Speaker 1: It begins with a rigor, followed by heats and chills
Speaker 1: during the first day. On the second day there is
Speaker 1: fever with intense malaise, thirst, lost of appetite, white tongue
Speaker 1: not actually dry, slight cough, heaviness of the head and eyes,
Speaker 1: and constant drowsiness. In most cases a humor distills from
Speaker 1: the nose and eyes, the effusion or suffusion of tears
Speaker 1: being the most certain sign of sickening for measles, more
Speaker 1: certain indeed than the exanthem. The child sneezes as if
Speaker 1: it has taken cold, the eyelids swell. There may be vomiting.
Speaker 1: More usually, there are loose green stools, and there is
Speaker 1: excessive fretfulness. On the fourth or fifth day, small red
Speaker 1: maculae like flea bites begin to appear on the forehead
Speaker 1: and the rest of the face, which coalesce as they
Speaker 1: continue to come out in increasing numbers so as to
Speaker 1: form Rasimo's clusters. These maculae will be found by the
Speaker 1: touch to be slightly elevated, although they seem level to
Speaker 1: the eye. On the trunk and limbs to which they
Speaker 1: gradually extend, they are not elevated. About the sixth day,
Speaker 1: the maculae begin to roughen and scale from the face downwards,
Speaker 1: and by the eighth day are scarcely discernible anywhere. On
Speaker 1: the ninth day the whole body is as if dusted
Speaker 1: with bran. The common people say that the spots had
Speaker 1: quote turned inwards, by which they mean that if it
Speaker 1: had been smallpox, they would have remained out longer and
Speaker 1: have proceeded to separation or maturation. The rash having thus
Speaker 1: gone in, there is an access of fever, attenuated with
Speaker 1: labored breathing and cough, the latter being so incessant as
Speaker 1: to keep the children from sleep day or night.
Speaker 2: Oh that's awful.
Speaker 1: It's not great.
Speaker 3: Yeah, but that sounds really miserable.
Speaker 1: Yes, So that was from Sydenham's account of London measles
Speaker 1: epidemic that happened all the way back in sixteen seventy.
Speaker 3: But it could be an account of what's going on today.
Speaker 1: It really could. It actually was very similar in a
Speaker 1: lot of ways to things that I read in my
Speaker 1: textbooks about describing measles.
Speaker 3: Including the common people.
Speaker 1: Part, maybe not that part, the common people.
Speaker 2: Hi i'm erin Welsh and i'm eron.
Speaker 3: Alman Updyke and this this podcast will kill you.
Speaker 1: And we're obviously talking about measles. If you haven't caught
Speaker 1: the hint yet.
Speaker 3: A lot of you asked for it and we've been
Speaker 3: wanting to do it, so here it is.
Speaker 1: Yeah, thanks for asking everyone.
Speaker 3: This one is there's a sense of urgency here though,
Speaker 3: which is very real.
Speaker 1: Yeah, why is that, Aaron?
Speaker 3: Well, I mean spoilers. There's measles going on right in
Speaker 3: the world today.
Speaker 1: So much measles today.
Speaker 3: There's a lot that's happening, and I think this is
Speaker 3: I this is a really interesting one to cover because
Speaker 3: it deals with a lot of different issues that we
Speaker 3: have sort of skirted around or skirted past, maybe touched
Speaker 3: on very briefly here and there, in terms of vaccination,
Speaker 3: in terms of how to view historical epidemics in the
Speaker 3: light of today. Yeah, measles is really one that's going
Speaker 3: to bring it all home.
Speaker 2: So I'm excited me too.
Speaker 1: It's gonna be fun. Yeah.
Speaker 3: So, speaking of fun, I think it's quarantine absolutely.
Speaker 2: And what are we drinking today today?
Speaker 1: We're drinking a rash decision.
Speaker 2: That's named because for.
Speaker 1: The characteristic measles rash.
Speaker 3: And the poor decision making of some people to not
Speaker 3: vaccinate their children.
Speaker 1: What yep, yeah, we said it. Okay, So what's in
Speaker 1: this drink that we're drinking.
Speaker 3: Well, we've got vodka, We've got grenadine, We've got ginger.
Speaker 2: Liqueur or ginger.
Speaker 1: Ale up to you. We've got lime.
Speaker 2: Juice and linoennberries.
Speaker 1: Oh yeah, if you're in Finland.
Speaker 3: Otherwise cherries if you're.
Speaker 1: Not in Finland where Lincoln berries are so abundant.
Speaker 3: Whatever small red berry to mimic the spots of the mees.
Speaker 1: And as always, we'll post the full recipe for this
Speaker 1: quarantine along with our place ba Rita, our non alcoholic
Speaker 1: version on our website as well as all of our
Speaker 1: social medias. This podcast will kill You on Instagram and
Speaker 1: Facebook and tpwky on Twitter.
Speaker 3: And also someone has someone has started a subreddit called
Speaker 3: tpwky which is really thrilling and we have seen the
Speaker 3: quarantine's posted there, So whoever is doing that, thank you
Speaker 3: very much.
Speaker 1: And you should know that Aaron Welsh checks it all
Speaker 1: the time and loves it and.
Speaker 2: Is I'm our lurker. Okay, so measles.
Speaker 1: Measles, should we talk about it?
Speaker 2: I think that's why we're here, all right.
Speaker 1: We're going to do that right after this break. All right, measles.
Speaker 1: Before I dive into the biology of measles, I want
Speaker 1: for everyone to know that we are going to be
Speaker 1: doing an entire episode focused on vaccines, where we'll talk
Speaker 1: about the history of vaccine development. Well, when I say we,
Speaker 1: I mean Aaron Welsh, I don't do that. I'll talk
Speaker 1: about how vaccines actually work in your body to give
Speaker 1: you immunity, and then we'll talk more generally about the
Speaker 1: status of vaccination across the US and the globe. Today
Speaker 1: we're talking about one disease, measles, that's often a large
Speaker 1: part of the conversation about vaccines, and we'll talk about
Speaker 1: why that is. But I'm not going to talk super
Speaker 1: broadly about vaccines because I do want to give measles
Speaker 1: the attention that it deserves specifically if that makes sense.
Speaker 3: Makes sense to me. Yeah, So stay tuned, people.
Speaker 1: Yeah, but we will talk about vaccines because vaccines are
Speaker 1: an important part of the measles story. Yes, okay, so measles.
Speaker 1: First of all, it's a virus. It's an RNA virus,
Speaker 1: which usually I say that means it's scarier than DNA
Speaker 1: viruses because they mutate and they're hard to target. But actually,
Speaker 1: it turns out measles has like very low antigenic diversity,
Speaker 1: so it hasn't changed over its history with humans.
Speaker 2: We got lucky, yeah, very.
Speaker 1: So that means that the vaccines that we developed way
Speaker 1: back when are still effective against the wild circulating virus today.
Speaker 1: So that's like the best news I have for you
Speaker 1: about measles. Downhill from here, cool, Yeah, gotta start off
Speaker 1: on a high, you know. Okay, So when you get
Speaker 1: infected with measles, the incubation period, which again is that
Speaker 1: period from when you first get infected until you start
Speaker 1: showing symptoms, lasts between ten and fourteen days.
Speaker 2: Okay, Okay.
Speaker 1: However, you become infectious up to five days before those
Speaker 1: symptoms start.
Speaker 3: You know, those are the deadly ones. Those are the
Speaker 3: ones really are.
Speaker 1: It's a very very big deal, and we've talked about
Speaker 1: it before with flu and things like that, but in
Speaker 1: the case of measles, the fact that you're infectious before
Speaker 1: you have any symptoms is an even bigger deal because
Speaker 1: the are not of measles, which again is the number
Speaker 1: of secondary infections that a single infected individual will cause
Speaker 1: if the entire population is susceptible for measles. That number
Speaker 1: is between thirteen and eighteen.
Speaker 2: Yep.
Speaker 3: It's highest one that we know, right, the highest one
Speaker 3: we know.
Speaker 1: Yeah, And what this essentially means is that for every
Speaker 1: single person who's infected, on average, ninety percent of the
Speaker 1: people they come in contact with who are susceptible will
Speaker 1: become infected with measles.
Speaker 3: That that's a horrifying statistic.
Speaker 1: Exactly.
Speaker 2: Yeah.
Speaker 1: I mean if you think about smallpox and how like
Speaker 1: massive of outbreak smallpox was able to cause. The are
Speaker 1: not of smallpox is between five and seven. And people
Speaker 1: are terrified of things like ebola or sars, and the
Speaker 1: are notts of those are like less than two for
Speaker 1: ebola or between two and three for sars. Yeah, and
Speaker 1: yet measles is this thing that infects almost everyone who
Speaker 1: comes into content act with an infected individual.
Speaker 3: Do you remember what the r not is of the
Speaker 3: virus that's in contagion.
Speaker 1: I don't remember what it actually is. I remember her listing.
Speaker 1: I don't know if they ever actually said it, because
Speaker 1: she just was like, we need to figure out what
Speaker 1: the r not is, But I don't remember. Yeah, we'll
Speaker 1: have to look it up.
Speaker 3: I remember her writing on the board measles fourteen.
Speaker 1: Yeah. I think she wrote polio on there too, which
Speaker 1: was like six or seven.
Speaker 2: Yeah, I think.
Speaker 1: Anyways, Okay, let's get worse. Okay, so measles is transmitted airborne,
Speaker 1: not just in respiratory droplets, but actually airborne. I told
Speaker 1: you it gets worse. So what that means is that
Speaker 1: measles can stay the virus infectious. Measles viral particles can
Speaker 1: stay suspended and alive and infectious in the forking air
Speaker 1: for up to two hours after an infected person leaves
Speaker 1: the room.
Speaker 3: Wait a second, So it's sort of like you know
Speaker 3: how pig pen in peanuts when he's got that cloud
Speaker 3: of dust around him. So if you were a measles kid,
Speaker 3: it would just be a cloud of measles that would
Speaker 3: stay in the room two hours after he left.
Speaker 1: Yeah, that's the thing. It stays in the room. And
Speaker 1: so what happens when there's okay, we have had some
Speaker 1: measles cases here in Champagne, and every time there's a
Speaker 1: new case, public Health sends out an alert and they
Speaker 1: give you a list of all the places that this
Speaker 1: person was during the time that they were infectious, along
Speaker 1: with the times that they were there, and those times
Speaker 1: include a two hour window after that person left because
Speaker 1: the room itself remains infectious. Good gracious, my god. Okay,
Speaker 1: all right, let me summarize the things we've learned so far.
Speaker 1: Measles is a virus that if I haven't before I
Speaker 1: even know I'm sick, for five full days, I can
Speaker 1: be walking around breathing, coughing into a room, and once
Speaker 1: I leave that room for two hours, people can walk
Speaker 1: into it and become infected by the air which contains
Speaker 1: my measles. And if those people are susceptible, meaning if
Speaker 1: they're unvaccinated, ninety percent of them will become infected. And
Speaker 1: then for four to five days after my symptoms resolve,
Speaker 1: I'm still infectious.
Speaker 2: Oh wow, yep.
Speaker 3: I'm just wondering the total amount of time that an
Speaker 3: individual is infectious.
Speaker 1: The total amount of time is probably a good two weeks. Okay,
Speaker 1: So okay, So let's talk about the symptoms. It starts,
Speaker 1: as the name of our future spinoff podcast would suggest,
Speaker 1: with a fever, and in this case with measles, we're
Speaker 1: talking about a really high fever, often up to one
Speaker 1: hundred and four ooh, one hundred and four fahrenheit forty
Speaker 1: degrees celsius. So the virus invades your bronchioles first. Your
Speaker 1: bronchioles are the tubes in your lungs.
Speaker 2: Where the air goes.
Speaker 1: It infects the epithelial cells, which we've talked about a
Speaker 1: lot in this podcast, because a lot of viruses infect
Speaker 1: those epithelial cells, which are the cells that line your bronchioles.
Speaker 1: And so that's why the first set of symptoms that
Speaker 1: you see after fever are respiratory symptoms, a cough, runny nose,
Speaker 1: You can get conjunctivitis if it moves up into your eye.
Speaker 1: And then within two to three days of after symptoms begin,
Speaker 1: you'll often get something called I believe it's coplic. It
Speaker 1: might be coplic.
Speaker 3: Oh yeah, coplic spots. Yeah yeah, I've read about the dude.
Speaker 2: Yeah, oh cool.
Speaker 1: So these are these small white spots in your mouth.
Speaker 1: And while these spots don't appear in every single case,
Speaker 1: they are a very common manifestation and there's pretty much
Speaker 1: nothing else that causes these particular types of spots. So
Speaker 1: they're what we call You're going to learn how to
Speaker 1: talk like a doctor pathonemonic for a disease pathonomonic. It's
Speaker 1: a really fun word. It basically means that it's a
Speaker 1: specific symptom that is very specifically characteristic and indicative of
Speaker 1: a particular disease. So once you see this symptom coplic spots,
Speaker 1: you can say that kid has measles.
Speaker 2: Can you spell that.
Speaker 1: Pa thho gno monic?
Speaker 3: Huh pathonomic it's.
Speaker 1: A weird word. Yeah, But so other examples, We've actually
Speaker 1: talked about some other diseases that have pathanomonic findings. Rice
Speaker 1: water stool is pathonomonic for what disease. So it's like
Speaker 1: a dead giveaway of cholera exactly. Yeah, it's like dead giveaway.
Speaker 1: It's like there's nothing else. There's no other diseases that
Speaker 1: you would see this symptom in essentially, So anyways, that's
Speaker 1: your voguet word for the day.
Speaker 2: I love it.
Speaker 1: So after those copleic spots, in another few days, you'll
Speaker 1: break out in a rash. And this is the classic
Speaker 1: measles rash. It's often called the bucket of paint rash.
Speaker 1: That's how I learned it in class.
Speaker 2: Can you explain to me what that means? Because you
Speaker 2: suggested that as a drinking.
Speaker 1: Like if someone took a bucket of paint and spilled
Speaker 1: it over your head, okay, because the rash starts up
Speaker 1: at your hairline and then it slowly works its way
Speaker 1: down across your face, over your trunk, onto your arm.
Speaker 1: So it's literally like if you took a bucket of paint,
Speaker 1: like the gatorade buckets after a football game or something,
Speaker 1: and you dumped it on top and now you have
Speaker 1: gatorade dripping down your face.
Speaker 3: Okay, So it's like the trajectory of exactly of where
Speaker 3: it's going to pass through. Yeah, not that you look
Speaker 3: like a bucket of paint has been dropped on you.
Speaker 1: Well, well, it also is that the rash becomes confluent
Speaker 1: and so it does pretty much cover your whole body.
Speaker 1: So it starts out as individual spots, but then those
Speaker 1: spots kind of merge together, so it does I mean,
Speaker 1: it doesn't actually look like paint because it's your skin,
Speaker 1: but you know, right.
Speaker 3: But that don't help me visualize what this what this
Speaker 3: looks like?
Speaker 1: Yeah, oh good, I'm glad. And so that rash, that
Speaker 1: rash is mostly caused actually by your immune system killing
Speaker 1: cells that are infected with the virus. So not caused
Speaker 1: by the virus itself necessarily okay. Now, in most cases,
Speaker 1: this rash is kind of one of the final symptoms.
Speaker 1: After a few days of this rash, both the rash
Speaker 1: and the fever will start to subside, and you'll recover
Speaker 1: in most cases. But not everyone will recover. For every
Speaker 1: one thousand people infected with measles, one or two will die,
Speaker 1: and at least one will develop acute encephalitis, which is
Speaker 1: an infection of your brain that can cause permanent brain damage.
Speaker 1: You can also get a lot of secondary bacterial infections
Speaker 1: like pneumonia, which is pretty common after a measles infection
Speaker 1: because of the damage that measles does to your respiratory tract.
Speaker 1: But and this part is a really big deal, measles
Speaker 1: also causes suppression of your immune system in general, and
Speaker 1: not just while you're infected, but for weeks or months
Speaker 1: after infection after you recover. If you recover, your immunal compromised,
Speaker 1: which means you're more susceptible to infection from other pathogens.
Speaker 1: And not yet done. It gets even more serious than that,
Speaker 1: because recent data has shown that infection with the measles
Speaker 1: virus destroys your immunologic memory. What so yes, this is
Speaker 1: the part I was hoping you didn't know because it's
Speaker 1: so terrifying. So it destroys your immune system's capacity for memory.
Speaker 1: And our immune system is essentially built on the fact
Speaker 1: that we have cells that live for a really long
Speaker 1: time and provide us with defenses against things we've already
Speaker 1: been exposed to. That's what immuneo logic memory is. Diesels
Speaker 1: wipe that out. So anything that you had been previously
Speaker 1: exposed to and should be able to fight off, you can't.
Speaker 1: It's like you had never been exposed.
Speaker 2: Oh my god.
Speaker 3: Okay, first question, Okay, I have two questions.
Speaker 1: Okay.
Speaker 3: The first one is that you said that it destroys
Speaker 3: the capacity. So does that mean that if you get infected,
Speaker 3: let's say, with something again, then you will not develop
Speaker 3: protective antibodies to that you could continue to get reinfected
Speaker 3: with that.
Speaker 1: So I that's a really good question. I don't know
Speaker 1: if it transiently suppresses your immune system overall and then
Speaker 1: it wipes out all of your memory cells. But I
Speaker 1: believe after the period of immune suppression, so like after
Speaker 1: a few weeks or months, you would be able to
Speaker 1: then mount an immune response. But it's just that it
Speaker 1: would have. It would be like mounting an immune response
Speaker 1: all over again, like you had never been exposed.
Speaker 3: But once that, once you had been re exposed to
Speaker 3: whatever it was, then subsequently, if you were exposed that
Speaker 3: you can still build memory.
Speaker 2: It's just sort of it wipes out.
Speaker 3: It basically clears out your hard drive. Yeah, starts you
Speaker 3: back in zero add stuff again.
Speaker 2: Okay, yeah, second question.
Speaker 1: Yeah, how great question. There is a paper on that,
Speaker 1: but it was getting very in depth technically on the
Speaker 1: like this is how these immune blah blah blahs, and
Speaker 1: I couldn't I couldn't deal with it, So I'll link
Speaker 1: to that paper. Yeah. And the other thing is I
Speaker 1: don't think that it's entirely clear. This is a pretty
Speaker 1: recent paper. We didn't realize just we knew about the
Speaker 1: short term suppression of your immune system. We didn't know
Speaker 1: until very recently. And the way that we actually found
Speaker 1: this out is looking at like long term data trends
Speaker 1: of mortality rates. So I don't think that it's entirely clear.
Speaker 1: There's mouse models that show that it's possible for measles
Speaker 1: to wipe out those cells, but it's not one hundred
Speaker 1: percent clear how the heck, measles is so powerful and
Speaker 1: destroys your immune system so.
Speaker 2: Much, that's amazing.
Speaker 1: It's it's oh my gosh. So measles infection is not
Speaker 1: just it can kill you by killing you outright. It's
Speaker 1: also associated with short term increases in opportunistic infection and
Speaker 1: long term I'm talking years increased mortality rates due to
Speaker 1: non measles disease. This is something that makes a lot
Speaker 1: of sense in light of vaccination, because what we know
Speaker 1: is that vaccination with the measles vaccine not only protects
Speaker 1: you from measles, but at a population level, it decreases
Speaker 1: mortality from non measles diseases for years after vaccination. And
Speaker 1: the reason that that is what's happening with vaccination is
Speaker 1: because of how strong the effect of infection with measles
Speaker 1: is on your immune system. It just destroys it.
Speaker 3: I think that the long and short of it is
Speaker 3: that being vaccinated against measles and getting measles naturally and
Speaker 3: then gaining immunity to it are not the same thing
Speaker 3: any respect.
Speaker 1: What's that exactly?
Speaker 3: Being naturally infected will lead you to have adverse health outcomes,
Speaker 3: probably ones that you won't even realize vaccinated protects you exactly.
Speaker 1: They're not even comparable, because that's something that I think
Speaker 1: a lot of people, you know, it's like, oh, well,
Speaker 1: why can't I just let my kid get the chicken
Speaker 1: pox instead of you know, giving him the chicken pox
Speaker 1: vaccine or whatever. And in this case, especially with measles,
Speaker 1: that is not the case. Vaccination protects you not just
Speaker 1: from measles, but it protects your immune system, and infection
Speaker 1: with measles wipes your immune system out. It's amazing, remarkable.
Speaker 2: I had no idea.
Speaker 1: I'm glad. It was really fun to get to tell you. Yeah,
Speaker 1: so that is that's measles, that's the virus. That's how
Speaker 1: it makes you sick. So it's all I've got aaron. Okay,
Speaker 1: so how did we get here? How did we learn
Speaker 1: how to fight this sucker?
Speaker 2: It's a good story.
Speaker 1: Cool, shall we take a quick break.
Speaker 3: Let's do it, but for real, because I'm gonna get
Speaker 3: a quarantinie. The measles virus probably came from something like
Speaker 3: bovine render pest.
Speaker 2: Oh future episode.
Speaker 3: Someday, or canine distemper virus, but archaeological evidence isn't really
Speaker 3: clear on that, so we don't really know exactly where
Speaker 3: it came from.
Speaker 2: Okay, but what do we know?
Speaker 3: Well, we know that the musles virus would have needed
Speaker 3: a pretty large population density with a sufficient influx of
Speaker 3: susceptible people in order for it to be sustained. Makes sense,
Speaker 3: it's a crowd disease. Yeah, But saying pretty large population
Speaker 3: density isn't exactly me being precise.
Speaker 1: So let's get some precision here.
Speaker 3: Erin, I mean that's my middle name, not at all. Okay,
Speaker 3: but there is some pretty cool math here actually. All right,
Speaker 3: So some researchers calculated that the virus has to move
Speaker 3: to a new host at least twenty six times a
Speaker 3: year if it's going to survive in a population.
Speaker 1: Interesting, that makes sense if it's too too weak two
Speaker 1: weak disease.
Speaker 3: Yeah, yeah, at a bare minimum, there needs to be
Speaker 3: twenty six susceptible people in a population every year for
Speaker 3: measles to persist.
Speaker 2: Okay, but there are a lot of butts.
Speaker 3: But then those people would have to be inclose or
Speaker 3: frequent enough contact for transmission, and then you know, once
Speaker 3: infected and hopefully recovered, you were immune. So new susceptibles
Speaker 3: had to come in from somewhere either being born whatever. Basically,
Speaker 3: while in theory you only need twenty six new hosts,
Speaker 3: but in practice you need.
Speaker 2: A whole lot more. So the more reasonable estimate.
Speaker 3: Was calculated to actually be a population this includes both
Speaker 3: susceptibles and immune of two hundred and fifty thousand people.
Speaker 1: Wow, that's a huge jump up.
Speaker 3: And so that's that's for maintenance, Okay, to keep the
Speaker 3: virus around, right, because otherwise, I mean, of course the
Speaker 3: virus could could go get into a population and sweep
Speaker 3: through it, no problem of any size. But this is
Speaker 3: for these cyclic outbreaks to happen. Yeah, but yeah, that
Speaker 3: is that is a pretty big size. So then when
Speaker 3: and where did people start to even form settlements that big?
Speaker 2: Yeah, the authors of.
Speaker 3: This Measles book that I read, which by the way,
Speaker 3: has a million cool maps figures so full of information,
Speaker 3: Holy cows, they did so much work on it. Anyway,
Speaker 3: So they started looking through archaeological records to make a
Speaker 3: list of possible places where a there would be enough
Speaker 3: people and b there would also be agriculture and exposure
Speaker 3: to domesticated animals because that's probably where the virus came from.
Speaker 3: And so then they came up with a list and
Speaker 3: dates for these so called urban nuclear areas, most of
Speaker 3: which were in the Fertile Crescent, but some were also
Speaker 3: in Central and South America and West Africa. But the
Speaker 3: most likely place where measles was first establis was in
Speaker 3: Sumaria and the Tigris and Euphrates River valley around three
Speaker 3: thousand BCE.
Speaker 1: Wow.
Speaker 2: So it's old.
Speaker 1: That's a long time ago.
Speaker 3: Five thousand years Yeah, okay, cool, So done, there we
Speaker 3: go established and that's the history of.
Speaker 2: Okay.
Speaker 3: But still we're there. Measles Sumeria three thousand BCE.
Speaker 1: Okay.
Speaker 2: But it wasn't there for.
Speaker 3: Long, or at least it wasn't only there for very long.
Speaker 3: Measles did what diseases do.
Speaker 2: Spread.
Speaker 3: The virus spread north to southern Europe, the rest of
Speaker 3: the Middle East, and east to India, China, and Japan,
Speaker 3: where early writings indicated it was there by like three
Speaker 3: hundred or eight hundred AD.
Speaker 1: Wow.
Speaker 3: As for Africa, measles didn't seem to establish there the
Speaker 3: way it did in Europe and Asia, possibly because of
Speaker 3: lower population density, I don't know, possibly because because of
Speaker 3: physical or landscape barriers making pathogen exchange not super frequent,
Speaker 3: or possibly it was there, and we just don't know
Speaker 3: about it because there aren't as many written records. Okay,
Speaker 3: I don't know. Distinguishing between measles and smallpox and historical.
Speaker 2: Text is really quite tricky, that makes sense.
Speaker 3: Yeah, I mean physicians didn't often, at least at various points,
Speaker 3: didn't make a distinction between the two. But that would
Speaker 3: change in the Middle Ages when measles really came into
Speaker 3: its own.
Speaker 1: H It's like I need to distinguish myself, my own person.
Speaker 1: I'm my own person, measles going through its teenage years.
Speaker 3: Yeah, I mean that side swept bangs and the heavy
Speaker 3: eyeliner top.
Speaker 1: I'm hitting too close to home. Yeah, I know, right.
Speaker 2: Right, Okay, all right.
Speaker 3: So by the Middle Ages, which let's say the fifth
Speaker 3: to fifteenth century, measles was fully established throughout the Old World.
Speaker 2: I mean it was there.
Speaker 3: If the population center was big enough, it was there.
Speaker 3: Although I wonder, I read this as a little side
Speaker 3: note to myself, I wonder how the Black Death, the
Speaker 3: bubonic plague in the fourteenth century, how that disrupted the
Speaker 3: measles epidemic pattern.
Speaker 1: Oh, it probably just it screws everything up as we saw,
Speaker 1: as we've seen.
Speaker 2: I just want to know. I didn't look it up though, Okay.
Speaker 3: Anyway, So during the Middle Ages is when physicians started
Speaker 3: to recognize and describe measles as a disease, although the
Speaker 3: term mezsles, for instance, was used to refer to the
Speaker 3: lesions from leprosy, and so it's not fully clear when
Speaker 3: it switched from being used interchangeably to being reserved just
Speaker 3: from measles alone. Okay, but the earliest reference that we
Speaker 3: can say for sure is talking about measles is from
Speaker 3: the physician Rasis, which was latinized from I'm going to
Speaker 3: try to pronounce this Abu Bakar Mohammad Eben Zakaria al Razzi.
Speaker 3: So he was from close to where Tehran is today.
Speaker 3: Not only was he one of the first people to
Speaker 3: suggest that a fever might be your body's natural defense
Speaker 3: against a disease. Oh in like the year nine hundred. Wow,
Speaker 3: he also wrote a whole treatise on how measles and
Speaker 3: smallpox were different things and how to tell them apart.
Speaker 3: Cool in nine hundred Yeah, wow, super cool.
Speaker 1: That's awesome. All right.
Speaker 3: So now all of that was just me laying the
Speaker 3: groundwork for getting to the real part of the story,
Speaker 3: which is fifteen hundreds onward. So by fifteen hundred, which
Speaker 3: is the end of the Middle Ages, measles was established
Speaker 3: in pretty much all parts of the Old World, but
Speaker 3: how much of it was actually impacting populations. As we've
Speaker 3: talked about, if you want to trace historical patterns of disease,
Speaker 3: you have to rely on some pretty iffy records. One
Speaker 3: of these, which is absolutely fascinating I came across is
Speaker 3: the London Bills of Mortality, which I think was started
Speaker 3: to keep track of plague outbreaks, but now they're a
Speaker 3: gold mine, not just for like statistics and looking backwards
Speaker 3: in time, but also for ridiculous names for diseases. For instance,
Speaker 3: in sixteen sixty five, which was a plague gear, three
Speaker 3: hundred and ninety seven people died of quote rising of
Speaker 3: the lights, which had to do with lungs, possibly crup Okay,
Speaker 3: eighty six people died of King's Evil, which is tuberculosis.
Speaker 1: Because they got it from the king.
Speaker 2: Well this was the whole royal touch, right.
Speaker 3: The king didn't cure them, so yeah, yeah, and five
Speaker 3: died of distracted distracted driving.
Speaker 1: It happens early.
Speaker 3: That horse and Buggy when we're buggies invented okay anyway,
Speaker 3: but you should look into it. It's it's fascinating and
Speaker 3: you'll also see some recognizable ones on there, you know, scurvy, leprosy, smallpox,
Speaker 3: and so on. And even though these records are incomplete
Speaker 3: and not super reliable, they can help to paint a
Speaker 3: picture of some of the disease trends, especially year to year.
Speaker 3: In London, there were measles deaths every year from sixteen
Speaker 3: seventy six to the mid eighteen hundreds. Wow, which shows
Speaker 3: that the disease was fully endemic.
Speaker 1: Yeah, but if.
Speaker 3: You look at the yearly trends, you can also see
Speaker 3: that there were some years with a lot of cases
Speaker 3: and some with just a few, and the interval between
Speaker 3: these outbreaks got shorter and shorter as time went on,
Speaker 3: and the deaths due to measles also grew, probably because
Speaker 3: population was growing, probably because crowded conditions, nutrition, et cetera,
Speaker 3: et cetera. And measles was also not just variable year
Speaker 3: to year, but also throughout the year, so it was
Speaker 3: a very seasonal disease. You knew that it was springtime
Speaker 3: in Europe when measles was on the rise, and then
Speaker 3: smallpox would follow in its footsteps in the fall, and
Speaker 3: some researchers have suggested that the measles epidemic in the
Speaker 3: spring weakened the population and led to a super intense
Speaker 3: smallpox epidemic in the fall.
Speaker 1: Oh my god, are you serious?
Speaker 2: Yeah?
Speaker 4: Oh dude, yeah, Oh it's really yeah.
Speaker 2: Oh my gosh, I love it.
Speaker 1: Flabbergasted, good work things this.
Speaker 3: So, this seasonality of measles was viewed as evidence that
Speaker 3: the origin was my asthma, bad air, of course, but
Speaker 3: a few people said, no, no, it's it's infected clothing
Speaker 3: or other agents or the air. And you know, but
Speaker 3: measles would shown to be contagious conclusively by someone with
Speaker 3: probably only the best intentions. The Scottish physician France's home
Speaker 3: had heard about Turkish physicians inoculating aint smallpox.
Speaker 2: I thought I can do that with measles.
Speaker 3: First, he tried to get some pus like material from
Speaker 3: the rash and bumps of his volunteers, but there, I
Speaker 3: guess there wasn't really it's.
Speaker 1: A pretty flat rash. It's not really a pussy situation.
Speaker 2: So he's like, I'll just go for the blood.
Speaker 3: The blood's fine, So he sliced open the most measly
Speaker 3: section of measles, the most easily awful. Yeah, and then
Speaker 3: he soaked put some cotton balls in there to soak
Speaker 3: up the blood. And then he sliced open the arms
Speaker 3: of twelve children and put those blood soaked cotton balls slices.
Speaker 1: Guy, what on earth?
Speaker 3: Well, he ten of the twelve came down with measles shining.
Speaker 3: But he was like, oh no, it's much milder. It's
Speaker 3: it's super mild. I don't know for sure whether it
Speaker 3: was milder, but they didn't die, and he viewed his
Speaker 3: experiment as a success.
Speaker 1: I'm sure he did.
Speaker 2: It was debated amongst his peers.
Speaker 3: So okay, but let's let's go back to some of
Speaker 3: these measles outbreaks though, because you know, I say, oh,
Speaker 3: an outbreak happened there there, and an epidemic happened here.
Speaker 3: You know, But what what numbers really am I talking about?
Speaker 3: For instance, the Great Glasgow epidemic of eighteen oh eight
Speaker 3: led to seven hundred and eighty seven measles deaths, most
Speaker 3: of which were children out of a population of around
Speaker 3: one hundred thousand people. Oh my gosh, which you know,
Speaker 3: compared to some of the other diseases that we've talked about,
Speaker 3: looks like a relatively small mortality rate. But measles did
Speaker 3: still kill. Yeah, when he was seventy three years old,
Speaker 3: Louis the fourteenth lost his son, his grandson, and his
Speaker 3: great grandson, all within eleven months of each each other
Speaker 3: to Measles. WHOA so his soul surviving great grandson would
Speaker 3: succeed him at the age of five.
Speaker 1: WHOA So.
Speaker 3: I don't claim to know anything about French history, but
Speaker 3: a quick Wikipedia skame tells me that Louis the fifteenth,
Speaker 3: which is the five year old who didn't die of measles,
Speaker 3: was one of the longest reigning monarchs and also the
Speaker 3: one whose excessive spending helped to lead to the collapse
Speaker 3: of the government and the French Revolution, and thus his
Speaker 3: grandson being beheaded.
Speaker 1: So so, pretty much we have Measles to thank for
Speaker 1: the French Revolution.
Speaker 3: Well, I just wanted someone to write an alternate history
Speaker 3: book on or TV show of what would have happened
Speaker 3: if Measles didn't wipe out so much of.
Speaker 2: The French royal line.
Speaker 1: Wow. Also, I didn't know that Louis the fourteenth lived
Speaker 1: to be so old seventy three. That's old. Yeah back then.
Speaker 3: Well he lived I think a few years beyond that
Speaker 3: as Wow, that's just when he lost everyone.
Speaker 1: That sucks, by the way for them.
Speaker 3: Yeah, But in general, measles was viewed in Europe as
Speaker 3: a moderately deadly disease that killed mostly children. But let's
Speaker 3: remember a couple of things about that. First, there are
Speaker 3: many other diseases going on at the same time that
Speaker 3: had horrific mortality rates, like plague, smallpox, tuberculosis, et cetera
Speaker 3: that may have overshadowed measles deaths. And second, these are
Speaker 3: populations that have some history of exposure to measles. But
Speaker 3: what happens when measles gets into a population that has
Speaker 3: never experienced it before?
Speaker 1: Can you tell us?
Speaker 2: I think I'm about to excellent.
Speaker 3: So let's go to the New World for another round
Speaker 3: of Colombian exchange.
Speaker 2: I guess how many people die?
Speaker 3: So you know, those those quaint measles mortality rates of
Speaker 3: like three.
Speaker 2: To five percent.
Speaker 1: Or even lower these days, Oh yeah.
Speaker 2: Way lower.
Speaker 3: Those are going to seem ridiculous to what I will
Speaker 3: tell you about.
Speaker 2: The New World.
Speaker 3: So Caribbean islands and Central American regions were the first
Speaker 3: hit by measles and other diseases brought over from Europe,
Speaker 3: and Cuba, for instance, may have lost up to two
Speaker 3: thirds of its entire population due to measles in fifteen
Speaker 3: twenty nine. O two thirds.
Speaker 1: That's my plague status. Yeah, Jesus, I had no idea.
Speaker 3: I didn't either. Measles was the leading cause of death
Speaker 3: in many of these places, competing with smallpox, typhus, mumps, influenza.
Speaker 2: Et cetera, et cetera.
Speaker 1: Wow.
Speaker 3: Yeah, I mean, the history of measles in the New
Speaker 3: World reads pretty much like you would expect it to,
Speaker 3: just a horrific tragedy. The conquistad or of Francisco Pizaro
Speaker 3: brings it to Nicaragua and then to Peru as he's
Speaker 3: on his mission to destroy the Incan Empire, and then
Speaker 3: from there it just sort of spreads all throughout South America,
Speaker 3: completely unimpeded by anyone or anything. And it also moves north,
Speaker 3: all within the span of a century or so from
Speaker 3: when Columbus landed. But it's not like it swept through,
Speaker 3: killing an enormous chunk of various populations and then disappearing.
Speaker 3: It became endemic in many of these regions with more
Speaker 3: major epidemics happening at irregular intervals, killing thousands regularly. So
Speaker 3: mortality rates they ranged from sixty percent at the beginning,
Speaker 3: then fifty, then twenty five, then sixteen, you know, sort
Speaker 3: of slowing down or creeping down a bit over time
Speaker 3: as the immune population built Upright, And obviously it's hard
Speaker 3: to separate out the effects of measles and smallpox and
Speaker 3: all the other diseases that were going on at the
Speaker 3: same time, but took a much larger toll than I knew.
Speaker 1: Yeah it did.
Speaker 3: Yeah, So, measles and smallpox are considered to be the
Speaker 3: two big killers of Native American populations of the New World,
Speaker 3: with only smallpox outranking measles and the number of deaths caused.
Speaker 1: Wow.
Speaker 3: And measles was also an epidemic disease in European settlements
Speaker 3: in North and Central America, primarily affecting children, but also
Speaker 3: every now and then getting its script on a larger
Speaker 3: proportion of the population. And it seemed for some reason
Speaker 3: like measles was more severe in the colonies than it
Speaker 3: was back in Europe. And our good friend Cotton Mather,
Speaker 3: you remember.
Speaker 1: Him, Why does that name sound familiar smallpox. Oh, I
Speaker 1: have such a hard time aeron with the names and
Speaker 1: the dates and things.
Speaker 3: Cotton Mather, we lost our minds over it, I believe. Yeah,
Speaker 3: I'm sure it was smallpox. Anyway, Well, Cotton lost his wife,
Speaker 3: three children, and his maid to measles in a span
Speaker 3: of two weeks. To ooh, he has a bunch of
Speaker 3: I found an article that had his diary entries during
Speaker 3: this time and it's really heartbreaking. Oh yeah, he so
Speaker 3: he noticed this big difference.
Speaker 2: He was like, why is it so deadly here? Back
Speaker 2: in the back in Europe?
Speaker 3: You know, this is seen as a routine illness, And
Speaker 3: probably it had to do with the lower population density.
Speaker 3: Maybe a larger susceptible population was built up. But yeah, Also,
Speaker 3: I wanted to shout out a listener named Meredith who
Speaker 3: sent us an email who had some fun Cotton mathered
Speaker 3: tidbits such as the fact that he may have been
Speaker 3: an instigator of the Salem witch trials and his father's
Speaker 3: first name was Increase.
Speaker 2: It's just fantastic, Oh, I remember that.
Speaker 5: Okay.
Speaker 3: Over the years from eighteen forty to the early nineteen hundreds,
Speaker 3: the world's population grew tremendously so almost doubled. And during
Speaker 3: this time we see a lot of measles epidemics of
Speaker 3: two kinds, so the typical cyclic measles outbreaks in endemic
Speaker 3: countries and the epidemic devastation in naive populations. Broadly, urbanization increased,
Speaker 3: as did transportation, and as did our understanding of how
Speaker 3: measles spreads. Okay, so this dude named Peter Ludwig PanAm,
Speaker 3: who is the measles guy, Okay, he really set the
Speaker 3: groundwork for what we understand about measles, or at least
Speaker 3: what we did going into the twentieth century, how measles
Speaker 3: moved through population. And so he developed all this information
Speaker 3: when he was tracking an epidemic in the Faroe Islands
Speaker 3: in eighteen forty six. So in eighteen forty six, in
Speaker 3: the Pharaoh Islands there were seven thousand, seven hundred and
Speaker 3: eighty two people living there. Of those, six thousand became
Speaker 3: infected by measles, So that's seventy seven percent became infected
Speaker 3: because the population was isolated, they had never had measles.
Speaker 2: So this dude PanAm went.
Speaker 3: Those to the Faroe Islands to watch the spread of
Speaker 3: the disease, making observations such as incubation period, classic symptoms,
Speaker 3: the time when someone's most infectious, so on.
Speaker 2: And he also noticed that all.
Speaker 3: Age groups seemed to be impacted, which wasn't normally the case.
Speaker 3: So he was like, oh, this could be because the
Speaker 3: population has never experienced it before and so on. So
Speaker 3: it was a pretty big conclusion to draw back then,
Speaker 3: and it made a big impact in terms of understanding
Speaker 3: future outbreaks and how they differed among different populations. So
Speaker 3: the final big impact of his report on this epidemic
Speaker 3: was his complete dismissal of miasma as the way it spread.
Speaker 3: It was like, no, measles is clearly contagious and the
Speaker 3: only way to prevent someone from getting infected is to
Speaker 3: isolate the infectious person.
Speaker 2: It's the only way.
Speaker 3: As for mortality rates due to measles, they did drop
Speaker 3: over time, but again, looking just at death due to
Speaker 3: measles infection during the epidemic is only going to show
Speaker 3: you the tip of the iceberg because of all of
Speaker 3: these things that we talked about, immunocompromise, this immune system, forgetfulness,
Speaker 3: not really forgetfulness.
Speaker 1: Just decimation. Really.
Speaker 3: Yeah, So major cities like London and Glasgow would see
Speaker 3: a few thousand cases of measles every year, with a
Speaker 3: few hundred deaths. Iceland experienced some intense epidemics. For instance,
Speaker 3: to quote an Icelandic surgeon during the eighteen forty six epidemic,
Speaker 3: it would be easier to count the people who escape
Speaker 3: the disease than to count those who were affected by it.
Speaker 2: For it spared very few.
Speaker 1: Wow.
Speaker 3: So similar was Hawaii, who lost one fifth of its
Speaker 3: population over the decade between eighteen fifty and eighteen sixty.
Speaker 2: Whoa uh huh.
Speaker 3: But also even in places where measles was supposedly endemic,
Speaker 3: like in the US, measles could still cause a huge problem.
Speaker 3: During the American Civil War, over the course of that
Speaker 3: over two hundred and four thousand troops were killed on
Speaker 3: the battlefields due to you know, fighting, but over twice
Speaker 3: that number died of disease, not measles alone, but just disease.
Speaker 3: Camp measles was one of them. So camp measles seemed
Speaker 3: to be more severe than regular measles. Weird, yeah, and
Speaker 3: had much deadlier complications. So you probably wouldn't die directly
Speaker 3: from measles, but you'd probably die from how it had
Speaker 3: weakened you. And sort of a more foreshadowing of this
Speaker 3: whole thing. Some surgeons during the war said that they
Speaker 3: thought the bulk of all serious illnesses nine out of
Speaker 3: ten cases during the Civil war were traceable to measles. Wow,
Speaker 3: all right, if you've ever learned the term virgin soil
Speaker 3: epidemic in a biology or public health class, never heard
Speaker 3: that term, no virgin soil epidemic, No, I haven't.
Speaker 2: It's basically like naive population epidemic.
Speaker 5: Oh okay, right, yeah, but okay, if you've heard either
Speaker 5: of those terms, it was probably in association with the
Speaker 5: Fiji measles epidemic of eighteen seventy five.
Speaker 3: Which destroyed close to a quarter of the entire population
Speaker 3: of that country. Let's track the sequence of events. In
Speaker 3: September eighteen seventy four, the most prominent chief of Fiji,
Speaker 3: King Kakabau, signs over Fiji to be under British rule. Obviously,
Speaker 3: this was a big deal politically, and many discussions had
Speaker 3: to follow so that people could figure out how things
Speaker 3: were going to fall out, basically, how things were going
Speaker 3: to work after Fiji became part of the British Empire.
Speaker 3: So King Kakabau, along with a couple of his sons
Speaker 3: went to Australia to chat with the Governor of Sydney.
Speaker 3: While there, Kacabau picked up measles, but he recovered before
Speaker 3: getting back on the ship, but his sons didn't, so
Speaker 3: their illnesses weren't detected until they were well on their
Speaker 3: way back to Fiji, and the doctor on the ship
Speaker 3: was like, Okay, you guys are sick. You're going in
Speaker 3: an isolation room. But when the HMS didoh arrived at
Speaker 3: the Fijian capital on January twelfth, eighteen seventy five, no
Speaker 3: yellow quarantine flag was flown and no notice of measles.
Speaker 2: Was made oh No.
Speaker 3: Over the next ten days after the ship got back,
Speaker 3: about sixty nine high up political people from all over
Speaker 3: Fiji and other nearby islands came to Kacaba's house and
Speaker 3: other political gatherings were taking place to discuss what it
Speaker 3: meant that the Kingdom.
Speaker 2: Of Fiji was no longer.
Speaker 3: So everyone after this goes their separate ways back to
Speaker 3: wherever they had come from. Oh no, bringing measles back
Speaker 3: as a souvenir unexpectedly.
Speaker 1: The worst souvenir.
Speaker 3: Within a couple of weeks, nearly all of those sixty
Speaker 3: nine chiefs would be dead and the epidemic would be unstoppable.
Speaker 3: Cases exploded, It just tore through. Oh my god, I
Speaker 3: mean it was enormously high mortality, which was probably exacerbated
Speaker 3: by the breakdown of infrastructure and any medical attention, as
Speaker 3: there just weren't people around to do it.
Speaker 2: It was also a.
Speaker 3: Really bad year weatherwise, with lots of hurricanes, which meant
Speaker 3: ruined crops and starvation or at the very least poor nutrition,
Speaker 3: which makes measles more deadly. Vitamin A deficiency really bad,
Speaker 3: very bad. So for two months, the epidemic raged, and
Speaker 3: the rest of the outside world had no idea because
Speaker 3: all of the harbors were closed to isolate the islands,
Speaker 3: to not allow any more cases in or any more
Speaker 3: cases out. So at the end of those two months,
Speaker 3: the world was like, how many people died? How many
Speaker 3: In a population of around one hundred and fifty thousand
Speaker 3: people estimated forty thousand, forty thousand died of measles, No
Speaker 3: one virtually, no one was spared, and a quarter of
Speaker 3: the population died.
Speaker 2: Oh my god, I had.
Speaker 3: No idea how absolutely devastating measles has been me.
Speaker 1: Neither, Yeah, I'm so glad we're doing this episode me too.
Speaker 3: On that note of the Fiji epidemic, I came across
Speaker 3: this incredible paper by doctor David Morins about this epidemic
Speaker 3: and also re examining in light of today, in today's
Speaker 3: political climate, in today's educational system. It was just a
Speaker 3: really eloquent, wonderful read, and we will definitely link to that.
Speaker 2: Moving on.
Speaker 3: In the first half of the twentieth century, measles was
Speaker 3: endemic nearly everywhere, at least in all places with the
Speaker 3: population large enough to sustain it, and it had its
Speaker 3: fun during both World Wars, of course, but fortunately the
Speaker 3: reign of measles was coming to an end, or at
Speaker 3: least that's the illusion.
Speaker 2: Okay.
Speaker 3: Although the mortality rate due to measles had dropped quite
Speaker 3: a bit in the twentieth century, it was still killing children,
Speaker 3: so it was still a big priority for vaccine development.
Speaker 3: Enter John Enders, so he's He's the reason I suggested
Speaker 3: the quarantining name Enders fame.
Speaker 1: Which would have been so good, just slightly too obscure, Yes,
Speaker 1: quite obscure.
Speaker 2: Maybe we can make a T shirt.
Speaker 1: Yeah, oh my god, Enders fame.
Speaker 2: Ender's fame in with the design of the Enders game book.
Speaker 1: Gut yeah, one hundred percent.
Speaker 2: But I've mentioned.
Speaker 3: Him at least once before on the podcast. I think
Speaker 3: in the context of polio, because he's the super famous
Speaker 3: virologist who, among other things, isolated the poliovirus which allowed
Speaker 3: people to make a vaccine. Salkn Saban and one Enders
Speaker 3: the Nobel Prize in nineteen fifty four.
Speaker 1: Okay, that does sound vaguely familiar.
Speaker 3: Okay, but in that same year, So in nineteen fifty four,
Speaker 3: he and another scientist named TC Peebles isolated the measles
Speaker 3: virus from an eleven year old boy. And having this
Speaker 3: virus that they could finally isolate, they could then measure
Speaker 3: it to see how much virus was present in particular culture,
Speaker 3: which made standardization really possible. So anyway, vaccine was just
Speaker 3: around the corner.
Speaker 1: Cool.
Speaker 3: So within six years they had a vaccine they could test, wow,
Speaker 3: which they did on uh oh, fifteen hundred developmentally delayed
Speaker 3: children in New York City, Oh dear, and four thousand
Speaker 3: children in Nigeria.
Speaker 1: Oh God, it's like we just never managed to get
Speaker 1: it right, do we? Oh dear?
Speaker 2: What I can tell those vaccine trials worked?
Speaker 1: Oh thank god? But fortunately not that much solace.
Speaker 3: I know, I know, and mass vaccination campaign started shortly
Speaker 3: after in nineteen sixty three. So in the first two
Speaker 3: years of the campaign, over ten million doses were given
Speaker 3: to kids in the US. But that wasn't enough, and
Speaker 3: the vaccination effort wasn't equal in all places, so for instance,
Speaker 3: rural and inner city areas had lower rates of vaccination,
Speaker 3: so new initiatives were planned. The target was to get
Speaker 3: at least ninety to ninety five percent of the population vaccinated,
Speaker 3: because that was the only way to actually break the
Speaker 3: cycle of outbreaks. Yeah, the year before the vaccine was introduced,
Speaker 3: there were over four hundred and eighty one thousand cases
Speaker 3: of measles in the US. Within four years, that number
Speaker 3: had dropped by more than half, and by nineteen sixty
Speaker 3: eight there were only twenty two thousand, two hundred cases
Speaker 3: in the US.
Speaker 1: That's amazing, bananas.
Speaker 3: But then tragedy struck because all of the campaign funds
Speaker 3: for measles were diverted for the rubella vaccine, and vaccination
Speaker 3: rates for measles dropped, and as a result, they tripled.
Speaker 2: A few years later, the cases tripled.
Speaker 1: Interesting but anyway, I bet I know how they fixed
Speaker 1: fat problem though. Mmr, yeah, they just put it together.
Speaker 1: You to put it in the same vaccine.
Speaker 3: Well, when I read that sentence, I was like, but
Speaker 3: wait a second, they read the same vaccine.
Speaker 1: Yeah.
Speaker 3: I want to quickly shout out some of the measurable
Speaker 3: positive impacts of the measles vaccine in the first eighteen
Speaker 3: years of its implementation. Okay, so cases averted between nineteen
Speaker 3: sixty three and nineteen eighty one, an estimated forty eight
Speaker 3: point four million cases. Wow, and over in almost five
Speaker 3: thousand lives saved.
Speaker 1: Is this in the US alone? Wow?
Speaker 3: And the benefits achieved in terms of monetary things four
Speaker 3: point five roughly billion dollars saved.
Speaker 1: Yeah.
Speaker 3: Yeah.
Speaker 1: Wow.
Speaker 3: International vaccination campaigns were started by the WHO in nineteen
Speaker 3: seventy four, and they were operated on basically a shoe
Speaker 3: string budget. But they did get the job well, they
Speaker 3: didn't get the job done necessarily, but they did really
Speaker 3: a lot of good work. And vaccination rates were high
Speaker 3: in some areas geographically variable due to logistical and other reasons,
Speaker 3: but all in all, measles cases, complications, and deaths went down,
Speaker 3: and many researchers said that there was no reason to
Speaker 3: believe that eradication is impossible, which brings us appropriately to
Speaker 3: the current status of measles and the dumpster fire slash
Speaker 3: poop parade slash Yeah.
Speaker 2: That's going on today.
Speaker 3: So tell me, tell me what is happening with measles today?
Speaker 1: Okay, all right, I'll take a quick break. So measles
Speaker 1: was eliminated from the US in the year two thousand.
Speaker 3: What aired?
Speaker 1: There's hundreds of cases going on right now and it's
Speaker 1: twenty nineteen.
Speaker 3: You're right, you took the words right from my mouth.
Speaker 1: So elimination means that for more than twelve months, there
Speaker 1: can't be any continuous disease transmission. Elimination does not mean eradication.
Speaker 1: It does not mean that there are zero cases. It
Speaker 1: just means there's not sustained transmission. Okay, So most of
Speaker 1: the cases of measles that we in the US begin
Speaker 1: as imported cases, So someone traveling who's unvaccinated comes back
Speaker 1: to the US or something like that. Most of the time, however,
Speaker 1: that wouldn't be an issue if the entire population was immune.
Speaker 1: But that's not the case because we have outbreaks. So
Speaker 1: basically every time that you see more than three cases
Speaker 1: in any one place that are linked. In the US,
Speaker 1: it's considered an outbreak. Three cases makes an outbreak. I'm
Speaker 1: fairly sure that at some point in the last nineteen
Speaker 1: years they considered a single case an outbreak, but I
Speaker 1: could be wrong about that. So let's talk about how
Speaker 1: many cases we've seen in the US. The first ten
Speaker 1: years after elimination were going pretty great. Since twenty ten,
Speaker 1: not so much. We've had several years of much much
Speaker 1: higher than normal cases. In twenty eleven, there were two
Speaker 1: hundred and twenty cases, in twenty thirteen, one hundred and
Speaker 1: eighty seven. In twenty fourteen, we hit an over twenty
Speaker 1: year high with six hundred and sixty seven confirmed cases
Speaker 1: across twenty three different outbreaks. Yeah, twenty fourteen a huge
Speaker 1: amount of those outbreaks or a huge amount of those cases.
Speaker 1: I think, like three hundred and eighty cases were in
Speaker 1: one outbreak alone.
Speaker 2: Where was that outbreak?
Speaker 1: The twenty fourteen there was three hundred and eighty three cases,
Speaker 1: primarily among unvaccinated Amish communities in Ohio. And then we
Speaker 1: get to twenty fifteen, probably the most infamous outbreak in
Speaker 1: recent days in the US, because that's the Disneyland outbreak.
Speaker 1: Oh yeah, So in twenty fifteen, there were one hundred
Speaker 1: and eighty eight cases that year in total, one hundred
Speaker 1: and forty seven of them happened from the Disneyland outbreak.
Speaker 4: Oh my gosh, there's your fourteen. Those are not of fourteen,
Speaker 4: right exactly. We had eighty six cases in twenty sixteen,
Speaker 4: one hundred and twenty and twenty seventeen, three hundred and
Speaker 4: seventy two last year. But so far, as of February fourteenth,
Speaker 4: twenty nineteen, we have already had one hundred and twenty
Speaker 4: seven confirmed cases, and actually I can tell you we
Speaker 4: can up that to one hundred and twenty nine because
Speaker 4: two more cases have been reported in Champagne, Illinois that
Speaker 4: aren't yet up to date on the CDC website. So
Speaker 4: the CDC website as of February fourteenth says there have
Speaker 4: been five outbreaks so far, but now we know there
Speaker 4: have been six because there are four confirmed cases in Champagne,
Speaker 4: which makes an outbreak.
Speaker 3: So that means that we are on track to have
Speaker 3: a banner year for measles.
Speaker 1: Yeah, in f US definitely. So the thing is that
Speaker 1: we can say that these are happening, These outbreaks are
Speaker 1: happening because of declining vaccination rates. So if you look
Speaker 1: at the US as a whole, the MMR vaccine rates
Speaker 1: are actually steady at about ninety one percent. However, that's
Speaker 1: not true across the entire country. There are pockets of
Speaker 1: the country where vaccination rates are much lower and where
Speaker 1: vaccination rates are declining. Additionally, over the past I think
Speaker 1: three years, there have been declines in the number or
Speaker 1: the percentage of new kindergarteners entering with vaccine exemptions personal
Speaker 1: vaccine exemptions. So that means you have more kids going
Speaker 1: into the public school system who are not vaccinated, right,
Speaker 1: So yeah, so.
Speaker 3: Obviously people who are becoming infected with measles are those
Speaker 3: who choose whose parents choose to not have them vaccinated,
Speaker 3: who choose not to be vaccinated, and those who cannot
Speaker 3: be vaccinated or those who don't have access. Yeah, the
Speaker 3: ones who for health reasons cannot be vaccinated. Do we
Speaker 3: have any sort of measurable idea of how much they
Speaker 3: are being impacted by these outbreaks, whether what proportion they constitute,
Speaker 3: you know, because presumably these people are immunocompromised or might
Speaker 3: be in a way where they cannot be vaccinated against measles,
Speaker 3: they get measles. It makes everything worse.
Speaker 1: Yeah, yeah, No, that's a really good question. I don't know,
Speaker 1: like I can tell you for sure that the vast, vast,
Speaker 1: vast majority of cases in meaesels outbreaks happened to unvaccinated individuals.
Speaker 1: So it's not like you got vaccinated and the vaccine
Speaker 1: just didn't work very well. It's actually a very effective vaccine.
Speaker 1: It's not one hundred percent effective, but it is pretty effective.
Speaker 1: So there are not stats that I can find on
Speaker 1: why those individuals are not vaccinated, whether it's because of
Speaker 1: you know, compromise or personal exemption, religious exemption, or lack
Speaker 1: of access.
Speaker 2: Okay, so let's zoom.
Speaker 1: Out a little bit and we'll talk about the world,
Speaker 1: and I'll also address a little bit more about this
Speaker 1: idea of why some people can't get vaccinated, because it's
Speaker 1: an important part of the story. Right worldwide, measles is
Speaker 1: still a huge, huge problem. It's a little difficult to
Speaker 1: get really great numbers, just like it is for most diseases.
Speaker 1: It's estimated that only about ten percent of measles cases
Speaker 1: are actually reported.
Speaker 2: Wow, that's very low.
Speaker 1: It's very low. It's surprisingly low. But the Measles Rebella initiative,
Speaker 1: which is a collaboration between the CDC, the WHO, the
Speaker 1: United Nations, UNICEF, and the American Red Cross. They have
Speaker 1: this big initiative where their goal is to eliminate measles
Speaker 1: from five out of the six WHO regions by twenty twenty.
Speaker 1: It's one year away, by the way. Oh okay, Yeah,
Speaker 1: they're not going to hit their goals and they know it,
Speaker 1: but they're trying. But they estimate that while in twenty
Speaker 1: seventeen there were one hundred and seventy three thousand cases
Speaker 1: reported worldwide, it's estimated that seven million people were infected
Speaker 1: with measles in twenty sixteen, for example. I'm sorry, yeah,
Speaker 1: seven million, seven million, but only.
Speaker 3: The ones that were reported were at one hundred and
Speaker 3: seventy thousand.
Speaker 1: It was Yeah, that was in twenty seventeen, so it
Speaker 1: was a little bit higher in twenty sixteen.
Speaker 2: Oh my god.
Speaker 1: And so it's estimated that ninety thousand children a year
Speaker 1: die from measles. Again, these are estimated numbers, not actual
Speaker 1: numbers of deaths that we know are confirmed. But that's
Speaker 1: like two hundred and forty six children a day it's major.
Speaker 3: Ninety thousand prevent deaths.
Speaker 1: Yeah, we're talking about ninety thousand human lives that are
Speaker 1: lost to a disease that we have the ability to prevent.
Speaker 1: It's horrifying that we have the ability to eradicate. Yeah, yeah,
Speaker 1: we do because we didn't mention this. But like smallpox,
Speaker 1: which we did eradicate, measles is a disease of only humans.
Speaker 1: There's no animal reservoirs to worry about. So if we
Speaker 1: can eradicate it from the human population, we eradicate it. Period.
Speaker 3: It's a great target for yeah, eradication.
Speaker 1: But so let's talk about the vaccine. So in terms
Speaker 1: of measles, the first thing I can tell you is
Speaker 1: that the MMR vaccine is safe. It's very safe. The
Speaker 1: rates of adverse events are extremely, extremely low, and the
Speaker 1: vast majority of those adverse events are things like fever
Speaker 1: and excessive crying compared to death and encephalitis, which is
Speaker 1: not that uncommon for infection with measles. Along with wiping
Speaker 1: out your entire immune system. The MMR vaccine is worlds
Speaker 1: and worlds safer, right. It's also very effective. It's not
Speaker 1: one hundred percent effective, but one dose of the MMR
Speaker 1: vaccine is about ninety three percent effective against measles and
Speaker 1: two doses, which is what's recommended in the US and
Speaker 1: in the World Health Organization would like to have everyone
Speaker 1: vaccinated with two doses. It's ninety seven percent effective, So
Speaker 1: that means that ninety seven percent of people will have
Speaker 1: immunity two measles after two vaccinations. So because of that,
Speaker 1: because it's not one hundred percent effective, and because of
Speaker 1: just how contagious measles is, ideally you have to have
Speaker 1: very very high vaccination coverage ninety five percent to interrupt transmission,
Speaker 1: and that is a huge challenge, and that's kind of
Speaker 1: the challenge behind why we haven't seen as much decrease
Speaker 1: in We've seen a huge decrease in measles. Don't get
Speaker 1: me wrong, but they have a hard road in front
Speaker 1: of them for a number of reasons. Number one, so
Speaker 1: the MMR vaccine, which again is measles, mumps, and rebella,
Speaker 1: so it covers three different diseases. But this is a
Speaker 1: live attenuated vaccine. So what that means is that it's
Speaker 1: an actual virus. It's three actual viruses. They're a modified
Speaker 1: strain of the virus that can replicate, just like a
Speaker 1: real virus would, but they do not cause disease. They
Speaker 1: basically grow these viruses in cell culture until they lose
Speaker 1: their virulence or their potency. So in some ways that
Speaker 1: makes for a better vaccine because your body responds to
Speaker 1: it in a way that's more akin to a real infection.
Speaker 1: But one of the challenges with a live virus vaccine
Speaker 1: is that, Number One, it has to be kept cold
Speaker 1: because it's a live virus, so when you're trying to
Speaker 1: go all over the globe, you might not always have
Speaker 1: access to a refrigerator, so that's challenge number one. Number Two,
Speaker 1: you have to give this vaccine via injection, which means
Speaker 1: you need trained healthcare workers to actually administer that vaccine,
Speaker 1: and you have to jab a needle into a tiny
Speaker 1: baby human and usually they don't like that, so that's
Speaker 1: stressful both for the caregiver and for the infant. Number Three,
Speaker 1: when the baby is born. When a baby is born,
Speaker 1: they get antibodies from their mom, and their immune system
Speaker 1: itself is super immature. It's basically nonexistent. Babies are like,
Speaker 1: they're just kind of useless. So you can't give a
Speaker 1: tiny baby human a live virus vaccine because a those
Speaker 1: maternal antibodies that are floating around in their blood will
Speaker 1: just destroy that virus, assuming that the mother has been
Speaker 1: either exposed or vaccinated to that virus, and b the
Speaker 1: baby wouldn't be able to mount a proper immune response anyways.
Speaker 1: So you can't give the MMR vaccine to babies until
Speaker 1: ideally they're at least twelve to fifteen months old. But
Speaker 1: in some cases when there's outbreaks going on, they'll give
Speaker 1: the MMR vaccine to babies as young as six months,
Speaker 1: but then they're gonna need a third vaccine because we
Speaker 1: don't actually think it's that effective at six months. It's
Speaker 1: kind of one of those better than nothings if there's
Speaker 1: an outbreak going on, Yeah.
Speaker 3: Which is tricky that you need that double dose and
Speaker 3: to time it right. So if you're part of the
Speaker 3: who mounting this campaign for vaccination, you can't just go
Speaker 3: to a place and vaccinate. You have to be at
Speaker 3: a place and vaccinate for a long periods of time.
Speaker 1: Yep. And also because it's attenuated vaccine and not a
Speaker 1: killed vaccine, people like you said who are immunal compromised
Speaker 1: can't get this vaccine because in those populations, it can
Speaker 1: cause more serious adverse effects. So what that means is
Speaker 1: that you are always going to have some percentage of
Speaker 1: the population who cannot get get vaccinated because of an immunocompromise.
Speaker 1: And you're always going to have a certain percentage of
Speaker 1: the population that's under twelve months so they can't get
Speaker 1: vaccinated either. So in order to hit that ninety five percent,
Speaker 1: you kind of have to vaccinate everyone who's capable of
Speaker 1: getting vaccinated. And like you said, the fifth point is
Speaker 1: that you have to give two of these. I mean,
Speaker 1: giving one is protecting ninety three percent of the population,
Speaker 1: So that's pretty good, but ninety seven is better. Oh yeah, right,
Speaker 1: So yeah, it's really challenging, and so I want to
Speaker 1: give credit where credit is due. The Measles and Rubella
Speaker 1: Initiative has given vaccination to over two billion children since
Speaker 1: they started in two thousand and one, and worldwide global
Speaker 1: vaccination rates are increasing actually across the globe if you
Speaker 1: just take a very broad view of it, that's not
Speaker 1: true everywhere. There's a lot of places where vaccination rates
Speaker 1: are declining. There are a couple of really big measles
Speaker 1: outbreaks going on right now outside the US as well.
Speaker 1: So in the Philippines there have been in the last
Speaker 1: two months from January to February of twenty nineteen, over
Speaker 1: eleven thousand confirmed cases oh my god, and one hundred
Speaker 1: and eighty nine deaths.
Speaker 3: What.
Speaker 1: And in Madagascar right now there's an output that's been
Speaker 1: going on since September that the last number I saw
Speaker 1: from the WHO said over sixty eight thousand cases and
Speaker 1: they're estimating nine hundred deaths. There's at least three hundred
Speaker 1: fifty eight sixty eight thousand, sixty eight zero zero zero.
Speaker 3: In Madagascar where a plague epidets had just ravaged the
Speaker 3: entire population.
Speaker 1: Yes, yep. And I should say too that in recent
Speaker 1: analyzes from the CDC, the vast majority of children in
Speaker 1: the US who are unvaccinated are also uninsured or underinsured.
Speaker 1: So we have a big problem with access in this
Speaker 1: country as well. It's I think it's sometimes easy to
Speaker 1: just blame it on, you know, the Disneyland outbreak. Oh,
Speaker 1: it's these rich people who are choosing not to vaccinate.
Speaker 1: But it's not just that in this country or in
Speaker 1: any country, it's also an access issue, and an education
Speaker 1: issue and a miseducation issue.
Speaker 3: Yeah.
Speaker 2: So it's a double whammy.
Speaker 3: We have gotten and would probably continue to get a
Speaker 3: load of questions from people living in certain fauci of
Speaker 3: outbreaks right now, so Seattle, Vancouver, New York.
Speaker 1: Yeah, and then now we have one here where I am.
Speaker 3: People who are vaccinated, people whose kids are vaccinated, whether
Speaker 3: there's any concern that they need to have for their
Speaker 3: own personal safety or the safety of their children.
Speaker 1: Basically, if you got two MMR vaccines, you are ninety
Speaker 1: seven percent sure that you're immune. Yeah, and babies, like
Speaker 1: I said, in places where there is an active outbreak
Speaker 1: going on, you can get the vaccine for those children
Speaker 1: as young as six months. What a fun said, guys.
Speaker 3: Well, it's very relevant and much more deadly.
Speaker 1: I know, I really didn't know that it, you know,
Speaker 1: because the number you have always seen now is like
Speaker 1: one to two per thousand. That's what it tends to
Speaker 1: be in current times.
Speaker 2: So not it killed a quarter of the population of Fiji.
Speaker 3: Good God sources, Okay, So I mostly relied on a
Speaker 3: book called Measles and Historical Geography of a Major Human
Speaker 3: Viral Disease by Andrew Cliff, Peter Haggett, and Matthew Smallman. Rayner.
Speaker 3: I mentioned this earlier, but an article by David Morans
Speaker 3: called Measles in Fiji eighteen seventy five Thoughts on the
Speaker 3: History of Emerging Infectious Diseases and also the Cambridge World
Speaker 3: History of Human Disease edited by Kenneth Kipple excellent.
Speaker 1: I had several good articles. This one on non medical
Speaker 1: exemptions is by main author is Jacqueline Olive and then
Speaker 1: the also Science article. On all of the articles and
Speaker 1: books we will always post along with links whenever we
Speaker 1: can on our website. This podcast will kill you dot com.
Speaker 1: You can find all of our sources from every single
Speaker 1: episode there. And somebody on Twitter also was making like
Speaker 1: a what do you call it, like citation friendly source
Speaker 1: list too on some like bibliography website that I didn't
Speaker 1: know existed, So I'll find that and post a link
Speaker 1: to it somewhere too.
Speaker 2: Great. Yeah, thank you all for listening.
Speaker 1: Thanks for requesting this. This was a really interesting one
Speaker 1: for us to get to research, and I think it was.
Speaker 1: It's very timely and relevant unfortunately.
Speaker 3: Yeah, thank you to Bloodmobile for providing the music for
Speaker 3: this episode and all of our episodes.
Speaker 1: We love it and that's all of our thank yous.
Speaker 2: Okay, Well, in that case, wash your hands.
Speaker 1: You filed the animals, and get vaccinated.
Speaker 2: Good lace
Speaker 1: M