This Podcast Will Kill You - Ep 44 Pertussis: Whoop Here It Is

Episode Date: February 18, 2020

[TRIGGER WARNING: see below] Whooping cough, that terrible childhood scourge, has been making an alarming comeback due to lapses in vaccination coverage across the globe. And in this episode, we’ll tell you why exactly its return is a cause for concern. From the devastation it wreaks on the body to the untold tragedy of past epidemics, pertussis is a dreaded disease that was nearly relegated to the past thanks to the amazing efforts of three incredible researchers, Pearl Kendrick, Grace Eldering, and Loney Gordon. But as the provider of our firsthand account illustrates, pertussis is still very much present today. We are joined by the incredible Catherine Hughes, who does us the honor of sharing her story about her son Riley and her efforts to raise awareness about the importance of childhood vaccinations. Read more about the Light for Riley campaign and the Immunisation Foundation of Australia to see the hugely important work being done. Trigger Warning: The firsthand account of this episode features the death of an infant. If you do not wish to hear this, skip to 5:10. See omnystudio.com/listener for privacy information.

This is exactly right. There are already enough things charging your card every month. Dinner should not be one of them, which is exactly why Blue Apron is now subscription-free. You heard that right, Blue Apron no longer requires a subscription. You can order meals when you want them and skip when you don't without adding another recurring charge. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients, so there's no meal planning and no extra grocery trip. Order now at Blue Apron.com. Get 50% off your first two orders plus free shipping with code this podcast 50.

Terms and Conditions Apply. Visit blueapron.com slash terms for more information. This is Bethany Frankel from Just Be with Bethany Frankel. Listen, I have a bone to pick with these dog food brands calling themselves fresh, natural, healthy. Sounds great, but a lot of these quote-unquote fresh dog foods in your fridge are not even 100% human grade, which is why feed your babies, just food for dogs. It's good enough for big and smalls, my precious babies, so it's good enough for your babies. 100% human grade, real ingredients, beef, sweet potatoes, green beans, delicious.

These are foods that you would want to eat. Not that the babies would ever share. Just Food for Dogs is the number one bet recommended fresh dog food back by over a decade of research. No marketing fluff. My dogs lose their minds at dinner. They run to the bowl, tags wagging, paws tapping, full Broadway performance every single night. So I do care about the food I feed big and smalls. So go to just food for dogs.com for 50% off your first box, no code, no gimmicks, just real fresh food.

Janice Torres here. And I'm Austin Hankwitz. We host the podcast, Mind the Business, Small Business Success Stories, produced by Ruby Studio, in partnership with Intuit QuickBooks. We're back for season four to talk to some incredible small business owners. The big thing about working at tech is that it's ever evolving, ever changing. everyone's a rookie. That's how fast the industry is changing. So what I'm really excited about is to be part of that change. So listen on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts. My name is Catherine Hughes and five years ago I gave birth to the most beautiful,

gorgeous little boy. His name was Riley and he had soft blonde hair and gorgeous piercing blue eyes. but when Riley was about three weeks old, he started to get sick. I really thought it was just a cold at first. It was just a bit of a runny nose, a bit of a sniffle, and I wasn't too worried. But then a couple of days later, I heard this tiny little cough. And I'll never forget the sound it made. It was so small, so innocuous, but it was really a sign of what was to come. my husband was away for work so I decided to call out a locum doctor to come visit our house one evening

Riley was about four weeks old at the time and Riley appeared perfectly healthy he was sound asleep and you just couldn't tell that there was anything wrong with him in between the coughing bouts so the doctor looked at Riley reassured me that I was probably worrying too much that Riley seemed to be perfectly okay. That evening, Riley slept and slept and slept and just did not want to breastfeed. He didn't want to wake up. He was so sleepy. I was feeling really uncomfortable at that stage, so my husband flew back in from work and we took him to hospital the next morning. And at hospital, he was admitted overnight because they were just a bit worried that he was not interested in breastfeeding anymore. But Riley didn't go home the next day. Each

day that he stayed in hospital, he just seemed to grow worse and worse and the coughing got more severe. It felt like every day there were just more tubes and wires and more doctors. Everything just got worse and worse. On his fourth day in hospital, we were moved into the pediatric intensive care unit. The doctors were concerned that he had developed pneumonia and they were pretty confident at this stage that he had whooping cough. When the doctors diagnosed Riley with whooping cough, I actually felt a bit relieved because I thought that there was, they'd be able to cure him. But there is no cure for whooping cough. You just kind of hope and pray that they get better as they are cared for in hospital. And Riley didn't get better. His organs started to shut down by

day five his heart was under a lot of strain and on on day five which was his last day in hospital he was unconscious they'd put him in a on life support and they'd tried to use ecmo to save his life and i just remember looking at his body on the bed it was a big bed a tiny little four-week-old baby on there but he was so swollen and just covered in so many wires and tubes it was really the most traumatic thing to see. And that afternoon, we watched as this pink, foamy stuff started coming out of his lungs, and the doctors told us that there was nothing more that they could do. We'd asked about organ donation, but unfortunately, I think his organs were just too

ravaged from the toxins released by the whooping cough bacteria. So at two in the afternoon, after five days in hospital, we took Riley off life support. And he was just hot and swollen and so sick. And they took all the chibs and wires out and we had to say goodbye to our little baby all because he had caught this horrible, preventable, whooping cough. And he was too young to be vaccinated. He was only 32 days old when he died. And at the time, pregnancy vaccination hadn't been routinely recommended or funded in Australia.

So newborn babies like Riley were extremely vulnerable to who been cough. And it cost him his life. Hi, I'm Erin Welsh. And I'm Aaron Oman-Updike. And this is, this podcast will kill you. Yeah, today it is. Today it is. Yeah, so you just heard from Catherine Hughes, who was kind enough to come on to the podcast and share with you her story.

And you're going to hear a little bit more from her later on in the episode as well. So thanks again, Catherine. That was, yeah. Yeah, it's a horribly depressing story that, unfortunately, isn't the only one out there. So today we're obviously talking about pertussis. Whoop and cough. To get us to this episode, we are drinking a very strong quarantini. Yes, it's basically all alcohol. It is called three women and a baby. And it's called that because the first really successful vaccine that was in widespread use was developed by three awesome women. Whoop, whoop. Girl power. Yeah. So what is in three women and a baby?

Well, it's rye whiskey, of course, because whiskey, as we all know, is the cure for all children's ailments. Of course. Don't do that at home. It's not true. Not evaluated by the FDA or this podcast. We're not being serious. No. It also has luxardo liqueur.

And chenar. Which is an artichoke lique lique. Which sounds weird, but it's quite tasty in context. It's bitter and delicious. Mm-hmm. Also, my band name. Bitter and delicious. Yeah.

That's a good band name, actually. Garnish with a cherry and enjoy. And we'll post the full recipe for this quarantini as well as our non-alcoholic placebo-rita on our website. This podcast Will Kill You.com and all of our social media channels. Making the placebo-rita is going to be a challenge for this one. You'll figure it out. We'll come up with something. Total faith.

Glad you do. I say you'll figure it out. I'll just be like nice. Now this feels like a group project again. I also want to give a quick shout out and thank you to Akiy. And I'm sorry that we might have just pronounced your name wrong, but for sending us the most adorable gift package from Texas, y'all. Oh my gosh. It's adorable. There's so many great things. Did you guys know something called Texeroni existed? It's macaroni in the shape of Texas.

Okay. It's everything I needed in life and I love it. I feel like that should be sold in stores across the U.S., but Texeroni version, not like, you know, Illinois version. Not like Illinoisoroni. No, I wouldn't eat that. Texas is a great shape for pasta. Who knew? It really is. I can't wait. We'll need to make mac and cheese together or something, Aaron. Oh my gosh, yeah. Anyways, thank you so much. That was really sweet of you and sorry it took forever for me to check our PO box. We should post pictures. Yeah, we should. Of us eating macaroni and cheese? Yes. Okay, cool. Cool. Okay. All right. Shall we jump right in? Let's do it. Should we take a quick break first? I think we need a breather, right? Yeah. Dinner shows up every night, whether you're prepared for it or not. And with Blue Apron, you won't need to panic order takeout again. Blue Apron meals are designed by chefs and arrived with pre-portioned ingredients, so there's no meal planning and no extra grocery trip. There, assemble and bake meals take about five minutes of hand. on prep. Just spread the pre-chopped ingredients on a sheet pan, put it in the oven, and that's it. And if there's truly no time to cook, dish by Blue Apron meals are fully prepared. Just heat them in the oven or microwave, and dinner is ready. And here's the exciting news. Blue Apron no longer

requires a subscription. You can order meals when you want them and skip when you don't without adding another recurring charge. Order now at blueapron.com. Get 50% off your first two orders plus free shipping with code this podcast 50. Terms and conditions apply. Visit blue apron.com slash terms for more information. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something. That's why O'Keefe's working hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions. Working hands creates a protective layer on the skin that locks in moisture.

It's non-greasy, unscented, and absorbs quickly. A little goes a long way. Moisturization that lasts up to 48 hours. It's made for people whose hands take a beating at work, from health care and food service to salon, lab, and caregiving environments. It's been relied on for decades by people who wash their hands constantly or work in harsh conditions because it actually works. O'Keefs is my hand cream of choice in these dry Colorado winters when it feels like my skin is always on the verge of cracking. It keeps them soft and smooth, no matter how harsh it is outside. We're offering our listeners 15% off their first order of O'Keefs. Just visit O'Keef's Company.com slash this podcast and code this podcast at checkout.

A timeless wardrobe starts with pieces that are built well from the beginning. From the fabrics to the fit, everything needs to last beyond one season. And that's how Quince approaches design. Quince has all the staples covered, from 100% organic cotton sweaters to premium denim made with stretch for all-day comfort and luxe cotton cashmere blends, perfect for the changing seasons. The quality shows in every detail, the stitching, the fit, the fabrics. Every piece is thoughtfully designed to be your new wardrobe essential. And each piece is made with premium materials in ethical trusted factories

and priced far below what other luxury brands charge. I recently got a pair of Quince's Bella stretch wide-leg jeans, and they are now in constant rotation. They are so comfortable. The fit is amazing, and they come in a bunch of different washes, so I'm about to go order some more. Refresh your wardrobe with Quince. Go to quince.com slash this podcast to get free shipping on your order and 365-day returns, now available in Canada, too. That's Q-U-I-N-C-E.com slash this podcast to get free shipping and 365-day returns.

com slash this podcast. So pertussis, aka whooping cough. Let's talk about what these symptoms are. So pertussis is caused by a bacterium, and the name of the disease, a colloquial name, whooping cough, tells you the most characteristic part of these symptoms. And that is this very distinctive whooping sound that is not actually during the cough, but it's as people try and take a breath of air in after an episode of coughing. And so is the the whoop, is that all ages that have whooping cough or is that mostly younger children? Good question. We'll talk a little bit more in a bit about the differences in symptoms. It can happen in people of any age, but it's most typical in younger age groups. Okay. And we'll talk about why in a bit. That's a really good question,

though. All right. So the bacterium that causes pertussis is called Bordidella pertussis. It's a little gram-negative rod. So again, gram-negative means it's pink when we stain it. However, while Bordidella pertussis is the most common cause of whooping cough, there are a couple of other very closely related bacteria species, including Bordidella periportesis and Bordadela bronchiceptica that can in some cases cause a very clinically similar disease. But Bordadela pertussis is the one that, for example, we have a vaccine for and kind of the most important of these species. Are you ready for questions? I feel like this is the earliest that I'm getting into. I can tell that you have them already. Okay. So about these different bacterial species,

are they as globally prevalent as just Bordetella pertussis? Good question. I know that periportezis is pretty widespread globally. I would guess that bronchiseptica is as well. One of the big differences is that these other species are found in many other species of animals as well, whereas Bordidella pertussis is a human-specific disease. Side note, though, Bordetella bronchuseptica causes kennel cough in dogs. Interesting. Huh. So anyways, pertussis is transmitted via respiratory droplets. I've seen estimates that the R-Not, which if you'll remember from previous episodes, is the number of secondary infections that a primary infection can cause.

I've seen estimates ranging anywhere from 5 to 15. Wait. I know. That's bigger than measles. I was going to say. Which doesn't seem right. Well, but I guess the R-N... Like the R not is, it's an average.

Yeah, but anyways, in any case, this is a highly, highly infectious disease. It spreads very easily. Yeah. In general, the incubation period, so the time between when you first get exposed and when you start to show symptoms, on average is about a week, maybe 10 days, but it can be quite a bit longer. And I think the reason that the range can be longer is twofold. partly it has to do with infectious dose, how much are you exposed to at the outset, but also it's very difficult to pinpoint when exposure might be in relation to symptoms because the onset of symptoms for this disease is kind of insidious,

which means it's slow and you might not recognize at first for like a week or more that what you're dealing with is actually pertussis. Oh, okay. So let's talk about how this little bacterium gets into you and causes disease. Okay. And then we'll talk about those insidious. That's one of my favorite words, insidious symptoms. Yeah.

Also, it's going to end up convincing a lot of people that they have whooping cough. Probably. I mean, I convinced myself that my baby had whooping cough. So you're not alone if this convinces you that you have whooping cough. Okay. We just apologize in advance. Yeah, we do. So, unlike many of the other diseases that we've talked about recently, including

like syphilis and E. coli, even Dengue, this is a highly, highly specific bacterium. So it doesn't just go throughout your whole body wreaking havoc. Bortatela pertussis replicates only in association with the ciliated epithelium of your lungs. How does it only reproduce there? How? It has, okay, so pertussis has a lot of different virulence factors on its surface that allow it to colonize our body and then cause the symptoms that it causes. It also has a number of different toxins, which are really ultimately responsible for a lot

of the symptoms that we see. And so these virulence factors very specifically allow it to bind to. the epithelium of our respiratory tract. Okay. And so those are the only cells that they bind to. Now, Bortatella does not invade our cells, but it binds to these respiratory cells, and then it replicates in association with those cells. So like next to those cells. What? This is so weird. Okay. I know, isn't it? So this is a very, like, I don't know how much you're going to talk about the evolution of this pathogen. Yeah. But it seems to me, like,

Based on this, we've had a long association with this pathogen. Am I right? I'm going to withhold comment until the history section. Excellent. That would be my guess based on the fact that this is a bacterium that is highly specialized to these cells in our respiratory tract. And it's a human-specific pathogen, so it's not found in a bunch of other animals. Right.

Okay, cool. But why? So are human respiratory cells that much different than, any other mammal respiratory cells? Oh, than any other mammal? I have absolutely no idea. I mean, I guess they're specific enough that the virulence factors that Bortatela pertusses has doesn't allow them to easily colonize other animals. Yeah, I'm just wondering what it is about the specificity that's like, I don't know. Yeah, great question. I mean, it makes sense, like, that it would, if it's going to specify on any cells, respiratory epithelia are great

because it's going to cause you to cough and sneeze, and that's going to spread the pathogen really far. Yeah. So from that perspective, it makes sense. But the specificity to humans, I don't know, man, how does that ever happen? Right? And again, Bortitella has a number of different toxins that it releases that result in a lot of the damage and symptoms that we see.

So in addition to like pilli, which we've talked about before, those sticky things that allow it to attach to the respiratory tract. Two of the important toxins that it has are, number one, a toxin called pertussis toxin. It's a really good name for it. That actually blocks the ability of our white blood cells to get back into our lymph system. Oh. So what that means is that you have white blood cells coming because they recognize bacteria, right? They're like, oh man, we need to come in and help out. But then what those white blood cells want to do is then go back to our lymph nodes and regroup so that they can like figure out a plan of attack kind of. So pertussis toxin blocks their ability to do that. So you end up with a ton of white blood cells in the bloodstream

because they've all come out to try and figure out what's going on with these bacteria, but then they can't get back where they want to be. Oh my gosh. Yeah. Okay. That's really interesting. It is. And it's one of the only systemic symptoms of abortateloportesis infection is this what we call lymphocytosis, a lot of white blood cells in your bloodstream. Okay. So that's pretty indicative. It is, yeah. I mean, you can get that in tons of other diseases, so it's certainly not specific at all. Right. But it's one of the only like systemic manifestations because this is a very respiratory specific pathogen. And then it has other toxins, which I forgot to write the name of. of down, of course. I think tracheal toxin is one of them, actually, that damage directly, caused

direct damage to the cilia of our respiratory epithelia. And so cilia are these little, what do you call this, Aaron? Fingers? Fingers? What I'm doing with my fingers? Like undulating. Undulating anemone, kind of things. Yeah, exactly. Little projections on these cells that help to sweep mucous and debris up and out of our respiratory tract. We talked a lot about them in our cystic fibrosis episode. Yeah. Anyways, so these other toxins, tracheal toxins and others, that Bortatella produce, caused damage to that system. So you're going to get a buildup of gunk in your lungs when you get infected with pertussis. Now we know what it does in your body, how it's infecting you, so what does it look like when you get infected? Not good. It's not good. So there are three main

phases to pertussis, what's called the cataral stage, I think that's how you pronounce it, the paroxysmal stage, and then the convalescent stage, aka recovery. So the cataral stage is this very insidious, nondescript illness. And this is what can make it difficult to pinpoint exactly when you might have started showing symptoms. And what I think is worst about this phase is that the symptoms are quite mild in a lot of cases. So these include something like a runny nose, not a gunky nose, just kind of a watery, runny nose. Carriza, so like tearing from your eyes, like kind of like a viral eye infection might be. Okay. Okay. Mm-hmm. Like watery eyes. Maybe your eyes get a little red. Maybe they're itchy. Like maybe you think it's allergy.

you might have some sneezing. And at first it starts off with a pretty mild cough. And that's how it begins. And in tiny kids, actually, across the board, if there is a fever, which often there isn't a fever at all, even if there is a fever, it's usually pretty mild. Like we're talking maybe like 101, which is a pretty low grade fever. If you're talking about a kid who's like over age two, you mostly wouldn't even be concerned about a fever that low because kids get fevers from everything.

Like every infection is going to give a kid a fever. So if a kid has a very low fever, you probably aren't going to be like, well, this kid is clearly very sick. You'll be like, oh, it's a little fever. They'll get over it. Right. But that's it. Those are the symptoms. This lasts for like one to two weeks.

It's super mild. the coughing sort of starts to get worse, but at this phase, it doesn't have anything that makes it stand out. It's not more frequent at certain times of day. It's not super productive. It's just like a kind of normal cough. Okay. And again, no fever. Then comes the paroxysmal phase. And this is the whooping cough of whooping cough. Okay. So the cough that starts out as mild in that catars. phase becomes paroxysmal. Paroxysmal means a sudden recurrence. So all of a sudden, out of the blue, people will have a massive coughing attack. These usually are like between five or ten, but they can be up to 30 coughs in a row. And they become also these paroxysms, these coughing attacks, become more frequent at night and overall increase in frequency both throughout the day and the night. And each one becomes more severe than the last. Okay. And it's kind of almost hard to describe how terrible these coughs are. So I actually found a paper from 1975 that's a really nice overview of protussis.

And I'm going to just read this. The child possessed of the coughing fit is a pitiful sight, all the more so as the observer is helpless to alleviate or terminate the attack. Each attack consists of 10 to 30 forceful coughs per spasm, and into each cough the patient appears to concentrate all his energy. He leans forward, or if standing, stands with legs spread, grasping the nearest object and leaning far forward, tongue protruded to the utmost, saliva and mucus streaming from nose and mouth, eyes bulging with tears streaming, his entire body racked with the total exertion of each cough. The coughing continues in a staccato series.

The face becomes more and more cyanotic, which means blue. The neck bulges with venous congestion and still the attack continues. Finally, when it seems certain that death is imminent, a final cough appears to clear offending secretions or mucus from the upper airway, and the first opportunity to inspire is offered. With a massive effort, inspiration ensues, air rushes into the lungs against a still narrowed glottis, and the characteristic whoop is produced. Oh my gosh. Yeah.

I'm just taking a second to, like, breathe. Right? Wow. Yeah. And so that's kind of a very classic description of what these paroxysms look like. They're horrible. I don't recommend Googling them, but you can find a lot of videos of them online. Are the coughs productive? Are you coughing up mucus or gunk from your lungs?

So yes and no. There is a lot of mucus in your lungs, and so it's thought that these coughing spasms are because of that mucus. It's like you're trying really hard to get that mucus up. But especially because this is often a disease of very young infants, they're not good at coughing stuff up. So they may or may not actually cough anything up. But there is a lot of mucus there that could potentially be coughed up. Okay. Yeah. One of the sort of other characteristic things that happens after these paroxysms is what's called posttussive vomiting. So it's really common to cough so hard that you end up vomiting.

Oh, gosh. Yeah. It's horrific. And these episodes are so exhausting. I mean, imagine you are literally unable to breathe this whole time, which is why that inspiratory whoop is so, like, it's so powerful. You're trying so hard to get air back into your lungs that as these progress and become more and more frequent throughout the ensuing days and weeks, this can last for weeks. people tend to become very, very exhausted.

So they might be sleeping most of the day and only awaken when they have these coughing fits and then fall kind of right back to sleep. It sounds so utterly exhausting. Yes. Oh, my gosh. And so especially in, well, in babies and in older children and adults, this can lead to weight loss because people might stop eating because they're just sleeping through, like, in between every coughing episode.

Right. You can also get a lot of complications from the actual force of the coughing. You can burst blood vessels in your eyes or under your skin. You can cough out like a hernia. You coughing so hard that you, like, result in a hernia through your belly button. You can crack ribs. Yeah. And often your chest wall will get really sore and tender, even if you don't break a rib,

just because you're working those muscles so, so hard to, cough so much. And then there are a number, kind of a couple of really important complications that can happen on top of this. The most deadly of which is a secondary pneumonia. Okay. So that's like a secondary, usually it's a secondary bacterial infection because you've been sick with pertussis for so long. And that often causes the most deaths. It's not the only way that you can die from pertussis, because these paroxysms can be so severe that you can have prolonged hypoxia, which means your brain isn't getting enough oxygen, that can result in encephalopathy. So brain damage, which can cause either long-term brain damage or can cause death, especially in young infants.

Yeah. Yeah, there's a number of other complications that you can get. You can rupture your trachea or your esophagus and get air that goes into like your subcutaneous tissue or you can collapse one of your lungs and get a pneumothorax from coughing so hard. Is that the air and subcutaneous tissue, is that in the 1918 flu, the pockets of air, the crackles and pops? Yep. Yeah. Yeah.

Snap crackle pop under your skin. So this phase overall, the paroxysmal phase, can last anywhere from one to four. four weeks. But even as it starts to improve and you enter the convalescent phase, it's a very gradual improvement. Another name for pertussis is actually the 100 days cough. Uh-huh. Yeah, because symptoms can continue for like up to six months. Yeah. So that's pertussis. Wow. Yeah. It is technically treatable with antibiotics, but the antibiotics work best if you can get treatment during that Cataral phase. Okay.

Which again is, I mean, a lot of people are never even going to seek treatment during that phase because that phase alone can last one to two weeks. Right. Yeah. And so treatment with antibiotics works best if you can get it, if you can get treatment during that initial phase. After that, the problem is that the bacteria have already started releasing all those toxins. So while antibiotics are still effective at eliminating the bacteria.

they don't really help with symptom treatment. Okay. So, yeah, what they do do is help to prevent further spread of the disease. So it is still really important to treat with antibiotics, even if you're not treating until later in the disease course. Right. Is there any antitoxin available? As far as I know, no.

Like, there's no antitoxin treatments that we have or anything like that. Okay. Like there was for diphtheria before. Yeah. Well, I guess still it is, but yeah. Okay. Interesting. Yep.

This is making me feel a lot like the diphtheria episode. Like you can't breathe. Yeah, sort of like the... Do you have a pseudomembrain covering your throat? Yeah. Yeah. Yeah. It's a horrible illness.

It's really horrible. But vaccine preventable. I think we should specify that at the outset of this. episode. This is a horrible illness and it is vaccine preventable. It really is. No kids should be dying from pertussis today and unfortunately they are. In theory it could be a target for eradication. Yes, because it's a human-specific disease. So, Aaron, how did we get here? Where did this horrible thing come from? I will answer that as well as I can just after this break. Anyone who works long hours knows the routine.

Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something. That's why O'Keefe's working hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions. Working hands creates a protective layer on the skin that lock up. in moisture. It's non-greasy, unscented, and absorbs quickly. A little goes a long way. Moisturization that lasts up to 48 hours. It's made for people whose hands take a beating at work,

from health care and food service to salon, lab, and caregiving environments. It's been relied on for decades by people who wash their hands constantly or work in harsh conditions because it actually works. O'Keefs is my hand cream of choice in these dry Colorado winters when it feels like my skin is always on the verge of cracking. It keeps them soft and smooth, no matter how harsh it is outside. We're offering our listeners 15% off their first order of O'Keef's. Just visit o'keefscompanny.com slash this podcast and code this podcast at checkout. This is Bethany Frankel from Just Be with Bethany Frankel. Listen, I have a bone to pick with these dog food brands calling themselves fresh, natural, healthy. Sounds great, but a lot of these quote-unquote fresh dog foods in your

fridge are not even 100% human grade, which is why feed your babies, just food for dogs. It's good enough for big and smalls, my precious babies, so it's good enough for your babies, 100% human grade, real ingredients, beef, sweet potatoes, green beans, delicious. These are foods that you would want to eat, not that the babies would ever share. Just Food for Dogs is the number one bet recommended fresh dog food back by over a decade of research. No marketing fluff. My dogs lose their minds at dinner.

they run to the bowl, tags wagging, paws tapping, full Broadway performance every single night. So I do care about the food I feed big and smalls. So go to just food for dogs.com for 50% off your first box, no code, no gimmicks, just real fresh food. Janice Torres here. And I'm Austin Hankwitz. We host the podcast, Mind the Business, small business success stories produced by Ruby Studio in partnership with Intuit QuickBooks. And we are back for. Season four, we're talking to small business owners who are doing incredible things in their industries, achieving their dreams, being their own bosses, putting in the work, and enjoying all the benefits

that come with it. This is our most exciting season yet. We're talking to more entrepreneurs about how they launched their vision, and more importantly, how QuickBooks on the Intuit platform helps them do more in less time. Working in QuickBooks just makes it easier to run the business, right? There's so much that you need to do when it comes. comes to running a business, building products, setting up marketing campaigns. And to run a business, you have to make sure that your finances are in order.

So it removes my anxiety from one side of it so that I can focus on everything else. Whether you're a long time listener or just getting started, tune in and join us. You'll be so glad you did. Listen on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. So if you think back to last year during our vaccines episodes, I talked a little bit about pertussis, particularly in the second episode, Part 2, where I talked a lot about the rise of vaccine hesitancy or the anti-vaccine movement nowadays and how the protesis vaccine actually played a pretty central role in that.

Yeah. And back then, I remember promising, oh, I'm not going to go into this. too much because we're going to do a full episode on pertussis. And here I am making good on that, promise. So since I've already talked a lot about the history of protesis when it comes to the rise of the vaccine hesitancy or anti-vaccine movements, I'm not going to go into too much detail on that. So I'll just refer you to part two of vaccines.

Good call. But even before I can get to that part of the story of protesis, there's so much to cover beforehand. So let's go back to the beginning. Throughout history, protusses has been somewhat overshadowed, I would say, by some of the other big-name diseases like smallpox, plague, cholera, tuberculosis, et cetera, sort of the ones that did really come through a population or a city and just wipe a lot of people out. But that doesn't mean that it was minor or easily ignored. Pertusses has been one of the biggest killers of children throughout history. And as I'm sure you're going to talk about, it remains a huge problem around the world today.

I've talked before about the difficulty in retrospectively diagnosing a disease based on historical accounts. Is this one easy? Especially if there's no physical evidence like skeletal damage or something like that. but yeah, pertussis doesn't have that problem as much as some of the other ones. Because the symptoms, as you describe, this whoop, this, the intake of air that's so restricted, it's a pretty characteristic and very noticeable. And it also has a tendency to just infect children. And so descriptions of a disease that mostly impacted children and was accompanied by a horrific cough

that then the breath in afterwards sounded like whooping, it's probably whooping cough. Yeah. Safe assumption. Safe assumption. This is where I think it's going to get interesting. I think so. Anyway. Okay.

So most historical reviews that I read of protesis say that the first definitive or most likely definitive epidemic of the disease happened in 1578 in Paris. All right. So 1578. Like, that's not that long ago. No, especially not for a human-specific pathogen that is so well-suited just to our one cell type. Yes. So.

Interesting. Okay. Interesting. The physician who wrote about this epidemic called the disease Kinta or Kintanatuses, probably to indicate that the severe coughing fits that you mentioned occurred every four or five hours. Oh, okay. And he also described it as being a new disease and or only referred it to like a couple other outbreaks. And he noted that it occurred mostly in children between the ages of four and ten with a violent cough that ended in vomiting, cyanosis, and often death.

However, there are a couple of other possible outbreaks of protesis that date back even further. So in an ancient Chinese medicine treatise dating back to the 600s, there is mention of something called the 100-day cough, which is the colloquial name for protesis in China today. And in this treatise, it says that the cough will last 100 days. And if not cured, 80 to 90 percent of people will die. Whoa. So that's very high. Very high.

And so because of that, because of that extremely, high reported mortality rate. Many researchers dispute this inclusion as whooping cough, saying that it seems to be too lethal to be whooping cough. And there was also no mention made of the fact that it mostly happens in children. So even though it is a 100-day cough now, it might have just changed names. Right. Like it might have just changed diseases, rather. Yeah. They used to call this thing 100-day cough, and now they call Pertussus's 100-day cough. Exactly. There are also a few other possible earlier, not earlier than the 600s, but earlier than Paris, a protesis epidemics in Persia around the 15th and 16th centuries.

And so around this time, just for reference, because I didn't really know this, Persia spanned from modern day Iran into parts of Central Asia and India. Okay. And so in the late 1400s, which is almost a century before the Paris-Pretaceous outbreak, there were two epidemic coughs that led to vomiting and unconsciousness and death in many people, both children and adults, and the fact that adults were affected could suggest that this was a new disease for the population and hadn't fallen into this pattern of childhood illness yet. And there are a few other epidemics in 16th century Persia that seem even more conclusively

to be Wuppenkov. But the take home from all of this, I think, is that the disease seems to be first recognized in humans only 500 or 600 years ago. Whoa, that's the opposite of what I guessed, Aaron. Yeah. So that leads to the question. Is this bacterium really only 500 or 600 years old? Is that when it evolved? No.

No. Definitely not. Definitely not. So there was a research article from 2005 that investigated the evolutionary history of Bordetella pertussis and found that it likely evolved from a human-specific lineage of the related species, Bortatela, bronchiceptica, around 2.5 million years ago. I'm sorry. Yeah. So.

So we go from 2.5 million to 500. Like what's happening? I mean, does that mean that humans have been living with this bacterium for since before humans were humans? And then it just all of a sudden started causing disease? Yeah. I mean, honestly, I don't have a satisfying answer, and I couldn't find one in any of the things that I read. So I think what a few of the articles mentioned is that the most likely scenario is that the bacterium probably circulated in a relatively non-virulant state in parts of Asia, possibly Southeast Asia, for most of its history. And then it evolved these virulence factors that allowed it to become super prevalent. and highly contagious and also lethal.

You know, I bet that is the biggest difference between when you asked about paraportosis and bronchuseptica and why those don't, at least aren't as prevalent, I think it is likely just that they don't cause disease as much, and it is because of those toxins. Like bronchiseptica doesn't produce protussis toxin and neither does periportosis. And it's thought that that's one of the main toxins that causes the symptoms that we see. That's interesting. Yeah. One of the things that I thought was really interesting is in these papers, it's harder to get a sense of historical genetic diversity for some of these bacteria that have had vaccines used against them.

Because you can imagine certain lineages or certain strains or subspecies or whatever have been wiped out in some places. And so the genetic diversity that we're left with now isn't necessarily representative of its historical. Yeah, that's a good point. But I thought that was really interesting. But yeah, I mean, it probably emerged or started causing epidemics five or six hundred years ago because that's when widespread trade and like global travel really kind of got up and running. So, yeah. Fascinating.

And another point in the column of this being a relatively new disease or recently evolved. virulence is that physicians around the time when it first started appearing, they were also baffled by the disease and seemed to make important notes of it. Okay. One physician said in 1894 that, quote, it is singular that a malady so distinctly marked as Wuppenkov should figure so little in the records of the disease from former times. There's no mention of it in like ancient Greece or ancient Rome, sorry, which is, I had to, I had to mention ancient Greece and Rome.

Right. No mention in the Ebers, Ebers, Papyrus. Oh my gosh. Was this even an episode of TPWK? Why? I don't know. It's going to have an asterisk next to it for sure. And the sudden appearance or apparent sudden appearance of Wupperskopf caused other problems as well

because it kind of popped up all over and in such severity, it gained all these different names, even within the same language and didn't even get its scientific name until 1906, like for the bacterium. Okay. Okay, but before we get to that, let's talk about a few of these names because I know that you're going to be excited for it. They're fine. Oh, okay. Yeah. We've had better ones.

Okay. There's no mad staggers or whatever. Dandy fever? Dandy fever. So there were several English names for the disease, including hooping cough, no W, chin cough, kink cough, and others. Kink cough was apparently the popular name for the disease in Scotland, and the word kink, I guess, was also used as a convulsive fit of coughing or laughter, a gasping for breath caused by coughing, laughing, or crying, the whoop and whooping cough. Interesting. It was like from a definition somewhere.

Yeah. In France, it was known as Kinta. In Italy, it was called Tosaferina or Tosa canina, canina, because the cough could sound like the barking of a dog. Ah, okay. Yeah. And all these names kind of slowed down the accumulation of knowledge about the disease, or it made it more difficult because it took a while for someone to go through and say, ah, yes, the chin cuff here is known as Hooping cough there, which is the same as Kinta there, something like that. Yeah. Yeah. And so throughout this time, though, the disease itself not slow down. After its first appearance in Europe in the 16th century, it would continue to cause epidemics until it fell into this childhood illness pattern. So appearing every year, every few years,

often at a particular time of year, and then impacting mostly children. Let's talk about that impact. Yeah. The numbers of infected kids per year are more difficult to get a sense for, but we do have some census data for a couple of places that can give us an idea of the number of deaths. Oh, no. In Sweden, for example, in the mid-1700s, Sweden seems to be particularly hard hit by Wippenkov, which I think is interesting historically. But in the mid-1700s, there was a death rate of about 151 per 100,000 people every year, which is really high. That's very high. 150 per 100,000 just from Wuppincolfe.

Yes. Wow. So that calculates to about 2,700 children per year in a population of 1.8 million, which is what it was in Sweden then. Oh, God. And so as I mentioned, these numbers are on the high end for deaths due to Wippenkoff, but it was still a really bad problem in other places as well. So in London, the annual death rate was around 29 per 100,000, around that same time in the mid-1700s, calculating to about 238 deaths per year in that population of 700,000.

Okay. And these numbers for London, though, would increase over the course of the 18th century, so the next 100 years, almost doubling. Whoa. And even occasionally surpassing the number of deaths caused by measles. Whoa. Yeah. So this trend in increasing virulence was repeated across a wide geographic range, which is kind of interesting because I think we have this idea that diseases tend to decrease in virulence over time. As we saw syphilis do, for instance, after its first appearance in Europe in the late 15th century.

But for whooping cough, this increase in virulence was probably due to a combination of an influx of new susceptibles every year or every few years. increasing population density overall and a bunch of other things like poor nutrition, poor air quality, ineffective treatment that may have contributed. And it probably could be also, or was a big part of it, that physicians just got better at diagnosing the disease and correctly attributing cases and deaths to it over that time as it kind of grew in infamy. That makes sense. Okay.

In any case, by the time that microbiology as a field started and grew, Pertesis was high up on the list of diseases that desperately needed a cure or treatment of some kind. Just as it did in the 1700s, the mortality due to pertussis and the prevalence of pertussis grew also in the 1800s with about 10% of infections ending in death. And that number would be higher for children of working classes or who just had poor nutrition or lower income. But one issue in trying to control the disease was knowing what the disease was. What was it caused by? So if you didn't know what was causing this, how could you even try to stop it? Physicians did recognize, though, that it was contagious, which I think is interesting

as we've talked about again. There is, like, if you read some of these old medical treatises, it's like, oh, you know, we can't ignore the fact that there is some sort of environmental component to this, but it does seem to be contagious. I do think that's so interesting, just that whole aspect of it. Before we knew that bacteria or viruses were things that were transmissible from person to person, just this idea that you could still somehow have a contagious disease despite that. It's so fascinating.

Yeah. So there were two researchers named Bordette or B-U-R-D-E-T and Jean-Jue, I guess. I think that's right. Spelled G-E-N-G-O-U. And these two guys had struggled to isolate the bacterium because even though the symptoms of the disease could last for a really long time, there was apparently a really narrow window in which you could actually culture the bacterium. But another issue was that it only grew in the lung.

It had that super high specificity that you mentioned towards the lung epithelial cells. So you couldn't pick it up from the blood of someone who was infected. And even if you were able to get a little like, you know, mucous sample. Yeah. The bacteria would quickly die outside the body. Yeah. But they kept at it. And they first saw the bacterium under the microscope in 1900. And six years later, we're finally able to grow the bacterium in a lab using a special broth. Wow. 1906. Uh-huh. 1906. That's like kind of late. But that's amazing that like they were able to do it considering where it grows and how difficult it is to culture. I mean, it's still hard to culture. Yeah. No, it's amazing. Also, Bordeaux had

isolated this bacterium, like when they could finally first grow it, from his son's sputum. Oh, was his son okay? I don't know. Okay. But there was one really sad treatise that I read from 1822, I think, something like that. And the physician who wrote it lost several of his children to Wuppenkov, and I think was inspired to research more about it after that horrible experience. Anyway. Okay, so then this development of being able to actually culture the bacterium in a lab was super important because it really laid the groundwork for trying to make a vaccine. And that was the big target from the outset.

Yeah. And the vaccines themselves, like ones for protesis, weren't that far behind. Just a few years after announcing they were able to culture the bacterium in the lab, These two dudes announced that they had developed a vaccine, Bordei and Jean-Ju. And then not far behind was someone named John Zahorski at Washington University in St. Louis. Oh. And he said, I've got a vaccine too. And neither of these vaccines would really prove to be that reliable, that stable, you know, that effective.

And it would take another couple of decades for an effective and reliable protusses vaccine to come on to the market. But during those decades, the prevalence of protussis remained high with between 5,000 and 8,000 deaths annually. And that's just in the U.S.? Okay. Mm-hmm. Wow. And then three awesome scientists come onto the scene. Bum-bom-bong. These are whom our quarantini is named after.

Can we, I feel like I imagine when you said three awesome scientists, like the Western doors opening and like. some spurs. Can we throw that sound effect in? Thanks. Yeah, let's do that. Howdy there, partner? I don't know. I don't know.

Okay. Anyway. So, walking through the saloon doors is Pearl Kendrick, Grace Eldering, and Loney Gordon. All right. Pearl Kendrick was born. I love the name Pearl. I think it's wonderful. very adorable. She was born in 1893 in Wheaton, Illinois. Yeah. I have no idea where that is.

Me either. And from, I probably should. From the start, Pearl was fascinated by evolutionary biology and disease. And after she graduated with a degree in zoology, she taught school during the week and then in her free time on the weekends took a train down to New York City to volunteer as a research assistant in a lab that worked on typhus. Oh, my gosh. God, I already am going to love these three women. Like, it's going to hurt my heart how much I love them. Oh, my gosh. Well, I just love it. It's like in my free time, a nerd after our own hearts. I love her. Right. Yeah. And she ended up loving her lab time, her research so much. And she was like, you know what? This is what I want to do full time. I don't want to be a teacher. I want to work in a research lab full time. And so that's exactly what she did. Wow. She started out working at the state health departments first in New York and then in Michigan.

And then in Michigan, she worked at a microbiology lab in Grand Rapids while also earning her PhD at Johns Hopkins on the side. What? She full-timed, full-timed it. What? Oh, my God. And while she was at this microbiology lab in Grand Rapids, she hired and mentored a scientist named Grace Eldering. Eldering was inspired to study science due to an extremely bad case of whooping cough that she had as a kid. Oh.

So she, like Kendrick, worked first as a teacher after graduating, but then applied for this job in the Michigan lab where she would work with Kendrick. And together, these two made headlines for their many developments in the world of protesis. Wow. For instance, in the early 1930s, they developed a diagnostic test for the bacterium, which was great because that could be used to determine how long an infected child was contagious. And that was then super important for quarantine and controlling the spread of the disease. Yeah.

Then came their work on the whole cell protussis vaccine. So up to this point, there had been, as I mentioned, several vaccines for protussis produced. But because it was so difficult to culture in the lab, only a very limited number of vaccines could be made. So it was often like one sample, one vaccine. Right. It wasn't an effective or efficient way to make vaccines. Yeah. Kendrick and Eldering found a way around this but didn't have the resources to widely administer the vaccine.

But a visit from Eleanor Roosevelt in 1936, so she was first lady at the time, changed all that. I'm like my heart is fluttering. There should be a movie. I'm fan girling so hard. Can we make a movie? Yeah, okay. Let's do it. I would watch it.

So would I. So Eleanor Roosevelt was super, she had like read about their work and she's like, I want to go to this lab and visit you and learn more about it. And she was really impressed by all the progress that they had made. And it's funny in reports, like not in reports, but I think in a letter or something from that time, either Kendrick or Eldering said that Eleanor Roosevelt was like one of the only people who had visited the lab who actually understood what was going on. That's really funny. I love that. So then, so yeah, Eleanor Vizot was so impressed that she was like, all right, I'm going to give you guys all the funding that you need. And they were like, oh, great, sweet.

So then within a few years, mass production of the Prattusses vaccine began. What? Boom. That's it. Just kidding. Yeah. I'm like, there's a third woman. There's a third woman.

She's coming out of the scene. So, yeah, there was, they had the ability to mass produce these. vaccines, but the demand still way outpaced the supply. So they needed to find a way to increase the amount of bacteria that could be cultured in the lab. Okay. They put out an ad for a position and hired a dietician named Loney Gordon on the spot. Interesting. Loney also came into science sort of through these back channels as well, like working first getting her degree in this and then working as a dietitian and then this and that. And they were then lucky enough that she applied for this position because her job was basically to try some different broth recipes until they could find one that

worked well for the, for Bortatela pertussis. And she got there. Like she wasn't that long, actually, until she found that adding sheep's blood to a broth did the trick. And so suddenly, with this new recipe, Kendrick, Eldering, and Gordon were able to start manufacturing this wholesale pertussis vaccine in large enough quantities not only for the state of Michigan, but also for other states as well. Wow. And this is in the 1930s. This is in the 1930s, early 1940s, yeah. Three women kicking booty developing a vaccine. I can't. That is so, so cool. It's so inspiring.

I love it. We do need to make a movie out of this. Seriously. And also, they didn't stop there. Like, they weren't just like, oh, this is good enough. Let's pat ourselves in the back and, you know. They were always seeking new ways to improve the production or efficacy of the vaccine. And so they started to play around with adjuvants, which, if you remember from the vaccines episode,

adjuvants are basically chemicals that are added to a vaccine. that can increase the effectiveness by stimulating the immune system in certain ways. Right. So the team from Michigan used aluminum hydroxide in the protesis vaccine, which, and correct me if I'm wrong, stimulates macrophages to basically do better at their jobs. Yeah, that sounds about right. Okay. They like pick up the antigens and interact with the lymphocytes and concentrate in lymph nodes and so on.

Yeah, exactly. So they're able to like increase the. the amount of immune response by driving your cells to that area kind of thing. Yeah. Yeah. Which makes it a longer lasting and more effective and better vaccine. And so this new and improved whole cell protesis vaccine with this adjuvant was put to the test in 1943. And it was shown to be super successful, provided lasting and effective protection against the disease.

And then a couple years later, in order to reduce the number of shots that children would have to get for vaccines, the protussis vaccine was combined with ones for diphtheria and tetanus in the mid-1940s. And that's why we called it the DTP vaccine. Yep. And this vaccine was widely administered throughout the whole world, and as a result, the incidence of protussis fell and fell. Here's some numbers. Yes. Before the pertussis vaccine, there were an estimated 270,000, cases of pertussis annually in the U.S. 207,000. 270,000.

Oh, I'm sorry. 270. 270. Wow. That's the number of cases. In the 1980s, so this is after the vaccine had been in use for approximately 40 years, and before the vaccine hesitancy movement really began, there were between 1,200 and 4,000 cases per year.

year. Wow. That's a drop of almost 99%. Wow. Wow. Wow. And so as I mentioned earlier, in that part two of our vaccines episode, I went into a lot of detail about how this pushback against the DTP vaccine began. And so I'm not going to do that here. But briefly, there was a global decline in vaccination rates with the DTP vaccine. And the fears were mostly based on the protest. as component of the vaccine. And so as you might expect, the decline in vaccine coverage led to outbreaks. So in Sweden, for instance, the annual incidence of protussis cases went from 700 total in 1981 to 3,200 in 1985, just four years later.

Wow. In Japan, there were 206 cases in 1971. In 1979, there were 13,105 cases. Holy mackerel. Mm-hmm. Obviously, something had to be done to get people to vaccinate again or to somehow, you know, reduce these fears, whatever it was. And so because so many people were not vaccinating out of fear that the whole cell protussis vaccine would lead to deadly side effects in their kids, one solution was just to make a new. vaccine, which is how we got the accellular protussis vaccine. So instead of these whole killed

bacteria, which is what the, you know, the name gives it away the previous vaccine was, it included just these toxins, these antigens from Berticella protesis. And the efficacy, and I'm sure you're going to talk more about this, but the efficacy of this vaccine wasn't as high as the whole cell version, but it was associated with fewer adverse reactions. And so that replaced the P component of the DTP vaccine, and it became DTAP, to stand for atelular pertussis in the 1990s. Yeah. Which Aaron means that we got at least one whole cell vaccine.

Cool. Yep. Probably a bunch, actually, because we were pretty much done getting our vaccinations by the time they introduced DTAP in 1992. Oh, yeah. Yeah. Excellent. One of the things that I find interesting when doing the research for some of these episodes

is that I get to read these articles that were written all like over a really long time span. Yeah. So like some were written in the 1800s, 1700s, whatever, translated from this and that. And you can see how the language used and the sentiment about a topic can really changes over time. Interesting. was especially apparent for protussis. In more recent articles, protesis is always described in the introduction as this re-emerging problem that highlights the difficulties in educating the public and how quickly progress

can be undone. But in these older articles or chapters from before the 1970s, but after the vaccine was developed, it was written about as a great triumph of modern medicine in many of them. There was one line that really stuck with me when reading one of these old articles. And it was the one that you mentioned earlier, the one from 1975. The author says, quote, as recently as 1948, pertussis remained a leading cause of death in children under 14 years of age in the United States. Now the disease has become almost a medical curiosity. The Center for Disease Control, for example, no longer routinely reports pertussis.

Wow. So, Erin, that was 1975. This is 2020. Tell me just how much that statement is no longer true. Yeah, you're not going to like it. Let's take one more quick break. Okay. Let's just go straight to the facts. Let's do it. 2018, United States of America. You want to guess how many cases of protests there were? Is it more than 5,000?

Yes. Oh, my gosh. 15,000. Okay. 15,000 cases of pertussis in the U.S. in 2018, including five deaths. 15,000 cases of a vaccine preventable. illness. Yep. So let's talk about that. Well, first, really briefly, we'll talk about it across the

globe. And then we really need to spend some time talking about this vaccine preventable disease aspect. The World Health Organization didn't have super great numbers more recently, like in the last couple of years. But for example, in 2014, it was estimated that there were 24, over 24 million cases of pertusses worldwide and over 160,000 deaths in children under age five years. What? 160,000 deaths from pertussis in children under age five in 2014. Oh my gosh. Yeah.

So this is not a disease that has gone away. And in fact, it's been on the rise for a number of years now, probably since the 90s. it's been kind of increasing every year. And there's a number of reasons for that. So let's start talking about this vaccine. You mentioned that in the late 80s, early 90s, is when we pretty much switched from a whole cell vaccine to an ac cellular vaccine. Mm-hmm.

That's really important. The ac cellular vaccine does not provide as long-lasting immunity as the whole-cell vaccine. So that means that immunity, while it still exists, is not for your whole life when you get the accellular vaccine. However, and this is really important, especially I think in talking to people who are vaccine hesitant who maybe sometimes use that as an excuse. Well, it doesn't provide long-lasting immunity. Wouldn't it be better just to get infected with the disease that kills people to begin with?

Even getting infected with pertussis does not provide lifetime immunity. Interesting. Yeah. This is a very interesting aspect of pertussis that I didn't realize until starting to research this. So even getting infected doesn't provide lifelong immunity. Does it provide longer immunity than getting a vaccine? Yes, most likely. But it's still, you can get reinfected with Bordetella pertussis even if you get infected as a child

and survive that infection. Is the infection less severe in subsequent infections? So overall, great question. Overall, whether you get infected and survive, which again, not everyone does, if you get infected or you get vaccinated, then the disease that you get subsequently is most likely to be less severe. So even though vaccination doesn't provide lifelong immunity, it's massively protective against serious illness and death from pertussis. even with the whole cell vaccine, immunity does wane, but it's usually over like maybe 10, 15, 20 years, whereas with the accellular, it might be seven to 10 years that your immunity starts to wane. So that means that if you got your last vaccine, say when you went to kindergarten,

then by the time you get to high school, you might not be immune anymore, or at least not completely immune. Your immunity has waned. So what we see is while we have, these really high numbers of pertussis today in the United States and across the globe, it's not just because of vaccine hesitancy. It's not only an unvaccinated people. We also see increasing, we see actually a shift in the age groups of people who get infected. So while you talked about kind of throughout the last 500 years of this disease, it's been mostly a disease

of children, right? Not babies necessarily, but children. This is a disease of childhood. Maybe like one to two year olds up to like 10 year olds were the majority of people who got sick before the introduction of any vaccine. Now today, the largest numbers of people who get sick are actually adolescents and young adults. So in 2018 in the U.S., 30% of those 15,000 cases were in people age 11 to 19. Wow. Okay. Yeah. I have a question about sort of the vaccine. Now, when you go to the doctor and you, because I know the tetanus vaccine, you need to get re-upped every Yeah, 10 years. 10 years. Yeah. When they give you that booster, is it D-TAP or is it just tetanus? Good question. It used to be just TD, which is tetanus and diphtheria. Now it's recommended that

adolescents get at least one booster of T-DAP, which is the adult version of T-Tetanus, diphtheria, and accellular pertussis. But it didn't used to be the case. So because we thought, oh, this provides a long enough immunity that because the whole cell vaccine did. But now it's recognized that immunity wanes faster than we may be expected, and that's part of the reason that we see an increase in the number of cases in older age groups. But this is really important because the other group that's massively

affected besides adolescents are the very, very old who are immunocompromised and tiny babies who are too young to be fully vaccinated. Right. And in those groups, over up to 50% of them will be hospitalized. And in that age group is where we also see the highest mortality rates. So while infants under the age of six months were only 9% of the total cases of pertussis in the U.S. in 2018, 42% of those babies were hospitalized. Two questions. How old do you have to be to get the first pertussis vaccine? Second question, when you go in for your tetanus booster, do you have to specifically ask

for T-TAP? First question is easy. You get your first D-TAP at around two months of age as early as six weeks, but usually at around the eight-week, two-month mark. And it's a series of like four vaccines usually. So you get it at two months, at four months, at six months. And so that's why up to six months, you haven't gotten your full dose of it. So you're still at risk. Okay. And in those kids and in older adolescents, it's more likely to present with an atypical course, which we kind of touched on a little bit. We hinted at in the biology section. But once you have some antibodies that you've built up against this infection, you're less likely to have that characteristic whoop of the whooping cough. Oh, okay. Because you have a less kind of intense infection.

But what's also scary is that in tiny infants, this can also present with just apnea, which means cessation of breathing entirely. Right. So you don't have the coughing. You don't have the whoop. You just have babies who stop breathing, which is terrifying. Yeah. That's horrifying. Yep.

Your second question was, do you have to specifically ask for a T-DAP? At this point, the recommendation is if you haven't, if you are an adult who hasn't had a T-DAP booster at any point in your life, then you should get one. And then after that, you would just get your regular tetanus and diphtheria every 10 years. But let's talk about a couple of specific groups that should get boosters and can talk to their physicians about this. Yeah. Would you just go to your physician and say, hey, can you check my titers? Absolutely. Check my records? You could do that. Yeah, check my records. Have I had one recently? If not, most physicians will be like, yeah, let's give you a T-Dap because certainly not going to hurt you. I was going to say, is there any harm in getting an early booster?

No, there isn't. And there are a few groups who should really consider getting boosters. Number one, anyone who's going to be in contact with a tiny baby. Pregnancy. It's now recommended, and it's in a lot of countries it's standard practice that during pregnancy in the third trimester, so between like 27 and 36 weeks, we give T-DAP boosters. And this has been hugely important in preventing illness in that time. tiny baby age group, so pre two months where that baby is entirely unvaccinated. If you vaccinate

during pregnancy, then you can pass antibodies, maternal antibodies, onto the baby. Right. Which is massively protective. That's amazing. And didn't used to be standard practice, unfortunately. That's pretty much all I have, Erin, about the state of protusses today. I tried to find some current research on what's going on. And the NIAID, the NIH page, was last updated in 2016. Whoa. Right? Come on. Come on. But. Well, it's hard because it's like with many of the other diseases that we do an episode on, it's like, oh, and then there's a new drug therapy. There's a new vaccine in development. There's a new something. But this is like, we have antibiotics. that can work if you give them early enough, and we have a vaccine that works.

So maybe the progress needs to be made in public education, in access, like reducing the barriers to vaccine access? I would say there could still be work to be done on creating a more effective vaccine that produces longer-lasting immunity as well, especially since we're seeing waning immunity and kind of developing a better immunization schedule, perhaps, for older children and adults. But what's hard is that it's easy to give vaccines to small kids because they come to the doctor on a regular schedule. Once kids get older and become adults, we don't necessarily go to the doctor on a regular schedule. So it's really hard, even if you have an effective vaccine to give a booster, it's hard to get that booster to everyone to actually create.

the herd immunity that we need to protect the vulnerable people in our population. It still seems like an upward battle. It's an upward battle for sure. It always is with diseases, though, isn't it? Yeah. Yeah. But there is a lot of amazing work done in this upward battle. And for, you know, pushing for vaccine education information and for just promoting the use of vaccines. And so one of these amazing people who's working on this, you heard from earlier, Catherine Hughes, and we wanted to have her talk a little bit about Light for Riley. As traumatic as it was, I'm sure, to go through and to relive it, you have really turned this

into a lot of advocacy and done amazing things as a result of this tragic situation. So can you tell us a little bit about sort of what that's been like for you to kind of take the worst possible situation and try and make something good out of it? I really believe that life can be measured in years, but it can also be measured in impact. And so when Riley died, we felt devastated that his life was so short in years, but we thought that perhaps we could somehow extend his life by making him. making sure that it had an impact on the world. So we sort of were loaded with that really strong urge

to do something to create a legacy for Riley. But we were also filled with a sense that what happened was so unfair and that it was preventable and that it shouldn't happen to other babies and other families. So we were really driven to spread awareness and we started our campaign, which is called Delight for Riley campaign.

we were really determined to shine a light on the importance of vaccination and the dangers of hooping cough. It was when Riley was really sick in hospital that I sort of jumped on my phone and began Googling all the information I could find out about whooping cough. And that's when I learnt that other countries were offering pregnant moms a hooping cough vaccine during pregnancy. and I felt so upset that this hadn't been offered to me in my pregnancy. I'd had the flu vaccine in pregnancy. I knew I was the type of mum to say, you know, yes, you know, if you recommend it, I'll do it.

And we know now that babies are born to mum so you have this whooping cough vaccine in pregnancy, the chance of them catching whooping cough is drastically reduced. So I truly believe Riley would probably still be here with us today if this pregnancy hooping cough vaccine had been offered to me. So with that knowledge, it was very instinctive for us to embark on our life for Riley campaign. We've done media interviews and social media campaigns, and we travel around to pregnancy expos where we talk to pregnant moms about the importance of getting vaccinated.

And we've seen really good uptake of this vaccine in Australia. So around 80% of moms are saying yes to this pregnancy vaccine. But then again, that's still 20% of babies who are being born at risk of contracting this disease, which is always circulating around our community. So there's so much more that we want to do. It's incredible work that you're doing, and it's also really inspiring because this must not be an easy thing to do. In your experience with the Light for Riley campaign,

what do you feel like have been the biggest challenges you've had to overcome? I think we've had two challenges with our Light for Riley campaign. The first is just coping with grief while trying to put ourselves out there. Grief is a funny thing and I think it's different for every person. But that's certainly been a challenge trying to manage grief and advocacy. And the second challenge we faced was, you know, for want of a better word, being attacked by the anti-vaccine movement. This happened within a day of Riley's death where we're getting messages on Facebook from anti-vaccine activists. And we've had, you know, an incredible amount of blog posts and Facebook messages and comments and all sorts of things from the anti-vaccine movement.

I truly believe that Riley's death is a bit of an uncomfortable truth for them. Riley was unvaccinated, who was too young to be vaccinated. And it's probably scary for them to realize that unvaccinated children die from vaccine-preventable diseases. We've also seen a lot of conspiracy theories about us. We've been told that we're actors, that we've been paid by big farmer. We've been told that Riley never existed. We've been told that we murdered him. All sorts of stuff.

And again, I think it's just because antivaxes can feel very uncomfortable when it comes to facing the truth. The best way for us to deal with the anti-vax movement is really to give them as little attention as possible. We don't respond to them for the most part. We ignore them. The people that we want to focus on are those who are on the fence or just don't know much about vaccination.

They're really the people that we want Riley's message to get across to. What sort of future plans do you have for the Light for Riley campaign? Do you have anything that's currently in the works or anything upcoming? In 2016, we launched our charity, the Immunization Foundation of Australia. And so that's kept us really busy. I absolutely love being a director of this foundation because we're not just focused on hooping cough, but on immunisation in general, we want all babies and all families to be protected from these

potentially deadly vaccine preventable diseases. So we'll continue travelling. I do lots of speaking and workshops. We present to schools. We've got puppet shows for kids to make them feel more comfortable with the process of vaccinating. We're looking to collect more stories about families who have suffered through vaccine preventable diseases because we believe it is so important that people know these stories because vaccination is almost a victim of its own success. We don't see these stories around so much because vaccines work so well. But as parents, we need to know why we vaccinate. And we're also looking at hopefully being able to donate some vaccines overseas later this year as well to children in developing countries.

That's wonderful. What an inspiring campaign. Where can our listeners learn more or read more about Like for Riley and some of the work that you're doing through the campaign? If you go to our Facebook page, which is just Light for Riley on Facebook, you can read all about Riley's story there. And then also on our website, which is www.IFA.org.com. Thank you so much for sharing your story not only with us and our listeners, but with everyone around the world, with your campaign. and all of the work that you're doing. It's really incredible. Yeah, this was really wonderful.

Thank you again so, so much. We really appreciate it. Thank you. Thanks. It's such a pleasure to speak to you guys. Apologies for my terrible Australian twang. Hopefully it doesn't ruin your whole podcast. I love it.

It's perfect. We love it. I think we need a little bit more twang on our podcast. For sure. For sure. That was fantastic. It's so inspiring. to hear yet another awesome woman doing incredible work on Protesis.

Yeah. Should we get into sources? Let's. Okay. I have somehow accumulated an unbelievable number of sources for this one. Wow. Look at you. Overachiever.

No, there was no, like usually I'm like, oh great, there's a book. I'll read that book. But there was no single book this time. so it was much more of a digging down the rabbit hole. But I'll mention a few of these. So one was from Aslanabadi at all from 2015, and that was about these possible epidemics in Persia. A couple great articles about just the history of protusses,

one by James Cherry from 2015, another by Chow at all from 2016. And the evolutionary paper came from Diavatopoulos at all 2005. And the title of our quarantini, three women and a baby, came from a title of a chapter of a book in Between Hope and Fear, A History of Vaccines and Human Immunity by Michael Kinch. And that one I mentioned also on our vaccines episode. Yeah. And honestly, there are a bunch more. And I'll just put them all on our website. Sorry, that was a really long list. Yeah, I have a number. We'll post all of them on our website. This podcast will kill you.com under the episodes tab.

All right. So thank you to Bloodmobile for providing the music for this episode and all of our episodes. Thank you again to Catherine Hughes for being so amazing and coming on to our podcast and be willing to share her story. And we hope that you all enjoyed it as well. And we will post links to Light for Riley in our show notes and on our website. So keep an eye on. out for that. And thank you to you all for listening. As always, we really love making this podcast, so thanks for letting us do that. Yes, we do. Well, with that, wash your hands. You filthy animals. This is Bethany Frankel from Just Be with Bethany Frankel. Listen, I have a bone to pick with these dog food brands calling themselves fresh, natural, healthy. Sounds great, but a lot of these quote-unquote

fresh dog foods in your fridge are not even 100% human grade, which is why Feed your babies. Just Food for Dogs. It's good enough for big and smalls. My precious babies. So it's good enough for your babies. 100% human grade, real ingredients, beef, sweet potatoes, green beans, delicious. These are foods that you would want to eat. Not that the babies would ever share. Just Food for Dogs is the number one bet recommended fresh dog food back by over a decade of research. No marketing fluff. My dogs lose their minds at dinner. They run to the bowl, tags wagging, paws tapping, full Broadway performance. every single night. So I do care about the food I feed big and smalls. So go to just food for dogs.com for 50% off your first box.

No code, no gimmicks, just real fresh food. Truck month is going on now at your local RAM dealer. Hurry in for great deals and exceptional offers on a powerful selection of RAM trucks. And right now purchase and get 0% financing for 60 months on 2026 RAM 1500 Big Horn and Laramie models. Don't miss this great offer. See your local RAM dealer. Not compatible with any other offers. 0% APR financing for 60 months

equals 1667 per month per 1,000 financed for well-qualified buyers through Stalantis financial services regardless of down payment. Not all customers will qualify. Contact dealer for details. Offer ends 3-2. Virgin Voyages presents

With Love from Alaska. The scenery out here is unreal. Mountains, glaciers, waterfalls, the ship? Designed for panoramic views, which is why I'm pretending to be a wildlife photographer. I am not. Yesterday we were hiking and kayaking.

Today, I'm watching for humpback whales. Anyway, wish you were here. Award-winning, Kid-Free Alaskan cruises from Virgin Voyages with immersive shore excursions and zero kid energy. Virgin Voyages.com.