This Podcast Will Kill You - Ep 64 Rubella: Timing is Everything

Episode Date: January 12, 2021

For many of us, rubella has simply come to mean the R in MMR, the routine childhood measles, mumps, and rubella vaccine. But that hasn’t always been the case. There was once a time when the rubella virus routinely made front page news and was at the center of countless legal discussions. This week, we explore everything you’ve ever wanted to know about this virus. We start off by asking what this virus does to your body and how it can cross the placenta, leading to congenital rubella syndrome. Then we journey through the short but impactful history of this disease, from the discovery of the effects the virus can have on a developing fetus to the widespread epidemics that spurred on the development of a vaccine. Finally we wrap up with some much-needed good news about the global decline of rubella and congenital rubella syndrome. See omnystudio.com/listener for privacy information.

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Terms and conditions apply. Visit blueapron.com slash terms for more information. This is Special Agent Regal, Special Agent Bradley Hall. In 2018, the FBI took down a ring of spies working for China's Ministry of State Security, one of the most mysterious intelligence agencies in the world. The Sixth Bureau podcast is a story of the inner workings of the MSS, and how one man's ambition and mistake. opened its fault of secrets.

Listen to the Sixth Bureau on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts. I'm Amanda Knox, and in the new podcast, doubt the case of Lucy Lettby, we unpack the story of an unimaginable tragedy that gripped the UK in 2023. But what if we didn't get the whole story? Evidence has been made to fit.

The moment you look at the whole picture, the case collapsed. What if the truth was disguised by a story we chose to believe. Oh my God, I think she might be innocent. Listen to doubt the case of Lucy Lettby on the Iheart Radio app, Apple Podcasts, or wherever you get your podcasts. On her second day of life, Kimberly Cowley had congestive heart failure.

Considering the vast array of health issues she had been born with, hearing and vision loss, a rare condition known as tetralogy of fallow, caused by a combination of four heart defects, any one of which is a killer, expectations of survival were low. Against all odds, Kimberly survived, but the road has been long and often painful. Born in Hamilton, Canada, in 1964, Kimberly spent the first two months of her life in the hospital. Her parents were young, and shortly after marriage, her mother became sick. She thought it might be a bout of flu.

And then, once she learned she was pregnant, she thought maybe that was why she felt unwell. It was neither. Her mother later learned that it had been Rubella, having come into contact with an infected relative in her first trimester. In 1964, the Rubella vaccine was still five years away from being available. When Kimberly was diagnosed with congestive heart failure that second day in the hospital, her parents realized the problems were much bigger than they had thought. Those first two months were a whirlwind of tests. All Kimberly's parents were told was that they would have to wait until later in life

to see how this translated in reality. Like most children, Kimberly started school at age five, but in all other ways, she was profoundly different from the other kids in her class. physically she was the size of a small three-year-old, and school was an immense challenge. Given no special tools, Kimberly was expected to learn at the same rate as her classmates while missing most of two of her senses. After eight hours of concentrating to hear, see, and keep up, she craved silence and to be left alone, meaning after-school friends were few and far between.

Often lonely, she grew up being bullied and picked on for her differences. Kimberly's parents were at a loss, not knowing what to do or how to cope. I needed advocates and they just weren't, she said. My mother had been a bully at school herself and continued that behavior with me. She was unable to relate to my disability. It was hard to get close to my father or brothers too because they didn't try to get close to me. Things became much worse emotionally for 11-year-old Kimberly when she was scheduled to have heart surgery. Her classmates taunted her, telling her she was going to die.

One parent was allowed to go into the operating room with Kimberly while anesthesia was being administered, but neither of her parents chose to provide this comfort. She went in alone. When she woke up, she smiled, despite the incredible pain, knowing she was alive, proving her schoolmates and the unfeeling world around her wrong. Her surgeon called her a willful, stubborn survivor. These days, Kimberly lives quietly. She has worked in the past, but seldom full-time. She exercises daily or risks losing her mobility and is a passionate archer. When she ventures out of her home, it's an exercise in extreme concentration. Kimberly uses a long cane to help her get around.

Her life is also about tools. Her laptop has magnification. Her Kindle reader is on the second largest font, and she paints her nails with the magnifying glass clipped to her glasses. You get used to being stared at, Kimberly said. The only difference between now and when I was a child is that now I don't care. I just smile.

I like who I am and how far I have come. I'm looking forward to the next adventures in my life. she said. I'm a vaccination crusader. If I can save just one life by telling, teaching, and pushing for vaccination, then I know it's all been worth it. Well, Aaron, that got me. I know. I know. It's a, yeah. That firsthand was from Kimberly Cowley, and I found it on a website called measlesrubellainitiative.org. And I will post a link to the full account, so that was excerpts. And also according to this website, Kimberly is working on a book. So that would be awesome to check out. Yeah. Yeah. Hi, I'm Erin Welsh. And I'm Aaron Alman Updike. And this is, this podcast

will kill you. And today I'm already crying. So it's going to be a great episode. Setting the stage, setting the tone for this episode today. Yeah. Yes, today we are covering Rubela, also known as German measles, although I don't know how many people still call it that nowadays. In like textbooks, I feel like you still hear it. Yeah. Yeah. Well, we'll be mostly calling it Rubella. Rubella.

That's what it's called. Yeah. Well, I guess to start us off, it's quarantini time? It's definitely, definitely quarantine time. What are we drinking this week? We're drinking. Chau Rubella. Very well done, air.

Thank you. And what is in the Chau Rubella? I don't know. Okay. I could tell you. Gin, cherry juice, grenadine, a splash of soda water, and also a fancy liqueur

that's like a raspberry liqueur called shamboard. Shamboard. Yeah. I liked the bottle was really pretty. A very ruby. rubella drink. I feel like that's appropriate. Ruby Rubella. Yeah, exactly. We will post the full recipe to the Chow Rubela on our website. This podcast will kill you.com as well as all of our social media channels. And that is also where you will be able to find the non-alcoholic

placebo rita. Oh yeah. We got you covered. We got you. All right. Is there some, there's some business. I guess we should run down the list of usual suspects before we dive in. For example, we have incredible merch for sale on our website. This Podcast Will Kill You.com. Just click on merch. You can find it. We have incredible offerings by the artist Abigail Irvin Penner, as well as Holly Sullivan. Really truly, I just got some of the Holly Sullivan's framed prints, and I am obsessed with them.

They're so cute. My gosh. And there are stickers of both, which like, if you're running out of wall space for pictures, which I definitely am, You have water bottle space. We also have a Goodreads list if you want to read more on any of the subjects that we talk about in addition to a bookshop affiliate account. And when we post the references to all of these episodes, we will also post links when available to the books that we mention on the podcast. Yep. Is that all of our business?

I think that's it. Okay. Let's dive in. Let's. This is going to be a big, fun, not fun, a big episode. It's going to be a big one. It's going to be very interesting. There's a lot, I feel like, to uncover that I had no idea about before diving in.

Oh, I can't wait to hear the history. But we'll start where we always do with the biology right after this break. 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 arrive 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 hands-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 You can order meals when you want them and skip when you don't without adding another recurring charge. 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 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 leaf. 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'Keef's.

Just visit O'Keef's company.com slash this podcast and code this podcast at checkout. I'm Clayton Eckerd, and in 2022, I was the lead of ABC's The Bachelor. Unfortunately, it didn't go according to plan. He became the first Bachelor to ever have his final Rose rejected. The internet turned on him. If I could press a button and rewind it all I would. But what happened to Clayton after the show made even bigger headlines. It began as a one-night stand and ended in a courtroom,

with Clayton at the center of a very strange paternity scandal. media is here. This case has gone viral. The dating contract. Agree to date me, but I'm also suing you. Please search for it. This is unlike anything I've ever seen before. I'm Stephanie Young. This is Love Trapped. This season, an epic battle of he said she said, and the search for accountability in a sea of lies. Listen to Love Trapped on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Obviously, we have two major points to talk about today in the biology, and that is rubella infection, like in

children and adults, and of course, congenital rubella syndrome, which I think most people listening probably know already the major complication of rebella infection is the effects that it can have on a fetus if someone is infected during pregnancy, especially and specifically early in pregnancy. When we did our triple E episode, Eastern equine encephalitis, like back in season three, I said during that episode that Rubella was a nether and one of the only non-arthropod-born alpha viruses in the family Toga Vira Day. But apparently in 2018, that was changed. And Rubella was reclassified. So it's not really anymore a Toga virus. It's in its whole own family called Matoneviride in the genus Rubivirus.

Huh. Okay. I know. So this is a self-correction because nobody has corrected me on that yet. I'm shocked. In any case, we are talking today about a virus. It is a single-stranded, positive RNA virus. Unlike a lot of other RNA viruses that we've talked about, it's pretty stable antigenically. So that's a large part of why we have a pretty effective vaccine. Spoilers. So in general, rubella virus is transmitted via aerosols, much like measles, which I feel like rubella and measles often go hand in hand in terms of our conversations, even though they're

really not that similar. But in this case, Rubela, it's really large particle aerosols, so it doesn't linger in the air the way that measles does. Okay. So that explains the lower are not committed to measles. exactly, right? So it is a respiratory virus, and like every virus on the planet, it has to infect a cell in order to replicate. In the case of Rubella, it generally first infects the cells of our respiratory tract and then the lymph tissue, which it's very easy to access from like our nose and nasal passages. But very, very quickly, within five to seven days after exposure, Rubela is able to disseminate.

throughout our bloodstream. So it causes a viremia, meaning you can detect virus in our blood, if you took a sample. And it leads to a pretty widespread systemic infection. What that means is that unlike some other viruses and pathogens that we've discussed, Rubela has a very wide tropism, meaning it can infect a huge range of our cell types, not just a few types of cells. That's very interesting. It really is. We don't still know exactly what receptor it uses on our cells to gain entry into our cells. But we know that it must be something that's present on like almost every cell type, if that makes sense. So that makes me wonder about other species.

So like I know that Rubella is human specific. It is. But if it infects all, like what is it then about all of these human cells? that makes it not able to infect other animals. Right. It's a really good question. So what is it using in our bodies to be able to infect almost all of ourselves, but really just humans? I mean, experimentally, you can infect other animals.

So it's not that it's impossible for other animals to become infected. It's just that in general, other animals, they're not good reservoirs. They're not, like, walking around in the world, infected with rebella virus. Ooh, so I wonder whether it's like just the transmission dynamics and like human behavior and or maybe like it just doesn't cause disease the way that it doesn't. That's so interesting. It's so interesting, right? Yeah, I know. It gets even more interesting, quite honestly.

But keep that in mind, right? Like this is a virus that can infect pretty much any cell type. Additionally, we know that like many, many viruses, at least part of the pathogenic effect of Rubela is by directly killing cells essentially. So when cells get infected with virus and the virus replicates inside those cells, that cell will undergo apoptosis, meaning that cell will die. So at least in part, that is responsible for the damage. That means it's not just our immune reaction or our immune response that's causing the symptoms that we see. But we'll put a pin in that because that's not the whole story.

And we'll move on to the symptoms, at least in grown humans. I want to skip ahead. Okay. In general, in children or adults who get infected, we are talking with Rebella about a very, very mild, self-limited illness if you have symptoms at all. In general, it starts with a rash, not a fever. Oh. That's the other sub-podcast.

It started with a fever, asterisk, unless it starts with a rash. Yeah, there go. Perfect. So in the case of Rebell, it generally starts with a rash. This rash is very similar, actually, to the one that we see with measles, which I think is a large part of why there's this overlap. It starts on the face. It generally spreads downwards towards the feet, encompassing almost your whole body.

They're just, the rash looks like small red spots, maybe with some bumps. But differences between the rebella rash and measles are that it spreads much more quickly, like within 24 hours. It generally lasts only a couple of days, like two to three days. And the rash doesn't coalesce or darken the way that measles rashes tend to do. Okay. I also read somewhere it was tingly. Oh, interesting.

Is that the case? You can feel it tingling? That's a tingly rash. I mean, granted, this description was from the mid-1800, so like, you know. I wonder, is that a description of how the rash feels, or is it something about, like, is that how you describe rashes? Like a tingly rash versus a lacy rash? I don't know.

I assumed it was it tingles. Well, because does measles tingle? I can't remember. Or does itch or burn? I don't think so. I didn't think so. So I thought that was one of the designating, like, interesting.

Or differentiating characteristics. Tingly. Tingly. What? I didn't read it. It doesn't mean it's not possible. But very differently from measles, that rash is often it. Okay.

In terms of the symptoms of Rubella, if you have that at all. Maybe you might also have a slight fever. Maybe you might have some swollen lymph nodes. But really, that's about it. It's a very mild illness. And again, that's if you even have symptoms. The older that you are when you get infected, the more likely that you'll have symptoms beyond the rash. But kids are more likely to like have the rash for sure, like have any symptoms whatsoever.

And if you have symptoms, number one is going to be the rash. Okay. In some cases, you can have things like arthralogas or joint pain, which can last for several weeks, but it's really rare. And even more rare are severe manifestations like encephalitis, the way that we do see with measles. We're talking, though, like one to three per six thousand cases. So this is a very rare complication. But also other complications that you can get from a wide variety of viral. and other infections, things like Gian Barre, myocarditis, which is when the virus infects your heart, optic neuritis, if it affects your eyes. These things are all possible, but they're not specific to Rubella, and they're very, very unlikely with a Rubella infection specifically. Gotcha. But that's not the big story when it comes to Rubella. No.

The big story is congenital Rubella syndrome or CRS. This is what happens when a person gets infected with Rubella, and you, you know, you, Usually this has to be a primary infection. So someone is being exposed and infected for the first time in their life while they are pregnant, specifically during the first trimester, which is the first 12 weeks of pregnancy. Now, if we remember back to our thalidomide episode, when I talked about the embryologic period of development, the first like 10 weeks or so, I talked a lot about how anything that has effects on a developing fetus during this period, when it's an embryo, not even a fetus, has huge downstream developmental effects.

Rubella is one of those infections that can infect a fetus, especially at this early, early stage. Essentially what happens is when a pregnant person gets infected with Rubella, as we already talked about, that virus spreads really rapidly throughout our bodies. And one of the places that it spreads and can infect is the placenta and the placental tissue. And then it can travel through that placenta and go on to infect pretty much any cell in that developing embryo or fetus. Now, what exactly happens inside an infected fetus is still not entirely clear, which I think is fascinating. So, yeah, I'm so surprised by that. Me too.

But we do know some things, and they're really interesting. There's kind of three main ways that Rubella has effects. We know that in grown humans, one of the main effects of Rubella that causes symptoms is direct cell death, right? But in the case of the developing fetus, that doesn't seem to be a main mechanism by which damage is induced. Isn't that weird? I wonder, does this have something to do? do with the fact that we still don't know the receptor? And that like maybe, I don't know. I mean, is it cell death? Okay. So if rebella virus can infect all those different cells that we have,

does it cause cell death in all of those cells? Or is it just a subset? Very good question. I don't know. And here's an on top of that. We think that at least part of the reason that a fetus is susceptible when it is and part of why, so this is an interesting, I was going to say this later, but I'm going to say it now. If a baby is born with congenital Rubella syndrome, they still harbor Rubella virus for months, if not years. And so in a fetus and a newborn, Rubella is not an acute infection. It's a chronic infection. So it's acting very differently in a fetus than it is in a person. Yes. So how much does that have to do with the fact that the immune system is still under development? Gosh, who knows? Right. Like what are those mechanisms and

what's the interaction with a well-developed immune system versus a fetal immune system? It gets complicated. But Aaron, it's about to get more complicated, so I have to keep going. Wait, but can I ask two questions? Oh, you can try. So, okay, my first question is if it can infect all these different types of cells, can it also be transmitted through means other than respiratory. Is respiratory just the primary way? Great question. And yes, yes. So you can culture virus from a whole bunch of different bodily fluids, poop, pee, eye, conjunctival fluid, even by scraping off the skin.

like the virus is in your skin, especially when you have a rash. It's actually in the rash and in non-rashy skin. So the virus is definitely everywhere. It's in your blood, but it's at highest level in the respiratory tract. Okay. That makes sense. Yeah. And my other question is in later trimesters or later on in the pregnancy, if someone becomes

infected, does the fetus have an immunity? Like, are there any effects? Pause that question. Okay. I'll answer that. I'll address that. Thank you. We will get there, Erin. Let's not jump our guns. Sorry, I got really excited. I know you did. So all I told you was what is not the main cause of the effects that we see in a developing fetus. I want to tell you what we think are, okay? Because we know some things. Okay. And because it gets even weirder. Infection in the fetus results in decreased cell growth and division.

So even if it's not killing cells directly, it's stopping cells from dividing. That's what a fetus does divide cells. But I mean, what that means is that in a developing fetus, you have a reduction in cell mass, and that can result in not enough cells recruited to shape a, embryologic parts the way that they should be developed. Okay. So that it's just a non, it's almost a side effect of, like there are so many downstream effects from a rebella infection that's not just, oh, the rebella virus targets those cells.

And there's more. Talk about downstream effects. Another cell type, even though we know that rebella can infect a lot of different cells, one of the big problems is when Rubella in a developing fetus infects the endothelial cells of the blood vessels. Those are the cells that line blood vessels. We end up talking about those a lot on this podcast. Interesting. Infection of those cells causes damage to fetal blood vessels, which can downstream

cause damage enough that they cause ischemia or tissue death in organs that are supplied by those blood vessels. So you can have downstream effects of damage. to organs because of damage to these blood vessels in the fetus. Okay. I have a question. Okay. Does the timing of infection during the first trimester matter, or is it just sort of any time? Absolutely.

The timing matters. So the timing is everything in terms of the effects that you see, in terms of the severity, everything. So there's a lot of details in a lot of the papers that I will post in terms of like the exact number of weeks for when you have this effect versus that effect. But in general, it goes like this. Infection within the first 12 weeks almost always is going to result in infection of the fetus. So infection of a pregnant person during the first 12 weeks of pregnancy for the first time with Rebella is going to end up. up infecting the fetus. In those first 12 weeks, almost all of those infections or a large proportion of those infections are going to result in some kind of fetal malformation or problem down the line. After like 16, 18 weeks especially, it's not that infection doesn't occur. It just doesn't

have those long term effects or downstream effects. And this is really weird. There's like a period of time in the second trimester where infection itself tends to be like lowest. And then in the third trimester, the fetus could become infected, but the most that you might see would be like some growth restriction. Okay. But at almost any point in pregnancy, a fetus could become infected. It's just that only in that early period of time are you going to see the effects. So let's talk a little bit more specifically about what you see, because then we can talk about even more specifically about the timing. Okay. So because this is a virus that can affect almost every cell, really almost any part can be affected,

almost any organ, really everything. But classically, there are kind of three large-scale ways in which congenital rebella syndrome can affect an infant born with it. One is with transient kind of short-lived manifestations that tend to happen if the viral load in that baby is very high at the time of birth. And we'll talk about what those look like. The second is with permanent manifestations. So that means something that happened during development that doesn't change that affected the development of that fetus. And then finally, there are, and this actually blew my mind because I never.

learned this previously, there are late onset problems that can happen that are not detectable at the time of birth, but become apparent later on. So we'll go through each of those. The transient ones, because this virus is infecting everywhere, they can be really wide-ranging. An infant can be born with jaundice, so that means kind of yellowed skin, which usually has to do with anemia or homolysis, so like red blood cells licing within their body because of infection. Hepatitis, so infection of the liver, enlargement of the liver or spleen. A kind of classic description of a baby born with CRS includes a blueberry muffin rash, which means purple spots on the skin. Interesting. Yes, and this is actually caused by, this is very interesting, it's caused by erythropoises, which is the

process of making red blood cells in the skin because you have anemia elsewhere and infection of the bone marrow potentially. So basically the baby is not making enough red blood cells. So other organs are recruited to help make blood cells and then you end up with this type of rash. Whoa. You could also have pneumonia, myocarditis, diarrhea, like a lot of different things can happen. These manifestations do tend to clear on their own. However, it comes with the caveat of these infants are very sick. And on top of that, you don't generally have only these transient manifestations. These babies are oftentimes born with things like growth restriction or other more permanent manifestations.

So mortality in babies born with this type of congeneral Rubella can be as high as 35% in some cases. Oh, my gosh. It's very sad. And I didn't even mention, but infection with Rubella, especially super early on, can also cause pregnancy loss, but I have no idea what the proportion of that is because I was not able to find numbers on like the incidence of that compared to infection that results in these things that we can see in a baby that's born. Okay, so now we have these permanent manifestations, and that means that something went wrong

during development. The most common consequence is deafness. This happens in like two-thirds of babies born with congeneral rebella, and it can be of varying levels, so complete to just mild hearing loss. You also can have neurologic complications, including developmental delays. A huge range of heart defects. The heart, aside from the ear, is like the second most common organ involved. I think one half of babies born with congeneral Rubella have some type of heart defect. And then the third most common is vision defects, which can be cataracts. Those are the most common about

a quarter of babies born with congeneral rebella have some degree of cataracts, but you can also have retinopathy, glaucoma, a whole number of vision problems. All of these happen either from problems during organogenesis, so the making of organs like your heart, or from tissue destruction and scarring, like in the case of hearing loss and some brain damage that can occur. Okay. Then we have the long-term or delayed manifestations.

And this is truly wild. These are things like type 1 diabetes, which occurs at anywhere from 50 to 200 times, depending on the paper you read, the rate of the general population. What? Right? So babies born with congeneral rebella can go on to develop type 1 diabetes. Also thyroid dysfunction, a number of different like autoimmune related thyroid dysfunction, vascular problems, the most severe and most rare. complication would be a panencephalitis, so infection of the entirety of your brain, and that is often fatal. But these can occur years down the line. Why? Why? Why? Yeah. But yeah, so your question

earlier about the specific timing, part of the reason, and I found this very interesting, because I was trying to, I was worried you were going to ask me a lot of real specifics about, like, how does cataracts occur and how does? Okay, so I went down some rabbit holes to try and figure out like what specific things are causing each of these, like the three most common effects that we see, which are deafness, heart defects and cataracts or vision problems. And part of the reason that hearing loss is one of the most common effects is because in contrast to some of the other more serious deficits, the effects that can produce hearing loss can happen later. The organ of corti in your ear is vulnerable to the effects of the virus up to the first 16 weeks. Whereas most of like the heart defects, the heart defects are uncommon after like eight weeks or so.

And then cataracts are uncommon after like weeks nine to 11, etc. So that's part of the reason why the ear tends to be affected. the most out of all baby born with CRS. Interesting. The good news is there's a vaccine. There's a vaccine. And Aaron, I can't wait to hear about the development and things like that. But it's a live attenuated vaccine, so it's a live strain of rebella virus that's been

grown in a lab so that it doesn't cause infection. One dose produces immunity in 95% of people that has been shown to last upwards of 21 years, which is phenomenal. It's a good one. It's a very good one. So in general, that's the only good news that I have. So, Aaron, what's up with this? Can you tell me about it?

Like, where did this virus come from? Why is it only in humans? How did we come up with a vaccine? And why isn't it gone yet? I don't know. My gosh, these are lots of questions. And I don't know if I'm going to be able to answer all of them, but I'll do the best that I can.

Right. 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'Keeffe'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 out there. side. We're offering our listeners 15% off their first order of O'Keefs. Just visit o'keefs company.com slash this podcast and code this podcast at checkout. I'm Clayton Eckerd, and in 2022, I was the lead of ABC's The Bachelor. Unfortunately, it didn't go according to plan. He became the first Bachelor to ever have his final rose rejected. The internet turned on him. If I could press a button and rewind it

all I would. But what happened to Clayton after the show? made even bigger headlines. It began as a one-night stand and ended in a courtroom with Clayton at the center of a very strange paternity scandal. The media is here. This case has gone viral. The dating contract. Agree to date me, but I'm also suing you.

Please search warrant. This is unlike anything I've ever seen before. I'm Stephanie Young. This is Love Trapped. This season, an epic battle of He Said She Said, and the search for accountability in a sea of lies. Listen to Love Trapped on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. China's Ministry of State Security is one of the most mysterious and powerful spy agencies in the world. But in 2017, the FBI got inside.

This is Special Agent Regal, Special Agent Bradley Hall. This MSS officer has no idea the U.S. government is on to him. But the FBI has his chats. texts, emails, even his personal diary. Hear how they got it on the Sixth Bureau podcast. I now have several terabytes of an MSS officer, no doubt, no question, of his life. And that's the unicorn. No one had ever seen anything like that.

It was unbelievable. This is a story of the inner workings of the MSS and how one man's ambition and mistakes opened its fault of secrets. Listen to the Sixth Bureau on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. So, Aaron, you asked, where does this come from? Yeah. We don't really know. Oh, I know.

Are you me or something? I know, I know. Okay. Here's what I'm going to do in the history section just to sort of like prepare you for the fact that there's going to be thousands of years of, like, me not talking about the history. I'm going to start with the evolutionary history and what we do. know about it. Okay. And then basically, I have to jump right to almost modern history. What? Because in terms of ancient history, Rubella was unlikely to be distinguished from the other relatively mild or often mild rash-causing illnesses. Right. I mean, as you described, the symptoms

aren't super specific. So unfortunately, that means like no mentions of ancient Egyptian papyri or Hippocrates or whatever. Well, I'm done listening to them. Just kidding. Okay. But as I mentioned, yeah, there seems to be this big question mark over the origins of the Rubla virus. I did read in one paper that looked at the molecular epidemiology of rebella viruses and the different Rubelovirus genotypes across the Asian continent. And they said that, oh, it's thought to have originated there, like somewhere in Asia. Okay. All right. But then I found a paper that was published super recently in nature in October 2020. So like, oh, just a couple months ago.

It's cool. Just for us. And they reported the first known relatives of the Rubella virus, which they isolated from several different species of mammals. What? This is interesting. So, Ruhugu virus, which is most closely related to Rubella, was found in a species of bat called the Cyclops Leeds.

nose bats, which I believe were in Uganda, and they appeared otherwise healthy. And it wasn't just like this isolated infection in one bat. It was found in around 50% of the individuals that they sampled. What? Yes. And they found the other virus, which they called Rustrella virus, in animals in a zoo in Germany that had gotten sick and eventually died from a severe acute neurological disease. What? The animals were a donkey, a capybara, and a rednecked wallaby. What? Aaron. I know. I know. I know. And so when they were searching for the cause of these deaths, they found Rustrella virus in the brain tissue of all three of these animals. And then they subsequently sampled other animals around the area to see if they could find the same thing. And

They found this virus in about half of the yellow-necked field mice that they tested. So they found these two, like, brand-new viruses. Seems to be. And then they were like, where, what are these? And they figured out they're closely related to Rubella? Really closely related. So, like, if you look at their genomes, they're, like, very similar in terms of, like, coding regions and stuff and the arrangement of those.

What? Yeah. Like, did they come from Rubella or did they come from a shared common ancestor? How old are these? Let me – so I don't know how old they are. Let me pull up the paper to see what sort of their – the evolutionary implications or timeline or whatever. If I'm reading this correctly, so all three of them came from a shared common ancestor, but Rustrella virus diverged before those two. What?

So it went first, Rustrella went off the tree, then Ruhugu, and then like, Rubella split secondly. What? Yeah. I don't know about the timeline or anything. Maybe it was in the paper and I just missed it. But, yeah. But basically, so from this paper, there were a couple of takehomes.

One was that given the ability for these viruses, especially Rustrella, to infect a diversity of mammal species. and now I'm adding my own little thing about what we know about the rebella virus to infect all different kinds of cell types. Right. That's, yeah. The rebella virus may have initially spilled over from wildlife into humans and that this does raise some concerns for future zoonotic spillover events.

Although I do want to give a PSA, as we always do, to say that bats are not evil. and the more funds and effort we put into this type of research and bat conservation, the less likely spillover events are going to occur anyway. Okay. But the other really cool implication from this paper is that these new viruses give us the ability to do more comparative studies or to explore different animal models so that we can better understand things about why this virus has such wide-ranging impacts

on the body or on the fetus. and yeah, so. Yeah, that's really fascinating. Yeah. So now we need to launch ourselves quite a bit forward in time to around the 18th century. Wow. Yeah. Yeah.

The debate over whether or not these rashy illnesses were different diseases or just different forms of the same disease was still kind of like ongoing. Although there had been some clarity reached regarding at least measles and scarlet fever being separate. and a handful of researchers had started talking about a third separate illness, one that they called Ruteln, I am going to be terrible at pronouncing this, which is German. To Redden, according to Google Translate. Throughout much of the 18th century and into the early 19th century, it was, in fact, mostly German researchers who seemed interested in characterizing this new disease, hence the name by which it would be popularly known in many places outside of Germany, German measles.

Again, not a name that we still use. It is not. But it did, but it was very, it was like much more heavily in use than Routin and Rubella. Yeah, definitely. Throughout the 1800s, there was growing acceptance that this disease was a separate, like a truly separate entity from measles and scarlet fever. But even with all of this discussion and research and a description in the early 1800s that basically covers many of the key features of Rubella, people in the medical science community remained a bit hesitant to accept that this was actually a separate disease.

But finally, the tide seemed to be turning when in 1866, following continued epidemics and other smaller reports of the disease, a British Royal Artillery Surgeon published an article describing a current outbreak of the disease known as Rutan, Routiln, in India. He closed out this article with a paragraph proposing a name change. Quote, the name of a disease is always a matter of some importance. It should be short for the sake of convenience and writing and euphonious for ease in pronunciation. I agree with that part, but that's only because I'm terrible at pronouncing anything. To continue.

It should, if possible, indicate. a definite group of pathological conditions. Routelan is harsh and foreign to our ears. Rubiola Notha and Rosalia idiopathica are too long and yet to be proved. I therefore propose Rubella as a name for the disease. But also that's just so English-centric. Is that not? I know.

I can't pronounce German. So let's call it. This thing that I'm going to make up entirely. Yeah. Yes. But the name did catch on. people were like, yeah, sure, let's do it. Although the term German measles would stick around for much longer in many places to kind of an annoying degree because it caused a whole lot of

confusion. It's not from Germany, and it's also not a type of measles. And at times, it also caused anti-German sentiment. For instance, in World War I, although it lagged behind other diseases such as influenza and typhus, Rubela did do some dance. image. U.S. Army hospitals admitted more than 17,000 soldiers for Rubella, and Rubella was the cause of over 211,000 days lost from duty. Wow. And the high prevalence of this disease led to lots of German measles jokes about Germany. And in World War II, the disease was nicknamed the Liberty Itch, or Victory Measles. Like Freedom Fries and Victory Measles. Yeah. Oh, my God.

Okay. For the next big development in Rubella history, we have to jump ahead again, this time to the early 20th century, around 1941. So far. Let's do a bit of context building here, my favorite thing to do, in terms of infectious disease and medicine. So it's kind of hard to imagine just how much the field of medicine had changed in 100. years from like 1841 to 1941. I want a compilation of every time that you've said that. I know. I know.

And I'm like, I feel self-conscious saying it because I'm like, God, surely people are sick of hearing the same thing. I love it, though. It helps me get into the mindset of like why, like, why 1941 was an important year, why that year, why things happened when they happened. Yeah. Yeah. Anyway. So germ theory had a lot to do with advancing knowledge regarding some of the most common or prevalent diseases in that time. But medical technology allowing for close observation and measurement of things previously only able to be described qualitatively turned the art of medicine into a science. Definitely have said that before.

Oh, yeah. And a great deal of this change can be described by a single word, special word. The growing body of knowledge regarding human anatomy and disease processes and treatments made it possible for different highly specialized fields to develop. Okay. Now, on to the infectious disease context. Jerm theory had been around for decades, but the pace of discoveries in terms of uncovering new pathogens or new treatments or vaccines was still incredibly high. Around 1941, we had a smallpox vaccine, a cholera vaccine, a typhoid vaccine, and others, and we were more easily able to tell, you know, oh, this disease is likely caused by a bacterium versus a virus versus a parasite. Antibiotics were on the cusp of widespread use, just a couple years away. And as a result of our increased understanding of how different diseases were transmitted and improved

sanitation infrastructure, the world was facing lower rates of death due to infectious disease than ever before. But of course, there was still an incredibly long way to go. Things like tuberculosis and polio still sickened or killed many people. And it also made them terrified. So a potential vaccine or treatment for these feared diseases held a lot of promise and hope for people. But I think it's important to remember that not all diseases were as equally feared or like the need of. for a vaccine for every disease was not as self-evident as it may be is today. Yeah, which is very interesting, especially in the context of Rubella. Exactly. So it was like, you know, when you are, when you have tuberculosis or polio outside your door, like you don't have room or even reason

to be scared of something as mild and routine like Rubella. Right. Which is what it seemed at the time. Yeah. And so while. epidemics of Rubella were tracked and control attempts were made, and research on the causative agent still continued, it didn't really take front and center the way other things did. But that would change starting in 1941. Oh, Australian pediatric ophthalmologist Norman McAllister Greg. There's your specialization. Yep.

Had been, he'd been practicing for close to 20 years when in 1940 and 1940. in 1941, he started to notice an unusual number of parents bringing in their babies with the same concerns, unusual cataracts or eye infections or other rare eye disorders. And, you know, he had been in the field for a while, and so he recognized that the rate of these conditions that he was seeing was uncommonly high. And he wondered whether there was some sort of link that was connecting them. And maybe it was unusual for the time, but he was the type of doctor that, listened to their patient's concerns and to their hypotheses as to why their kid was sick and what had caused it. He exhibited patience and empathy, at least from what I've read about him.

Wow. And one day, Greg, which is, it's his last name, but it's really just funny for me to be like, Greg. Greg. I see there are two Gs here, but like, Greg. Greg. So one day, Greg overheard a couple mothers of his patients, so children with rare cataracts talking in the waiting room about what they thought had caused their child's poor eyesight. One of the mothers wondered out loud whether it could have been the Rubella infection that she

had early in her pregnancy. And the other mother also mentioned that she too had gotten sick with Ruebella while pregnant. And instead of immediately dismissing this as another superstition, which there were plenty of superstitions, as no doubt many other physicians would have done, he considered it a plausible idea. Despite the fact that at that point, the idea of an infectious disease affecting a fetus had not really been considered, much less explored. Fascinating, Aaron. And so he asked around to other colleagues whether they had seen similar cataracts in babies or young children,

and if they said yes, he reached out to the parents of those children to ask whether the mother had experienced a rebella infection during pregnancy. Wow. And what he was finding was that a substantial proportion of those women said yes, a proportion that was at least great enough for him to expand his efforts and conduct an actual, like, official planned study into this phenomenon. And through this additional research, he found that a rebella infection during pregnancy, especially early on in pregnancy, was associated with a suite of eye problems, but that it wasn't

limited to just the eyes. There was, there also seemed to be cardiac involvement in some of the children. In 1941, he compiled his findings into a report that he presented at the October meeting of the Ophthalmological Society of Australia. Some Australian newspapers also happened to pick up this story, and Greg found himself the recipient of tons of phone calls from people who had been infected with Rubella during pregnancy, and their child had either sight or hearing or heart or developmental issues. And so public and scientific interest in this possible link between rubella infection during pregnancy and congenital defects grew.

And the bigger picture of congenital rubella syndrome took shape, although that term wouldn't be really used until the 1960s. Rubela has been likely infecting humans for thousands of years. And so I think it's natural to ask the question, why did it take until 1941 for people to make the connection between a rubella infection during pregnancy and congenital abnormalities. What was so special about that year or about Dr. Gregg? I set up some of the historical context earlier, especially the role that specialization in medicine likely played, but there's more to the story. First, Norman Gregg was notable

in that he listened to the mothers in his office and pursued a lead that others may have dismissed due to the fact that A, nothing like it had been observed before, and B, it was originally put forth by women, most of whom weren't medically trained in any way, or even maybe had received formal education. In his writings and interviews, Greg acknowledged the contribution of these mothers whose strong interest in their child made them observant and willing to recount any information that might be relevant. In addition, Greg was not just a piece of a person. pediatric ophthalmologist whose specialization meant he saw a ton of patients from a wide geographic area, he was also a university researcher, meaning he could undertake an epidemiological study and

do some stats to see whether his research questions were answered. And if so, what those answers were. And the other notable thing, not necessarily about Greg, but about the time period, was that World War II was underway. And the assembly and movement of truth. And the assembly and movement of troops led to widespread rebella epidemics, not just in Australia, but across the globe as well. And those rebella epidemics in the military, of course, spilled over into the broader public. And so the increase in the frequency of those unusual cataracts he was seeing was likely the result of those rebella epidemics. Yep, that makes sense.

Whoa, Aaron. I know. It's interesting. I just like to put myself in the shoes of, like, you know, why that? Why this person? Yeah. You know, it's cool to think about. Yeah, I, the whole epidemics thing about Rubella is very interesting too, because it's

definitely like majority a disease of childhood. But in all populations, before vaccines, there was going to be some proportion of people of childbearing age who are still susceptible. So then what causes an outbreak in kids versus in adults? versus in people who are pregnant. Like, it's just so interesting to think about all of the different factors that would have had to combine to lead to these not just rebella, but congenital rubella outbreaks. Like, ugh, it's very interesting.

Right. Especially at a time when, you know, I think the other really key thing is that rubella, at least then, like, people knew it was a virus, but they didn't know which virus. And diagnosis based on, like, clinical presentation was iffy a lot of the times. was usually a process of elimination. Have you gotten measles before? Have you gotten scarlet fever before? Yes. Okay, this is probably rebella. Well, and on top of that, there's such a high rate, especially in adults, of no symptoms whatsoever, like a completely asymptomatic infection. It's like over 50%, right? Yeah, it's about 50% in kids that'll be asymptomatic. And in adults, it can be as high as like six or

seven to one. Yeah. So a really high rate. So the fact that he was able to like find statistical significance in his samples of like asking people, hey, did you get Rubella when you were pregnant or whatever? Like, that's, oh, man. Yeah. It's, it's amazing to think about it. It really is. But what did the rest of the world think of Greg's hypothesis? Greg, I don't know. Well, while researchers and clinicians in Australia were pretty quick to accept Dr. Gregg's findings as fact and start informing people about the dangers of Rubella infection during pregnancy, the rest of the world wasn't so keen or so quick to believe him or his research, which does have some merit.

Greg's data set only included children with congenital defects. The methodology behind how he collected the data was unclear. And there was still some doubt that Rubella could be reliably distinguished from measles and scarlet fever. And his critics argued that Greg's findings were suggestive of a link but not conclusive. Okay. But I think it's also interesting that scientifically the idea that compounds or pathogens could cross the placenta was not new. It was something that embryologists and pathologists had, you know, known for probably at least a few decades. But most clinicians at the time probably didn't receive training or specific education in embryology the way they do now. And still, nothing like this had ever really been observed before in humans in terms of a virus. And so this got some people thinking that viruses represented this whole new realm to be feared in terms of negative effects during pregnancy. Huh.

So anyway. But despite this initial doubt, the link became more accepted as clinicians did their own tracking of patients or patient case histories in places like North America and Europe. And data supporting the link just seemed to grow and grow and grow. And the boundaries of congenital rebella syndrome also seemed to be like, you know, grow as well. or expand as well. And from there, it trickled out into the public. For some people who had had a child with congenital rubella syndrome, it was a relief to know why that had happened, to have some sort of an answer because it relieved some

of the anxiety or worry they may have carried in terms of deciding whether to have another child or it may have relieved some of the guilt that they may have carried with them. With the dangers of Rubella uncovered and yet no vaccine. for its prevention, doctors considered what to do to minimize the risk of infection in pregnant people. Stop epidemics in their tracks, inform the public of the risks of this virus, which had previously been thought to be minimal. Prophylaxis really seemed like the only way to actually ensure the safety to pregnant people. Others recommended that people should try to become infected while young to gain lifelong immunity, like, you know, rubella parties.

Like those were actually a thing. Although others strongly recommended against that, considering, like, there could be severe consequences of infection. Like, why invite a pathogen when there could be something that you don't know happens? Right. But until there was a vaccine, there was also the recognition that rebella and thus congenital rubella syndrome was not entirely unavoidable. And some of the advice, like, keep it.

away from small kids was completely impractical for some mothers who maybe already had a couple of school-age kids in home. Small kids. Yeah. That was like, yeah, what are they supposed to do? Like, live in a hotel for nine months? Oh, that's like, well, I just, this is a little bit off topic, but like, after a C-section, you're not supposed to like lift over 20 pounds. So if you have a toddler, it's like, well, you can't touch them. Yeah. But it's, yeah. Oh, dear. Yeah. And so, Recognizing this in the popular media, the headlines shifted towards a concern that the continued epidemics of Rubella would lead to what was framed as an enormous social problem, where an institution's or long-term care facilities would be overwhelmed and families would be

hugely stressed. During this time, the prevailing view in the U.S. was that children with CRS were seen as tragedies, and the parents and families of those children as the children as the victims of those tragedies. Now, of course, our society has evolved a bit in empathy, but this framing wasn't just because of a lack of empathy back then. It was also because during that time period, we lacked the knowledge and resources to adequately care for people who were differently abled. Often the solution was institutionalization, which was a huge financial strain.

and public schools weren't equipped also to provide additional resources that's going to make education possible for children with congenital rebella syndrome. Yeah. And especially when you think about deafness and hearing loss, that often wasn't able to be diagnosed until much later in life, which is still the case in some parts of the world, which is hugely detrimental to learning ability. Whereas now, if you're able to identify it early on, you can already get, you know, things in place to be able to help that child with what they need. So that's huge for sure. Yep.

And all of these things also were compounded by the social stigma and shame that was associated with having a child with congenital defects. Why didn't you take better care of yourself during pregnancy? Like all of these accusational, you know, questions of like pointing fingers and assigning blame to people who like it's- Blame the mothers. To mothers primarily, yes. Yeah. And, you know, the emotional turmoil would have affected everyone in the family. And of course, what parent doesn't want the best for their child, for their child to be healthy and to have no limits on what they can do and achieve.

The media attention on congenital rubella syndrome reached new heights in the early 1960s when an enormous rubella epidemic was underway in the U.S. But although it was like quite a sizable epidemic, this was not. not the first rebella epidemic in decades. In 1958, for example, there was another rebella epidemic across the U.S., but it didn't make nearly as many headlines. So let's consider why this early 1960s rebella epidemic might have caused such alarm. I can take some guesses. Yes. If you've listened to the podcast before, there are two possible reasons you could guess right away. Number one was polio.

Jonas Salk's polio vaccine had been developed and deployed a little over 10 years before. And so the specter of polio and the paralysis that it could cause was still pretty fresh in the minds of many people. And secondly, even more recently, Erin, thalidomide. That's right. Thalidomide. And if you haven't listened to our polio or thalidomide episodes, go check. those out for more historical context on that situation. But the litemite had this enormous impact on the U.S., even though the U.S. largely escaped, not entirely, as we talked about in the episode,

but people read the news articles and testimonials of parents and saw the pictures of children born with limb malformations. Yeah, that makes sense. And essentially it put this image to their fears of what could happen with Rubella epidemic, especially since. unlike polio, there was no vaccine, and unlike thalidomide, it was not safely off the shelves. Right. Yeah, yeah. The thalidomide scandal of a few years before turned this rebella epidemic from what would have been a largely private matter to a public one.

The rubella epidemic that began in 1963 and continued through 1965 was enormous. Approximately 12.5 million people became infected with rebella. Whoa. Mm-hmm. And an estimated 20,000 babies were born with congenital rebella syndrome. Oh, my gosh. With around, there are tons of different numbers quoted, but one I saw was 11,000 miscarriages and therapeutic abortions. Wow.

Which brings me to the next big step in the history of rebella. It was the combination of both the thalidomide scandal and this rebella epidemic of the early 1960s. that led to more open discussion of abortion and ultimately widespread abortion law reform in the U.S. Really? Yes. No way. I had no idea. I know.

I know. Me either. I stumbled across it when I was looking for like books on Rubella. Wow. Uh-huh. So as we talked about in our birth control episode, birth control isn't new. Abortions aren't new. They're not a 20th century invention.

Not at all. Although I think we tend to think of roversuade as being the moment where abortion came into the open and it had only been practiced in back alleys and in people's basements up to that point, that's not quite accurate. During the Depression, for instance, safe abortion clinics practiced openly. But with the conservative moral backlash really only beginning in the 1940s and 1950s, which was also a very politically conservative time. abortions didn't stop, of course, but they just became more unsafe and more secretive and more

like, you know, there were more moral implications to it. Right. Yeah. In the early 1960s, you could still seek an abortion in some states through applying for one and having a hospital abortion review committee look over your case. It was basically like a panel of generally male doctors. Yeah, a bunch of dudes deciding whether or not you get to, oh my goodness. And then often, at least like in some instances, you would have to undergo several physical or gynecological exams with members of that abortion review committee.

Absolutely not. Isn't that? Yeah. Yeah. That's appalling. And throughout the 1940s and 1950s, abortion was painted as an incredibly dangerous thing to do. It was often resulting in death and those seeking or performing abortions were criminals or immoral or deficient or evil in some way. Thalidomide, and I highly recommend people read about Sherry Finkbein sometime, because that also plays a huge role in the history of abortion and abortion law reform.

But thalidomide and the Rubella epidemic of the early 1960s turned this discussion of abortion into one of a right to be informed and make an informed choice, to choose what a woman felt was right for herself and for her family. It began to be considered as necessary or right, and its illegality was considered more immoral than its legality. Interesting. And it is true that the image of people seeking abortions changed during this time. It became more of a middle class problem. And so that did definitely put a spin on, like it had to be a white middle class person seeking abortions. Mm-hmm. Mm-hmm.

Yeah, they're the only ones who can seek abortions more than. Early legal battles in abortion often sued physicians and hospitals that provided false information or refused to provide any at all, which prevented the patient or the person seeking the abortion from making their own decisions about their body or their family or their own life. For instance, a woman would go to a doctor and say, I don't feel well, something's wrong with me, and he would be in his brain thinking, oh, that looks like Rubella, but it's probably not, it might not be, I don't want to worry her unnecessarily. And so then he might note it on her chart but not ever tell her. What? So that would happen or it would be a doctor saying, actually, I'm not sure if it was Rubella. These early legal battles were all about information and access to information and a patient's right to access that information.

Right, yeah. Some of these lawsuits came to be known as wrongful birth or wrongful life suits, and they ended up revolutionizing abortion law in the U.S. But there is one quick note that I want to make about Rubella abortion and people of color during this period. Often, whether or not an abortion granted someone the approval to seek a therapeutic abortion depended on a recorded positive diagnosis of Rubella. But as we discussed in our Rocky Mountain Spotted Feudy fever episode, skin rash diagnoses in people of color is notoriously difficult and lacking in guidance in the medical literature. But there is a medical student named Malone Mukwende, who is

working on a book that is going to address this and the problem of not having, like, accurate pictures or, like, information in medical literature. It's like, it's 2020. I can't believe that it's, but it's incredible. I'm so, yeah. Yeah, I can't wait for that book. So anyway, but this added one more layer of discrimination and bias against people of color in the medical realm, you know, just as per yuge. As per yuge. Anyway, in addition to propelling abortion law reform forward, the Rubella epidemic in the U.S. in the 1960s also propelled scientific research forward. The virus that caused Rubella was identified in 1962.

And the first test for Rubella, like whether someone was newly infected or had been previously infected, was developed in 1965 by Stanley Plotkin. Plotkin. I read some of his papers. Yeah. But the biggest goal was a vaccine, which was seen as the best solution, scientifically and culturally, in light of abortion. Since Rubella epidemics tended to occur every four to six years, 1970 was sort of this looming deadline, when the never. big epidemic was expected to happen. Fortunately, a live attenuated vaccine was developed in 1966 by scientists at the NIH who agreed to share it widely on the condition that it not be patented. Awesome. And I know, Aaron, you were like, I can't wait to hear about the story of the

vaccine, but like that's basically all I have for the development. Yeah, but that, I mean, that's what I wanted to know. Like, what was the, the impetus for that? Yeah. Yeah. Because in the context of like such a mild generally illness. I was really interested in like what were the factors driving the vaccine development. So you answered those burning questions. And so once this vaccine was available, there was a massive vaccination campaign in the U.S. in the late 1960s. And despite Nixon's ridiculous budget cuts and basically like having to depend on an army of volunteers, it would prove to be one of the most successful vaccination campaigns in history. That's awesome.

Hopefully to be upset by the COVID vaccine. Fingers crossed. Fingers crossed. By the spring, so here's a quote. By the spring of 1972, 75% of all school children and more than half of all children between one and four years old had been immunized against Rubella. From 1966, you said it was developed? 69 is when this campaign started.

And then 60, wow. So in three years. years. That's pretty phenomenal. It's huge. A few years later, the Rubella vaccine would be combined with the measles and mumps vaccine. And by, I don't know, the 1980s, for many people, Rubella simply came to mean just the R in MMR. Yep. That's it. Absolutely. Which is fascinating. How fast we forget these things. Oh, yeah. Over the next few decades, massive vaccination campaigns decrease the global prevalence of rebella and congenital rebella syndrome dramatically, and it was eliminated in the U.S. in 2004.

However, lapsed vaccination rates, I can hear that intake of breath, Aaron, anticipating the bad news to come. However, yep. Yep, lapsed vaccination rates and lack of access to vaccinations in other places has led to rebella and congenital rebella syndrome continuing to be a huge problem in many places, which is where I end my story and pass the mic to you, Erin. Oh, great. Love to pick it up on happy notes like that. You're welcome. We'll take a quick break first and then dive in. So this will be relatively quick and like kind of mostly good news, Erin. That's good. Nice. Not great news, but decent. Good, not great. Excellent.

Not great. So let me just hit you with numbers straight off the bat. All right. And we're just going to talk really about the last 20 years from like 2000 to 2020. Okay. Cool. So as of early 2019, 168 out of 194 countries that the World Health Organization like monitors had introduced Rubella vaccination as part of their childhood vaccination series.

168 out of 194. So that's a lot. Global coverage was estimated. So that means the total number of kids who get vaccinated was estimated at 69%, which was up from in 2000, 21%. Wow. Yeah. So that's pretty great. Yeah. Because of that, and this is going to get interesting. The total reported cases of Rubella, not congenital Rubella syndrome, but Rubella, declined by 97%. Oh, in the last 20 years? In the last 20 years, from over 670,000 cases reported in 2000 to just over 26,000 cases reported in 2018. And here's what's really important about that. Reporting has gotten worlds better for Rubella in that. In that.

that time period. So it's even, it's likely that it's even more than a 97% decrease. Right. So we've had a huge increase in the number of countries that report. In 2000, only 53% of countries reported their Rubela numbers. And in 2018, 91% of countries were reporting something. Granted, this is all going to be an underestimate, blah, blah. We always say that. That's always true. But still, that's major. Yeah. Right? Like 50% more or like 40% more countries are reporting. and we have a 97% decline in Rubella cases. Whoa. That's amazing.

It's incredible. And that's because of vaccines. Because of vaccines. For congenital Rubella syndrome, the story is not quite as beautifully perfect, but it's still very reassuring. In 2000, there were 156 cases reported. Do you think there were only 156 cases, Aaron? No. Definitely not.

In 2018, there were only 449 cases. reported. So that's an increase. But again here, the percent of countries reporting increased from 39 percent to 71 percent. Wow. So that means that 71 percent of countries are doing some kind of surveillance to look for congenital rubella and identify it and then reporting those numbers to the World Health Organization. That's excellent. It's very excellent. So in our measles episode, when was that? Season two? Yeah, I think so. I'll go. Anyways, way back when we talked a lot, I'm pretty sure, if I remember correctly, about the global vaccine action plan and the measles and Rubella initiative, which are these

groups of plans that the World Health Organization kind of helps coordinate and minister across all the regions, where most regions, not every region, but most regions had a goal to eliminate measles and rubella by the year 2020. Oh, this year. So yeah, here we are. We're recording at the end of 2020. This episode will be out in early 2021. We have not achieved those targets. We don't have the data from 2020 yet, but as of the 2019 Global Vaccine Action Plan reports, I will post a link to the full reports, which has every region, The five different regions, which is the African region, the American region, the eastern Mediterranean region, the European region, and the Southeast Asian region, and the Western Pacific region. So those are all the regions. Each of them have their own reports. Each of them had slightly different goals. Each of them are at slightly different places on meeting those goals. No one has met their goals completely, but every region has made major progress for the most part on getting towards those goals. And the Americas were declared free of endemic rubella in 2015. And as far as I can tell, they have maintained this status. But like you said, Aaron, because of lack of low vaccine rates in certain places, the report.

actually combines measles and rubella. And so some countries in the Americas have had endemic transmission, I think so far is just of measles and not rebella. But I mean, that just kind of means that rebella could be not far behind. Right. Sure. All it takes is just one. Exactly. Right. Yeah. But still, that's pretty major progress. And I feel like this year, especially, any progress is something that we should celebrate. Yes. We need some victories. Agreed. So, yeah, I mean, that's pretty much the status of Rubella.

It's just sort of these vaccination campaigns and trying to make sure that every kid has access to a Rubella vaccine. Mm-hmm. I mean, this is a more uplifting ending than many of our episodes. I think so, too. Yeah. Yeah. Well, good.

I'm glad. Okay. I guess is it time for sources? Yeah, I think so. I read a book called Dangerous Pregnancies, Mother's Disabilities and Abortion in Modern America. And this is by someone named Leslie Reagan, who is at the University of Illinois. Really?

Yeah. Interesting. Yeah, it was a very interesting read. Yeah, I really enjoyed it. It did totally open my mind to like, oh, my gosh, I had no idea about the link between this. fascinating. And then I want to shout out the nature paper I mentioned by Bennett at all from 2020 called Relatives of Rubella Virus in Diverse Mammals. And then finally,

just a couple other like older papers I pulled the history from one by Cooper from 1985 called the History and Medical Consequences of Rubella and by Forbes from 1969 Rubela historical aspects. And there were a few more that I'll post as well. I found a very phenomenal book chapter in Remington and Klein's infectious diseases of the fetus and newborn infant written by none other than Reef and Plotkin. Oh, Plotkin. That was very thorough. And then a number of other papers as well, which we'll link to on our website, this podcast will kill you.com. Just click on our episodes tab and you can find the sources from every single episode we've ever done.

Every single one. 64. Four? Four? Yes. What? Wow. Well, thank you to Bloodmobile for providing the music for this episode and all of our episodes. And this podcast Will Kill You is a member of Exactly Right Network. So if you love us, check out all the other Exactly Right podcasts.

There's so many. Heck, yes. They make this stuff happen. They make it possible. And you know who else makes it possible is you, listeners. You do. Thank you, thank you, thank you from the bottoms of our hearts. Seriously. From the bottom of our hearts? For the bottoms of our hearts?

Well, so the bottom is the ventricles, which are the parts of our hearts. The ventricles of our hearts, specifically the left ventricle. You heard it here first, listeners. Thank you from the left ventricle of our hearts. That's a powerful one. Oh, oh my gosh. Well, okay, let's end this thing. Until next time, wash your hands.

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