necessarily all
Speaker 1: from Uganda. So it includes this list includes a ten
Speaker 1: year old girl from Africa whose home country was not specified,
Speaker 1: who had a fever and headache and antibodies against CICCA.
Speaker 1: And then there was a researcher who decided to inject
Speaker 1: himself with the Eastern Nigeria strain of ZICA, so he
Speaker 1: got a head Yeah. I think he was like, oh,
Speaker 1: it's mild. I want to be the first one to
Speaker 1: describe this about myself, jeez.
Speaker 2: Whatever. And there were some other people here.
Speaker 3: And there, all in Africa.
Speaker 1: Yeah, So most of these Zega cases were detected in Africa,
Speaker 1: but at some point in the nineteen sixties, the virus
Speaker 1: moved to Asia, popping up in Malaysia, Pakistan, and Indonesia.
Speaker 1: In the late sixties and seventies, Okay, and then Zeka
Speaker 1: began to pick up steam. Yes, here's where we get rolling.
Speaker 1: In two thousand and seven, a bunch of people on Yap,
Speaker 1: which is an island in the Caroline Islands group in
Speaker 1: the Western Pacific, started showing symptoms of something that resembled
Speaker 1: dengay but was much milder. This infection was also accompanied
Speaker 1: by a rash, and test for dengay came back negative.
Speaker 1: This sudden outbreak prompted a physician working at the yapp
Speaker 1: Department of Health Services to reach out to the CDC
Speaker 1: for help. The CDC deployed some EIS agents and they
Speaker 1: began the hunt.
Speaker 3: Oh our dream, my dream, my dream too. Ye.
Speaker 1: Sample after sample came back positive for ZICA, which was bizarre.
Speaker 1: In the sixty years of zeica history, at that point,
Speaker 1: the virus had never been responsible for a large outbreak.
Speaker 2: It was barely.
Speaker 1: Recognized to be a disease causing pathogen in humans.
Speaker 3: Right, it's just like, oh, yes, like four people have
Speaker 3: gotten sick, like they had a headache.
Speaker 2: Yeah. Yeah.
Speaker 1: And when I say a large outbreak, I mean that
Speaker 1: an estimated seventy three percent of YAPS seven thousand inhabitants
Speaker 1: became infected with ZICA over a five month period. Whoa
Speaker 1: who seventy three percent and they.
Speaker 3: Like, seventy three percent had symptomatic illness.
Speaker 1: No, so seventy three percent was was estimated based on
Speaker 1: those who did have symptomatic illness. Interesting, So this is
Speaker 1: this is based on the twenty symptom twenty percent symptoms,
Speaker 1: eighty percent asymptomatic.
Speaker 3: Okay, breakdown wow though, seventy three percent yeah. Oh and
Speaker 3: then just like that it faded away, gone. So nineteen
Speaker 3: forty seven, pops up, Nobody cares. Nobody cares. Two thousand
Speaker 3: and seven, what's going on?
Speaker 2: Then?
Speaker 3: Nobody cares?
Speaker 2: Yeah, Basically.
Speaker 1: Because of the mildness of symptoms, if you were even
Speaker 1: unlucky enough to have symptoms, the hospitals and clinics weren't
Speaker 1: overwhelmed by people seeking treatment, and so it Yeah, it
Speaker 1: just showed up. It spread through the population like wildfire,
Speaker 1: and it disappeared without seeming to leave any substantial damage
Speaker 1: in its wake at first. But before the aftershocks of
Speaker 1: ZICCA would be recognized, the virus made its second dramatic
Speaker 1: appearance again in a Pacific island group, this time in
Speaker 1: French Polynesia in October. In twenty thirteen, six years and
Speaker 1: a few months after the YAP outbreak had ended, alert
Speaker 1: went out about a bunch of people with rashes, fevers,
Speaker 1: bloodshot eyes, swollen joints, with most of these cases occurring
Speaker 1: on Tahiti. Again, Dangay was the primary suspect, and that
Speaker 1: in itself was worrying. The first time you get dan
Speaker 1: gay can be excruciating. They don't call it breakbone fever
Speaker 1: for nothing. But if you are exposed to a different stereotype,
Speaker 1: you can actually get something called danngae hamorrhagic fever or
Speaker 1: Danngae shock syndrome, which can kill you much more easily.
Speaker 2: Yeah.
Speaker 1: So if this was a new type of dengay that
Speaker 1: the island group hadn't seen before, that was very concerning.
Speaker 2: Yeah.
Speaker 1: But again tests for Dangae came back negative, and again
Speaker 1: the true culprit was found to be zekavirus. As with
Speaker 1: the app outbreak, a large proportion of the population of
Speaker 1: Tahiti became infected with ZEKA, with the majority of infections
Speaker 1: being asymptomatic, and the cases that were symptomatic tended to
Speaker 1: be again mild, rarely requiring hospitalization. But then something started happening,
Speaker 1: the first indication that zica was not as benign as
Speaker 1: it seemed. Here and there, a person infected with ZICA
Speaker 1: would show up to the hospital a couple weeks after
Speaker 1: their illness and report with partial paralysis. These cases were
Speaker 1: determined to be Giambarret syndrome, and the link to ZICA
Speaker 1: was pretty clear, at least statistically. Where in previous years
Speaker 1: there would be three to five cases of giambarre, now
Speaker 1: there were dozens and the only thing that seemed to
Speaker 1: be different was the Zeka outbreak, but that didn't stop
Speaker 1: the rumors, of course, that the cases of paralysis were
Speaker 1: caused by something else, like pesticides for example.
Speaker 3: Always blame it on the pesticides. Always the easiest thing
Speaker 3: to blame it on.
Speaker 1: And that's yeah, I mean sometimes it is pesticides. But
Speaker 1: that's something that we see pop up time and time
Speaker 1: again in the history of Zeica.
Speaker 2: Rumors.
Speaker 1: Trying really hard to work a Fleetwood mac joke and
Speaker 1: to hear, but I cannot find anything. I can never
Speaker 1: I never came up with anything.
Speaker 3: You could have just started singing instead. Go on, give
Speaker 3: it to me just a little.
Speaker 2: Maybe, maybe I'll make a fake album cover.
Speaker 3: Anyway, rumors rumors.
Speaker 1: At least in the months after the outbreak, it appeared
Speaker 1: that the only serious possible outcome of infection with the
Speaker 1: zekeavirus was giambarre. No reports of microcephaly had been made,
Speaker 1: and as with the YAP outbreak, the virus burned through
Speaker 1: the population. This time, only sixty six percent of the
Speaker 1: population of around two hundred and fifty thousand people oh
Speaker 1: was infected.
Speaker 2: Six of two, or sixty six percent NBD, just a.
Speaker 3: Few thousand people, No big deal.
Speaker 1: Handful really really, and then it seemed to disappear. In
Speaker 1: Following this large scale outbreak, Zeka showed up on other
Speaker 1: islands in the Pacific throughout twenty fourteen, including Rapanui also
Speaker 1: known as Easter Island, and the Cook Islands, but these
Speaker 1: outbreaks didn't get as many headlines as the one on
Speaker 1: Yap and in French Polynesia, largely because the population wasn't
Speaker 1: as big, and also probably because Zica still wasn't considered
Speaker 1: much of a threat. The next time Zico would make
Speaker 1: front page news, it would do so in a big,
Speaker 1: big way, in an international way, and it would stay
Speaker 1: there for months, if not years. Yeah, let's continue our
Speaker 1: journey across the Pacific, jumping across South America and landing
Speaker 1: all the way over on the Atlantic coast of Brazil
Speaker 1: May twenty fifteen, where as Zeka epidemic was raging. Although
Speaker 1: later molecular tests would show that the virus had been
Speaker 1: circulating in Brazil at least since twenty fourteen, the epidemic
Speaker 1: wasn't recognized until May twenty fifteen, probably for many reasons,
Speaker 1: including mosquito population dynamics and the natural epidemic growth of
Speaker 1: this population during the middle of the Brazil outbreak. There
Speaker 1: was a lot of discussion as to where did this
Speaker 1: come from? Where did this come from when? It could
Speaker 1: have been a lot of different sources, but it seems
Speaker 1: likely that it was that it came over at some
Speaker 1: point during this something called the VA world Sprints VA
Speaker 1: world Sprints, which is this outrigger canoe races held in
Speaker 1: Rio in August twenty fourteen, and so this is a
Speaker 1: month after the World Cup that had many participants from
Speaker 1: the Pacific Islands where there had been cases of zeka.
Speaker 1: So another theory is that it was introduced during the
Speaker 1: FIFA Confederations Cup, which is a pre World Cup.
Speaker 2: Match thing that is that was played thing.
Speaker 3: I don't know, some like big time football people are
Speaker 3: going to be like, it's not a match thing, Aaron.
Speaker 2: It could be a match thing if I wanted to
Speaker 2: be a match thing.
Speaker 3: Obviously not sports fanatics over here.
Speaker 1: That match thing was played in June twenty thirteen, and
Speaker 1: so that would mark a slightly earlier origin.
Speaker 3: Would that also be even earlier than the French Polynesia outbreak?
Speaker 1: It would, But there have also been indications that the
Speaker 1: virus was present in Haiti and some other Caribbean islands
Speaker 1: before or at least at the same time as the
Speaker 1: French Polynesia.
Speaker 3: Huh interesting.
Speaker 1: So up to this point we had seen how the
Speaker 1: virus could act on relatively small islands, but how would
Speaker 1: it behave when it got to a country with some
Speaker 1: very high population densities and then spread to the rest
Speaker 1: of the continent Because mosquitoes don't exactly acknowledge political boundaries.
Speaker 1: At first, the epidemic mirrord that of Yap and French Polynesia,
Speaker 1: mostly mild infections with very few people needing hospitalization, and
Speaker 1: a heightened incidents of Giambarre. But this epidemic was different
Speaker 1: than those other ones in a couple of key ways,
Speaker 1: one expected and the other a complete surprise. First, ZEKEA
Speaker 1: didn't burn through the population like it did in the
Speaker 1: island outbreaks, but rather established more of a permanent transmission zone,
Speaker 1: which was somewhat expected given that the much larger population
Speaker 1: meant a constant supply of susceptible people and a much
Speaker 1: much larger geographic area meant more places to spread. And
Speaker 1: at this point you can probably guess what the surprise
Speaker 1: difference was in this outbreak, because there's one essential thing
Speaker 1: about Zica that has been conspicuously absent from.
Speaker 2: The history so far microcephaly. You got it.
Speaker 1: In October twenty fifteen, five months after Ezeka epidemic had
Speaker 1: been confirmed, doctors in the northeastern city of Recife noticed
Speaker 1: that they were delivering an unusually high number of infants
Speaker 1: with microcephaly, and a few of these doctors suggested that
Speaker 1: there was a link between the zekavvirus and microcephaly, based
Speaker 1: purely on the shared epidemiological patterns of the two. Both
Speaker 1: ZICA and microcephally were highest in the northeastern part of Brazil,
Speaker 1: and the delay between the ZICA outbreak and the microcephaly
Speaker 1: made sense given a prenatal exposure, and in November of
Speaker 1: twenty fifteen, Brazil declared a state of emergency as the
Speaker 1: number of diagnoses of microcephaly climbed past twenty seven hundred.
Speaker 1: Some obstetricians and even public health officials were advising women
Speaker 1: not to get pregnant, which was unheard of, and it
Speaker 1: shows how dramatic the uptick and microcephaly was during this time,
Speaker 1: and also serves as a bit of a preview for
Speaker 1: the many debates that would be held on the international
Speaker 1: stage about zicca, its effects and recommendations for those in
Speaker 1: endemic areas. At the time when the state of emergency
Speaker 1: was declared, there was as of yet no definite pathophysiological evidence,
Speaker 1: no lab studies on animal models, no meta analysis that
Speaker 1: clearly demonstrate the link between microcephaly and ZICA, which naturally
Speaker 1: led to speculation. And I'm sure you remember some of
Speaker 1: the other rumors about what was causing the increase in
Speaker 1: microcephally genetically modified mosquitoes to fight dangay, chemical larvacide and
Speaker 1: drinking water that was intended to kill mosquito larvae. Yeah,
Speaker 1: the rubella vaccine. Ooh, I didn't hear that one. Yeah,
Speaker 1: because apparently rubella can cause microcephale.
Speaker 3: Yeah, it can cause a lot of fetal defects in
Speaker 3: if a pregnant woman gets infected. But also pregnant women
Speaker 3: don't receive the MMR vaccine which contains rubella because it's
Speaker 3: a live vaccine.
Speaker 1: Well, we've never known anti vaxxs to be logical or
Speaker 1: fact based in any.
Speaker 2: Of their Sorry.
Speaker 1: Maybe another one was that there was no actual increase
Speaker 1: in microcephale cases at all, but that Brazil hadn't been
Speaker 1: keeping track of the case as well, or they had
Speaker 1: changed the definition so that a larger skull circumference would
Speaker 1: be classified as microcephalic. Side note, it was actually the reverse,
Speaker 1: so the upper limit of what was considered microcephale had
Speaker 1: actually been decreased. Ooh, but for most of the cases
Speaker 1: that were microcephae as a result of ZICA.
Speaker 2: They were not on the borderline, so it wouldn't have mattered.
Speaker 3: Yeah.
Speaker 1: And then there was the apparent absence of microcephale outbreaks
Speaker 1: in places where ZEKA was endemic, such as parts of
Speaker 1: Africa and Asia, but that could be explained by early
Speaker 1: exposure and subsequent lifetime immunity, which also explains why we
Speaker 1: hadn't really seen a big outbreak. It probably has just
Speaker 1: been there circulating for a long time. It seemed like
Speaker 1: every time one rumor was discounted, another popped up into
Speaker 1: its place. I remember these rumors making the rounds during
Speaker 1: late twenty fifteen and early twenty sixteen, none of them
Speaker 1: calling themselves rumors, of course, more like could franken mosquitoes
Speaker 1: be responsible for the increase microcephaly?
Speaker 3: BuzzFeed headlines kind of thing, right.
Speaker 1: Well, and then the article that goes with that headline
Speaker 1: just wildly speculates and it's not actually asking that question.
Speaker 1: It's more like frank and mosquitoes could be responsible, you know,
Speaker 1: And it takes phrases like could indicate as yes, definitely.
Speaker 2: It does this.
Speaker 1: And this is where the very real disconnect between how
Speaker 1: science is written about for academic journals and how science
Speaker 1: is written about for newspapers becomes very apparent. Yeah, for instance,
Speaker 1: if there is a paper in a scientific journal that said,
Speaker 1: this finding is highly suggestive of a causative link between
Speaker 1: zica and microcephaly, that sounds that might sound fairly uncertain,
Speaker 1: or at least more uncertain compared to zica causes microcephale.
Speaker 3: I just feel like what you said sounded so certain.
Speaker 3: I was like, wow, were there papers that said that
Speaker 3: back then? Because to me that sounds like really, But
Speaker 3: that's because I read scientific papers.
Speaker 1: You read these papers, and it is I mean, all
Speaker 1: of the wording is incredibly cautious, because that's how science
Speaker 1: is done. Very very rarely is anything ever proven. Instead,
Speaker 1: hypotheses are supported every now and then, rarely a theory
Speaker 1: will be developed. And that's about the closest thing we
Speaker 1: have to anything being proven, and this is one of
Speaker 1: the reasons that the link between zica and microcephale seem
Speaker 1: to take a while to become fully established. There cannot
Speaker 1: be jumping to conclusions. Each piece of evidence has to
Speaker 1: be carefully measured and weighed, especially when lives.
Speaker 2: Are on the line.
Speaker 1: All things considered, the link between zica and microcephally took
Speaker 1: not very long at all to be established, thanks in
Speaker 1: part to a policy of freely publishing data that many
Speaker 1: researchers took part in, as well as a pledge to
Speaker 1: make ZICA articles freely accessible during the duration of the emergency.
Speaker 1: On February first, twenty sixteen, the WHO declared a public
Speaker 1: health emergency of international concern over the possibility that zica
Speaker 1: caused microcephaly, which was very carefully worded the possibility, but
Speaker 1: not more than two months later, the wording of the
Speaker 1: WHO Zeca report changed to quote. Based on observational, cohort
Speaker 1: and case control studies, there is strong scientific consensus that
Speaker 1: Zeca virus is a cause of GBS microcephalye and other
Speaker 1: neurological disorders GBS meaning gambarre. Scientists looked back at places
Speaker 1: that had ZEKA outbreaks before, like French Polynesia and Yap
Speaker 1: and found clusters of microcephaly. They did lab experiments showing
Speaker 1: that the virus injected into a mouse at any stage
Speaker 1: of pregnancy could be deadly to the fetus, and they
Speaker 1: had case control studies in which they followed women who
Speaker 1: had tested positive for ZICA infection during pregnancy through the
Speaker 1: time they had given birth. There was no one study
Speaker 1: that showed this definitive link. It was many small ones,
Speaker 1: because that's how science is done. And this link, like
Speaker 1: you mentioned, between a mosquito born virus and a horrible,
Speaker 1: horrible neurological disorders was unprecedented in medicine. If most of
Speaker 1: the world had had its head turned toward Brazil during
Speaker 1: late twenty fifteen, its eyes were starting to wander in
Speaker 1: the early months of twenty sixteen as the virus made
Speaker 1: its way throughout other parts of South America and up
Speaker 1: through Central America. Even before the link between Zica and
Speaker 1: microcephaly had been established, even before the WHO had declared
Speaker 1: its first global emergency, countries were issuing travel advisories for
Speaker 1: its citizens. If you are pregnant or thinking of becoming pregnant.
Speaker 1: You shouldn't travel to x or y country where there
Speaker 1: is an ongoing outbreak of zica. And as the sexual
Speaker 1: transmission aspect of zica became apparent, that was incorporated into
Speaker 1: the warning. It became more wide. It wasn't just towards
Speaker 1: pregnant women. It was also about if you have been
Speaker 1: to a country, you should consider this, and yeah, etc.
Speaker 3: Use safe sex practices and blah blah blah.
Speaker 2: Yeah.
Speaker 1: Of course there was a lot of fear about bringing
Speaker 1: the virus to the US because the mosquito vector is
Speaker 1: present there. But what about warnings or advice for the
Speaker 1: people living in those epidemic regions? What should they be
Speaker 1: told about zika? As I mentioned earlier, some public health
Speaker 1: officials and physicians were advising their patients to wait to
Speaker 1: get pregnant, but there had been no formal statement to
Speaker 1: that effect from governments early on, and should there be.
Speaker 1: This was a big debate among reproductive health and infectious
Speaker 1: disease specialists and was reported to be causing quite a
Speaker 1: rift within organizations like the CDC. What role, what right
Speaker 1: does the government have to make these recommendations to women
Speaker 1: about what they should or shouldn't do with their bodies,
Speaker 1: and when access to birth control wasn't possible for many
Speaker 1: in some places, most of the women in these countries,
Speaker 1: for married women, in Guatemala, Bolivia, and Haiti, less than
Speaker 1: thirty five percent of women had access to birth control
Speaker 1: at the time time that this book was written. So
Speaker 1: in twenty sixteen, other places fared barely better fifty percent,
Speaker 1: sixty percent. And what about women who can't delay pregnancy
Speaker 1: by a couple of years due to biological reasons, or
Speaker 1: they just don't What about too or they don't want to? Yeah,
Speaker 1: what about the dark history of forced birth control that
Speaker 1: has lingered in some places, sterilization programs for convicted people. Ultimately,
Speaker 1: most countries didn't recommend waiting to get pregnant, although some
Speaker 1: did said wait two years, wait six months, whatever. Most
Speaker 1: instead recommended protective measures such as mosquito nets, bugspray, and screens.
Speaker 1: But this brought to light the really important issue of
Speaker 1: access that I, in reading this book, didn't feel like
Speaker 1: it got enough attention or coverage. Access to accurate information,
Speaker 1: access to healthcare, access to birth control, access to these
Speaker 1: protective bugnets, these these mosquito sprays, access to the things
Speaker 1: that would allow you to protect yourself and your family
Speaker 1: and to make an informed decision.
Speaker 3: I remember when they were talking about making those recommendations
Speaker 3: and in some areas making them like just telling women
Speaker 3: you can't get pregnant, don't get pregnant, and just being
Speaker 3: so infuriated at that idea because it is often so
Speaker 3: difficult to get birth control. I mean even in the US,
Speaker 3: it's often very difficult to get birth control, you know. Yeah, Oh,
Speaker 3: it was just so infuriating.
Speaker 1: Even if these recommendations had been made, because even if
Speaker 1: it was just these these governments saying you should wait
Speaker 1: to get pregnant, then it's almost like they're washing their hands, yeah,
Speaker 1: of rs, because it's like, well, then if you got pregnant,
Speaker 1: you went against our recommendation, so there's nothing we can
Speaker 1: do for you. Instead of the fact that it's like,
Speaker 1: well it wasn't exactly a choice for me, perhaps that
Speaker 1: I you know, all of these different aspects, Yeah, admits
Speaker 1: these Zica was continuing to spread and spread and spread,
Speaker 1: and panic reached an all time high during the lead
Speaker 1: up to the twenty sixteen Olympics in Rio. Yeah, and
Speaker 1: the final tallly of cases of zica and cases of
Speaker 1: microcephaly reported for those attending the games was zero.
Speaker 3: H yeah, so zero very anticlimactic.
Speaker 1: Great, yeah, but well, make make no mistake. Zica was
Speaker 1: still an ongoing problem in Rio during this time, particularly
Speaker 1: in poor areas with little infrastructure and no access to healthcare.
Speaker 3: Just not amongst people who were at the Olympics who.
Speaker 1: Could afford to travel to the Olympics and spray themselves
Speaker 1: with bug spray or whatever else. I think that this,
Speaker 1: so far in our podcast, is the closest the history
Speaker 1: has gotten to the epidemiology. So I feel like we
Speaker 1: should just jump straight into it. Aaron tell me about
Speaker 1: you can know? Is there a vaccine?
Speaker 2: Let's do it.
Speaker 3: Okay. PAHO, which is the Pan American Health Organization during
Speaker 3: like from twenty fifteen all the way through twenty seventeen,
Speaker 3: had lists that were updated several times a month of
Speaker 3: the cumulative case reports from every country across the Americas
Speaker 3: that included the number of octocthonous cases. That's a new
Speaker 3: VOCA word. I love that sorta word, autocthinus. Aaron tell
Speaker 3: us what it means.
Speaker 1: Basically, it means are you telling, are you asking me?
Speaker 1: Or are you asking you?
Speaker 3: Oh?
Speaker 2: Good question? I'm asking you. I know sometimes you talk
Speaker 2: to you.
Speaker 1: So basically it means arising from the same location exactly.
Speaker 3: Yeah, So octogulinist cases of transmission in the US are
Speaker 3: cases that weren't imported from somewhere else. There are cases
Speaker 3: that were transmitted in the US. So the number of
Speaker 3: octopolinist cases as well as the number of imported cases.
Speaker 3: But what I find gobsmacking about the pah.
Speaker 2: Good word, great word.
Speaker 3: The most recent update that pa Hoo has about the
Speaker 3: number of cumulative cases of zecavirus was last updated January fourth,
Speaker 3: twenty eighteen.
Speaker 2: So a year year ago.
Speaker 3: We'll see if this changes by the time we release
Speaker 3: this episode, but as of recording, the data that I
Speaker 3: have is from one year ago. Okay, so as of
Speaker 3: January twenty eighteen, the countries that have been hardest hit
Speaker 3: by far in terms of the total number of cases
Speaker 3: are Brazil and Puerto Rico. Over one hundred and thirty
Speaker 3: seven thousand total cases in Brazil ill and over forty
Speaker 3: thousand in Puerto Rico. And that's just confirmed cases. That
Speaker 3: doesn't include many, many more suspected cases.
Speaker 1: Is that number total or is that just for twenty
Speaker 1: sixteen twenty seventeen or twenty seventeen to twenty that's.
Speaker 3: Twenty sixteen twenty seventeen, so we don't have numbers from
Speaker 3: twenty eighteen yet. And what's also important to point out,
Speaker 3: and I do want to make this important because it's
Speaker 3: important in epidemology in general, but it's super important in
Speaker 3: this case, is that those are the largest number of
Speaker 3: cases overall. So while Brazil had the largest number of cases,
Speaker 3: it's a massive country, right, So in epidemiology we don't
Speaker 3: really look at raw numbers that often. We usually use
Speaker 3: incidence rate rather than straight numbers to get a sense
Speaker 3: of how many people are affected based on the population's size.
Speaker 3: So we look at the number of cases per one
Speaker 3: hundred thousand people. Yeah, So in that case, it's actually
Speaker 3: some of the Caribbean islands, for example Curasow, which had
Speaker 3: over two thousand confirmed cases, but the incident's rate is
Speaker 3: over four thousand cases per one hundred thousand people.
Speaker 2: Oh my gosh.
Speaker 3: And in Brazil the case rate is still extremely high,
Speaker 3: one hundred and seventy six cases per one hundred thousand
Speaker 3: people in Brazil.
Speaker 2: Wow.
Speaker 3: Yeah, that's that's really high. That's really high. Puerto Rico,
Speaker 3: the incident's rate was over one thousand cases per one
Speaker 3: hundred thousand people from twenty sixteen to twenty seventeen. So
Speaker 3: for comparison, in the US, in that time period, there
Speaker 3: were two hundred and twenty seven confirmed octogthonous transmission cases.
Speaker 3: That means people who acquired zeke infection in the United
Speaker 3: States two hundred and twenty seven. That's a incidance rate
Speaker 3: of point zero six cases per one hundred thousand people.
Speaker 3: So overall, across all the countries in the Americas that
Speaker 3: have been affected, there have been over two hundred and
Speaker 3: twenty three thousand confirmed cases and five hundred and eighty
Speaker 3: thousand suspected cases. Is three thousand, seven and twenty cases
Speaker 3: of confirmed congenital ZEKA Syndromeugh. Yeah, it only had twenty
Speaker 3: deaths listed, but I'm not sure that that counts fetal
Speaker 3: deaths or early pregnancy loss. I don't believe that it does,
Speaker 3: but I'm not positive.
Speaker 2: Okay.
Speaker 3: So, and I will say that this is not the
Speaker 3: only place that ZICA is happening. So I actually was
Speaker 3: checking pro med and there was an outbreak of ZICA
Speaker 3: going on in India very recently.
Speaker 2: Okay, and do we know what strain that is or I.
Speaker 3: Have absolutely no idea because I didn't go further down
Speaker 3: that rabbit hole. It's a great question, though, Okay, so
Speaker 3: now the question is what are we doing about it?
Speaker 3: Now that zica is on everybody's radar. We should have
Speaker 3: a vaccine for it, right, just like after the a
Speaker 3: bullet outbreak we had a vaccine right right? Oh yeah, yeah, no,
Speaker 3: well we do now though, Well let's talk about why.
Speaker 3: So one of the things I think that I was
Speaker 3: so excited to talk about zica virus is that it's
Speaker 3: such a beautiful example of a disease that we have
Speaker 3: known about for seventy years. That's a long time, and
Speaker 3: yet we know so little about this disease.
Speaker 2: Yeah.
Speaker 3: One of the reasons is in our scurvy episode, you
Speaker 3: touched briefly on the idea of developing animal models, right,
Speaker 3: which is a really important part of studying diseases that
Speaker 3: infect humans. And I don't remember the exact year that
Speaker 3: you said the guy came up with the guinea pig
Speaker 3: as the model.
Speaker 1: Eighteen ninety three, Thank you, wasn't it really?
Speaker 2: No, I don't have no idea, but it was a
Speaker 2: long time ago.
Speaker 3: Right, it's a very long time ago, and that's what
Speaker 3: allowed us to hone in on and figure out what
Speaker 3: exactly was happening with scurvy. Well with zeica. It's not
Speaker 3: that we didn't have any animal models. It's not that
Speaker 3: they didn't exist at all. But two things. One, very
Speaker 3: few good animal models actually did exist, and number two,
Speaker 3: the ones that did exist were made from very very
Speaker 3: old strains, like the nineteen forty seven first discovered strain
Speaker 3: of Zeca virus. And viruses evolve, they change, so it's
Speaker 3: important to have animal models that actually reflect the viruses
Speaker 3: that are circulating in the population. And it has only
Speaker 3: been in the last three or four years that you
Speaker 3: can find a ton of papers where people are literally
Speaker 3: developing animal models to study zeka. Wow, it is so cool.
Speaker 2: So is there is there a candidate animal model?
Speaker 3: Now there are several, and so I'll post some of those.
Speaker 3: There's actually a really nice review that goes through all
Speaker 3: of the research that's been done currently and what the
Speaker 3: most promising animal models are. And so mostly it's mice
Speaker 3: and non human primates. So those are the two biggest
Speaker 3: ones and makes sense, right, they're just kind of some
Speaker 3: of the biggest in general. But what's really important is
Speaker 3: developing this non human primate model though, because the effects
Speaker 3: of zica, like mouse placentas aren't equivalent to human placentas,
Speaker 3: and mouse fetal development is nothing like, well not nothing like,
Speaker 3: but very dissimilar to human fetal development. So developing these
Speaker 3: non human primate models in order to study the effects
Speaker 3: of ZICA on fetuses is really really important, right, And
Speaker 3: so they've done a lot of that. They've infected pregnant
Speaker 3: monkeys with ZICA and found their fetuses to have reduced
Speaker 3: growth of the fetal brain, white matter deficiency, axonal damage
Speaker 3: which means damage to the axons, which are like the
Speaker 3: long spindly bits of your neurons, and more. And they've
Speaker 3: been able to detect ZECA virus in all different kinds
Speaker 3: of placental tissue and fetal tissue.
Speaker 2: Wow.
Speaker 3: Yeah, so these links are very clear, even though we
Speaker 3: don't know the exact pathophysiology of like how exactly is
Speaker 3: ZEKA infecting this cell and then what is it doing
Speaker 3: within that cell? We know that it's infecting the fetus,
Speaker 3: it's infecting the fetus brain, and it's causing this damage
Speaker 3: and development of these animal models allows us to get
Speaker 3: a better understanding, not just of that pathophysiology, so that
Speaker 3: someday we will know exactly how it's causing disease. We
Speaker 3: can also study the mechanisms by which it's able to
Speaker 3: be sexually transmitted. Yeah, we can study the mechanisms by
Speaker 3: which it can cause gion beret. This also allows for
Speaker 3: the study of antibody therapy, antiviral therapy, and vaccine developments. Aha,
Speaker 3: so let's talk about it. There are vaccines in development,
Speaker 3: including at least several all DNA vaccines.
Speaker 2: Oh fav your fave.
Speaker 3: However, it's many, many years away before we'll see any
Speaker 3: real action from that most likely.
Speaker 2: That makes sense.
Speaker 3: It makes sense because prior to these most recent outbreaks,
Speaker 3: nobody was paying attention to zica.
Speaker 2: Which also makes sense.
Speaker 1: I mean, it was it does, a very mild infection
Speaker 1: that no one knew had this under its right up
Speaker 1: its sleeve.
Speaker 3: So I think an important contrast to make here is
Speaker 3: that with ebola. Before the twenty fourteen outbreak, there had
Speaker 3: been a lot of funding to study ebola, and there
Speaker 3: had been vaccines that were in development, but funding for
Speaker 3: those had often dried up, and so while they had
Speaker 3: been started down the long road of vaccine development. They
Speaker 3: hadn't made it all the way with zica. People have
Speaker 3: been starting completely from scratch. So the World Health Organization
Speaker 3: has a pretty awesome Actually, I can't believe I just
Speaker 3: found out about this. They have a vaccine development tracker,
Speaker 3: and I'll definitely put a link to it on our website.
Speaker 3: But on this you can see the status of vaccine
Speaker 3: development for a whole number of different diseases, including zecavirus.
Speaker 3: So there are yeah, it's very cool. There are a
Speaker 3: lot of different groups that are working on it, and
Speaker 3: you can see exactly what phase they're in. So at
Speaker 3: this point, basically all of the Zeka vaccines are in
Speaker 3: phase one trials. There's two that are in phase two trials.
Speaker 2: Okay.
Speaker 3: Phase one is essentially just making sure that this vaccine
Speaker 3: is safe and not going to kill people or maime them.
Speaker 2: So you just give importance it's really important.
Speaker 3: You just give the vaccine to a small number of people,
Speaker 3: probably in various dosages, and you're just trying to make
Speaker 3: sure that it doesn't make anybody sick or cause any
Speaker 3: serious adverse reactions. Phase two is when you actually try
Speaker 3: and see if it works, which is harder to do.
Speaker 3: It's not testing it against anything else. That's phase three,
Speaker 3: where you have like controls, right, Yeah, so it's just
Speaker 3: trying to see if it's a effective at all. And
Speaker 3: this is hard for well, it's hard for vaccines in general,
Speaker 3: but it's really hard for diseases that have low incidents
Speaker 3: because if you're never exposed to a disease, you can't
Speaker 3: really really test if it works. But we also can't
Speaker 3: give people diseases that's not a thick hole. So what
Speaker 3: you can do is test for an immune response, so
Speaker 3: you can give people a vaccine and then you can
Speaker 3: test their blood after a certain period of time to
Speaker 3: make sure that they're actually making antibodies against the vaccine components.
Speaker 3: So cool. So that's the stage that two of the
Speaker 3: vaccines are in, but most of them are still just
Speaker 3: in phase one, where they're just trying to make sure
Speaker 3: that their vaccines don't kill anybody. And that's what's happening
Speaker 3: with Zeka research.
Speaker 2: That's pretty cool.
Speaker 3: It's pretty cool. It's been very quickly added to the
Speaker 3: who's list of priority diseases. So yeah, it's a I
Speaker 3: think probably very exciting time to work in the ZEKA field.
Speaker 2: Yeah, I can imagine.
Speaker 1: So I have a question, Okay, only five to fifteen
Speaker 1: percent of women who are infected with ZECA while pregnant
Speaker 1: have an adverse outcome, right, are there any other outcomes
Speaker 1: associated with the ninety five to eighty five percent of
Speaker 1: women who are not, so something like are there developmental
Speaker 1: disorders in otherwise, you know, physically healthy children, Are there
Speaker 1: anything that's diagnosed at a higher rate, anything like that.
Speaker 3: It's a good question, and I don't think that we
Speaker 3: know yet at this point, because remember that since the
Speaker 3: first time that we found out that even microcephaly was
Speaker 3: a thing associated with ZICA was just two years ago.
Speaker 1: But some of those kids, presumably from like the Yap
Speaker 1: outbreak or the French Polynesia, would be right, But that.
Speaker 3: Would mean that people would have to be doing study
Speaker 3: on those people now, and I don't know that they are.
Speaker 3: So I would guess that I know that in Brazil
Speaker 3: there are definitely longitudinal studies that are being done and
Speaker 3: are probably following up on those exact outcomes, But I
Speaker 3: don't know if people have looked back to see in
Speaker 3: older kids if there's any other effects. I'm not sure.
Speaker 3: It's a really good question, though, because it definitely, you know,
Speaker 3: seems possible, right, Yeah, that's sika. Wow, it's a scarier
Speaker 3: one than I gave it credit for when I first
Speaker 3: heard about it, that's for sure.
Speaker 2: Oh yeah, it's a scary one.
Speaker 1: It's a sad one, and it's definitely present tense future
Speaker 1: tense verbs apply here.
Speaker 3: Yeah. Absolutely. It will be very interesting, I think, to
Speaker 3: see if there is continued cases and continued sort of
Speaker 3: epidemics of microcephaly or in the Americas, or if this
Speaker 3: becomes like it perhaps was in Africa, just sort of
Speaker 3: an endemic disease that people get exposed to in childhood
Speaker 3: and then we no longer see it as affecting pregnant
Speaker 3: women because women have been exposed to it when they're younger.
Speaker 3: It's going to be really interesting to follow Zeka over
Speaker 3: the next few decades.
Speaker 2: Yeah, absolutely, yeah, uh sourceness. Yeah.
Speaker 1: I have some papers that I will put on the website.
Speaker 1: And I also, as I mentioned earlier, the book Zeka
Speaker 1: by Donald McNeil, which was written in twenty sixteen before
Speaker 1: the Olympics, right on the heels of that first or
Speaker 1: of the big Brazil outbreak.
Speaker 3: Cool. I have a number of articles, the one I
Speaker 3: do want to shout out that I thought was super
Speaker 3: interesting was by Thomas Morrison and Michael Diamond. That is
Speaker 3: a summary of animal models. We will, as always, link
Speaker 3: to all of the articles and books that we used
Speaker 3: in this episode on our website that's this podcast Will
Speaker 3: Kill You dot com slash episodes, so you can find
Speaker 3: all of our sources from every episode there.
Speaker 1: And and thanks to Bloodmobile for providing the music for
Speaker 1: this episode and all of our episodes.
Speaker 3: Love yeah, and thank you dearest listeners, listeners to our ramblings.
Speaker 2: We love you, Yes we do. It's the best.
Speaker 1: It is, Okay, until next time, wash your hands, you
Speaker 1: filthy animals. U.