WEBVTT - Ep 82 Anthrax: The Hardcore Spore 0:00:01.680 --> 0:00:05.600 Every September. Like many, I feel sick and frightened around 0:00:05.600 --> 0:00:08.520 the anniversary of the nine to eleven attacks. But it 0:00:08.600 --> 0:00:11.680 was the weeks following September eleventh that would forever change 0:00:11.680 --> 0:00:14.520 my life. During that time, I was the victim of 0:00:14.600 --> 0:00:17.480 terrorism when I opened a letter containing a lethal amount 0:00:17.560 --> 0:00:21.599 of anthrax. Around September eighteenth, two thousand and one, I 0:00:21.640 --> 0:00:24.800 headed to work as a desk assistant at NBC Nightly News. 0:00:25.320 --> 0:00:28.760 One of my jobs was opening mister Brocaw's mail. There 0:00:28.800 --> 0:00:30.720 was one letter that looked as if it were written 0:00:30.720 --> 0:00:34.520 by a child. Something seemed unusual. I had never seen 0:00:34.520 --> 0:00:38.040 a letter containing a granular substance. I mentioned the strange 0:00:38.120 --> 0:00:41.440 letter to my friends. Nothing happened for about ten days. 0:00:42.000 --> 0:00:44.760 Then one Friday night, my throat began to swell up 0:00:45.280 --> 0:00:48.479 a cold, I thought, but it worsened over the weekend. 0:00:49.000 --> 0:00:53.199 My glands were soon enormous. Monday morning came and my 0:00:53.320 --> 0:00:56.600 face was barely recognizable. I went to the doctor, who 0:00:56.640 --> 0:00:59.160 said it was a reaction to my acutane medication and 0:00:59.200 --> 0:01:02.560 I should rest in a few days later, I went 0:01:02.640 --> 0:01:05.039 back to work, but I still felt a bit off. 0:01:05.680 --> 0:01:08.280 A week or so after I was sick mister Brokaw's 0:01:08.280 --> 0:01:12.760 assistant became sick. Both of our symptoms were unusual. Authorities 0:01:12.760 --> 0:01:16.320 became involved when Bob Stevens died at the American Media 0:01:16.360 --> 0:01:19.200 Building in Florida at the end of September. The pieces 0:01:19.280 --> 0:01:22.720 slowly began to come together. I soon learned why I 0:01:22.760 --> 0:01:27.240 had been sick anthrax poisoning. Like mister Brocaw's assistant, I 0:01:27.280 --> 0:01:31.080 had contracted cutaneous anthrax. The events over the next few 0:01:31.120 --> 0:01:34.120 months changed my life. I had carried anthrax back on 0:01:34.200 --> 0:01:37.399 my clothes and had contaminated my home. I chose to 0:01:37.400 --> 0:01:41.000 have all of my things destroyed. I lost my most 0:01:41.120 --> 0:01:45.920 personal belongings, all my precious pictures and mementos. I worried 0:01:45.959 --> 0:01:48.640 I might die. I'll have to see doctors the rest 0:01:48.640 --> 0:01:51.640 of my life. I'll never have an overall sense of 0:01:51.680 --> 0:01:55.240 security again. That's what I lost, But what I gained 0:01:55.320 --> 0:01:58.560 was the deep, true appreciation for my family, friends and 0:01:58.600 --> 0:02:49.160 coworkers who support was incredible. WHOA yeah, So that was 0:02:49.200 --> 0:02:53.360 an account of Casey Chamberlain written in two thousand and six, 0:02:53.520 --> 0:02:56.800 and I will post the link to the full account 0:02:57.240 --> 0:03:00.520 on our website. And it was in regard it's two day, 0:03:00.520 --> 0:03:03.000 two thousand and one Anthrax Letters. 0:03:03.480 --> 0:03:04.200 I remember that. 0:03:04.919 --> 0:03:06.639 Oh yeah, I remember that too. 0:03:08.040 --> 0:03:08.280 Hi. 0:03:08.639 --> 0:03:11.919 I'm Erin Welsh and I'm Erin alman Updyke and this 0:03:12.080 --> 0:03:13.720 is this podcast will kill. 0:03:13.560 --> 0:03:16.799 You obviously today we're talking about Anthrax. 0:03:17.120 --> 0:03:24.120 Obviously, Yes, yes we are. This is such first season 0:03:24.440 --> 0:03:26.600 type of material Erin. 0:03:27.360 --> 0:03:28.880 It's big. It's a big one. 0:03:29.120 --> 0:03:32.880 It's a big one, and it makes me. It makes 0:03:32.919 --> 0:03:35.760 me kind of happy that we've already done some of 0:03:35.800 --> 0:03:39.440 the enormous ones, because I think now at this point 0:03:39.480 --> 0:03:43.600 I would be so perfectionistic and so like, oh gosh, 0:03:43.600 --> 0:03:45.800 I didn't get this, and oh I should talk about 0:03:45.800 --> 0:03:48.400 this too, and the episodes would be like eight hours long. 0:03:48.720 --> 0:03:51.240 I'm so, is that not what we're about to get into. 0:03:51.400 --> 0:03:56.720 Okay, Yeah, it's going to be pretty long, but it's 0:03:56.720 --> 0:03:59.200 going to be fun. It's going to be really interesting. 0:04:00.040 --> 0:04:03.600 Scope of this is huge, massive, and we've got some 0:04:03.840 --> 0:04:05.800 very exciting guests to bring on. 0:04:06.320 --> 0:04:09.160 We really do, we really do. 0:04:09.800 --> 0:04:12.680 But first, but first, it is. 0:04:13.120 --> 0:04:17.240 Quarantine any time. You know, I always check my imaginary watch. 0:04:17.360 --> 0:04:18.880 When I say that, like it and. 0:04:18.920 --> 0:04:21.000 It's does that mean it's always quarantiny time on your 0:04:21.000 --> 0:04:21.719 imaginary watch? 0:04:21.920 --> 0:04:22.599 Yes, it is. 0:04:25.880 --> 0:04:29.880 So what are we drinking this real quarantiny time, non 0:04:29.880 --> 0:04:31.240 imaginary quarantiny time. 0:04:31.640 --> 0:04:36.840 We're drinking spore me another? Get it? 0:04:37.520 --> 0:04:39.120 What is in spo me another? 0:04:39.640 --> 0:04:42.919 Well, it's basically a stout float. 0:04:43.560 --> 0:04:45.880 Yeah, and you can kind of go wild with it, 0:04:46.000 --> 0:04:51.840 like you know, coffee stout, coffee stout, chocolate stout, chocolate 0:04:51.960 --> 0:04:56.080 spicy chili stout, I don't know whatever, and whatever ice 0:04:56.120 --> 0:04:59.200 cream you want. I have chocolate chip cookie dough currently, 0:04:59.400 --> 0:05:00.680 so that's what I'm doing. 0:05:01.520 --> 0:05:02.159 Yeah. 0:05:02.400 --> 0:05:05.479 We will post the full recipe for the quarantiney and 0:05:05.520 --> 0:05:07.880 the non alcoholic plus sy Verrita on our website This 0:05:07.960 --> 0:05:10.640 Podcast will Kill You dot Com as well as all 0:05:10.680 --> 0:05:13.560 of our social media channels, so make sure you follow 0:05:13.680 --> 0:05:16.880 us to get to make yourself this for me another? 0:05:17.320 --> 0:05:22.080 Yeah, exactly what other business do we have today? Erin? 0:05:23.480 --> 0:05:26.720 Well, we can just go through the usual suspects. Check 0:05:26.760 --> 0:05:29.479 out our website This Podcast will Kill You dot Com. 0:05:29.680 --> 0:05:32.599 You can find things like all of our sources for 0:05:32.680 --> 0:05:37.000 each episode there, as well as transcripts alcohol free episodes, 0:05:37.160 --> 0:05:41.200 links to our Goodreads list, bookshop dot Org, affiliate account, 0:05:41.360 --> 0:05:46.400 music by Bloodmobile are awesome cool merch There's Patreon links. 0:05:46.440 --> 0:05:47.920 There's honestly so much more. 0:05:48.000 --> 0:05:51.880 Go check it out, and you can also listen to 0:05:52.000 --> 0:05:54.880 this episode and all of our past and future episodes 0:05:54.920 --> 0:05:59.400 on Amazon Music, Apple, Stitcher, or wherever you get your podcasts. 0:05:59.760 --> 0:06:03.720 All right, should we dive in, let's. 0:06:03.440 --> 0:06:29.680 Do it right after this break. So Anthrax. We touched 0:06:29.680 --> 0:06:35.000 on this ever so briefly in our Sweating Sickness episode, Yes, 0:06:35.040 --> 0:06:39.280 which probably just honestly angered people. They were like, what, 0:06:40.080 --> 0:06:40.840 that's all. 0:06:41.279 --> 0:06:43.479 Well, and that's why we're doing it right now, so 0:06:43.720 --> 0:06:45.080 that the full picture. 0:06:45.440 --> 0:06:50.760 Yeah, So anthrax really is the name of the disease 0:06:51.080 --> 0:06:56.120 that is caused by this particular bacterium. But I just 0:06:56.160 --> 0:06:58.240 want to like say up front that there's a really 0:06:58.240 --> 0:07:00.800 good chance that I'll probably just say anthrax at some 0:07:00.880 --> 0:07:04.800 point when I'm referring to the bacteria. So just bear 0:07:04.839 --> 0:07:05.120 with me. 0:07:05.400 --> 0:07:06.479 Oh, I'm going to do that. 0:07:06.839 --> 0:07:11.160 Okay a lot good probably, so we'll both just do 0:07:11.240 --> 0:07:16.160 that and make someone angry. But anyways, the bacterium which 0:07:16.240 --> 0:07:21.920 causes anthrax is known as Bacillis and thracis. This is 0:07:21.920 --> 0:07:30.240 a gram positive spore forming rod shaped little bacterium. And 0:07:30.320 --> 0:07:33.640 we'll talk a lot more about the importance of those 0:07:33.680 --> 0:07:37.760 spores as we go through this. Oh yeah, they're like 0:07:38.240 --> 0:07:39.320 they're the most important thing. 0:07:40.840 --> 0:07:46.640 And this bacterium is related to a pretty large group 0:07:47.640 --> 0:07:52.880 of other bacterium in the group known as Bacillis serious 0:07:52.920 --> 0:07:57.680 ce r e us. But for the most part, what 0:07:57.760 --> 0:08:01.520 I think is so interesting is that Bacillis anthrasis is 0:08:01.560 --> 0:08:07.360 one of the most genetically monomorphic, meaning there is not 0:08:07.640 --> 0:08:11.680 a lot of genetic variation in this species across the 0:08:11.960 --> 0:08:13.640 entire globe. 0:08:14.040 --> 0:08:16.640 It's kind of bananas. 0:08:17.040 --> 0:08:20.840 It really is, like, this is a bacterium that is 0:08:21.480 --> 0:08:25.960 very ubiquitous. It's found across the whole globe. And yet 0:08:26.760 --> 0:08:32.600 if you grab one Anthrax bacterium from like Siberia and 0:08:32.640 --> 0:08:36.520 another from North America, they're going to be so similar. 0:08:37.640 --> 0:08:43.000 It's fascinating. And for the most part, this is the 0:08:43.040 --> 0:08:47.320 only species in the large B serious group that usually 0:08:47.520 --> 0:08:54.240 causes serious disease in humans. But there is a serahvar 0:08:54.400 --> 0:08:58.040 of be serious that can cause a disease very similar 0:08:58.120 --> 0:09:01.280 to anthrax, and will probably touch on that a little 0:09:01.280 --> 0:09:04.360 bit more later in this episode. But where I want 0:09:04.400 --> 0:09:07.199 to start is with the life cycle of this pathogen, 0:09:07.640 --> 0:09:11.240 because by going over its life cycle, we'll learn who 0:09:11.480 --> 0:09:15.800 tends to get infected or affected by anthrax, and we'll 0:09:15.840 --> 0:09:19.040 learn how it's transmitted, and then we can get into 0:09:19.040 --> 0:09:21.640 how it actually causes all of the damage and then 0:09:21.760 --> 0:09:23.720 what those symptoms look like in humans. 0:09:23.840 --> 0:09:25.280 Okay, sounds good. 0:09:26.320 --> 0:09:31.000 So Basillis anthrasis spores are where we're going to start. 0:09:31.880 --> 0:09:36.000 These spores exist in the soil and on vegetation, Like 0:09:36.040 --> 0:09:41.120 I said, pretty much worldwide. They can persist in a 0:09:41.320 --> 0:09:46.079 huge range of environmental conditions across the globe for years 0:09:46.640 --> 0:09:54.600 or in some cases decades or maybe centuries. These spores 0:09:54.960 --> 0:10:02.079 don't really replicate probably asterisk or asterisk. They just mostly 0:10:02.160 --> 0:10:05.360 hang out in the environment, and then at some point 0:10:06.040 --> 0:10:12.600 they're ingested, most commonly by herbivorous mammals, especially large ungulates 0:10:12.679 --> 0:10:18.480 like say cattle or zebras or hippos or antelope or goats, whatever. 0:10:19.200 --> 0:10:25.480 And then, because these herbivores often eat things like spiky grasses, 0:10:25.559 --> 0:10:32.520 for example, they might have small abrasions throughout their gastrointestinal tract, 0:10:33.120 --> 0:10:37.400 and these spores can then enter into the animal's blood 0:10:37.440 --> 0:10:41.120 stream through these little openings, these little like cuts in 0:10:41.160 --> 0:10:45.559 their mucosal lining. Once those spores are introduced into the 0:10:45.600 --> 0:10:50.120 blood stream, they're promptly engulfed by macrophages, which are white 0:10:50.120 --> 0:10:54.920 blood cells, and that is where the trouble starts. The 0:10:55.000 --> 0:11:02.040 spores inside these macrophages are activated back into full fledged bacteria, 0:11:02.120 --> 0:11:05.280 and they begin to replicate, often in the lymph nodes, 0:11:05.320 --> 0:11:07.440 which is where these white blood cells are traveling to. 0:11:08.600 --> 0:11:14.559 And then these bacteria that are replicating burst out of macrophages. 0:11:15.040 --> 0:11:19.360 They travel throughout the bloodstream. They replicate and replicate and 0:11:19.440 --> 0:11:25.160 cause overwhelming infection that almost inevitably leads to the death 0:11:25.400 --> 0:11:31.160 of the host. It's sad, it's absolutely devastating, and in 0:11:31.400 --> 0:11:36.360 many species of animal this generally happens so suddenly that 0:11:36.520 --> 0:11:39.760 very often the first symptom of infection in herd is 0:11:39.840 --> 0:11:42.840 just the sudden death of one animal, followed by many more. 0:11:43.440 --> 0:11:46.880 And it happens so quickly. Incubation period is often as 0:11:46.880 --> 0:11:49.560 short as thirty six to seventy two hours. 0:11:50.679 --> 0:11:54.400 How so fast, so fast. 0:11:55.080 --> 0:12:01.840 And what's important is that when the host die, in 0:12:02.000 --> 0:12:10.120 so doing, they release billions billions of vegetative bacteria. So 0:12:10.720 --> 0:12:17.400 the anthrax bacteria upon contact with the air in the environment, 0:12:17.920 --> 0:12:23.480 these bacteria spoiulate, they form those spores again, they are 0:12:23.520 --> 0:12:28.000 released into the environment and thus complete their life cycle. 0:12:28.559 --> 0:12:33.200 It's just like botulism where we were like, why does 0:12:33.200 --> 0:12:36.600 it kill you? Because it's because it needs to kill 0:12:36.600 --> 0:12:38.920 you in order to be transmitted. 0:12:38.600 --> 0:12:48.320 Exactly, exactly fascinating. Okay, So obviously my favorite question to 0:12:48.320 --> 0:12:52.280 try and answer is like, wh how how how can 0:12:52.320 --> 0:12:56.040 this kill so quickly? Yeah, Aaron, how Okay? Let me 0:12:56.080 --> 0:13:00.760 tell you. So. Basilla's Anthrasis anthrax has a couple of 0:13:00.800 --> 0:13:04.079 different virulence factors, which are the things that bacteria have 0:13:04.240 --> 0:13:07.360 that make us sick or animals sick and like allow 0:13:07.480 --> 0:13:12.439 them to be pathogenic. They have one virulence factor that 0:13:12.559 --> 0:13:16.080 makes a capsule, so it's like a little capsule that 0:13:16.120 --> 0:13:19.600 surrounds the bacterium that makes it really hard for immune 0:13:19.640 --> 0:13:23.120 cells to actually engulf and get rid of those bacteria 0:13:23.240 --> 0:13:27.440 via phagocytosis. Oh okay, so that's one, but it's not 0:13:27.600 --> 0:13:31.600 the most important. Well it is like essential, but the 0:13:31.679 --> 0:13:35.880 other ones are more exciting. The other virulence factor they 0:13:35.920 --> 0:13:42.000 have encodes two different exotoxins. We've talked about toxins a 0:13:42.000 --> 0:13:44.760 fair amount on this podcast, but it's been i think 0:13:44.960 --> 0:13:48.959 kind of a little while. So as a refresher, toxins 0:13:49.000 --> 0:13:53.839 are generally usually proteins that bacteria or other organisms can 0:13:53.960 --> 0:13:59.280 make that cause us harm in some way. In the 0:13:59.320 --> 0:14:04.560 case of Bacillis anthrasis, there's two different exotoxins which are 0:14:04.600 --> 0:14:08.960 called edema toxin and lethal toxin. 0:14:09.320 --> 0:14:11.839 Ooh uh, let me guess what the second one does. 0:14:12.200 --> 0:14:18.040 Yeah, yeah, you're right. And so each of these two 0:14:18.080 --> 0:14:22.800 different toxins is made up of two proteins. They're each 0:14:22.840 --> 0:14:28.960 made up of one part a protein called protective antigen PA, 0:14:29.440 --> 0:14:33.160 and then lethal toxin is made up of PA plus 0:14:33.400 --> 0:14:37.200 lethal factor, which is another protein. And then edema toxin 0:14:37.320 --> 0:14:40.120 is made up of the PA plus edema factor, which 0:14:40.120 --> 0:14:44.240 is another toxin. And they do like what you said, 0:14:44.280 --> 0:14:47.360 like what it sounds like. They do. The protective antigen 0:14:47.520 --> 0:14:52.000 part of each of these toxin protects the toxin itself 0:14:52.400 --> 0:14:55.000 and make sure that the toxin can make its way 0:14:55.040 --> 0:14:59.720 into our cells. And then you have a diema factor 0:14:59.760 --> 0:15:03.640 which causes a lot of inflammation and swelling, and lethal factor, 0:15:03.720 --> 0:15:07.360 which causes mostly cell death, especially of a white blood cells. 0:15:08.040 --> 0:15:09.960 What's the mechanism of cell death? 0:15:10.040 --> 0:15:12.960 Like I knew that you were going to ask, so 0:15:13.040 --> 0:15:16.640 let me scroll to my specific questions. Aaron is going 0:15:16.680 --> 0:15:23.520 to ask me section. Hmm, it's via a cast base 0:15:23.640 --> 0:15:27.720 one dependent cell death program known as pyroptosis. 0:15:28.320 --> 0:15:31.400 I almost wish I didn't ask, I know, I know. 0:15:32.240 --> 0:15:36.080 So the specific mechanisms of action of both lethal toxin 0:15:36.160 --> 0:15:39.200 and a dema toxin are absolutely fascinating and they've been 0:15:39.240 --> 0:15:42.520 studied in great detail. I have a ton of papers 0:15:43.000 --> 0:15:44.960 that people can read if they want to know this 0:15:45.120 --> 0:15:49.680 specific like cell like receptor by receptor detail of how 0:15:49.720 --> 0:15:53.160 these work, but essentially to go over just the broad 0:15:53.200 --> 0:15:57.000 strokes of it for the sake of this podcast. The 0:15:57.080 --> 0:16:01.360 toxins both together have actions both in the early phase 0:16:01.400 --> 0:16:05.880 of infection, where these toxins serve to downregulate and suppress 0:16:06.040 --> 0:16:11.240 our immune response. This is what allows for Basillis anthrasis 0:16:11.280 --> 0:16:15.840 to persist and replicate within our bodies so that you 0:16:15.920 --> 0:16:19.920 have a huge number of bacteria in the blood. And 0:16:19.960 --> 0:16:23.440 then later in the course of infection, these two toxins 0:16:23.480 --> 0:16:28.880 together create the edema, so the swelling, vascular collapse, and 0:16:29.080 --> 0:16:32.920 eventually shock that does lead to death, which, like you said, 0:16:33.000 --> 0:16:36.520 erin is pretty much an essential part of the natural 0:16:36.640 --> 0:16:37.840 history of this pathogen. 0:16:38.200 --> 0:16:44.000 And it's also like for at least in the twentieth century, 0:16:44.200 --> 0:16:48.560 there was the prevailing thought that, oh, pathogens will evolve 0:16:48.640 --> 0:16:52.040 to be more mild. That's just the way evolution works. 0:16:52.080 --> 0:16:55.160 And this is case in point that does not happen. 0:16:56.480 --> 0:16:59.320 Yeah, I mean not for a pathogen like this, right, Yeah, 0:17:00.000 --> 0:17:05.400 something where the host has to survive in order to transmit. Yes, 0:17:05.640 --> 0:17:09.879 but this is not a directly transmitted pathogen. This is 0:17:10.040 --> 0:17:13.080 essentially an environmentally transmitted disease. 0:17:13.440 --> 0:17:16.879 It's fascinating. This is why like mode of transmission and 0:17:17.080 --> 0:17:20.399 virulence I think are just still two of the like 0:17:20.440 --> 0:17:23.640 the most fascinating topic or one of the most fascinating topics. 0:17:23.760 --> 0:17:28.000 Oh, I agree, absolutely amazing. Last point I want to 0:17:28.040 --> 0:17:31.320 make about these virulence factors, and this gets back to 0:17:31.320 --> 0:17:35.400 what we were talking about with these this new serivar 0:17:35.560 --> 0:17:41.400 of Bacillis sirius that we've seen both of these virulence factors. 0:17:41.440 --> 0:17:46.040 So the capsule and the two toxins, both of them 0:17:46.119 --> 0:17:51.840 are required in order for anthrax to be pathogenic like 0:17:51.920 --> 0:17:56.720 to cause anthrax. But both of these virulence factors are 0:17:57.320 --> 0:18:01.600 encoded on plasmids, which there are circular little pieces of 0:18:01.680 --> 0:18:05.400 DNA that are not part of the main genome, which 0:18:05.440 --> 0:18:08.680 means they can be passed back and forth from bacterium 0:18:08.720 --> 0:18:09.520 to bacterium. 0:18:10.119 --> 0:18:13.760 But how often does that happen, the passing back and forth. 0:18:14.720 --> 0:18:18.280 It's a really good question, especially in a bacterium like 0:18:18.280 --> 0:18:21.200 Basillis anthrasis, which for the most part we think doesn't 0:18:21.280 --> 0:18:24.560 replicate well in the environment. How often is it going 0:18:24.600 --> 0:18:27.679 to be even coming in contact with other bacteria to 0:18:27.720 --> 0:18:31.119 be transmitting and passing plasmids. I don't know the answer 0:18:31.119 --> 0:18:32.840 to that. It's a really interesting question though. 0:18:33.240 --> 0:18:35.560 So I know that like they there has been some 0:18:35.640 --> 0:18:38.639 evidence that they form biofilms, but I don't know if 0:18:38.680 --> 0:18:42.320 that's just from like one individual bacterial cell. 0:18:43.000 --> 0:18:49.439 Yeah, and from what I understand, while Basillis anthrasis can 0:18:49.600 --> 0:18:52.359 in theory replicate in the soil, like they don't need 0:18:52.400 --> 0:18:55.520 to be inside of a host to replicate necessarily, they're 0:18:55.560 --> 0:18:59.639 really bad competitors, right, So in the most part in 0:18:59.640 --> 0:19:02.280 the en even if they could try and replicate, they're 0:19:02.320 --> 0:19:07.320 just not good at it, and so they get out competed. Okay, cool, yep, 0:19:07.720 --> 0:19:15.040 fun question Aron. Okay, So now what does this actually 0:19:15.080 --> 0:19:18.359 look like in humans? Yeah, that's what we usually talk 0:19:18.400 --> 0:19:21.840 about on this podcast. And how do humans get exposed? 0:19:22.720 --> 0:19:26.719 There are a few different ways that humans can become infected. 0:19:27.400 --> 0:19:31.879 There's three main routes that you can get infected. Cutaneous 0:19:32.040 --> 0:19:36.560 anthrax when spores enter through breaks in your skin. You 0:19:36.600 --> 0:19:40.600 can get gastrointestinal anthrax if you ingest the spores, very 0:19:40.640 --> 0:19:45.240 similar to how most animals become infected, or you can 0:19:45.320 --> 0:19:50.920 inhale the spores, which results in inhalational anthrax. So let's 0:19:50.960 --> 0:19:54.240 go through each of these one by one. The cutaneous 0:19:54.280 --> 0:19:58.120 form worldwide, by far, is the most common in humans. 0:19:58.560 --> 0:20:01.520 Something like ninety to ninety five percent of cases worldwide 0:20:01.560 --> 0:20:05.440 are cutaneous anthrax. So this is when spores enter through 0:20:05.480 --> 0:20:09.000 like a cut in your skin, just like in animals. 0:20:09.320 --> 0:20:12.880 Like I described, for the main transmission cycle or main 0:20:12.920 --> 0:20:17.320 life cycle of this pathogen, the replication still happens in macrophages, 0:20:17.720 --> 0:20:20.600 but in the case of cutaneous it tends to be 0:20:21.560 --> 0:20:26.159 those macrophasas that stay locally in the skin surrounding where 0:20:26.320 --> 0:20:29.760 the spores were introduced, or in nearby lymph nodes. So 0:20:29.840 --> 0:20:33.600 let's say you get a cut on your arm, then 0:20:33.680 --> 0:20:37.600 maybe you'll get swelling in the lymph nodes under your armpit. Okay, 0:20:38.400 --> 0:20:41.919 the first symptom that you usually see is just a 0:20:41.960 --> 0:20:46.920 little bump that's it, just a little bump. It's generally painless, 0:20:47.200 --> 0:20:51.200 but it's often quite itchy. And this happens anywhere from 0:20:51.320 --> 0:20:57.320 one to twelve days after exposure. But usually that little 0:20:57.320 --> 0:21:01.240 bump starts to get swollen, like all around it. There 0:21:01.240 --> 0:21:04.040 starts to be some swelling, more than you would expect 0:21:04.040 --> 0:21:07.719 from something like a regular bug bite. And then this 0:21:07.840 --> 0:21:12.560 bump gets surrounded either by small little vesicles, little fluid 0:21:12.560 --> 0:21:16.680 filled blisters all around the bump, or like one large, 0:21:16.800 --> 0:21:20.280 like one or two centimeter blister that kind of encompasses 0:21:20.440 --> 0:21:21.760 that initial bump. 0:21:22.720 --> 0:21:25.280 Anyone right now who has a bug bite is staring 0:21:25.320 --> 0:21:25.560 at it. 0:21:25.760 --> 0:21:30.959 I don't it's gonna get worse. I keep going, hopefully 0:21:31.000 --> 0:21:36.960 your bug bite won't. And this blister, it's filled with 0:21:37.160 --> 0:21:41.720 clear fluid. So it looks at first, especially a lot 0:21:41.760 --> 0:21:43.560 like the kind of blister that you might get on 0:21:43.600 --> 0:21:45.800 the back of your heel after you walk all day 0:21:45.840 --> 0:21:48.800 in new shoes. You know, those really like taut fluid 0:21:48.840 --> 0:21:49.600 filled blisters. 0:21:49.720 --> 0:21:51.760 Oh I'm familiar, uh huh. 0:21:51.800 --> 0:21:56.480 But unlike those blisters on your heel, it is surrounded 0:21:57.080 --> 0:22:02.159 in a wide margin by what they call gelatinous edema. 0:22:02.920 --> 0:22:03.399 Okay, so. 0:22:05.000 --> 0:22:09.240 Swelling that makes your skin feel like there's like jello 0:22:09.480 --> 0:22:10.119 underneath it. 0:22:10.600 --> 0:22:12.040 That is disturbing. 0:22:12.280 --> 0:22:12.600 Mm hm. 0:22:13.480 --> 0:22:16.040 Often you're just like m hmm, yeah, it is. 0:22:16.840 --> 0:22:21.080 Often people might also have some like low grade fever, 0:22:21.560 --> 0:22:25.240 maybe they're feeling kind of crappy, and then this vesicle, 0:22:25.320 --> 0:22:29.680 this blister enlarges and eventually it pops, just like the 0:22:29.720 --> 0:22:35.800 blister on your heel, except that this blister leaves an ulcer, 0:22:35.960 --> 0:22:41.040 a pretty sizable one potentially, and this ulcer progresses into 0:22:41.080 --> 0:22:45.880 a black eshkar, which is kind of like a really 0:22:45.920 --> 0:22:49.200 really gnarly looking scab. Okay, that's the best way I 0:22:49.200 --> 0:22:52.240 can describe it. It's like completely black. It's basically entirely 0:22:52.320 --> 0:22:57.359 dead necrotic tissue. That's pretty characteristic of cutaneous anthrax. 0:22:57.640 --> 0:22:58.720 How deep is that? 0:22:59.200 --> 0:23:03.520 Good question? It not necessarily that deep, but they can 0:23:03.600 --> 0:23:06.720 be quite large, like encompass a pretty large area. They 0:23:06.760 --> 0:23:08.119 don't tend to scar. 0:23:09.040 --> 0:23:13.320 Oh interesting, okay, yeah. 0:23:11.920 --> 0:23:16.639 But what's much worse even is the edema. So the 0:23:16.800 --> 0:23:20.479 swelling is still present and often it continues to grow, 0:23:20.800 --> 0:23:24.520 and especially if the lesion, instead of on your arm, 0:23:24.800 --> 0:23:28.879 was near your face or your neck, the swelling can 0:23:28.960 --> 0:23:32.440 get so intense that it can block your airway. 0:23:33.080 --> 0:23:36.440 Oh my god, and it's still gelatinous. 0:23:36.960 --> 0:23:41.000 Yeah, it's like a gelatinous your face. 0:23:43.160 --> 0:23:46.760 Just imagining pressing down on my skin and just feeling 0:23:46.800 --> 0:23:50.840 like jello underneath it. That would be very alarming, very say. 0:23:50.720 --> 0:23:56.879 The least that's very alarming is a good description. And 0:23:57.040 --> 0:24:03.080 while cutaneous anthrax is the least lethal of the three forms, 0:24:03.400 --> 0:24:07.320 and in many cases these esh cars heal over the 0:24:07.359 --> 0:24:11.880 course of two to three to six weeks, especially if 0:24:11.920 --> 0:24:15.040 this edema is near the face or neck, it can 0:24:15.080 --> 0:24:18.280 be fatal because of just how much swelling you get, 0:24:19.480 --> 0:24:24.199 or if this extends beyond just a local infection and 0:24:24.320 --> 0:24:30.200 does cause a more systemic infection. So, if cutaneous anthrax 0:24:30.280 --> 0:24:35.359 is untreated, mortality ranges from five to twenty percent, although 0:24:35.400 --> 0:24:37.639 I have seen estimates as high as like thirty or 0:24:37.680 --> 0:24:43.000 more percent. With antibiotics, though, mortality is less than one percent, 0:24:43.520 --> 0:24:44.760 so that's excellent. 0:24:45.840 --> 0:24:48.520 Which antibiotics, by the way, I always remember. 0:24:48.280 --> 0:24:50.720 A whole range of antibiotics. You can use kind of sillin, 0:24:50.800 --> 0:24:54.480 you can use clindamycin, you can use doxycycleankins. 0:24:54.600 --> 0:24:58.960 Yeah, resistance very little, great, yes, figured. 0:25:00.440 --> 0:25:03.959 So moving on to the next most deadly form, and 0:25:04.000 --> 0:25:08.399 that would be gastrointestinal anthrax in a lot of ways. 0:25:08.400 --> 0:25:12.960 You can actually think of gastrointestinal anthrax as cutaneous anthrax, 0:25:13.000 --> 0:25:18.680 but in your guts, so jello, guts, jello, Yeah, guts, 0:25:18.720 --> 0:25:23.040 not exactly, but kind of let me go into detail. Okay, 0:25:23.840 --> 0:25:29.080 So gastrointestinal anthrax is really how anthrax is spread in 0:25:29.680 --> 0:25:34.320 its enzootic cycle, right. Herbivores are most often infected while 0:25:34.320 --> 0:25:38.360 grazing on grass or ingesting soil that's contaminated with anthrax spores. 0:25:39.160 --> 0:25:42.680 So while humans could be infected that way, most commonly 0:25:42.800 --> 0:25:47.600 humans get infected with gastrointestinal anthrax by ingesting meat that 0:25:47.720 --> 0:25:53.080 is contaminated with the spores. And there are two different 0:25:53.280 --> 0:25:57.920 forms of gasterintestinal anthrax depending on where the spores enter 0:25:58.320 --> 0:26:04.240 your body and break through your mucosa, either oropharyngeal so 0:26:04.320 --> 0:26:07.439 in the back of your throat, or truly intestinal in 0:26:07.480 --> 0:26:15.320 your intestines, but pathologically, both essentially result in ulcer formation, 0:26:16.000 --> 0:26:18.760 not dissimilar to the ulcers that you see on the skin, 0:26:20.040 --> 0:26:22.480 but as you can imagine, ulcers in your throat or 0:26:22.520 --> 0:26:25.480 your intestine are a much bigger problem than on your 0:26:25.520 --> 0:26:30.359 skin because they can lead to perforation your face. 0:26:30.960 --> 0:26:35.080 Sorry, it just sounds really painful. It's not. The ulcer 0:26:35.200 --> 0:26:38.520 is not painful, right, that's what they say. 0:26:38.640 --> 0:26:43.280 I don't know. They look awful, so gosh, supposedly they're 0:26:43.320 --> 0:26:43.959 just itchy. 0:26:44.720 --> 0:26:47.800 It just still seems highly uncomfortable. 0:26:49.000 --> 0:26:51.000 I'm gonna get more uncomfortable. 0:26:51.640 --> 0:26:56.359 Wonderful. Okay, that's what this podcast is about. 0:26:58.080 --> 0:27:03.200 So remember when I said that often the bacteria travel 0:27:03.240 --> 0:27:04.919 to your lymph nodes and you get a lot of 0:27:04.960 --> 0:27:09.240 swelling in your lymph nodes. If this happens in your guts, 0:27:10.400 --> 0:27:14.159 you get swelling or lymphatinopathy in the lymph nodes in 0:27:14.200 --> 0:27:19.720 your throat potentially if we're talking oralpharyngeal infection, or in 0:27:19.760 --> 0:27:22.959 the mesentary which is the connective tissue that holds your 0:27:23.000 --> 0:27:25.880 guts in place. We have a ton of lymph nodes 0:27:25.880 --> 0:27:29.960 in there, and if those become severely inflamed and very swollen, 0:27:30.440 --> 0:27:34.919 that can lead to potentially intestinal obstruction. It can also 0:27:35.040 --> 0:27:37.640 lead to acieties, which we've talked about at a fair 0:27:37.760 --> 0:27:40.000 number of times on this podcast. But that's basically the 0:27:40.000 --> 0:27:43.520 build up of fluid in your abdomen because the blood 0:27:43.600 --> 0:27:46.840 vessels and the lymph nodes, the whole lymph system that 0:27:46.840 --> 0:27:50.440 should drain fluid gets congested. Because of all this swelling, 0:27:51.840 --> 0:27:56.399 you can through these ulcers or through just ischemia. Because 0:27:56.400 --> 0:27:59.320 of all this swelling, you can get perforation of the bowels, 0:27:59.359 --> 0:28:03.960 which is a pretty serious emergency. And because we're talking 0:28:04.000 --> 0:28:08.680 about becoming infected through the mucosa, so through a cut 0:28:08.800 --> 0:28:11.880 in your gastrointestinal tract, rather than through your skin, which 0:28:11.920 --> 0:28:17.320 is quite thick, this disease is far more systemic than 0:28:17.400 --> 0:28:22.280 cutaneous anthrax, so it makes its way to your bloodstream 0:28:22.400 --> 0:28:27.040 much more easily than from our skin, and for that reason, 0:28:27.119 --> 0:28:30.399 the mortality rate is much higher. It's usually twenty five 0:28:30.480 --> 0:28:32.440 to sixty percent if untreated. 0:28:33.400 --> 0:28:33.760 I have a. 0:28:33.760 --> 0:28:39.680 Question, yes, Sarin, So you mentioned that basillisanthrasis is not 0:28:39.800 --> 0:28:44.720 a good competitor. Does any of that potentially have anything 0:28:44.760 --> 0:28:47.960 to do with the gut microbiome and not being able 0:28:47.960 --> 0:28:51.320 to establish there or is it not really that because 0:28:51.320 --> 0:28:52.920 it's perforations in your gut. 0:28:53.280 --> 0:28:57.400 Yeah, so that's a really interesting question. I haven't read 0:28:57.520 --> 0:29:00.000 anything on this. I don't know that there's been study, 0:29:00.560 --> 0:29:03.680 so I can't answer it like with data, but I 0:29:03.720 --> 0:29:05.479 can tell you based on what I know of the 0:29:05.520 --> 0:29:10.200 life cycle it enters our gut as spores. It's not 0:29:10.520 --> 0:29:15.080 establishing an infection in our gut, okay, so it's not 0:29:15.120 --> 0:29:17.840 going to be competing with anything any other bacteria that 0:29:17.880 --> 0:29:21.240 live in our gut that are commensals. And what's really 0:29:21.240 --> 0:29:25.080 interesting about this pathogen is that even though it's not intracellular, 0:29:25.200 --> 0:29:28.600 so it doesn't live its life inside of our cells, 0:29:29.120 --> 0:29:35.239 it does necessarily have to enter macrophages, we think, in 0:29:35.440 --> 0:29:40.600 order for the spores to reactivate and become you know, 0:29:40.960 --> 0:29:42.600 replicating bacteria again. 0:29:43.280 --> 0:29:47.040 Okay, so it's able to sort of like sneak in 0:29:47.360 --> 0:29:49.880 under the guys of macrophages and then get to high 0:29:50.000 --> 0:29:51.200 enough volume or whatever. 0:29:52.160 --> 0:29:52.280 Right. 0:29:52.360 --> 0:29:54.400 Interesting, Yeah, and it does. 0:29:54.480 --> 0:29:56.880 And I do also think it's interesting that for the 0:29:56.880 --> 0:30:01.000 most part, it does need we think at least it 0:30:01.320 --> 0:30:05.240 needs a break in the mucosal lining. It can't just 0:30:06.040 --> 0:30:08.560 like other bacteria that we've talked about on this podcast do. 0:30:08.760 --> 0:30:12.000 It can't burrow its way through our mucosa on its own. 0:30:12.120 --> 0:30:15.000 It has to enter through a wound of some kind 0:30:15.000 --> 0:30:19.480 that's already there. And so I wonder if that plays 0:30:19.480 --> 0:30:23.120 a lot into why different animals are differently differentially susceptible 0:30:23.160 --> 0:30:25.160 based on what they're eating, and how likely they are 0:30:25.200 --> 0:30:26.680 to have some kind of. 0:30:27.040 --> 0:30:31.320 How much ruffage is exactly how much captain crunch they 0:30:31.480 --> 0:30:33.920 ate because like these abrasions everywhere. 0:30:36.920 --> 0:30:47.840 That's so true. Oh that's really really interesting. Okay, Anyways, 0:30:48.560 --> 0:30:51.080 that's castro intestinal anthrocs. Do you have any more questions 0:30:51.120 --> 0:30:51.720 about that one? 0:30:52.040 --> 0:30:53.160 I don't think so. 0:30:54.640 --> 0:30:58.880 Symptoms you have, you know, abdominal pain, nause of, vomiting, fever, diarrhea, 0:30:59.320 --> 0:31:01.400 and then you pretty much die very. 0:31:01.320 --> 0:31:05.200 Rapidly, and you die because of all the same things 0:31:05.400 --> 0:31:07.320 like or your body is it diarrhea? 0:31:07.400 --> 0:31:09.680 What? Yeah, we're going to talk a little bit more 0:31:09.720 --> 0:31:12.560 about the mechanisms when we get to the next form, 0:31:12.600 --> 0:31:17.520 which is the deadliest form, which is inhalational anthrax. 0:31:17.400 --> 0:31:18.280 The most terrifying. 0:31:18.360 --> 0:31:21.960 Yes, the most absolutely the most terrifying, and the reason 0:31:22.120 --> 0:31:26.760 that most people who have heard of anthrax are probably 0:31:26.880 --> 0:31:29.200 most terrified of it because they think of anthrax and 0:31:29.240 --> 0:31:31.960 they think of bioterrorism, and that that means that they're 0:31:32.000 --> 0:31:34.600 thinking of inhalational anthrax. So whether they know it or not, 0:31:35.400 --> 0:31:41.760 So the inhalational form, in this form, you have a 0:31:41.880 --> 0:31:45.600 biphasic illness, so you have two different parts to this infection. 0:31:46.800 --> 0:31:50.680 The first part happens about one to six days after exposure. 0:31:51.280 --> 0:31:54.880 It starts pretty non specifically fever. I feel cruddy, my 0:31:55.000 --> 0:31:58.120 muscles ache, maybe I have a cough since I inhaled 0:31:58.160 --> 0:32:02.200 something into my lungs, be some chest pain. And then 0:32:02.240 --> 0:32:06.880 within two to three or four days, your fever will increase, 0:32:07.720 --> 0:32:10.600 but you'll become short of breath. You won't be able 0:32:10.640 --> 0:32:13.560 to breathe, you can't get in enough air. You might 0:32:13.600 --> 0:32:18.120 get cyanosis because you Cyanosis is when your skin turns 0:32:18.160 --> 0:32:22.520 blue because you literally don't have enough oxygen. Often your 0:32:22.560 --> 0:32:25.080 lymph nodes and your neck will get so swollen that 0:32:25.120 --> 0:32:29.600 those will further obstruct your windpipe. So then when you 0:32:29.640 --> 0:32:36.320 breathe in it might sound like which is called strider. 0:32:38.840 --> 0:32:44.960 And about half of people will progress to complications like 0:32:45.120 --> 0:32:49.080 meningitis because these bacteria have crossed the blood brain barrier. 0:32:49.720 --> 0:32:53.240 If you get meningitis, it's essentially one hundred percent chance 0:32:53.280 --> 0:32:57.040 that you're going to die, even with treatment. But even 0:32:57.080 --> 0:33:01.960 if not, as this bacteria replicates throughout your body because 0:33:01.960 --> 0:33:05.920 of those toxins, what happens is that you very rapidly 0:33:05.960 --> 0:33:10.400 progress to shock. So shock we've talked about a lot, 0:33:10.440 --> 0:33:12.960 But it's essentially there's a lot of ways that it 0:33:13.000 --> 0:33:15.040 can happen. But what it means is that you're not 0:33:15.120 --> 0:33:20.400 getting blood and oxygen perfusing your tissues. So in this case, 0:33:20.480 --> 0:33:23.000 it can happen kind of in a lot of different ways. 0:33:23.040 --> 0:33:27.720 You're losing a lot of fluid because of these toxins 0:33:27.800 --> 0:33:31.240 and their actions both on your blood vessels and also 0:33:31.320 --> 0:33:34.959 on your lymph system, essentially just causing a lot of 0:33:35.040 --> 0:33:40.120 swelling and in some cases actual bleeding and bleeding out 0:33:40.160 --> 0:33:44.440 of places that you're not supposed to bleed. So in general, 0:33:44.920 --> 0:33:49.760 with inhalational anthrax, whether because of the meningitis or whether 0:33:49.800 --> 0:33:53.600 because of the shock, death usually happens within twenty four 0:33:53.640 --> 0:33:56.760 to thirty six hours of that second stage of the illness. 0:33:57.200 --> 0:34:01.160 Okay, that's terrifying, horrifying. 0:34:00.920 --> 0:34:06.320 It's very horrifying. And what happens in inhalational anthrax, and 0:34:06.400 --> 0:34:12.880 the difference between inhalational anthrax and cutaneous and gastrointestinal anthrax 0:34:13.320 --> 0:34:16.719 is that in the case of inhalational when these spores 0:34:16.760 --> 0:34:22.520 are inhaled, they're engulfed by macrophasas that live in the 0:34:22.560 --> 0:34:26.040 bottoms of our lungs, the little alveoli which are where 0:34:26.160 --> 0:34:31.160 gas exchange happens, and these macrophasas take those spores to 0:34:31.239 --> 0:34:33.359 a set of lymph nodes that are right along the 0:34:33.400 --> 0:34:37.000 center of our chest called the media stynum, and that 0:34:37.200 --> 0:34:39.959 is where they germinate and begin to replicate, and from 0:34:40.040 --> 0:34:46.759 there they very rapidly produce a huge, huge amount of bacterimia, 0:34:46.840 --> 0:34:49.560 so tons of bacteria that are able to go throughout 0:34:49.600 --> 0:34:53.919 your whole bloodstream, a huge amount of toxin, and then 0:34:54.160 --> 0:34:58.320 the shock and the death. So this is an inhaled spore. 0:34:58.719 --> 0:35:02.200 So it's a quote li lung thing, but it's not 0:35:02.280 --> 0:35:03.680 really a lung. 0:35:03.760 --> 0:35:08.080 Disease, right, it's just the avenue of entry exactly right. 0:35:09.440 --> 0:35:13.919 So in general, mortality rate in some outbreaks has been 0:35:13.960 --> 0:35:18.160 as low as forty six percent. That's with really good treatment. 0:35:18.480 --> 0:35:20.919 As low as forty six percent. 0:35:20.880 --> 0:35:23.759 Yeah, that was the US in two thousand and one. 0:35:25.200 --> 0:35:28.840 The death rate was forty six percent, But it's usually 0:35:28.920 --> 0:35:33.359 as high as eighty five to ninety five percent. And 0:35:33.440 --> 0:35:37.160 like I said, if it progresses to meningitis, it's nearly 0:35:37.200 --> 0:35:42.360 one hundred percent. It's treatable, especially early on in the infection, 0:35:42.560 --> 0:35:47.120 but often especially if it progresses to meningitis, antibiotics alone 0:35:47.239 --> 0:35:50.839 often aren't enough because of the high level of toxemia 0:35:52.080 --> 0:35:59.120 because of the toxins themselves. So yeah, really briefly, there's 0:35:59.160 --> 0:36:04.560 also actually a forethroot that has been documented pretty rarely, 0:36:04.880 --> 0:36:09.399 but that is injectional anthrax, and this has been documented 0:36:09.640 --> 0:36:14.479 in several places throughout Europe because of contaminated heroin, which 0:36:14.520 --> 0:36:18.560 is very scary. And the reason that this is different 0:36:18.640 --> 0:36:22.399 than just cutaneous anthrax, even though it's a needle going 0:36:22.440 --> 0:36:25.279 through the skin, is that it ends up producing a 0:36:25.360 --> 0:36:29.720 deeper soft tissue infection, which is more likely to result 0:36:29.719 --> 0:36:33.359 in systemic infection and therefore has a higher mortality rate 0:36:33.960 --> 0:36:37.959 because it's introduced much deeper than just a superficial skin 0:36:38.000 --> 0:36:38.799 infection would be. 0:36:39.200 --> 0:36:45.200 Gotcha. So it's not the needle, it's the heroin itself, right. 0:36:45.160 --> 0:36:48.560 Yeah, it's been from contaminated heroin, not from like needles 0:36:48.560 --> 0:36:50.680 that were dropped in soil or something like that. 0:36:50.800 --> 0:36:50.920 Right. 0:36:51.760 --> 0:36:52.000 Yeah. 0:36:52.000 --> 0:36:52.320 Wow. 0:36:52.800 --> 0:36:58.279 Yeah. It is treatable in animals and in humans, so 0:36:58.320 --> 0:37:01.959 that's exciting, and there is a vac technically, yes, yes, 0:37:02.480 --> 0:37:06.440 that's for animals and for humans, but it's not a 0:37:06.440 --> 0:37:10.240 great vaccine for animals or for humans. 0:37:12.120 --> 0:37:14.920 Yeah, low protection or Yeah, for. 0:37:15.000 --> 0:37:18.560 Reasons that we don't fully understand, it doesn't produce super 0:37:18.680 --> 0:37:22.040 long lasting immunity. So even for animals, they have to 0:37:22.040 --> 0:37:26.640 get boosters like every year. For humans, the vaccines that 0:37:26.680 --> 0:37:28.160 we have, at least the one that we have in 0:37:28.200 --> 0:37:30.840 the States, you have to get a dose at times 0:37:30.960 --> 0:37:34.040 zero and then again at two weeks and four weeks, 0:37:34.120 --> 0:37:36.120 and then six months, and then twelve months and then 0:37:36.160 --> 0:37:38.800 eighteen months, and then every year after that. 0:37:38.800 --> 0:37:43.440 That's a lot of Yeah, compliance must be challenging to 0:37:43.520 --> 0:37:44.480 achieve on. 0:37:44.400 --> 0:37:49.640 That, Yeah, it definitely can be. So speaking of the 0:37:49.680 --> 0:37:53.680 anthrax vaccine and animals, we wanted to bring on a 0:37:53.800 --> 0:37:56.760 very special guest to help us explore a huge area 0:37:56.800 --> 0:37:59.880 of this disease and this microbe that we've really just 0:38:00.040 --> 0:38:03.440 barely touched on so far, and that is the impact 0:38:03.520 --> 0:38:07.120 of anthrax on domestic and wild animals, you know, aarin, 0:38:07.320 --> 0:38:10.080 so that we don't have to just speculate about how 0:38:10.160 --> 0:38:13.520 much captain crunch a cow versus a deer is eating. 0:38:14.680 --> 0:38:19.480 So we consulted an expert. We were so thrilled to 0:38:19.520 --> 0:38:23.400 get to chat with doctor Johanna Salzer, veterinary medical officer 0:38:23.440 --> 0:38:27.080 at the CDC. So we'll let her introduce herself. 0:38:28.440 --> 0:38:31.640 So I'm Johannah Slzer. I'm a veterinary Medical Officer and 0:38:31.920 --> 0:38:35.480 Bacterial Special Pathogens Branch at the US Centers for Disease 0:38:35.520 --> 0:38:38.960 Control and Prevention. I serve as both a veterinarian and 0:38:39.000 --> 0:38:40.040 an epidemiologist. 0:38:40.840 --> 0:38:43.840 Yay, We're so thrilled to get to talk to you today. 0:38:44.880 --> 0:38:47.760 So we wanted to ask you, you know about because 0:38:47.760 --> 0:38:51.359 you are both a veterinarian and you know infectious disease 0:38:51.400 --> 0:38:56.320 epidemiologists researcher, we wanted to ask you about anthrax in animals. 0:38:56.360 --> 0:38:58.160 So could you tell us a little bit about what 0:38:58.280 --> 0:39:01.799 the course kind of in general of anthrax as a 0:39:01.840 --> 0:39:05.240 disease looks like in animals other than humans. 0:39:05.840 --> 0:39:10.960 Sure so. So antrax affects different animal species differently, So 0:39:11.000 --> 0:39:14.000 there are some animals that are more affected and have 0:39:14.120 --> 0:39:17.000 more severe disease than others. So usually when we think 0:39:17.040 --> 0:39:23.560 about anthrax and animals, we think about herbivores, so cattle, sheep, goats, 0:39:24.000 --> 0:39:29.560 and wild herbivores such as zebras and buffalo and other antelope. 0:39:30.040 --> 0:39:33.440 And in these animals when they either ingest or inhale 0:39:33.840 --> 0:39:37.680 the bisilcanthracist spore, they have a pretty rapid onset of 0:39:37.719 --> 0:39:43.319 disease and pretty severe. And so usually the first sign 0:39:43.320 --> 0:39:46.359 of disease in these animals is actually said in death. 0:39:47.000 --> 0:39:49.840 And so usually the first sign of that you have 0:39:49.880 --> 0:39:54.160 an outbreak of anthrax in a herd is when animals 0:39:54.160 --> 0:39:58.360 are found dead and the carcasses present with you know, 0:39:58.480 --> 0:40:02.279 lacar ric or mortis or reduced rigor mortise and dark 0:40:02.320 --> 0:40:05.840 blood that can be oozing from the mouth or nostrils 0:40:05.920 --> 0:40:11.200 or anus marked bloating and often this rapid decomposition of 0:40:11.239 --> 0:40:12.840 the carcass. 0:40:12.880 --> 0:40:18.960 Interesting, that's awful. Yeah, So looking now more specifically, are 0:40:19.000 --> 0:40:23.040 there any big differences in how this disease happens among 0:40:23.120 --> 0:40:27.000 different animal species? Like are some animals more susceptible or 0:40:27.040 --> 0:40:29.319 seem to be more susceptible or is it just a 0:40:29.360 --> 0:40:31.680 difference in exposure risk? 0:40:32.480 --> 0:40:36.880 Yeah, so some animals are considered more resistant. So species 0:40:36.920 --> 0:40:42.799 like pigs, dogs, cats, carnivores, some of your scavengers. So 0:40:43.000 --> 0:40:45.000 actually some of the animals that would maybe feed on 0:40:45.080 --> 0:40:49.120 a carcass are the animals that if they are infected, 0:40:49.160 --> 0:40:53.320 they have less severe disease and it's more rarely fatal. 0:40:54.280 --> 0:40:59.120 Interesting, that's fascinating. So I mean, because this is a 0:40:59.160 --> 0:41:02.160 disease that can you know, these really massive outbreaks and 0:41:02.200 --> 0:41:05.400 like you were saying, just really rapid death and decomposition 0:41:05.520 --> 0:41:09.440 of the carcasses leading to further outbreaks. What do control 0:41:09.520 --> 0:41:13.320 efforts kind of look like and entail once an outbreak 0:41:13.360 --> 0:41:16.520 has been identified and how does that control differ for 0:41:16.600 --> 0:41:19.759 an outbreak maybe in livestock versus wildlife. 0:41:20.600 --> 0:41:23.920 Yeah, so the two primary tools that we have for 0:41:24.080 --> 0:41:30.319 controlling anthrax are livestock vaccination and vaccination programs for anthrax, 0:41:30.880 --> 0:41:33.680 especially in areas that are known to be endemic. So 0:41:33.800 --> 0:41:36.920 vaccination it has been done in wildlife, but it is 0:41:36.960 --> 0:41:39.000 pretty challenging right because most of the time it would 0:41:39.040 --> 0:41:44.160 involve darting of an animal and then proper carcass disposal. 0:41:44.160 --> 0:41:47.160 When you do have an animal that suspected are confirmed 0:41:47.760 --> 0:41:52.279 to diet of anthrax, the carcass disposal so the recommendations 0:41:52.320 --> 0:41:55.440 are either to concinerate or burn a carcass, and if 0:41:55.440 --> 0:41:59.440 that's not possible, then to bury. And even with livestock 0:41:59.440 --> 0:42:02.080 this can be a challenge. There are places where anthrax 0:42:02.200 --> 0:42:05.200 is endemic that there's just not much top soil you're 0:42:05.200 --> 0:42:08.200 not able to actually physically bury an animal or perhaps 0:42:08.280 --> 0:42:11.120 there's a burned band or other reasons. You wouldn't burn 0:42:11.160 --> 0:42:15.280 a carcass with wildlife. It's even you know, a bigger 0:42:15.320 --> 0:42:18.160 challenge because you have to find the carcass fairly quickly 0:42:18.600 --> 0:42:23.200 before scavengers do, and that's that's often nearly impossible with wildlife. 0:42:23.680 --> 0:42:26.680 And wildlife there are also larger carcasses, right you're talking 0:42:26.719 --> 0:42:32.880 about elephants or hippos buffalo one of the outbreaks that 0:42:33.360 --> 0:42:36.560 we recently consulted on in Namibia, some of the recommendations 0:42:36.560 --> 0:42:39.960 were just to bury the carcasses when possible, and to 0:42:40.080 --> 0:42:42.799 just minimally move them to try to prevent further like 0:42:42.880 --> 0:42:44.640 environmental contamination. 0:42:46.000 --> 0:42:51.200 In places where there's like mixed cattle and wildlife grazing. 0:42:51.239 --> 0:42:53.720 I know that that's been happening a lot, like integrated farms. 0:42:54.239 --> 0:42:59.200 Would that practice increase the risk to domestic animals or 0:42:59.280 --> 0:43:03.520 decrease the risk almost to the wildlife, because maybe an 0:43:03.560 --> 0:43:06.440 anthrax operate could be identified more quickly even if there 0:43:06.480 --> 0:43:09.360 are more like susceptible individuals. I was just thinking about 0:43:09.360 --> 0:43:12.160 how that practice might affect either the risk or like 0:43:12.200 --> 0:43:15.640 control measures for anthrax in those in those animal populations. 0:43:16.520 --> 0:43:18.759 Yeah, I mean that is a perfect example of where 0:43:18.880 --> 0:43:24.160 vaccination and good vaccination programs like our strongest weapon against anthrax. 0:43:24.760 --> 0:43:28.080 You're asking Aaron, like identifying a wildlife case early then 0:43:28.200 --> 0:43:33.520 could trigger vaccination in livestock. Yeah, And I think that 0:43:33.560 --> 0:43:38.120 actually is the case in Taxess where you do have 0:43:38.120 --> 0:43:43.040 a lot of wildlife mingling with livestock from a veninary perspective. Like, 0:43:43.360 --> 0:43:45.799 one of the things I most love about working on 0:43:45.840 --> 0:43:49.239 anthrax is because it is one of those diseases, much 0:43:49.239 --> 0:43:51.400 like Rabi's, that if you could protect the animal and 0:43:51.440 --> 0:43:55.239 prevent the disease in animal, you protect people and anthrax. 0:43:55.760 --> 0:43:59.680 Working on antras and livestock specifically and protecting livestock you 0:43:59.760 --> 0:44:01.759 know also in turn can not only protect people but 0:44:01.800 --> 0:44:06.560 also wildlife, which is one of the things that you know, 0:44:06.640 --> 0:44:09.919 I find so fascinating by anthrax, Like it really much 0:44:09.960 --> 0:44:13.240 like Raby's has this the connectivity is so tight between 0:44:13.320 --> 0:44:16.640 human and animal health and with anthraxs you also have 0:44:16.680 --> 0:44:19.239 this environmental piece where you have to have all these 0:44:19.520 --> 0:44:23.640 the right environmental conditions for the sport to survive too. 0:44:24.200 --> 0:44:27.000 So it's kind of the poster health for one health 0:44:27.239 --> 0:44:29.480 and approaching you know, using a one health approach to 0:44:29.520 --> 0:44:30.640 disease control. 0:44:32.480 --> 0:44:35.359 Thank you so much, doctor Salzer for taking the time 0:44:35.400 --> 0:44:38.879 to chat with us. It was so fantastic and we 0:44:38.920 --> 0:44:39.920 really appreciate it. 0:44:40.120 --> 0:44:46.080 Yeah, we do. It was absolutely thrilling. So, Aaron, after 0:44:46.120 --> 0:44:49.719 all that, what can you tell me about the history 0:44:49.880 --> 0:44:53.720 of anthrax? Like, where did this come from? And how 0:44:53.760 --> 0:44:54.520 did we get here? 0:44:55.200 --> 0:44:59.640 I can't wait, but let's take a quick break first. 0:45:30.200 --> 0:45:33.400 For many of us, especially those that remember watching the 0:45:33.440 --> 0:45:36.720 news coverage in two thousand and one on the Anthrax letters. 0:45:37.680 --> 0:45:42.200 More on that later, anthrax holds a very specific meaning, 0:45:42.680 --> 0:45:47.280 that of a bioterrorism agent, and that reputation or perception 0:45:47.360 --> 0:45:50.680 of anthrax hasn't diminished over the years, despite the fact 0:45:50.719 --> 0:45:53.560 that anthrax poses a much more real threat as a 0:45:53.560 --> 0:45:57.239 disease of livestock and wildlife that it has as a 0:45:57.239 --> 0:46:04.600 bioweapon so far bioweapon angle itself, that's relatively new. Throughout 0:46:04.680 --> 0:46:09.560 its very long history, anthrax has been many things, a 0:46:09.600 --> 0:46:14.800 punishment from the heavens, an agricultural disease, an occupational hazard, 0:46:15.400 --> 0:46:20.520 and now a potential weapon of bioterrorism. So my goal 0:46:20.680 --> 0:46:23.640 for the history section is to take us through these 0:46:23.680 --> 0:46:28.320 different phases of anthrax and let's begin at the beginning, 0:46:28.880 --> 0:46:38.200 the evolutionary origins. Yes, so, as you mentioned aaron, Basilla santhrasis, 0:46:38.280 --> 0:46:41.480 it's kind of a funky little pathogen. It's not super diverse. 0:46:41.920 --> 0:46:46.920 It reproduces clonally primarily. And actually this incredible lack of 0:46:46.960 --> 0:46:50.080 diversity meant that it was only in the past few 0:46:50.200 --> 0:46:53.279 decades or so, past two decades or so, with the 0:46:53.320 --> 0:46:58.080 development of next generation sequencing technology, that researchers were able 0:46:58.120 --> 0:47:01.319 to get a full picture of its lutionary history and 0:47:01.520 --> 0:47:06.800 relationships among different strains or clades. Before it was too difficult. 0:47:06.440 --> 0:47:11.480 Yeah, because they were just too similar across exactly. Yeah, fascinating. 0:47:12.080 --> 0:47:16.520 So what did they find. Well, first of all, they 0:47:16.560 --> 0:47:21.000 found that Basilis anthrasis likely evolved several tens of thousands 0:47:21.040 --> 0:47:24.279 of years ago. I couldn't actually find like a very 0:47:24.280 --> 0:47:28.839 good estimate of when it first emerged or diverged, but 0:47:29.000 --> 0:47:32.600 in any case, several researchers believe that it evolved from 0:47:32.640 --> 0:47:36.279 an insect pathogen or insect commensal. 0:47:36.120 --> 0:47:39.760 Oh mm hmm, like some of the really. 0:47:39.760 --> 0:47:47.560 Exactly Basillis thuringentsa. I don't know what syringiensis, thank you. So, yeah, 0:47:47.560 --> 0:47:51.239 it evolved from this insect pathogen or commensal, and it 0:47:51.440 --> 0:47:56.960 diverged from Basilla sirius after acquiring those virulence plasmids. Okay, 0:47:57.800 --> 0:48:01.560 it's thought that Basilis anthrasis emerged in sub Saharan Africa, 0:48:02.360 --> 0:48:05.440 but the location of where it's spread from and then 0:48:05.480 --> 0:48:11.080 this burst of diversification is likely to have happened somewhere 0:48:11.080 --> 0:48:14.120 in the Fertile Crescent, which is where the domestication of 0:48:14.160 --> 0:48:16.160 livestock primarily happened. 0:48:16.320 --> 0:48:17.640 That makes sense, makes. 0:48:17.480 --> 0:48:22.279 Sense, And it's unclear exactly how this bacterium got to 0:48:22.320 --> 0:48:25.879 the Americas. But there are a couple of hypotheses which 0:48:25.920 --> 0:48:29.880 are not mutually exclusive. So when an introduction could have 0:48:29.960 --> 0:48:33.280 come during the Holocene by ungulates traveling over the Bearing 0:48:33.400 --> 0:48:36.839 land Bridge and then you know, down into the Americas. 0:48:37.520 --> 0:48:40.560 And another source of introduction is thought to be European 0:48:40.600 --> 0:48:45.640 trappers who brought it into the Eastern Us. But overall, 0:48:46.040 --> 0:48:49.440 like you said, anthrax is a very slow moving creature, 0:48:49.520 --> 0:48:56.040 evolutionarily accumulating mutations slowly. And this quality of Anthrax has 0:48:56.040 --> 0:48:58.880 made it a lot easier to trace not only its history, 0:48:59.000 --> 0:49:02.920 but it also has as great forensic value in tracing 0:49:03.040 --> 0:49:06.160 the source of an anthrax bioweapon, such as in the 0:49:06.160 --> 0:49:08.799 case of the two thousand and one anthrax letters, so 0:49:08.880 --> 0:49:15.239 like pinpointing exactly where this particular strain came from, which 0:49:15.239 --> 0:49:17.760 is pretty interesting. But anyway, I'm getting ahead of myself 0:49:17.800 --> 0:49:20.239 a little bit. And so now that we've got the 0:49:20.280 --> 0:49:23.360 evolutionary history out of the way, let's check in with 0:49:23.560 --> 0:49:25.200 ancient history and antrax. 0:49:26.800 --> 0:49:28.560 This really is like it first season. 0:49:29.040 --> 0:49:37.080 It super is. I'm overwhelmed. Anthrax seems like it was 0:49:37.160 --> 0:49:41.360 definitely known in ancient times. The fifth and maybe sixth 0:49:41.360 --> 0:49:45.879 Biblical plagues, the plague of livestock and the plague of boils, respectively, 0:49:46.640 --> 0:49:48.840 which always makes me think of Brooklyn ninet nine the 0:49:48.880 --> 0:49:58.200 plague of boils. Anyway, anyway, those have often been held 0:49:58.239 --> 0:50:00.840 to be anthrax as well as Render Past Like I 0:50:00.920 --> 0:50:03.880 know that I mentioned these biblical plagues in the Render 0:50:03.880 --> 0:50:07.600 Pest episode. Yeah, and in ancient writings in India from 0:50:07.760 --> 0:50:13.840 five hundred BCE or so describing did the diseases of animals? 0:50:13.920 --> 0:50:17.600 Anthrax seems to be one of those diseases described. It 0:50:17.680 --> 0:50:20.280 was also known in ancient Greece and in ancient Rome. 0:50:20.440 --> 0:50:23.680 The poet Virgil wrote about animal plagues, one of which 0:50:23.719 --> 0:50:28.480 sounds an awful lot like anthrax. Here's a quote for you. 0:50:29.520 --> 0:50:32.640 A terrible plague once sprang up there and raged on 0:50:32.800 --> 0:50:35.719 through the warmer part of autumn, not only destroying one 0:50:35.760 --> 0:50:39.600 flock of sheep after another, but killing animals of all kinds. 0:50:40.320 --> 0:50:43.400 Nor did the victims die an easy and uncomplicated death. 0:50:43.920 --> 0:50:46.800 After a burning fever had raged through in animal's veins 0:50:46.800 --> 0:50:49.960 and shriveled its flesh, the fluids again became abundant and 0:50:50.040 --> 0:50:55.400 virtually dissolved the bones. Oh yeah, it sounds rough, no 0:50:55.400 --> 0:51:00.520 matter what it is and right, and one of these plagues, 0:51:00.640 --> 0:51:04.319 one of Virgil's plagues, supposedly wiped out almost half of 0:51:04.360 --> 0:51:07.400 both the human and animal populations of Rome, and the 0:51:07.440 --> 0:51:10.080 disease continued to be a major problem in the area 0:51:10.200 --> 0:51:13.640 for centuries, popping up over and over again. This tendency 0:51:13.719 --> 0:51:17.800 of anthrax, which is like to haunt certain farms or regions, 0:51:18.360 --> 0:51:22.280 gave rise to almost like a mythology around the disease, 0:51:22.719 --> 0:51:28.520 and it meant that generational knowledge was required, so families 0:51:28.600 --> 0:51:32.160 or villages had to remember like where the bodies were buried, 0:51:32.200 --> 0:51:35.400 so to speak, and pass that information down so that 0:51:35.440 --> 0:51:40.320 future generations could avoid grazing livestock in those areas. 0:51:39.960 --> 0:51:42.400 Not even so to speak, but like literally. 0:51:42.160 --> 0:51:46.279 Literally and not even so to speak. Yeah, actually side note, 0:51:46.280 --> 0:51:50.080 I saw a really cool paper about how the spots 0:51:50.120 --> 0:51:54.600 where carcasses are actually end up being an attractant to 0:51:55.480 --> 0:52:00.319 animals because like, if an animal dies of anthrax, that 0:52:00.480 --> 0:52:04.760 nutrient influx into the soil will actually help plants grow 0:52:05.040 --> 0:52:09.239 like better and faster, thus attracting other animals, thus influencing 0:52:09.239 --> 0:52:11.520 the transmission chain at. 0:52:11.320 --> 0:52:14.040 What time frame though, Because I was reading about how 0:52:14.200 --> 0:52:15.520 for the first year. 0:52:15.880 --> 0:52:19.640 The second year, the second year, the first year it's avoidant, 0:52:19.680 --> 0:52:22.640 the second it's attractant, the third year the preference goes away. 0:52:22.880 --> 0:52:26.560 Fascinating, I know, because it seems like after two years 0:52:26.600 --> 0:52:29.640 is when infectivity goes down. So that second year is. 0:52:29.640 --> 0:52:37.960 When crucial trick. Isn't that so ugh? It's just evolution ecology, 0:52:38.120 --> 0:52:45.600 It's just magical. Ah. But this tendency to like, you know, 0:52:45.920 --> 0:52:50.200 haunt certain areas led to for instance, in France, some 0:52:50.280 --> 0:52:53.279 of these areas being referred to as the cursed fields, 0:52:53.560 --> 0:52:57.560 the cursed fields, so widespread trade of animals and animal 0:52:57.600 --> 0:53:01.400 products ensured that these cursed fields could spring up anywhere, 0:53:02.040 --> 0:53:06.200 and by around one thousand CE, anthrax was really well 0:53:06.320 --> 0:53:10.360 established throughout the Old World. Germany and the British Isles 0:53:10.480 --> 0:53:14.080 experienced major outbreaks of anthrax in the tenth, thirteenth, and 0:53:14.200 --> 0:53:19.000 fourteenth centuries, and these episolotics resulted not only in the 0:53:19.040 --> 0:53:22.719 deaths of livestock, but also in the humans and dogs 0:53:22.760 --> 0:53:25.440 and birds and other animals that fed on the cattle 0:53:25.480 --> 0:53:30.520 carcasses or they ended up starving due to food shortages 0:53:30.960 --> 0:53:32.359 or nutritional deficiencies. 0:53:33.320 --> 0:53:38.240 So does that mean that anthrax moved around the world 0:53:38.880 --> 0:53:41.480 from livestock trading exactly? 0:53:41.600 --> 0:53:46.040 Yeah, well livestock trading and fur trading, wow, and like 0:53:46.239 --> 0:53:49.000 wool and so on. So it is. This is what's 0:53:49.000 --> 0:53:51.080 so interesting to me is that you know, for a 0:53:51.120 --> 0:53:56.680 lot of diseases that are human specific, they moved around 0:53:56.680 --> 0:53:59.600 the world due to human travel, but it was also 0:53:59.760 --> 0:54:03.960 it was almost an inevitability. But like with anthrax, I 0:54:03.960 --> 0:54:08.440 feel like we really lent a helping hand, right Like, it's. 0:54:09.840 --> 0:54:14.359 What this is blowing my mind right now? 0:54:14.400 --> 0:54:17.920 Actually yeah, I mean, it turns out this is one 0:54:17.960 --> 0:54:21.520 of like the big ones like oh Capital b capital O. 0:54:21.719 --> 0:54:27.760 It's it has been I mean, and it has really 0:54:27.840 --> 0:54:33.600 had like a huge impact on history and ecology, and 0:54:34.000 --> 0:54:35.880 it's just really fascinating to me. 0:54:36.800 --> 0:54:38.920 Let me give you an example, oh please. 0:54:39.200 --> 0:54:43.600 In sixteen thirteen in southern Europe, a massive outbreak of 0:54:43.640 --> 0:54:48.760 anthrax is estimated to have killed around sixty thousand people 0:54:49.480 --> 0:54:55.239 and untold numbers of livestock. What uh huh. Over the 0:54:55.239 --> 0:54:58.120 next one hundred years, so like, between the sixteen hundreds 0:54:58.120 --> 0:55:03.000 and seventeen hundreds, anthrac's outbreak seemed to grow stronger and 0:55:03.080 --> 0:55:07.440 deadlier in some ways, which probably definitely had something to 0:55:07.480 --> 0:55:11.319 do with this increased movement and trade. And one of 0:55:11.360 --> 0:55:15.000 these places of trade was the New World. Even if 0:55:15.120 --> 0:55:18.080 anthrax had been brought over across the Bearing Land Bridge 0:55:18.160 --> 0:55:21.960 around ten thousand years ago, it greatly spread in prevalence 0:55:22.000 --> 0:55:28.279 an outbreak intensity following European colonization. It seems that anthrax 0:55:28.280 --> 0:55:30.480 began to be perceived as a problem in the New 0:55:30.480 --> 0:55:34.120 World by the fifteen hundreds, but the biggest and most 0:55:34.120 --> 0:55:37.640 devastating outbreak of what was likely anthrax didn't occur until 0:55:37.640 --> 0:55:42.600 the seventeen seventies in what is now Haiti. In this outbreak, 0:55:42.880 --> 0:55:49.120 an estimated fifteen thousand people died of anthrax and untold. 0:55:49.200 --> 0:55:53.880 Thousands of cattle and other livestock also perished, and a 0:55:53.960 --> 0:55:57.239 major component of this anthrax outbreak that contributed to its 0:55:57.280 --> 0:56:00.560 deadliness was the fact that an earthquake occur in the 0:56:00.600 --> 0:56:04.200 middle of the outbreak, making food even more scarce than 0:56:04.239 --> 0:56:08.080 it was before, and so out of desperation, people began 0:56:08.120 --> 0:56:10.640 to eat the livestock that had died of anthrax, which 0:56:10.680 --> 0:56:12.400 of course led to even more cases. 0:56:13.680 --> 0:56:16.399 Yeah, I feel like it's important to also point out 0:56:16.440 --> 0:56:19.280 that cooking the meat doesn't kill the spores. 0:56:19.920 --> 0:56:21.839 Oh no, these spores are like. 0:56:21.760 --> 0:56:24.080 They're like prions practically. 0:56:23.680 --> 0:56:37.960 I know. Nevertheless, they persisted. Yeah, a hardcore spore, my gosh. Okay, So, 0:56:38.080 --> 0:56:42.120 although this seventeen seventy outbreak of anthrax may have been 0:56:42.200 --> 0:56:47.640 the most devastating, it certainly wouldn't be the last. But 0:56:47.719 --> 0:56:50.120 before I go into more of those, let's talk names 0:56:50.200 --> 0:56:53.239 real quick. Okay, I'm not going to go through all 0:56:53.239 --> 0:56:56.000 the different names, because there are very many, but I 0:56:56.040 --> 0:56:58.600 will go over some of the patterns that we have 0:56:58.680 --> 0:57:01.359 seen in these names, and so one is that they 0:57:01.600 --> 0:57:05.360 often called out that grazing animals were most commonly infected, 0:57:05.800 --> 0:57:10.759 so like cowsickness, goat sickness, etc. And another is that 0:57:10.840 --> 0:57:13.880 the skin condition caused by anthrax, which is like the 0:57:13.920 --> 0:57:17.160 most common manifestation, as you pointed out, also made an 0:57:17.200 --> 0:57:20.520 appearance in many of the names. And the word anthrax 0:57:20.560 --> 0:57:25.680 itself comes from the Greek anthracos, meaning coal or carbuncle, 0:57:26.640 --> 0:57:29.720 and many other names call out the black color that 0:57:29.760 --> 0:57:33.400 can often result from the anthrax skin condition. 0:57:33.800 --> 0:57:37.000 Right, Yeah, it's a very characteristic. Yeah. 0:57:37.560 --> 0:57:42.080 And the Latin word anthrax also means carbuncles or malignant boils. 0:57:42.880 --> 0:57:46.560 The French word for the disease was sharbone like carbon 0:57:47.160 --> 0:57:52.919 like coal or charcoal, and the whole body forms of anthrax, though, 0:57:53.040 --> 0:57:57.080 were of course called by many different names because no 0:57:57.080 --> 0:57:59.960 one yet knew that the diseases were linked. 0:58:00.360 --> 0:58:03.640 Right, that's what's so interesting about these ones that have 0:58:03.800 --> 0:58:11.320 such varied manifestations. Yeah, who connected cutaneous anthrax to inhalational anthrax? 0:58:11.640 --> 0:58:14.880 Uh huh? Oh, well, I'm gonna tell you that. Oh good, 0:58:16.200 --> 0:58:18.760 I can tell you his name, I can tell you 0:58:18.760 --> 0:58:23.080 how he did it. And another characteristic, or another parallel, 0:58:23.160 --> 0:58:25.360 was that many of these names included a reference to 0:58:25.440 --> 0:58:29.760 the spleen in the disease's name, So like in South Africa, 0:58:29.840 --> 0:58:32.960 the disease was referred to as spleen illness and in 0:58:33.040 --> 0:58:37.920 German spleen fire or inflammatory death of the spleen. Does 0:58:37.920 --> 0:58:39.240 the spleen I mean, does that a. 0:58:39.240 --> 0:58:42.280 Lot of It's a giant lymphoid organ There we go. 0:58:43.200 --> 0:58:46.480 As I've talked about before, the names that people use 0:58:46.560 --> 0:58:49.680 for a disease can tell us about the importance of 0:58:49.720 --> 0:58:52.880 the disease to humans or what they saw as it's 0:58:52.960 --> 0:58:57.760 defining characteristics. And maybe it was because of the economic 0:58:57.800 --> 0:59:01.720 importance of livestock, the fact that humans could also become ill, 0:59:02.360 --> 0:59:07.080 or the terrifyingly random and rapid way it killed. It's 0:59:07.120 --> 0:59:10.280 pretty clear that anthrax, in all of its various forms, 0:59:10.400 --> 0:59:15.400 was not an overlooked disease. By the seventeen hundreds, widespread 0:59:15.440 --> 0:59:19.160 global trade and population growth had led to, among other things, 0:59:19.880 --> 0:59:26.440 increasing urbanization and industrial specialization, and that also included textile production. 0:59:27.720 --> 0:59:31.240 So rather than wool or leather products being processed at 0:59:31.280 --> 0:59:34.240 the same place where the farms were, they were sent 0:59:34.280 --> 0:59:41.760 to textile mills where many people worked. The animal products wool, hides, skins, etc. 0:59:42.200 --> 0:59:46.760 Began to be transported long distances and aarin can you 0:59:46.880 --> 0:59:47.880 guess who. 0:59:47.800 --> 0:59:51.880 Hitched a ride anthrax sports exactly. 0:59:53.400 --> 0:59:56.600 At some of these busy textile mills in France, a 0:59:56.720 --> 0:59:59.040 physician named and I'm going to need your help with 0:59:59.040 --> 1:00:05.400 this pronunciation. Air okay, Nicholas, Okay, Nicholas, and then Fournier 1:00:05.840 --> 1:00:09.640 foh you are, and I er, yeah, that was great perfect. 1:00:10.200 --> 1:00:13.120 Fournier started to notice that some of the workers began 1:00:13.200 --> 1:00:16.080 to show signs of illness similar to those experienced by 1:00:16.080 --> 1:00:21.280 the animals where the materials came from, and the rate 1:00:21.360 --> 1:00:24.440 of these conditions was substantially higher than it was in 1:00:24.440 --> 1:00:28.640 the general population. And it wasn't just inflamed skin that 1:00:28.720 --> 1:00:32.800 these workers were experiencing, but also the GI symptoms or 1:00:32.840 --> 1:00:38.880 the full body manifestations of anthrax. Fournier, inspired in part 1:00:38.920 --> 1:00:42.280 by his older colleague, began to question whether these diseases 1:00:42.640 --> 1:00:45.439 with different names, thought at the same time to all 1:00:45.440 --> 1:00:51.040 be distinct diseases, were really all the same thing. He 1:00:51.200 --> 1:00:55.600 noticed a common thread binding the affected people together. They 1:00:55.640 --> 1:00:58.720 all had some connection to animal hair or animal parts, 1:00:58.800 --> 1:01:04.280 either eating or working or cleaning whatever, some sort of connection, 1:01:05.200 --> 1:01:08.720 and he published his findings and his description of anthrax 1:01:09.360 --> 1:01:12.240 in a booklet that may not have been very popular 1:01:12.360 --> 1:01:14.680 at the time of publication. But it would go on 1:01:14.760 --> 1:01:19.320 to greatly influence other researchers and physicians and veterinarians that 1:01:19.360 --> 1:01:22.640 came after him, And it would also mark him, at 1:01:22.760 --> 1:01:25.440 least in my eyes, as pretty dang ahead of his time, 1:01:26.000 --> 1:01:29.200 because all of these observations and hypotheses that he was 1:01:29.240 --> 1:01:33.520 making were taking place in the mid seventeen hundreds. Wow, 1:01:33.680 --> 1:01:36.720 the birth of germ theory was still about one hundred 1:01:36.800 --> 1:01:37.360 years away. 1:01:38.920 --> 1:01:41.600 That is truly remarkable. 1:01:42.320 --> 1:01:47.280 Yes, it reminds me a lot again of the botulism dude. 1:01:47.320 --> 1:01:50.200 I can't remember his name. Remember, he made all of 1:01:50.240 --> 1:01:51.680 these amazing achievements. 1:01:51.920 --> 1:01:54.640 Yet he's the one who did like all of the things, 1:01:54.720 --> 1:01:57.640 like he discovered the pathogen, did the test, did the 1:01:57.680 --> 1:01:59.440 thing found, a treatment, found a use. 1:01:59.280 --> 1:02:03.280 Blah blah blah everything. Yeah, yeah, he was cool. Only 1:02:03.320 --> 1:02:09.200 I can remember his name. Like I said, limited space here, okay, 1:02:11.160 --> 1:02:14.320 oh okay, but speaking of germ theory, shall we jump 1:02:14.320 --> 1:02:15.680 one hundred years into the future. 1:02:16.200 --> 1:02:18.920 I just want to give Fournier like a second more 1:02:18.960 --> 1:02:20.640 credit because I am still blown. 1:02:20.400 --> 1:02:23.760 Away, Okay, a moment of appreciation for Fournier. 1:02:25.800 --> 1:02:31.920 Nice job, dude, Okay, Okay. 1:02:33.080 --> 1:02:35.280 There's no we were gonna get away with not laughing 1:02:35.280 --> 1:02:42.200 about that one. Okay, Anthrax actually played a pretty huge 1:02:42.280 --> 1:02:47.320 role in the development of germ theory. What, yes, this 1:02:47.360 --> 1:02:50.400 is again where I was like, what this bacteria has 1:02:50.440 --> 1:02:51.880 so much beneath the surface? 1:02:52.320 --> 1:02:53.880 Okay, keep going, Okay. 1:02:55.760 --> 1:03:00.520 Basilla Santhrasis was one of the first bacterial species actually 1:03:00.560 --> 1:03:04.520 that was really intensively studied. It was used as one 1:03:04.520 --> 1:03:08.320 of the first case studies to develop cox postulates what 1:03:09.080 --> 1:03:12.280 to understand the ecology of the disease and the role 1:03:12.280 --> 1:03:16.360 that the environment played, what, and to develop a vaccine? 1:03:16.880 --> 1:03:19.640 Like why don't I know any of this, Aaron? It 1:03:19.680 --> 1:03:20.880 feels like I should know this. 1:03:21.320 --> 1:03:27.080 I think it was all overshadowed by two thousand and one. Yeah, 1:03:27.400 --> 1:03:29.680 but yeah, I think also there's a question in that 1:03:29.840 --> 1:03:33.120 as to why not just why don't you know all this? 1:03:33.280 --> 1:03:36.160 But why anthrax? Why was it so heavily studied? 1:03:36.520 --> 1:03:41.560 I mean because those killing people and their cows. 1:03:40.840 --> 1:03:43.520 Those are a couple of the reasons. So definitely, yeah, 1:03:43.640 --> 1:03:47.400 cause these huge episolotics that led to loss of life, 1:03:47.600 --> 1:03:52.800 loss of like wealth, et cetera. It was terrifying, you know, 1:03:52.920 --> 1:03:55.880 just a very threatening disease in terms of the symptoms 1:03:55.920 --> 1:03:58.640 and the mortality rate, and also how it seemed to 1:03:58.680 --> 1:04:02.160 appear randomly, so like untangling that mystery seemed to have, 1:04:02.360 --> 1:04:07.200 you know, would have placed it at high priority. Another reason, though, 1:04:07.320 --> 1:04:11.320 is that anthrax cases continued to rise in people who 1:04:11.360 --> 1:04:15.880 worked with animals or animal products, not just livestock farmers, 1:04:15.920 --> 1:04:20.480 but tanners and butchers and wool sorders as well. Yeah, definitely, 1:04:20.840 --> 1:04:23.400 and number four this is a very practical reason. But 1:04:23.480 --> 1:04:28.560 the Anthrax bacillis is actually like quite large ye so yeah, 1:04:28.600 --> 1:04:31.200 so it was large enough to be easily seen under 1:04:31.200 --> 1:04:34.920 a mid eighteen hundred's microscope, and it also turns out 1:04:34.920 --> 1:04:41.520 it's pretty easily stained as well. But still, the discovery 1:04:41.560 --> 1:04:47.040 of the Anthrax bacillis begins probably earlier than you might expect, 1:04:47.440 --> 1:04:53.480 in the eighteen fifties. Why this is like before germ theory. Really, 1:04:53.560 --> 1:04:57.000 it's like the very very beginning of germ theory in 1:04:57.040 --> 1:05:00.040 that time. So like eighteen forty nine eighteen fifty the 1:05:00.080 --> 1:05:04.480 French and a German researcher both observed the bacteria independently 1:05:04.560 --> 1:05:08.439 at like nearly the same time, and no one knows 1:05:08.520 --> 1:05:12.840 like priority doesn't really matter, but it still led to 1:05:12.880 --> 1:05:15.960 this huge controversy in both France and Germany trying to 1:05:16.200 --> 1:05:20.000 claim to who first discovered the Anthrax bacillis. And I 1:05:20.040 --> 1:05:23.200 think it's interesting because this controversy between France and Germany 1:05:23.640 --> 1:05:27.200 was just a preview of the contentious rivalry that would 1:05:27.200 --> 1:05:31.680 emerge between the French Louis Pasture and the German Robert 1:05:31.800 --> 1:05:36.600 Koch when it came to anthrax and all other things microbiology. Okay, 1:05:36.680 --> 1:05:40.240 so observing the rods in the blood of infected humans 1:05:40.360 --> 1:05:44.800 or animals was pretty easy, like those two earlier microbiologists did, 1:05:45.640 --> 1:05:48.640 But isolating those rods and growing them in a lab 1:05:49.000 --> 1:05:53.439 is a whole nother story. Yeah. Yeah, And so by 1:05:53.480 --> 1:05:58.440 recognizing that the Anthrax bacillis and other microbes were living things, 1:05:58.600 --> 1:06:02.560 early microbiologists were faced with the enormous hurdle of figuring 1:06:02.600 --> 1:06:07.120 out how to feed and shelter them, how to keep 1:06:07.200 --> 1:06:10.680 them happy enough to grow in an artificial setting outside 1:06:10.720 --> 1:06:15.000 of an animal. Yeah. An anthrax, because it has this 1:06:15.120 --> 1:06:20.560 like pretty unusual life cycle, proved to be quite technically challenging. 1:06:20.920 --> 1:06:25.040 Yeah, that's why it's surprising that it was so one 1:06:25.040 --> 1:06:25.720 of the first. 1:06:26.320 --> 1:06:29.320 Yeah, it's surprising that it was one of the first. 1:06:29.440 --> 1:06:31.680 But I also think that the way that it was 1:06:31.760 --> 1:06:37.280 studied was rather ingenious. Okay, so Robert Cooch, like, I'm 1:06:37.320 --> 1:06:39.040 not going to go into too many details, but what 1:06:39.120 --> 1:06:42.120 he did was he developed a culture slide. It was 1:06:42.160 --> 1:06:44.360 like a little had a little dip in it that 1:06:44.520 --> 1:06:47.560 not only allowed the bacillas to live, but it also 1:06:47.760 --> 1:06:53.280 allowed an observer to closely watch its every move. And 1:06:53.360 --> 1:06:56.040 this slide is how he was able to observe that 1:06:56.120 --> 1:06:59.280 the rods at the edge of the liquid suspension, those 1:06:59.320 --> 1:07:03.040 that were like more exposed to air, they were undergoing 1:07:03.160 --> 1:07:04.040 shape changes. 1:07:04.640 --> 1:07:05.360 Stop it. 1:07:05.880 --> 1:07:09.600 Yes, they were turning into long filaments and they started 1:07:09.640 --> 1:07:10.480 to look granular. 1:07:11.880 --> 1:07:12.800 Stop it. 1:07:13.720 --> 1:07:18.000 In other words, if they were transitioning into perfectly formed spores. 1:07:19.360 --> 1:07:26.880 He oh, I am losing it right now. Okay, but 1:07:27.040 --> 1:07:30.800 this is the eighteen hundreds and we're talking about looking 1:07:30.840 --> 1:07:38.320 through a microscope and watching a Bacterium sporiulate. Yeah, what 1:07:39.720 --> 1:07:41.840 the heck? 1:07:42.560 --> 1:07:48.120 Eighteen seventy six, I'm dead now, I know, because the 1:07:48.240 --> 1:07:53.960 implications for that discovery were enormous. So like, not only 1:07:54.200 --> 1:07:59.160 did this answer a whole host of questions, why did 1:07:59.160 --> 1:08:02.840 the basillas seemed to disappear in blood and tissue samples 1:08:02.880 --> 1:08:07.320 after the animal died because it did turn into his bore. 1:08:09.040 --> 1:08:11.240 Why greazing animals seemed. 1:08:11.000 --> 1:08:14.240 To be the most affected because they ate so much 1:08:14.240 --> 1:08:15.560 of it in the soil. 1:08:15.760 --> 1:08:19.920 And how on earth this bacterium survived in the soil 1:08:20.040 --> 1:08:23.280 and was able to cause seemingly random outbreaks. 1:08:23.479 --> 1:08:26.160 Oh my gracious. 1:08:25.880 --> 1:08:30.559 It's I mean, it's amazing. So you know, another reason 1:08:30.640 --> 1:08:35.360 why anthrax became a model organism is because Coke published 1:08:35.800 --> 1:08:40.800 his super detailed protocol for cultivating these anthrax withcilli And 1:08:40.840 --> 1:08:44.120 so for that reason, everyone was able to go out 1:08:44.160 --> 1:08:47.720 because like you said, it's globally distributed, or find a 1:08:47.760 --> 1:08:51.880 farm that had an anthrax outbreak, get some blood, and 1:08:51.920 --> 1:08:54.400 then you know, work with it in the lab. So, 1:08:54.640 --> 1:08:57.439 I mean, it's really weird to think about now because 1:08:58.240 --> 1:09:00.840 a anthrax is so deadly, and b were like that 1:09:00.880 --> 1:09:05.160 should be under high you know, like highly control substance, but. 1:09:05.240 --> 1:09:09.479 Three or four, like you can't just do that, you 1:09:09.640 --> 1:09:10.479 can't just do that. 1:09:10.680 --> 1:09:18.200 But they just did that. And so anthrax was used 1:09:18.240 --> 1:09:22.240 not only to develop Cox postulates, but also the principles 1:09:22.240 --> 1:09:25.240 that researchers would use to ensure that the bacterial species 1:09:25.280 --> 1:09:28.840 they were working on was indeed the species they thought 1:09:28.840 --> 1:09:34.400 it was so things like morphology, lab requirements, staining principles, 1:09:34.520 --> 1:09:38.240 life cycle illustrations like it was used as a model 1:09:38.320 --> 1:09:39.439 for all of those things. 1:09:39.800 --> 1:09:40.160 Wow. 1:09:40.840 --> 1:09:43.960 And Koch's anthrax research also caught the eye of none 1:09:44.040 --> 1:09:49.439 other than Louis Pasture. Among his many achievements. Pasture is 1:09:49.479 --> 1:09:54.920 often credited with developing the first anthrax vaccine, but in 1:09:55.000 --> 1:09:57.439 doing the research for this episode, I learned that he 1:09:57.760 --> 1:10:01.880 actually was not the first. The first was a veterinarian 1:10:02.120 --> 1:10:06.960 named Jean Joseph Henri Toussaint, who used heat and chemicals 1:10:07.000 --> 1:10:09.960 to develop a strain of anthrax that would produce an 1:10:09.960 --> 1:10:13.760 immune response in an animal without killing it. Heat and 1:10:13.840 --> 1:10:17.160 chemicals like again ahead of its time eighteen hundreds, late 1:10:17.200 --> 1:10:21.559 eighteen hundreds. He successfully tested his vaccine on twenty sheep 1:10:21.800 --> 1:10:26.080 and published his findings, and Pastur came across Pussant's vaccine 1:10:26.120 --> 1:10:30.160 work and decided to test it out. So in a 1:10:30.439 --> 1:10:35.240 public and highly publicized demonstration, he injected anthrax into two 1:10:35.280 --> 1:10:38.160 groups of sheep, one that had been vaccinated and the 1:10:38.200 --> 1:10:42.120 other not. I mean, newspapers were like came from all over. 1:10:42.280 --> 1:10:44.840 It's been now made into a movie like. This was 1:10:44.880 --> 1:10:49.760 a huge demonstration and thank goodness it worked. All of 1:10:49.800 --> 1:10:53.000 the sheep who had not been vaccinated died and those 1:10:53.080 --> 1:10:54.439 that had lived. 1:10:55.000 --> 1:10:55.520 Wow. 1:10:55.960 --> 1:10:59.040 And this public demonstration was not only a very exciting 1:10:59.080 --> 1:11:02.920 demonstration of theory in action and the life saving power 1:11:02.960 --> 1:11:06.439 of vaccines, but it also firmly placed Pasture as the 1:11:06.560 --> 1:11:10.320 creator of the anthrax vaccine because he. 1:11:10.360 --> 1:11:12.200 Was like, I'm gonna do it loudest. 1:11:12.840 --> 1:11:15.120 Well, not only did he do it loudest, but he 1:11:15.160 --> 1:11:18.400 also was like, oh no, my vaccine is way better. 1:11:18.520 --> 1:11:22.360 I used a much better like thing. You know, Touissant's 1:11:22.400 --> 1:11:27.920 method is unreliable and unscientific and blah blah blah. And 1:11:28.240 --> 1:11:32.120 poor Toussaint, he who was both less well known and 1:11:32.240 --> 1:11:36.840 less powerful than Pasture, was also suffering from a neurodegenerative 1:11:36.880 --> 1:11:38.720 disease that would go on to kill him at the 1:11:38.720 --> 1:11:41.040 age of forty one, and so he didn't have the 1:11:41.080 --> 1:11:43.920 ability to really assert his claim to fame. 1:11:44.320 --> 1:11:47.160 That's very sad, Errands. 1:11:47.360 --> 1:11:52.839 Very sad Pasture did not create the first anthrax vaccine. 1:11:53.760 --> 1:11:56.000 Maybe that's the take home. No, it's not really. There's 1:11:56.040 --> 1:11:58.559 lots of other take homes, but let that be one 1:11:58.560 --> 1:12:02.600 of them. Anyway. Vaccine credit aside The important thing was 1:12:02.640 --> 1:12:06.800 that there was now an anthrax vaccine, and the administration 1:12:06.920 --> 1:12:09.800 of this vaccine to livestock all over the globe did 1:12:09.840 --> 1:12:13.320 a great deal to reduce the incidence of the disease, 1:12:14.840 --> 1:12:18.000 but it did still happen. And here is where I 1:12:18.040 --> 1:12:24.559 want to revisit anthrax as an occupational disease. At this 1:12:24.600 --> 1:12:28.000 point in anthrax's history, it was still viewed primarily as 1:12:28.040 --> 1:12:32.000 a rural agricultural disease, despite Fournier's work in the French 1:12:32.040 --> 1:12:35.439 textile mills of the seventeen hundreds, because people just ignored 1:12:35.439 --> 1:12:42.320 that work straight up. But this characterization of anthrax as 1:12:42.479 --> 1:12:45.280 just agricultural that was about to change. 1:12:45.760 --> 1:12:46.160 Okay. 1:12:46.479 --> 1:12:49.679 By the late eighteen hundreds, the textile industry in Europe 1:12:49.680 --> 1:12:52.920 had become very centralized, even more so than one hundred 1:12:52.960 --> 1:12:56.719 years prior, with large factories where different types of wool 1:12:56.800 --> 1:13:00.599 and hair and skins would be imported from all the world. 1:13:01.800 --> 1:13:04.479 In these factories, a disease started to show up with 1:13:04.600 --> 1:13:07.240 increasing prevalence in the workers who would sort the wool. 1:13:07.760 --> 1:13:14.799 Wolfsorter's disease, as it's called. One day you felt fine, 1:13:14.920 --> 1:13:17.880 the next you got a fever and pneumonia like symptoms 1:13:18.120 --> 1:13:22.440 and then you collapsed and died. And during these outbreaks, 1:13:22.520 --> 1:13:25.400 no one yet knew that Wolfsort's disease was actually a 1:13:25.439 --> 1:13:29.639 type of anthrax. And that's because anthrax at the time, 1:13:29.760 --> 1:13:32.320 like I said, was still thought of just as a 1:13:32.400 --> 1:13:36.560 disease of agriculture. And at the same time, most anthrax 1:13:36.640 --> 1:13:41.000 cases tended to be cutaneous rather than inhalational. Yeah, and 1:13:41.040 --> 1:13:46.880 Wolfsort's disease is inhalational. Remember how scrapy like, which is 1:13:46.880 --> 1:13:49.680 the pre on disease of sheep, increased in prevalence and 1:13:49.800 --> 1:13:55.960 geographical distribution because of the wool trade. Yeah, yeah, anthrax also, 1:13:56.880 --> 1:13:59.640 And there was like around this time, which is like 1:13:59.720 --> 1:14:04.360 all so similarly, when wool demand grew so much and 1:14:04.400 --> 1:14:07.720 scrapey became a huge problem and also more widely distributed. 1:14:08.680 --> 1:14:13.720 That high demand for exotic furs and wolves grew so 1:14:13.960 --> 1:14:18.160 much that some farmers became more reluctant to lose out 1:14:18.160 --> 1:14:20.800 on a profitable fleece from a goat or sheep that 1:14:20.840 --> 1:14:26.559 died prematurely, perhaps from anthrax, Oh dear, yep, And so 1:14:26.600 --> 1:14:29.519 they would shear the animal anyway and send off the hair, 1:14:30.240 --> 1:14:36.080 which often still had bits of blood or skin attached. Yeah, 1:14:36.360 --> 1:14:39.000 the wool. Sorder would then comb the wool using newly 1:14:39.080 --> 1:14:42.439 developed machinery, which would often result in the dirt and 1:14:42.520 --> 1:14:46.960 dust and blood and skin particles turning a bit aerosolized. 1:14:47.160 --> 1:14:50.440 Oh god, yeah, just like a haze of anthrax. 1:14:50.600 --> 1:14:51.200 Oh God. 1:14:52.120 --> 1:14:57.320 And I think to us now, Wolfsort's disease may seem 1:14:57.479 --> 1:15:00.400 like an isolated problem limited to a various part of 1:15:00.439 --> 1:15:05.920 the population, but that wasn't the case at all. Wolfsorders 1:15:05.960 --> 1:15:12.599 made up a huge part of the occupational community, and 1:15:12.680 --> 1:15:15.240 to give you some sense of how much of an 1:15:15.240 --> 1:15:19.719 impact occupational anthrax had during this time, considered these stats 1:15:19.720 --> 1:15:25.679 from Italy. Between eighteen ninety and nineteen oh four, thirty 1:15:25.760 --> 1:15:29.200 six thousand, four hundred and thirty six cases of anthrax 1:15:29.439 --> 1:15:35.600 were registered among tanners, brushmakers, and woolworkers, with seven three 1:15:35.680 --> 1:15:37.240 hundred and eight deaths. 1:15:37.479 --> 1:15:40.760 WHOA, that's a lot. That's a lot. 1:15:41.320 --> 1:15:43.519 And so it makes sense then that there would be 1:15:43.560 --> 1:15:47.679 many epidemiologists hard at work on this problem. But among 1:15:47.720 --> 1:15:52.559 all of these epidemiologists, John Henry Bell may have been 1:15:52.600 --> 1:15:56.479 the most influential in getting wolfsorders disease to be widely 1:15:56.520 --> 1:16:00.760 recognized as a form of anthrax. It was also one 1:16:00.760 --> 1:16:03.360 of the first to push for workers' rights or at 1:16:03.400 --> 1:16:06.559 least call out the responsibility of the employer in providing 1:16:06.600 --> 1:16:09.719 a safe work environment and minimizing the risk of disease. 1:16:10.120 --> 1:16:12.840 Oh kidd it, h huh. 1:16:12.960 --> 1:16:15.920 As a physician, Bell would often be called upon to 1:16:15.960 --> 1:16:19.880 perform autopsies on those who died of woolsorters disease, and 1:16:19.960 --> 1:16:23.479 he became increasingly frustrated with what seemed to him to 1:16:23.520 --> 1:16:27.560 be careless employers who refused to acknowledge their own responsibility 1:16:27.600 --> 1:16:31.120 in the disease and so under cause of death he 1:16:31.200 --> 1:16:35.120 started to put things like employer's neglect and not properly 1:16:35.320 --> 1:16:41.360 washing or disinfecting imported mohair. Whoa yeah, and so you know, 1:16:41.760 --> 1:16:44.559 not employers don't want to be blamed for the death 1:16:44.600 --> 1:16:48.840 of their employees or you know. And also I think 1:16:48.880 --> 1:16:50.920 that his voice was loud enough and he was prominent 1:16:51.000 --> 1:16:53.719 enough in the community to really like raise the alarm 1:16:53.760 --> 1:16:56.320 on this wow And so in effect he started this 1:16:56.479 --> 1:16:59.960 activist movement among the woolfsorts to protest these working can 1:17:00.000 --> 1:17:04.519 conitions and to fight for protections from anthrax. And this 1:17:04.840 --> 1:17:08.360 also marked one of the first occasions of an infectious 1:17:08.400 --> 1:17:14.360 disease being recognized as an occupational hazard. So interesting, so. 1:17:14.479 --> 1:17:21.080 Many pieces to this anthrax puzzle. Err, I know, gosh. 1:17:21.120 --> 1:17:25.640 Practices like vaccination or increased sanitation of wool reduced the 1:17:25.680 --> 1:17:29.240 incidence of anthrax among these workers, but it did still 1:17:29.280 --> 1:17:33.200 pop up, and not just in the wool sorders. For instance, 1:17:33.360 --> 1:17:37.280 early shaving brushes were made of like animal hair, and 1:17:37.520 --> 1:17:41.000 some of these carried anthrax spores on them, And so 1:17:41.120 --> 1:17:43.519 when somebody would use a brush on their face that 1:17:43.680 --> 1:17:46.439 they had tiny little cuts from shaving, oh no, yeah, 1:17:46.479 --> 1:17:49.400 the spores would get in there and cause cutaneous anthrax. 1:17:49.640 --> 1:17:50.519 No thank you. 1:17:51.240 --> 1:17:54.800 And horse hair was often used as an ingredient in 1:17:55.040 --> 1:18:00.160 plaster and often or at least occasionally contain anthrax spores. 1:18:00.800 --> 1:18:04.240 By the early nineteen hundreds, the perception of anthrax had 1:18:04.240 --> 1:18:08.200 evolved into one of both agricultural and industrial importance, and 1:18:08.320 --> 1:18:12.520 several tools had been developed to combat the disease. Vaccines, 1:18:12.600 --> 1:18:14.680 which I'm not going to go into the history of, 1:18:15.040 --> 1:18:17.920 except to say that new and improved ones had been developed. 1:18:18.400 --> 1:18:22.680 Better sanitation practices and serum were all variously used and 1:18:22.760 --> 1:18:25.880 seemed to make a pretty substantial dent in slowing transmission. 1:18:26.479 --> 1:18:29.479 Anthrax seemed to be turning into a disease of the past, 1:18:31.400 --> 1:18:36.519 not quite. The world wars of the twentieth century really 1:18:36.640 --> 1:18:41.080 showcased how inventive and cruel and brutal and relentless humanity 1:18:41.160 --> 1:18:45.360 could be when it comes to killing other humans, and 1:18:45.439 --> 1:18:48.920 one of these methods of murder happened to be bioweapons. 1:18:49.960 --> 1:18:52.519 Long before the two thousand and one anthrax attacks in 1:18:52.560 --> 1:18:56.240 the US, there had been previous attempts to develop anthrax 1:18:56.280 --> 1:19:01.080 into a bioweapon by nearly every country involved in these 1:19:01.120 --> 1:19:07.120 global conflicts. Anthrax is always has always been near the 1:19:07.160 --> 1:19:11.080 top of the list of potential bioweapon agents because of 1:19:11.120 --> 1:19:14.800 its high mortality rate, its relatively easy manipulation in the 1:19:14.920 --> 1:19:19.840 lab thanks to its model organism status, its durability, its 1:19:19.880 --> 1:19:23.519 ability to survive an explosion, and the existence of a 1:19:23.640 --> 1:19:28.000 vaccine which could protect those who were administering the bioweapon. 1:19:29.479 --> 1:19:33.200 That is a gross part that I did not realize 1:19:33.320 --> 1:19:38.400 was a criteria for what makes a good bioweapon. Mm hmmmmm, Yes, 1:19:38.479 --> 1:19:40.240 that's so gross. 1:19:40.880 --> 1:19:47.040 Yeah, gross is Yeah, it's the right word. Research was 1:19:47.040 --> 1:19:50.320 carried out in many countries to work on how best 1:19:50.360 --> 1:19:53.200 to use antrax as a weapon, maybe in warfare, with 1:19:53.280 --> 1:19:57.160 shrapnel bombs, or as a massive civilian attack using high 1:19:57.160 --> 1:20:01.920 altitude bombs or atomizers, or may you know, lace some 1:20:02.080 --> 1:20:05.439 anthrax in lindseed cakes and then drop those into German 1:20:05.479 --> 1:20:08.000 fields where they would be eaten by the cattle, killing 1:20:08.080 --> 1:20:11.200 cattle and then humans that ate the cattle. It's a 1:20:11.320 --> 1:20:13.760 very specific example that I'm giving because that was an 1:20:13.840 --> 1:20:20.360 actual British operation called Operation Vegetarian during World War Two. 1:20:21.360 --> 1:20:23.160 I know, like I wrote this, and I'm like, am 1:20:23.160 --> 1:20:23.960 I reading this right? 1:20:24.280 --> 1:20:26.120 Yeah? 1:20:26.320 --> 1:20:30.719 Yeah. Scientists dealt with things like the logistics of how 1:20:30.880 --> 1:20:35.240 high a bomb should be deployed to impact the widest area, 1:20:35.960 --> 1:20:38.560 which way the wind was going, or which form of 1:20:38.640 --> 1:20:41.040 the bacillis, so we should we do like a liquid 1:20:41.080 --> 1:20:43.960 suspension or a spore form it would be most likely 1:20:44.040 --> 1:20:46.840 to cause death or be the most stable, or how 1:20:46.880 --> 1:20:51.400 to protect those deploying the weapon. So we know that 1:20:51.439 --> 1:20:55.040 people worked on anthrax as a bioweapon during these wars 1:20:55.080 --> 1:20:58.080 and researched it as a possibility, but did anyone ever 1:20:58.240 --> 1:21:02.840 try it out well. The first instance of anthrax being 1:21:02.920 --> 1:21:06.080 used as a bioweapon is often cited as a part 1:21:06.120 --> 1:21:09.320 of a World War One German sabotage program in which 1:21:09.360 --> 1:21:12.839 anthrax was supposed to be administered to Allied draft animals 1:21:12.880 --> 1:21:18.519 like horses, mules, reindeer, et cetera. In nineteen seventeen, German 1:21:18.560 --> 1:21:22.320 spy Baron von Rosen was captured in Norway and accused 1:21:22.320 --> 1:21:27.479 of smuggling a bioweapon anthrax filled glass capillaries concealed in 1:21:27.520 --> 1:21:34.080 sugar lumps. So these anthrax sugar cubes. In nineteen ninety eight, 1:21:34.160 --> 1:21:39.400 they were analyzed and anthrax genetic material was found, so 1:21:39.600 --> 1:21:44.200 like maybe there was something to it. However, in twenty 1:21:44.200 --> 1:21:47.360 seventeen a paper came out that suggests that those anthrax 1:21:47.400 --> 1:21:51.160 colonies were actually just lab contamination, and so we'll never 1:21:51.200 --> 1:21:54.600 really know if the sugar cubes held anthrax were not 1:21:54.640 --> 1:21:59.320 actually but we do have solid evidence of weaponized anthrax 1:21:59.360 --> 1:22:03.000 being tested on humans from Unit seven thirty one, and 1:22:03.040 --> 1:22:05.439 so this is the infamous unit of the Japanese Army 1:22:05.479 --> 1:22:08.559 that in World War II carried out bioweapons testing on 1:22:08.800 --> 1:22:11.840 human and animal subjects, and also where no one was 1:22:11.840 --> 1:22:14.559 ever punished because the US made an immunity deal to 1:22:14.600 --> 1:22:18.320 get access to all their research in exchange for immunity cool. 1:22:18.080 --> 1:22:20.000 Which is the episode where you talk a lot about 1:22:20.040 --> 1:22:20.679 that one. 1:22:20.680 --> 1:22:27.519 Hantaviruss I believe anyway, thousands of people, primarily in the 1:22:27.560 --> 1:22:32.519 historical region Manchuria, were intentionally dosed with anthrax to observe 1:22:32.560 --> 1:22:37.679 how quickly it killed or the dose necessary medicalized torture 1:22:37.760 --> 1:22:43.520 that mostly resulted in death. There were anthrax shrapnel bombs 1:22:44.000 --> 1:22:47.160 that were blasted at people tied to stakes nearby, with 1:22:47.240 --> 1:22:51.519 different body parts exposed to test dose and site of entry. 1:22:51.880 --> 1:23:00.840 What the actual I know and many Many other countries, 1:23:00.960 --> 1:23:05.400 including France and England and Germany and Canada and the US, 1:23:06.040 --> 1:23:10.800 performed similar horrifying experiments on weaponized anthrax on animal subjects 1:23:10.840 --> 1:23:15.439 throughout World War II. As you can expect, as we 1:23:15.640 --> 1:23:19.320 all expect, research into anthrax as a bioweapon did not 1:23:19.600 --> 1:23:23.160 cease with the end of World War II, nor did 1:23:23.160 --> 1:23:26.439 it end in nineteen seventy two, when nearly every country 1:23:26.479 --> 1:23:31.759 around the globe signed the Biological Weapons Convention, which banned research, development, possession, 1:23:31.800 --> 1:23:38.799 and deployment of biological weapons. In nineteen seventy nine, in Serdloftsk, Russia, 1:23:39.760 --> 1:23:44.360 approximately one hundred people maybe more fell ill and died 1:23:44.600 --> 1:23:49.559 within a few days of anthrax. Most of the people 1:23:49.920 --> 1:23:52.880 were workers at a ceramic plant located across the street 1:23:52.920 --> 1:23:57.160 from a biological research facility whose main project was you 1:23:57.200 --> 1:24:03.600 guessed it, aerosolized anthrax. Yeah, well, bioweapons with aeroed anthrax 1:24:03.680 --> 1:24:08.160 is the main yep. And the Soviet government claimed at 1:24:08.160 --> 1:24:12.280 the time, oh, that's ingestional anthrax, that they just got 1:24:12.280 --> 1:24:16.120 it from eating tainted meat. And then they also happened 1:24:16.120 --> 1:24:20.519 to destroy all of the victim's medical records. And then 1:24:20.840 --> 1:24:26.320 later investigations though, like they invited American researchers to come 1:24:26.360 --> 1:24:29.400 in and investigate the source of this outbreak, and that 1:24:29.520 --> 1:24:33.320 revealed that a filter that was preventing the fine anthrax 1:24:33.360 --> 1:24:37.680 powder from escaping the building had been removed and no 1:24:37.720 --> 1:24:40.080 one had noticed, And so the drying machines with this 1:24:40.280 --> 1:24:44.639 mound of like anthrax were turned on, basically blowing these 1:24:44.680 --> 1:24:52.120 anthrax spores into the outside air. Oh no, yeah, downwind 1:24:52.760 --> 1:24:57.479 was as you can guess, the ceramic plant. There's a 1:24:57.479 --> 1:25:00.519 whole book on this written by one of the American 1:25:00.560 --> 1:25:03.240 researchers who helped to uncover the truth about this incident. 1:25:03.320 --> 1:25:07.840 It's called Anthrax The Investigation of a Deadly Outbreak looks fascinating. 1:25:07.880 --> 1:25:11.040 I didn't read it, but I'll post it anyway. Around 1:25:11.080 --> 1:25:15.040 the same time as the speredlofsk incident, an enormous outbreak 1:25:15.040 --> 1:25:17.840 of anthrax was taking place in what was then Rhodesia 1:25:18.040 --> 1:25:22.479 now Zimbabwe, the largest epidemic of the last two hundred years. 1:25:22.760 --> 1:25:24.040 Oh my god. 1:25:24.200 --> 1:25:28.759 Between nineteen seventy eight and nineteen eighty four, one hundred 1:25:28.800 --> 1:25:33.400 and one thousand, nine hundred and ninety cattle and seventeen thousand, 1:25:33.520 --> 1:25:36.760 one hundred and ninety nine people were stricken with anthrax 1:25:37.160 --> 1:25:39.200 and nearly two hundred people died. 1:25:39.760 --> 1:25:40.480 Whoa. 1:25:40.800 --> 1:25:45.439 This outbreak, which was obviously economically devastating, took place at 1:25:45.479 --> 1:25:48.760 a time of great civil unrest in the country, and 1:25:48.920 --> 1:25:51.360 there has been a lot of speculation that the surge 1:25:51.400 --> 1:25:54.960 in anthrax cases was due to the intentional release of 1:25:55.000 --> 1:25:58.559 anthrax as a bio weapon. And while there's not a 1:25:58.560 --> 1:26:01.200 whole lot of physical evidence that's the case, there is 1:26:01.240 --> 1:26:04.000 a good deal of circumstantial evidence. And I'll post a 1:26:04.040 --> 1:26:06.439 great review that goes over this outbreak and all the 1:26:06.479 --> 1:26:11.720 different sort of hypotheses. Okay, this is a long episode. 1:26:11.920 --> 1:26:14.599 Just a couple more bioterrorism incidents, and then I'll throw 1:26:14.640 --> 1:26:18.320 it back to you, okay. In nineteen ninety three in Japan, 1:26:18.960 --> 1:26:22.600 a liquid culture of anthrax was sprayed from the rooftops 1:26:22.640 --> 1:26:26.040 by a religious cult, but no one got sick because 1:26:26.080 --> 1:26:28.639 it turns out it was the strain of anthrax used 1:26:28.760 --> 1:26:35.719 to vaccinate animals and was therefore harmless. Kay, great news. 1:26:36.120 --> 1:26:39.919 And then finally the two thousand and one Anthrax Letters. 1:26:40.920 --> 1:26:43.160 And I'm just going to go over the basics here, 1:26:43.479 --> 1:26:47.920 like some very surface level stuff because this episode is 1:26:48.439 --> 1:26:52.479 very long as is, and be there might be a 1:26:52.560 --> 1:26:55.439 time in the future where I give this topic the 1:26:55.560 --> 1:26:58.680 time that it truly deserves, which is my way of 1:26:58.760 --> 1:27:06.840 throwing in like a very vague potential teaser. S. Stay tuned, Yes, 1:27:06.880 --> 1:27:10.599 definitely stay tuned for more updates on that, but okay, 1:27:11.240 --> 1:27:15.759 the Anthrax Letters. The first victim of the Anthrax Letters 1:27:15.840 --> 1:27:19.680 was Bob Stevens, editor for tabloid publisher American Media, in 1:27:19.760 --> 1:27:23.320 Boca Ratonne, Florida, on October fourth, two thousand and one, 1:27:23.680 --> 1:27:26.240 a couple of days after opening a letter that contained 1:27:26.240 --> 1:27:29.920 a threatening note. He checked himself into a hospital due 1:27:30.000 --> 1:27:34.960 to trouble breathing. The next day. He died. A few 1:27:35.000 --> 1:27:39.160 days after his death, one of his coworkers developed cutaneous anthrax. 1:27:39.880 --> 1:27:42.760 Then cases of anthrax started popping up in New York 1:27:42.800 --> 1:27:46.720 City news outlets, studios for NBC News, and headquarters of 1:27:46.760 --> 1:27:52.280 the National Inquirer, all from letters containing anthrax spores. Anthrax 1:27:52.320 --> 1:27:56.920 letters arrived at US Senators Tom Dashel and Patrick Leahy's offices, 1:27:57.400 --> 1:28:00.120 and then postal workers in New Jersey, in Washington in 1:28:00.200 --> 1:28:05.640 DC became sick with inhalational anthrax. In total, twenty two 1:28:05.680 --> 1:28:09.280 people became sick due to these anthrax letters, eleven with 1:28:09.360 --> 1:28:14.400 cutaneous anthrax and eleven with inhalational anthrax, and five of 1:28:14.400 --> 1:28:19.639 those with the inhalational form died pretty quickly. It seemed 1:28:19.720 --> 1:28:23.479 likely that the person responsible had access to a highly 1:28:23.520 --> 1:28:27.559 secure scientific facility where the deadly so called AIM strain 1:28:27.720 --> 1:28:32.719 was kept, and genetic testing also supported this, which created 1:28:32.760 --> 1:28:36.960 this like very strange situation right where like everyone who 1:28:37.000 --> 1:28:40.920 worked at you SAMRID, which is United States Army Medical 1:28:41.120 --> 1:28:46.080 Research Institute of Infectious Diseases much easier to say you SAMRID. 1:28:45.760 --> 1:28:48.560 Yeah, the longest acronym of all time, yep. 1:28:49.160 --> 1:28:51.360 But everyone who was working there, you know, they were 1:28:51.400 --> 1:28:55.080 treated as both suspect and they were also these essential 1:28:55.120 --> 1:28:58.160 assistants to the case because they would be the ones 1:28:58.240 --> 1:29:01.960 performing the genetic tests and the analyzes that would reveal 1:29:02.120 --> 1:29:05.599 where the anthrax from the letters came from. It's like 1:29:06.080 --> 1:29:07.920 a really strange thing to think about. 1:29:08.160 --> 1:29:09.160 Yeah, that's bizarre. 1:29:09.520 --> 1:29:15.400 Yeah. And the investigation itself into who was responsible for 1:29:15.600 --> 1:29:19.880 the anthrax letters, it has so many twists and turns 1:29:20.080 --> 1:29:22.679 and you know, at least a couple of dead ends. 1:29:23.200 --> 1:29:27.160 But years after the letters were mailed, super sensitive genetic 1:29:27.240 --> 1:29:31.160 tests were developed that allowed investigators to identify not only 1:29:31.200 --> 1:29:34.200 the strain of anthrax used in the letters, but the 1:29:34.320 --> 1:29:37.639 specific flask where those spores had come from. 1:29:37.920 --> 1:29:39.440 That is amazing. 1:29:39.960 --> 1:29:45.120 I know, it's just such an interesting, like course of investigation. 1:29:45.560 --> 1:29:45.960 Yeah. 1:29:46.000 --> 1:29:48.920 The more technology you have and then I don't know, 1:29:48.960 --> 1:29:51.880 and also the characteristics of anthrax itself, like or the 1:29:51.960 --> 1:29:55.240 basilis anthrasis right, the fact that it's so clonal, the 1:29:55.240 --> 1:29:58.320 fact that it doesn't really like evolve very much or 1:29:58.479 --> 1:29:59.680 is like so consistent. 1:30:00.439 --> 1:30:03.960 Yeah, that you can identify it down to the flask, 1:30:04.040 --> 1:30:05.599 that's incredible. 1:30:05.439 --> 1:30:10.240 Yeah, exactly. And it turns out that these anthrax spores 1:30:10.439 --> 1:30:13.000 had come from a flask at you Samrid that was 1:30:13.080 --> 1:30:17.599 under the care of researcher Bruce Ivans, and Ivan's motive 1:30:17.920 --> 1:30:20.439 was thought to be that he wanted to save the 1:30:20.479 --> 1:30:23.840 anthrax vaccine program, which was in danger of being shut down. 1:30:24.560 --> 1:30:27.759 And so you know, if there were suddenly a bunch 1:30:27.800 --> 1:30:31.040 of deadly anthrax cases, then the need for the program would, 1:30:31.120 --> 1:30:35.320 you know, become clear or something. And throughout the investigation, 1:30:35.520 --> 1:30:38.959 Ivans never confessed. I believe that there was no physical 1:30:38.960 --> 1:30:43.200 evidence found connecting Ivans like home or car to the 1:30:43.240 --> 1:30:48.560 anthrax envelopes, and Ivans himself died of an acetamnifin overdose 1:30:48.720 --> 1:30:53.439 in two thousand and eight, but the circumstantial evidence does 1:30:53.479 --> 1:30:56.719 seem pretty strong, and like I said, there's a lot 1:30:56.840 --> 1:31:00.760 more to the story that I didn't do it justice. 1:31:01.439 --> 1:31:04.679 And even if we never have a conclusive answer as 1:31:04.720 --> 1:31:07.920 to who sent those letters, one thing is for sure. 1:31:08.400 --> 1:31:11.880 The two thousand and one anthrax letters forever seared anthrax 1:31:11.920 --> 1:31:15.760 as a dangerous bioweapon in the minds of the public. Yeah, 1:31:16.040 --> 1:31:21.040 so it started out as an agricultural disease, transformed into 1:31:21.080 --> 1:31:26.040 that of an occupational hazard and now a bioweapon. Since 1:31:26.080 --> 1:31:29.080 two thousand and one, we've learned so much more about 1:31:29.120 --> 1:31:32.680 the ecology of this Bacillus, how it infects wildlife, how 1:31:32.720 --> 1:31:35.559 it interacts with plants and may not be as dormant 1:31:35.560 --> 1:31:39.080 in the soil as we previously thought. How anthrax may 1:31:39.160 --> 1:31:43.479 not just be a disease caused by basilisanthrasis, the role 1:31:43.520 --> 1:31:46.800 that Necrophagius flies may play in transmission, the risk that 1:31:46.800 --> 1:31:49.880 a warming climate plays, and expanding the geographical distribution of 1:31:49.920 --> 1:31:55.400 his pathoges. Oh my goodness, and so on and so forth. Clearly, 1:31:55.760 --> 1:31:59.559 despite being one of the longest studied bacterial species, there 1:31:59.600 --> 1:32:06.280 are still many many mysteries to uncover. So erin, where 1:32:06.280 --> 1:32:08.479 do we stand with anthrax today? 1:32:08.960 --> 1:32:12.439 Oh my goodness. I will try to bring us up 1:32:12.479 --> 1:32:14.759 to speed right after this break. 1:32:44.720 --> 1:32:45.160 Wow. 1:32:45.360 --> 1:32:48.240 Okay, those were a lot of questions that you left 1:32:48.400 --> 1:32:53.040 open for me, Aaron, So let me just say, off 1:32:53.080 --> 1:32:55.360 the bat, I'm not going to be able to answer those, 1:32:56.720 --> 1:33:01.040 but we're going to call in some backup. So historical 1:33:01.240 --> 1:33:06.120 analysis reveals, and I think this is really interesting. For 1:33:06.240 --> 1:33:13.040 every ten anthrax cases in animals that leave anthrax carcasses, 1:33:13.160 --> 1:33:19.080 essentially that tends to result in one human cutaneous anthrax case. 1:33:20.160 --> 1:33:27.960 H there is one case of human gastrointestinal anthrax for 1:33:28.080 --> 1:33:33.040 every three thousand, just over three thousand anthrax infected animals 1:33:33.240 --> 1:33:33.880 that are eaten. 1:33:34.960 --> 1:33:40.360 Wow, wait for every three thousand anthrax infected animals that 1:33:40.360 --> 1:33:40.840 are eaten. 1:33:40.960 --> 1:33:43.679 So we didn't get into this in the biology erin 1:33:44.120 --> 1:33:48.960 But while we don't fully know exactly the infectious dose, 1:33:49.320 --> 1:33:55.120 it's estimated to be quite high, especially for gastrointestinal and 1:33:55.400 --> 1:34:01.000 inhalational anthrax. Humans are actually probably pretty resistant to anthrax infection. 1:34:02.360 --> 1:34:08.000 That is very interesting, I know, okay. 1:34:08.280 --> 1:34:14.040 And we also know from historical data that in humans 1:34:14.600 --> 1:34:20.280 there are about one hundred thousand cutaneous cases for every 1:34:20.680 --> 1:34:27.960 enteric or gastrointestinal case that occurs worldwide. Wow. And inhalational 1:34:28.000 --> 1:34:35.559 anthrax today is extremely uncommon, Okay. So that's what we 1:34:36.040 --> 1:34:43.480 do know. Globally overall, we have a fairly poor understanding 1:34:43.760 --> 1:34:51.439 of global risk and incidents of anthrax. But we do know, 1:34:51.640 --> 1:34:56.200 like I said, that human infection largely results from interactions 1:34:56.240 --> 1:34:59.920 with animals or animal products, and so outbreaks in human 1:35:00.280 --> 1:35:05.439 tend to occur both temporally and spatially in association with 1:35:05.520 --> 1:35:09.680 outbreaks in animals. And we also have a lot of 1:35:09.680 --> 1:35:13.120 good data that shows that in most parts of the world, 1:35:13.520 --> 1:35:18.599 widespread distribution of vaccines for domestic animals and livestock is 1:35:18.760 --> 1:35:23.439 really effective at reducing infection in animals and in humans. 1:35:25.560 --> 1:35:28.960 But like we've talked about in pretty much every episode 1:35:28.960 --> 1:35:32.880 of this podcast, our estimates of incidence and prevalence are 1:35:32.920 --> 1:35:36.280 only as good as the surveillance that we do. And 1:35:36.320 --> 1:35:39.479 in the case of anthrax, even though in almost every 1:35:39.520 --> 1:35:45.160 country it's a global presence and it's a notifiable disease, 1:35:46.040 --> 1:35:48.920 we still just don't have excellent data in a lot 1:35:48.920 --> 1:35:52.080 of cases. And I think this is probably at least 1:35:52.080 --> 1:35:56.360 in part because it's not specifically a human disease and 1:35:56.600 --> 1:35:59.240 it can often infect wildlife. It's really hard to get 1:35:59.240 --> 1:36:05.360 a handle on something as big as that, understanding everything 1:36:05.439 --> 1:36:09.960 from the course of the disease to the ecological characteristics 1:36:10.000 --> 1:36:14.720 in so many different ecosystems. It's a massive challenge. Oh yeah. 1:36:15.000 --> 1:36:19.800 So anthrax is really I think probably especially fun for us, Aaron, 1:36:20.720 --> 1:36:26.320 because it's an environmental pathogen that really requires a large 1:36:26.360 --> 1:36:33.720 scale interdisciplinary approach to understanding and control. And because of that, 1:36:34.400 --> 1:36:37.040 we wanted to talk to someone who is an expert 1:36:37.240 --> 1:36:41.280 in this type of interdisciplinary research when it comes to anthrax. 1:36:41.880 --> 1:36:46.240 Understanding the disease dynamics in wildlife, evaluating the climate and 1:36:46.400 --> 1:36:50.960 environmental patterns and the distribution of anthrax, identifying the challenges 1:36:50.960 --> 1:36:54.959 and predicting outbreaks, and most of all, working across fields 1:36:55.000 --> 1:36:58.799 to most effectively control the incidents of this devastating disease. 1:36:59.479 --> 1:37:03.240 Were so lucky to get to chat with spatial epidemiologist 1:37:03.439 --> 1:37:07.120 Morgan Walker. And we'll let her introduce herself right now. 1:37:11.320 --> 1:37:12.679 My name is Morgan Walker. 1:37:12.800 --> 1:37:16.240 I am a spatial epidemiologist at the University of Florida. 1:37:17.120 --> 1:37:20.040 I work in doctor Jason Blackburn's lab and we are 1:37:20.120 --> 1:37:23.280 house jointly in the Department of Geography and the Emerging 1:37:23.320 --> 1:37:27.840 Pathogens Institute at UF and my research focuses on the space, 1:37:27.880 --> 1:37:32.280 shoot and poral patterns of diseases and disease spread, especially 1:37:32.320 --> 1:37:36.559 of bacterial zoonoses, which are acterial diseases that can affect 1:37:36.680 --> 1:37:39.880 both animals and humans, one of which is anthrax. 1:37:40.600 --> 1:37:44.240 Awesome, thank you so much for joining us. We're so 1:37:44.360 --> 1:37:45.960 excited to talk with you. 1:37:47.200 --> 1:37:48.639 Thank you so much for having me. 1:37:49.320 --> 1:37:52.200 So we want to just start off by asking, you know, 1:37:52.400 --> 1:37:56.680 a very basic general question, what is the current worldwide 1:37:56.680 --> 1:38:00.679 distribution of b anthrasis? Like, I know, it's a big one. 1:38:01.040 --> 1:38:04.960 And so because there are presumably patterns in the distribution 1:38:05.040 --> 1:38:07.840 of this pathogen, we also wanted to ask you, you know, 1:38:07.920 --> 1:38:11.519 what are some of the environmental or climatic determinants of 1:38:11.560 --> 1:38:14.040 its distribution. What are some of the patterns that we see. 1:38:14.520 --> 1:38:17.000 Yeah, so it is definitely a big one. It's distributed 1:38:17.120 --> 1:38:21.000 pretty much globally. Some of the areas where it is 1:38:21.120 --> 1:38:24.680 endemic or where we typically see cases are areas like 1:38:25.200 --> 1:38:29.360 Central Asia, the midwest of the United States, extending up 1:38:29.400 --> 1:38:33.719 into the northwest territories of Canada, sub Saharan Africa, southern 1:38:33.840 --> 1:38:38.400 eastern Europe, and southeastern Australia. And part of the reason 1:38:38.400 --> 1:38:40.760 why it has such a wide range is because it 1:38:40.800 --> 1:38:44.920 can form a protective spore around it, which makes it 1:38:44.960 --> 1:38:48.880 really hearty and really resistant to a variety of environmental 1:38:48.960 --> 1:38:53.479 and climatic conditions. But it survives best in soils with 1:38:53.680 --> 1:38:58.320 slightly alkaline phs and soils where there's high calcium concentrations, 1:38:58.800 --> 1:39:01.759 and in soils where there's lots of organic matter present, 1:39:01.840 --> 1:39:03.760 so fertile soils excellent. 1:39:04.360 --> 1:39:08.160 So then what types of kind of environmental or ecological 1:39:08.200 --> 1:39:11.360 patterns do we know of that are tied to an 1:39:11.400 --> 1:39:16.040 increased risk of anthrax outbreaks, either among animals or even humans. 1:39:17.080 --> 1:39:17.960 That's a great question. 1:39:18.520 --> 1:39:22.160 It's something that we're definitely still researching and trying to 1:39:22.160 --> 1:39:24.759 figure out, because if we have a better idea of 1:39:24.840 --> 1:39:27.800 why an outbreak happens, we can do better predicting when 1:39:27.800 --> 1:39:30.280 they're going to occur and how intense they're going to be. 1:39:30.800 --> 1:39:33.200 There's not a clear consensus at this point what the 1:39:33.240 --> 1:39:37.080 mechanism is that leads to an outbreak, because outbreaks have 1:39:37.160 --> 1:39:41.240 happened in such a variety of geographies and a variety 1:39:41.280 --> 1:39:45.600 of ecological conditions into such a wide variety of animal species. 1:39:45.880 --> 1:39:48.840 But what we can't say at this point is it 1:39:48.920 --> 1:39:51.880 seems to be that in the mid to high latitudes 1:39:51.880 --> 1:39:55.519 of the world, the pattern that precedes an outbreak is 1:39:55.560 --> 1:39:58.240 that there will be a wet spring followed by a 1:39:58.280 --> 1:40:02.360 hot dry period, and then there will be a rainfall event. 1:40:02.439 --> 1:40:05.559 So basically just it will brain really hard, and then 1:40:05.880 --> 1:40:08.599 a few days after that rain event there will suddenly 1:40:08.600 --> 1:40:13.320 be cases popping up. And we are still researching why 1:40:13.360 --> 1:40:18.960 exactly that pattern leads to outbreaks, but in areas like 1:40:19.000 --> 1:40:23.520 West Texas, we see both on the ground and anecdotally 1:40:23.520 --> 1:40:27.080 when talking to land managers that those conditions seem to 1:40:27.120 --> 1:40:31.840 allow the populations of biting fly populations to explode. So 1:40:32.400 --> 1:40:36.280 we think that biting flies are mechanical vectors of the disease, 1:40:36.880 --> 1:40:40.720 which essentially means that when a biting fly bites an 1:40:40.760 --> 1:40:44.479 animal that is actively fighting an infection and has the 1:40:44.520 --> 1:40:47.960 solo sand brasis circulating through its bloodstream, it can get 1:40:48.080 --> 1:40:51.720 the bacteria on its mouth parts and then fly to 1:40:51.760 --> 1:40:54.240 another animal, bite it and infect it. 1:40:56.160 --> 1:41:01.040 That's like such an interesting mechanism of dispersal because it's 1:41:01.080 --> 1:41:05.519 like a vector but not a vector, but not a vector, yeah, 1:41:05.560 --> 1:41:09.879 in the way that we like traditionally think of vectors. Yeah, 1:41:10.520 --> 1:41:12.559 so you know, and I know that you said that 1:41:12.600 --> 1:41:15.880 we're still sort of working out the exact risk factors 1:41:15.960 --> 1:41:20.880 for an anthrax outbreak, But how do we monitor how 1:41:21.080 --> 1:41:25.040 risk of exposure to anthrax changes over time? And then 1:41:25.080 --> 1:41:28.600 also how does that risk in general differ between you know, 1:41:28.760 --> 1:41:31.800 let's say some groups of wildlife or some groups of 1:41:31.840 --> 1:41:35.280 domestic animals and humans as well, Like, how does the 1:41:35.400 --> 1:41:37.040 risk change for those different groups? 1:41:37.920 --> 1:41:43.920 Yes, so globally, the use of active surveillance or continually 1:41:44.000 --> 1:41:47.599 monitoring risk in a population for antas, it's really limited, 1:41:47.760 --> 1:41:51.760 especially because areas can go long time periods about seeing 1:41:51.760 --> 1:41:54.800 an outbreak, so people will get into a habit of 1:41:54.840 --> 1:41:58.160 not really worrying about it, and so they're not actively monitoring. 1:41:58.600 --> 1:42:01.960 It's much more common to do you sort of passive surveillance, 1:42:02.280 --> 1:42:05.759 which means that on the animal side of things, if 1:42:06.160 --> 1:42:09.280 a land manager sees an animal that is exhibiting clinical 1:42:09.320 --> 1:42:11.880 signs of anthrax, they might have that animal tested, or 1:42:11.920 --> 1:42:14.759 they might have that animal carcass tested if the animal 1:42:14.760 --> 1:42:17.400 actually succumbs to disease. And then on the human side 1:42:17.400 --> 1:42:21.160 of things, passive surveillance pretty much looks like waiting for 1:42:21.479 --> 1:42:25.080 humans to get infected to come into a clinical setting 1:42:25.120 --> 1:42:27.840 because they need to be treated, and then that's how 1:42:27.920 --> 1:42:33.760 cases get reported. So almost all mammals are susceptible. However, 1:42:34.000 --> 1:42:37.280 the animals that we typically see diet of antacts are herbivores, 1:42:37.439 --> 1:42:42.280 so that's why it's a big problem in livestock amongst cattle, goats, 1:42:42.400 --> 1:42:47.600 and sheep, whereas carnivores actually very rarely succumb to anthrax, 1:42:48.439 --> 1:42:52.839 so it does differ amongst animal groups. And then for humans, 1:42:52.960 --> 1:42:57.200 risk is definitely sort of dependent on occupation and behavior, 1:42:57.720 --> 1:43:02.920 so obviously if you're land manager that's trying to handle 1:43:02.960 --> 1:43:05.280 an outbreak and dispose of the carcasses, that's something that 1:43:05.320 --> 1:43:09.960 will put you at risk. But also it's not uncommon 1:43:10.400 --> 1:43:13.000 in certain areas of the world for people who are 1:43:13.479 --> 1:43:15.920 raising livestock. If they see an animal that's sick, they 1:43:16.000 --> 1:43:18.040 might go ahead and slaughter that animal just so that 1:43:18.080 --> 1:43:21.120 they can try to recover some of the financial investment 1:43:21.240 --> 1:43:25.519 that they've spent. And then once they are slaughtering the animal, 1:43:25.680 --> 1:43:30.320 handling infected animal meat outputs you at risk for continuous anthrax. 1:43:30.760 --> 1:43:32.360 And then if you go. 1:43:32.280 --> 1:43:34.680 On to sell that meat and people eat it and 1:43:34.720 --> 1:43:38.240 it might be undercooked, they can also become infected that way. 1:43:38.800 --> 1:43:43.320 Got it. So, as a pathogen that spends part, if 1:43:43.360 --> 1:43:47.479 not the majority, of its life cycle in the external environment, 1:43:47.600 --> 1:43:52.920 like not being pathogenic necessarily, it seems like very likely 1:43:53.200 --> 1:43:56.559 that global climate change is going to or maybe already 1:43:56.600 --> 1:44:00.479 has begun to impact the distribution of Basilla's and racis 1:44:00.600 --> 1:44:03.160 in some way. So could you talk a little bit 1:44:03.200 --> 1:44:05.960 about what some of the models are predicting in regards 1:44:06.040 --> 1:44:09.240 to the impact of a warming climate on either a 1:44:09.280 --> 1:44:11.880 shift or expansion in the range of this pathogen, and 1:44:11.920 --> 1:44:14.800 what might that mean for the kind of shifting landscape 1:44:14.800 --> 1:44:15.240 of risk. 1:44:16.040 --> 1:44:19.200 Yes, So this moment in time, there's a lot of 1:44:19.320 --> 1:44:22.479 uncertainty in the face of climate change when thinking about 1:44:22.479 --> 1:44:25.639 the soles and racis, because there could absolutely be range 1:44:25.680 --> 1:44:29.519 expansion where we see that new areas are now suitable 1:44:29.560 --> 1:44:32.760 for the bacterias to survive, but at the same time, 1:44:32.800 --> 1:44:36.200 some models predicted there will be range contraction. Additionally, some 1:44:36.240 --> 1:44:39.639 people hypothesize that outbreaks could become more intense because those 1:44:39.760 --> 1:44:42.240 weather patterns that I talked about earlier, where there's a 1:44:42.240 --> 1:44:44.479 really wet spring and then a hot dry period that 1:44:44.520 --> 1:44:46.640 could happen more frequently, or it could be on like 1:44:46.800 --> 1:44:50.320 larger scales. But at this point it's really difficult to 1:44:50.479 --> 1:44:53.759 know exactly what's going to occur. 1:44:53.880 --> 1:44:55.440 We don't really have enough data. 1:44:55.920 --> 1:45:00.120 And because antax, there's a lot of stigma around it, 1:45:00.160 --> 1:45:03.840 so it's actually under reported globally. So we're still kind 1:45:03.880 --> 1:45:07.760 of working on getting highly accurate maps of just where 1:45:07.760 --> 1:45:11.519 cases are occurring today. So projecting that into the future 1:45:11.560 --> 1:45:14.280 is something that's pretty difficult at this point to do. 1:45:14.960 --> 1:45:21.320 Gotcha, gotcha. Yeah, Fortunately for Basilla Santhrasis, we do have 1:45:21.520 --> 1:45:26.479 various methods of control or prevention sometimes treatment. So we 1:45:26.520 --> 1:45:29.479 have like a vaccine, we have antibiotics, and we have 1:45:29.600 --> 1:45:34.160 also just improved sanitation and monitoring measures, and so we 1:45:34.200 --> 1:45:36.240 wanted to ask sort of how do the use of 1:45:36.360 --> 1:45:42.280 these different control measures differ between wildlife and domestic animals 1:45:42.280 --> 1:45:47.000 for instance, or just between animals in general and humans. So, like, 1:45:47.120 --> 1:45:50.480 for instance, let's say that there's an outbreak in wildlife, 1:45:51.120 --> 1:45:54.879 how might different control strategies be used in that outbreak 1:45:54.880 --> 1:45:57.920 compared to one in livestock for instance. 1:45:59.520 --> 1:46:01.919 Yes, so that is the good news. There are different 1:46:02.080 --> 1:46:06.640 control strategies. And for livestock, there is a vaccine that's 1:46:07.160 --> 1:46:10.920 very effective and it's been in use for decades and 1:46:10.960 --> 1:46:12.040 it's easy to administer. 1:46:12.280 --> 1:46:15.599 But the downside of that is that. 1:46:15.760 --> 1:46:20.520 The vaccine is most effective twenty one days after vaccination, 1:46:21.160 --> 1:46:23.240 so it might not be most effective to administer in 1:46:23.280 --> 1:46:26.000 the middle of an outbreak. And then additionally, the vaccine 1:46:26.040 --> 1:46:30.400 has to be readministered annually, so that is time consuming 1:46:30.479 --> 1:46:33.840 and can sometimes be difficult. In terms of wildlife, the 1:46:33.920 --> 1:46:38.880 vaccine is safe for wildlife. That is an off label use, 1:46:39.200 --> 1:46:42.519 meaning that there haven't been that many clinical trials done 1:46:42.560 --> 1:46:47.200 to confirm the safety and efficacy of vaccine and wildlife, 1:46:47.200 --> 1:46:49.040 but it has been used for a variety of species 1:46:49.080 --> 1:46:52.240 and seems to be effective. The problem with that is 1:46:52.280 --> 1:46:55.960 that the vaccine is an injectable vaccine, so if you 1:46:56.000 --> 1:46:58.679 can't get close to the wildlife in question, that makes 1:46:58.720 --> 1:47:03.080 it very difficult. Can dart So if you have a 1:47:03.160 --> 1:47:04.760 dart and you put the vaccine in it and then 1:47:04.800 --> 1:47:06.920 you can shoot the animal, that is a way to 1:47:07.000 --> 1:47:11.639 administer it. And that's sometimes used for wildlife that are 1:47:12.320 --> 1:47:14.680 like on some of these closed franches that have like 1:47:14.760 --> 1:47:19.439 exotic wildlife species that are expensive animals. Sometimes people try 1:47:19.479 --> 1:47:21.760 to do that, but they also have to weigh the 1:47:21.880 --> 1:47:24.800 risk of then you can potentially injure the animal with 1:47:24.880 --> 1:47:27.840 a dart versus administer in the vaccine. 1:47:28.360 --> 1:47:29.840 Right. Interesting. 1:47:30.240 --> 1:47:34.160 Yeah, So you know, with these different control strategies, does 1:47:34.200 --> 1:47:37.040 their effectiveness vary regionally? 1:47:37.840 --> 1:47:38.200 Yes. 1:47:38.720 --> 1:47:41.920 Vaccine use is a strategy that varies regionally and by 1:47:42.000 --> 1:47:46.719 country and sometimes even within countries. In the former Soviet Union, 1:47:46.720 --> 1:47:50.400 for example, they have a legacy of really high vaccination 1:47:50.520 --> 1:47:53.639 of livestock, so that's still in place in many countries 1:47:53.720 --> 1:47:57.960 in Central Asia and Eastern Europe, whereas a lot of 1:47:58.000 --> 1:48:01.479 areas in for example to here, in Africa and South 1:48:01.479 --> 1:48:04.280 and East Asia, the amount of vaccinations going out to 1:48:04.320 --> 1:48:08.200 livestock are really low, sometimes around like zero to five percent. 1:48:08.840 --> 1:48:11.520 So one of the methods of control during an outbreak 1:48:11.760 --> 1:48:17.280 is proper carcass disposal. So it's very important to try 1:48:17.280 --> 1:48:19.479 to dispose of the carcass in a way that will 1:48:19.520 --> 1:48:22.880 minimize the amount of bacterial that gets leached out into 1:48:22.880 --> 1:48:23.600 the environment. 1:48:24.040 --> 1:48:25.760 How we recommend that people do that. 1:48:26.160 --> 1:48:28.800 The best method is through burning, and if you can't 1:48:28.800 --> 1:48:32.720 burn the animal thoroughly, we recommend that people bury it. 1:48:33.080 --> 1:48:36.240 If you can't bury it, we recommend decontamination. 1:48:35.560 --> 1:48:36.639 With a bleach spray. 1:48:37.320 --> 1:48:42.240 But regionally, especially in areas if they're experiencing an outbreak 1:48:42.280 --> 1:48:44.920 in the hot, dry season, it might be too dangerous 1:48:44.960 --> 1:48:48.160 to try to burn the animal carcass because of the 1:48:48.240 --> 1:48:49.880 danger of wildfires. 1:48:50.760 --> 1:48:55.720 So with anthrax, it's one of these examples of a 1:48:55.760 --> 1:48:59.280 system that there are so many different angles where not 1:48:59.320 --> 1:49:01.559 only can you study it, but you kind of have 1:49:01.680 --> 1:49:05.040 to because you have you know animal hosts, you have 1:49:05.200 --> 1:49:09.320 a human disease, you have the genetics or the microbiology 1:49:09.400 --> 1:49:13.840 of the pathogen itself, but then you have the environmental aspects. 1:49:14.240 --> 1:49:18.560 You have all these different regional aspects of different cultural practices. 1:49:18.600 --> 1:49:22.639 It's so much and then there's like public health big 1:49:22.680 --> 1:49:25.360 scale on top of all of that. So could you 1:49:25.439 --> 1:49:29.600 talk a little bit about how interdisciplinary research is just 1:49:29.680 --> 1:49:33.519 so crucial for a disease like anthrax and kind of 1:49:33.560 --> 1:49:37.680 what interdisciplinary research looks like in practice. 1:49:38.200 --> 1:49:43.280 Yeah, So interdisciplinarity is really important for anthrax because, as 1:49:43.280 --> 1:49:47.280 I donostics, there are many different agencies and research groups 1:49:47.280 --> 1:49:51.720 and stakeholders all involved, and our lab aims to be 1:49:51.800 --> 1:49:53.800 a part of the practice by being involved in so 1:49:53.800 --> 1:49:56.719 many different pieces of the puzzle. So we do things 1:49:56.760 --> 1:50:00.240 from working outbreaks on the ground with land manager, to 1:50:00.320 --> 1:50:03.000 then taking those samples that we collect back to the 1:50:03.080 --> 1:50:07.280 lab and doing diagnostics to hold genome sequencing, to then 1:50:07.400 --> 1:50:11.040 mapping the outbreak and trying to analyze it, to then 1:50:11.200 --> 1:50:15.719 also working with partners internationally to try to mutually educate 1:50:15.720 --> 1:50:20.160 ourselves about the disease and also to help inform them with. 1:50:20.200 --> 1:50:21.479 Prevention of the disease. 1:50:22.040 --> 1:50:25.479 So there's definitely a lot of components to go into it, 1:50:25.560 --> 1:50:29.439 and it's difficult to coordinate, and it's as many public 1:50:29.439 --> 1:50:30.160 health issues are. 1:50:30.200 --> 1:50:32.519 There's so a lot of progress to be made. 1:50:32.560 --> 1:50:35.519 As I mentioned, there's a lot of sigma around anthrax, 1:50:35.600 --> 1:50:39.840 so it goes under reported globally. And it's also really 1:50:39.840 --> 1:50:44.439 difficult to determine the exact distribution of vaccination and how 1:50:44.439 --> 1:50:47.320 many vaccines are going out to animals. So to more 1:50:47.360 --> 1:50:51.320 accurately understand where cases are occurring as well as vaccination, 1:50:51.760 --> 1:50:56.600 we really need more accurate reporting, which takes interdisciplinarity and 1:50:56.640 --> 1:50:59.960 the cooperation between many different groups and agencies. 1:51:24.680 --> 1:51:28.960 That was so awesome. Thank you so much, Morgan, and 1:51:29.200 --> 1:51:31.519 thank you to doctor Saltzer as well. That was just 1:51:32.160 --> 1:51:33.680 so great. I loved it. 1:51:33.880 --> 1:51:36.160 We were so lucky to get to have both of 1:51:36.200 --> 1:51:37.040 you on. Thank you. 1:51:37.760 --> 1:51:44.680 Yeah, all right, this was a really fun episode to do. 1:51:44.760 --> 1:51:48.240 It was super interesting, so many different angles. 1:51:48.600 --> 1:51:50.439 I feel like I learned a lot. 1:51:51.240 --> 1:51:55.160 Yeah, absolutely, Speaking of learning a lot and learning a 1:51:55.200 --> 1:51:57.360 lot more, should we do sources? 1:51:57.560 --> 1:51:58.480 Let's these sources? 1:51:58.880 --> 1:52:03.479 Okay, So for this episode, I have a lot of 1:52:03.520 --> 1:52:08.120 sources and I will list all of them on our website, 1:52:08.160 --> 1:52:10.519 but I do want to shout out a book that 1:52:10.600 --> 1:52:14.040 I used called Death in a Small Package, A Short 1:52:14.080 --> 1:52:16.519 History of Anthrax by Susan Jones. 1:52:17.080 --> 1:52:21.080 Yeah. I also had quite a number of sources Aaron 1:52:22.520 --> 1:52:24.400 a couple that I wanted to give a special shout 1:52:24.400 --> 1:52:26.599 out to. There was a paper it's a little old 1:52:26.640 --> 1:52:29.120 now from nineteen ninety eight by the World Health Organization 1:52:29.439 --> 1:52:32.600 that is Guidelines for the Surveillance and Control of Anthrax 1:52:32.600 --> 1:52:35.360 in Humans and Animals. It's just a really nice kind 1:52:35.360 --> 1:52:40.439 of overview of just how broad anthrax is. And then 1:52:40.600 --> 1:52:43.880 a couple of really great papers by doctor Colin Carlson 1:52:44.960 --> 1:52:49.120 really focusing on how important interdisciplinary research is for anthrax. 1:52:49.439 --> 1:52:52.040 So there's a paper from twenty eighteen called Spores and 1:52:52.120 --> 1:52:57.320 Soil from Six Sides, Interdisciplinarity and the Environmental Biology of Anthrax. 1:52:58.200 --> 1:53:01.920 And Morgan Walker wrote an awesome paper that came out 1:53:01.920 --> 1:53:05.280 in twenty twenty called Ungulate Use of locally infectious Zones 1:53:05.320 --> 1:53:09.080 in a re Emerging Anthrax risk Area. You'll find the 1:53:09.160 --> 1:53:11.640 list of all of our sources from this episode and 1:53:11.760 --> 1:53:14.519 every one of our episodes on our website This podcast 1:53:14.520 --> 1:53:17.880 will kill you dot com, Yes you will. 1:53:17.920 --> 1:53:22.479 Thanks again so much to our absolutely wonderful guests. It 1:53:22.600 --> 1:53:25.400 was such a joy yeah to chat with you, it 1:53:25.439 --> 1:53:25.920 really was. 1:53:26.320 --> 1:53:28.640 Thank you also to Bloodmobile, who provides the music for 1:53:28.720 --> 1:53:31.080 this episode and all of our episodes. 1:53:31.040 --> 1:53:33.559 And thank you to the exactly Right Network, of whom 1:53:33.560 --> 1:53:35.160 we are a very proud member. 1:53:35.680 --> 1:53:39.240 And thank you to you listeners, you make this podcast 1:53:39.240 --> 1:53:39.840 worth making. 1:53:40.000 --> 1:53:44.439 Honestly, seriously, absolutely one hundred percent true. And also a 1:53:44.520 --> 1:53:48.040 special shout out to our patrons. We love you and 1:53:48.080 --> 1:53:55.960 appreciate you like so much, so much. Okay, well, until 1:53:56.000 --> 1:53:57.960 next time, wash your hands. 1:53:57.760 --> 1:54:03.519 You filthy animals. 1:54:00.040 --> 1:54:15.320 Obu bon bu bu bu bu bu