Ep 150 Norovirus: Tip of the poop iceberg

00:00:00
Speaker 1: When I was nine months pregnant. I woke up one morning and felt really off. I was nauseous and could only eat peanut butter toast. Being nine months pregnant, I figured it had something to do with that, so I just continued on to work, where I was in a rheumatology clinic during my pediatrics residency. After about a half hour in clinic, I felt like I might vomit, so I apologized to the team and I went home. Luckily, I made it home before the vomiting started. Once it started, it was pretty continuous and I could not keep down even SIPs of water. I started having abdominal cramping as well, which started to be more worrisome, especially since I was nine months pregnant. I reached out to friends and family who thought it could be signs of labor, so we went into labor and delivery floor to get checked out. There, they determined I was not in labor. They did some labs, which looked good, and then sent me home with nausea meds. At home, I started having fevers and full body aches. I could barely move from bed, and my husband kept waking me up to drink SIPs of electrolyte solution with a nauseamed The night was pretty okay, but the next day the diarrhea started, which was horrible and unforgiving. That wrapped up quickly, however, and the whole thing was over in about thirty six hours. Two days later, I was scheduled for induction, and even then when I went in, I was still dehydrated and the nurses were finding it hard to get an ivy, so they had to poke me a few times. We started the induction and my husband started feeling a little nauseous, and then he's also started vomiting. He gets a nervous stomach, so at first we didn't really think too much about it, but within a few hours he had profuse vomiting, fevers and diarrhea at the same time. He looked bad enough that the labor and delivery nurses insisted he go to the emergency department, and we decided to stop the induction and I went home. As my husband was evaluated in the emergency department and eventually admitted for fluids. I was at home waiting to hear how he was doing, and my water broke, so I went back in and delivered a healthy baby. Girl. The following morning, we had so really phenomenal Ellen D nurses who helped coordinate my husband coming up to see the baby from the emergency department, and our first family photo was of all of us in hospital attire and all of us in diapers. We found out for my husband's testing that we both had moura virus, which was I probably picked up at work somewhere, but it could have truly been anywhere. I was really scared that our baby would get it, knowing it was so much worse for little ones that had no reserve. But she remained healthy and we all went home in a couple of days. It was a really humbly experience for all of us. And I will never underestimate maura virus.

00:03:20
Speaker 2: Yeah, yeah, yeah, you know, yeah, yeah, it's not great.

00:03:30
Speaker 3: Understatement, understatement, Yeah that is. I thank you for reliving that for us. I know that it was a horrible experience, so we appreciate it.

00:03:47
Speaker 2: Thank you.

00:03:48
Speaker 3: Hi.

00:03:49
Speaker 2: I'm Aaron Welsh and I'm Erin Allen Updake.

00:03:52
Speaker 3: And this is this podcast will Kill You, And today.

00:03:55
Speaker 2: We're talking about none other than neurovirus.

00:03:59
Speaker 3: You know, Aaron, I was getting ready for like for tonight, like, you know, brushing my hair or whatever, and I was like, have I ever had neurovirus? And for some reason that in that moment, after spending a week reading about neurovirus and writing about it, that was the first I actually wondered if I had personally experienced it. And I think, yes is the answer.

00:04:21
Speaker 2: Yes. I feel like I can remember times when you almost certainly had neurovirus?

00:04:28
Speaker 3: Are you thinking of the one when I was in Finland and I had to get off the bus in the winter and bar everywhere?

00:04:33
Speaker 2: That one was very bad.

00:04:34
Speaker 3: I remember that.

00:04:36
Speaker 2: I feel like there were several other times too, when you had really bad GI things and I was like, yeah, it's probably aurovirus.

00:04:42
Speaker 4: Oh my gosh.

00:04:44
Speaker 2: I can very distinctly remember the most recent, the most memorable time that I almost certainly had neuro virus. Don't know what else it would have been. I mean, I guess there's a many other things that could have been. But it was when my older son was in daycare when he was a baby, and all the other kids at daycare had had some barfing thing and then both Brett and I got it and my kid did not, And I was like.

00:05:10
Speaker 5: What if I don't get we'll talk wait though, okay, yeah.

00:05:15
Speaker 3: Oh okay, yeah, I have so many questions already. We can't do this. That would be the earliest yet on record for us. Yeah, we'll get there.

00:05:27
Speaker 2: I can't wait first. But first, it's quarantiny.

00:05:31
Speaker 3: Time, quarantin any time, Aaron, What are we drinking this week? We're drinking the cruise. I mean, I think that for most of us, when you hear neurovirus, your first thought is, oh, that thing that happens on cruise ships.

00:05:49
Speaker 2: For me, it's the opposite, Like, when I hear cruise ships, the first thing I think of is neurovirus.

00:05:56
Speaker 3: Well, in any cares, I don't know if we can dispel that, but we we will dispel the fact or the notion that cruise ships are somehow the only place that you can get neurovirus. Oh yeah, it's far from the truth. I've never been on a cruise, and I have gotten aurovirus, so and of one counts. But we decided to make this delicious not delicious sounding quarantini a martini because Martini's pair really well with another great source of neurovirus, which is oysters.

00:06:33
Speaker 2: None of this sounds appealing in all honesty. No, I know we're gonna make people like never eat food again or have fun again.

00:06:41
Speaker 3: It's gonna be Yeah, it's gonna be awesome. But I mean, there's really nothing you can do.

00:06:47
Speaker 1: Yeah.

00:06:47
Speaker 2: No, we'll post the full recipe for that quarantini and are non alcoholic plasy barita on our website, this podcast okay you dot com and all of our social media channels.

00:06:58
Speaker 3: We certainly will on our website this podcast will kill you dot com. It is a treasure trove of things, of links that you can click. Links to our bookshop dot org, affiliate account, our Goodreads list, links to music by Bloodmobile, links to merch, links to Patreon, and then you can find non link things like our sources for all of our episodes and other stuff. Check it out. Well then, well then any other business, rate review, subscribe merch.

00:07:32
Speaker 2: Check it out.

00:07:34
Speaker 4: Yeah.

00:07:36
Speaker 2: Should we just get into the biology of neurovirus.

00:07:39
Speaker 3: Let's do it. Let's take a quick break and then get nauseous together.

00:08:17
Speaker 2: Neurovirus is an RNA virus. It's in the family callisiveri day, which I don't think that we've ever covered any viruses in that family before except.

00:08:29
Speaker 3: Aaron RHDV RHDV. Yeah, rabbit hemorrhagic disease virus. Yes, it is like that came out fast.

00:08:37
Speaker 2: We talked a little bit about that in our mixematosis episode. But then Aarin, you interviewed an expert on rabbit hemorrhagic disease virus.

00:08:45
Speaker 3: So yeah, check Robin, she's amazing. Check out that episode. Yes, it's such a fascinating story too. But anyway, so.

00:08:54
Speaker 2: These are RNA viruses. They're small, they're round. They are a family of viruses that infect a pretty wide range of mostly vertebrate hosts. And the one that we're talking about today, neurovirus. There are a bunch of different genotypes and it's a few of them, mostly one, two, and four that are the ones that cause the most human disease. And neurovirus is a human enteric virus, which means it's infecting and causing us to get sick. In our guts are GI tract. Oh yeah, And like many of our GI tract infecting friends on this podcast, be they viral, bacterial, or otherwise, neurovirus is spread through fecal oral contact, which means poop gets in your mouth.

00:09:45
Speaker 3: Yep, but good stuff, great stuff.

00:09:48
Speaker 2: Neurovirus gets a lot more creative than that, because neurovirus has been shown to be spread through aerosolized vomit.

00:09:57
Speaker 3: You know, Aaron, when I learned about that, I was just in awe of both the facts that neurovirus can do that, but also that we're not all constantly sick with neurovirus. It's disgusting.

00:10:15
Speaker 2: It gets so much more contesting, Aaron, I get excellent.

00:10:18
Speaker 3: Just keep it, just keep piling it on.

00:10:19
Speaker 2: I'm ready, literally aerosolized vomit. That's the way that it can spread. It also is a frequent offender in contaminated food, and with neurovirus. Food is often contaminated either at the point of production, think about things like spinach recalls, et cetera, from like when it was packaged, as well as the point of preparation, so that kale salad that you ordered and someone didn't wash their hands that well. We also see water contamination, not just drinking water, but also ocean's rivers, you name it, and in general contaminated in vices. And here's where it starts to get even worse.

00:11:05
Speaker 3: Okay, starts to get get it.

00:11:08
Speaker 2: It's just beginning, Aaron. Neurovirus is an incredibly infectious virus. It often takes less than one hundred viral particles to produce an infection, which is not a lot of virus. And when people get neurovirus, when they're infected with nourovirus, they're pooping it out. It's shed in their feces, and people can shed it for an incredibly long time, even if they never show any symptoms of it.

00:11:40
Speaker 3: Do you have a question, Aaron, Yes, yes, Aaron, I do. I have multiple questions? So number one, how long can people shed? Number two asymptomatic? Tell me more about that.

00:11:54
Speaker 2: Oh my gosh, I was so excited, except it was not the exact two questions that I thought you were going to ask. Oh what did you think I'm doing? Two questions from you right here? And I have those two answers.

00:12:06
Speaker 3: Fuck Okay, Okay, let me see what else I could ask?

00:12:11
Speaker 2: Uh?

00:12:11
Speaker 3: You said that, I'll give you a shed.

00:12:13
Speaker 2: I said, they shed a lot of virus in their poop?

00:12:17
Speaker 3: How much virus do they shed in their poop?

00:12:20
Speaker 2: So glad you asked? Okay, let me answer these one at a time. How long can people shed neurovirus at a minimum We're talking seven to ten days, but many studies suggest four to eight weeks.

00:12:38
Speaker 3: Erin excellent news.

00:12:41
Speaker 2: Really great news. How much virus per poop? Literally, so glad you asked, because if you hadn't, I was going to tell you anyways, this is mind blowing erin people shed anywhere from one hundred thousand to one billion viral particles per gram of poop.

00:13:05
Speaker 3: No, that is not possible.

00:13:11
Speaker 2: Per gram. Do you wonder how much a gram of poop is? Because the amount of time that I spent looking this up is not insignificant. A gram of feces is about a quarter teaspoon. We are talking minimum one hundred thousand to a million, up to a billion. Some papers say even potentially more, but I couldn't do that math per quarter teaspoon of poop. And as we'll see, nour virus often gives you diarrhea, so it's not like a small amount that you're pooping.

00:13:40
Speaker 3: No, it's easily in the cups to leaders range of things, right, Yes, easily, okay, like a pinch, a pinch of poops billion potentially yep. How are we not all infected? All the time I ask you again.

00:14:00
Speaker 2: And then once people poop it out, this virus can also survive in the environment for how long you might ask another great question, two weeks on surfaces and up to two months in water. And yes, I have not months, but two incitations to back all of these ridiculous numbers up because they are ridiculous.

00:14:21
Speaker 3: Yeah, okay, so it really was like the tip of the poop iceberg. Yes, when you said things are going to get worse, I didn't fully appreciate that.

00:14:32
Speaker 2: Yep, you're welcome, excellent, and Aaron to continue answering your questions. Asymptomatic carriers. Yes, asymptomatic individuals can harbor this virus and continue the cycle of infection even without ever suffering its consequences. And I knew that you would ask how often is this asymptomatic? And what's the deal here? I don't have an exact answer as to how often people are asymptomatic, but in various studies that have been done during outbreaks just where they would check for example, like random kids poop in daycare centers and things like that, the range was anywhere from like eleven to forty percent of people that they examined in these various studies who didn't have diarrhea would end up testing positive for neurovirus depending on the setting that they were studying people. So potentially a pretty high amount of people can harbor neurovirus and not necessarily have symptoms from it. And I'll get into a little bit more detail as to why that might be.

00:15:37
Speaker 3: Yeah, blood types, et cetera. Curious kind of Okay, Yeah, I was trying to read about it, and then I was like, ooh, don't spoil yourself. But also wait what and then I couldn't understand it, and then I was like, just leave it to Aaron to tell you later. But okay, in these studies, these are are these like high risk environments or during out or is it just straight up we're going to go to an elementary school, which I guess maybe could be considered a high risk environment, right, right, It depends.

00:16:07
Speaker 2: On your definition. It was a variety so that there was a bunch of different studies that were cited in a bunch of different review papers, and some of them were like during outbreaks, where they tested people who maybe were associated but didn't have symptoms, and so you might think that they were more likely to be exposed. But then other studies where they yeah, just checked random kids poop and daycare centers to be like, how many of these kids are pooping out aurovirus, and so that's why there's such a big range. Okay, Yeah, and like I mean, how many of these kids maybe like had neurovirus like three weeks ago and then so they're still pooping it. I don't have those numbers, but in any case, you definitely can have asymptomatic carriers. Yeah, if you're going to be symptomatic from neurovirus, the incubation period is usually quite short. It can be as short as twelve hours. More often it's between twenty four and forty eight hours. And there is only one good thing, if there is any good thing.

00:17:06
Speaker 3: About this virus whining, let's hear it.

00:17:10
Speaker 2: Yeah, it's that it's almost always self limited, and so the symptoms are usually pretty short, about forty eight to seventy two hours, like two or three days, just.

00:17:23
Speaker 3: Three days of literally barfing water that you're trying to ingest.

00:17:28
Speaker 2: I know it's not I didn't say it was good news. I just know the closest that we come.

00:17:36
Speaker 3: Oh my gosh, yeah.

00:17:39
Speaker 2: Well, anyways, I think that we got a really great description of symptoms in our first hand account, So thank you again so much for being willing to share your story with us. But I will go in once again to a little bit of detail for us on what the symptoms of noravirus look like. Paint a picture if you will, Oh, please, yes, for any of us who have Aaron myself listeners ever woken up or just like you're going about your day feeling normal, and then suddenly, in the middle of what you thought was going to be a normal day, you just start feeling a little bit like trash like kind of all over. You just start feeling like unwell in your body, and then you start to feel a little bit nauseous, and then shortly thereafter you start just vomiting, just really truly vomiting your brains out. And then after that you have body aches and maybe a bit of a fever, some chills, You think you can drink some water, you vomit again, and the next time that you vomit, you poop all over yourself on the bathroom floor, and then feel so horrible that you cry about it, and you're still fevering, and this cycle repeats itself a few more times throughout the night, and you wake up the next day it's still kind of going though. Maybe you know when it's going to be diarrhea and when it's going to be vomit.

00:19:14
Speaker 3: The age old question.

00:19:16
Speaker 2: You never quite know. Then you survive on SIPs of gatorade. You wake up the next day feeling a little bit improved, and you think, is it over. You nibble on some crackers and you think, at least you'll survive today. You probably had neuro virus yep. So that's usually how it goes. It's usually vomiting predominant at the forefront, often with fever, headaches, body aches, and usually moving into diarrhea, which usually comes after the vomiting. But these symptoms are all a little bit nonspecific, and none of them are like an absolute clincher. That's just kind of the most common scenario. And like I said, most of the time this lasts for just a few days and then you get better on your own. If it happens in the setting of an outbreak or a little mini outbreak where it just spreads through your household, then you also notice or might notice this really short incubation period where you get sick, and then a day and a half later your husband gets sick, and then a day and a half later your friend who came over gets sick, et cetera. So that is the most common way that we see both outbreaks happen and individual cases. But that does not mean that nora virus can't be more severe, because it absolutely can so, especially in people with comorbidities be they just age. So kids who are very very young under the age of five are more likely to get very ill because of the diarrhea and vomiting that they have with neurovirus, and same thing with our elders, those who are over seventy five, eighty, even over sixty five if they have other comorbidities, and more and more in recent years, we are also seeing that people with various immune deficiencies have the potential to have a more severe infection, and that didn't always used to be the case, which is interesting and we're not quite sure whether it's changes in the genotype of the virus or what exactly is the reason for that, But in these populations then neurovirus can cause a severe enough infection that people need to go to the hospital for ivy fluids or supportive care, and people can end up dying. We will talk in the current events section about how many people die, but it's hundreds of thousands of people a year who die from neurovirus infection in the tiniest of babies, so teeny tiny newborn babies. Neurovirus can also cause something called necrotizing enterocolitis, which sounds bad because it is bad, and this means essentially that the bowels, the guts die and this can be very, very severe for these babies.

00:22:12
Speaker 3: That's awful.

00:22:13
Speaker 4: Yeah, So that's.

00:22:16
Speaker 2: The main story when it comes to neurovirus. But usually in this podcast, in these episodes, I like to try and dive into more detail on like how do these viruses like make us sick? But here's where things get interesting. As if this wasn't interesting enough already.

00:22:38
Speaker 3: Right here is where things are interesting everyone the moment. How many can in.

00:22:44
Speaker 2: Time stamp with neurovirus. We don't have an animal model for nourovirus, so we don't have a lot of data on like how is it entering our cell? Which cells is it entering? Why does it cause so much vomiting? Why does it then cause diarrhea? Like, we don't really have a lot of that level of detail on the path of physiology of this virus, which I wasn't expecting in all honesty. But here's what we do have, Aaron, and it gets at your question of asymptomatic carriers.

00:23:19
Speaker 4: Yeah.

00:23:37
Speaker 2: I don't know if this is when this data first started, but I was reading this paper that cited a really really old study that has since been verified, and now we have some data as to why they found these results. There was this old study that showed they took a group of people and they challenged them with poop from nourovirus, a bunch of poop. Yeah, like twelve of them, and half of them got sick and half of them didn't. And then they rechallenged those same people with more poop, and when they re challenged them, the ones who got sick the first time got sick again, and the ones who didn't get sick the first time didn't get sick the second time either. So the researchers were like, what, that's weird, Why and why is this like a repeatable finding? You might think like, oh, well, maybe just someone wasn't exposed to as much or whatever. It turns out that this who gets sick and who doesn't might have and likely has something to do with a combination, of course, of the many different strains of this RNA virus, because there's a lot of different strains, but also our genetics and specifically some of the sugars that attach to our red blood cells.

00:24:59
Speaker 3: It's so weird. It's so weird.

00:25:01
Speaker 2: It's weird. It's not our blood type specifically, so Aarin you mentioned blood type. We have an ABO blood typing system, which more accurately should be called an Abo H system, but everyone ignores the H. And I'm not going to get into a lot of detail on the blood typing system because it doesn't actually matter that much for neurovirus. But these sugars, they're called anigens. These anigens that are attached to our blood cells also get secreted into our saliva and other mucous membranes, including other anigens as well, like Lewis anigen. There's a few others that people secrete. However, some people don't secrete these anigens into their saliva, and these people are called non secrets, and non secretors happen to be somewhat protected from neurovirus.

00:26:01
Speaker 3: Why why.

00:26:03
Speaker 2: A great question. So these histo blood group anigens, these are hbga's and it's the A and the B and the H et cetera. These are the receptors that the virus binds to on ourselves. And so the thought is that because non secretors just don't have as much of this in the environment for the virus to bind to in your mouth or in your gut or wherever you're getting exposed to this virus, then that is why they are at least relatively protected, because they just it's not there for the virus to bind to.

00:26:38
Speaker 3: Mm hmm. Then I's okay, yeah, it's not.

00:26:41
Speaker 2: That, but like buying of an answer, but it's interesting.

00:26:44
Speaker 3: I mean, it makes sense, it's like it's logical, but also I just want to know, like, why what else is this involved in?

00:26:51
Speaker 2: Right?

00:26:52
Speaker 4: Yeah?

00:26:53
Speaker 2: Do you mean just like the blood types and stuff?

00:26:55
Speaker 3: I feel like when people realize that blood typing was a thing, right, or that we had these you know, different blood types, that it was going to answer everything, right, or at least that's my perception about it. But then it turns out it doesn't really seem to have all that much effect size in terms of differences.

00:27:14
Speaker 2: Yeah, yeah, it's.

00:27:15
Speaker 3: Interesting that like, and again I know this is not blood types, but it's you know, on the fringe of that.

00:27:21
Speaker 2: Right, it's related to your blood type. And what is very interesting to me is that it's not necessarily that like someone with this blood type is a necessarily a non secretor right, Like those two things don't go hand in hand. And at the same time, at least some of the data that I saw suggested that maybe some people with you Aaron blood type AB might be relatively protected. So here I am calling you a neurovirus queen when it's me.

00:27:49
Speaker 3: Yeah, I have had neurovirus, so well.

00:27:53
Speaker 2: I mean there's who knows, maybe it was agnovirus, there's a lot of others. In any case, though, that's what we know about the like nitty gritty of neurovirus when it comes to diagnosis. A lot of times, like we did for ourselves during this episode, Erin, we can clinically diagnose neurovirus, especially during outbreaks. There's a really interesting set of criteria that you can use to diagnose neurovirus during outbreaks, even without having molecular tools and it holds up even like many years after people came up with this criteria, they went back and looked at outbreaks that they had like PCR data, and they were like, Wow, these criteria actually do a pretty good job. It's essentially that like almost everyone's vomiting, like more than half of people are vomiting. The incubation period is twenty four to forty eight hours, the total duration of illness is between twelve and sixty hours, and not total, but like the mean duration of illness, and that in the people that you were able to get samples from, you didn't find any bacterial pathogen obviously, right right, race. Yeah, But so those are like the outbreak criteria that people can use. And the bummer is we still don't have any specific treatment for neurovirus, and so when people do get very ill from neurovirus, all we really have is supportive care, and we still don't have any vaccine. But there's a lot of work being done. So prevention is really the key to neurovirus.

00:29:26
Speaker 3: I mean, hand sanitizer doesn't work now, but washing your hands does.

00:29:32
Speaker 5: Yeah, but weagline one of the Yeah, one of the outbreaks that I read about was on the Pacific Crest Trail in twenty twenty two, I think, and.

00:29:43
Speaker 3: I think that last year is when the CDC was like, oh, we connected the dots. It was neurovirus. But basically on the trail people were getting who were doing a through hike, we're getting super sick after saying like this cabin or whatever.

00:29:58
Speaker 2: And I feel like I saw some TikTok on TikTok who probably had forgotten that anyways.

00:30:04
Speaker 3: Sorry, it's like like on the PCT. Yeah, yeah, yeah, and like it completely makes sense to me, even though I never would have thought of it before. When you're hiking and camping, especially if you're like doing backpacking, like you can't you don't get to thoroughly wash under running water twenty second, twenty five seconds whatever it is. It's just.

00:30:24
Speaker 2: Yep, and so there, I mean, unless you are lucky enough to have a stream where you can, but then you're Washington stream water.

00:30:31
Speaker 3: So then you're washing and streamwater and yeah, then what a horrible place to to also have NonStop vomiting and diarrhea, just like potentially that country trail.

00:30:41
Speaker 2: Yeah yeah, so Aarin, can you tell me where did the fires come from? How is it here with us, what all about it?

00:30:51
Speaker 3: Let's let's do that. Let's let's get into it right after this break. The first part of our story begins in nineteen twenty nine with a report written by John Zahorski, a pediatrician in Saint Louis. In this report titled hyper emesis or hyamus or the Winter Vomiting Disease, The.

00:31:41
Speaker 2: Winter vomiting Disease, the.

00:31:43
Speaker 3: Winter vomiting Disease. In this report, Zahorski describes how he's observed and treated epidemics of gastro intestinal illness over the past thirty years, over his entire career, and they all tend to happen in the winter months. And this report seemingly struck a nerve with other pediatricians who were like, uh, yeah, mass outbreaks of vomiting in the winter, a lot of kids. Yep, that sounds familiar. Been there, done that. And they also had been wondering, like, what on earth could this be caused by? Is it one disease or not? The most popular working theory at the time was that it was milk. Milk milk like cows, like cow's milk. Yeah, and specifically that milk having been delivered on the doorstep would freeze in the winter months, and then it would pop. The liquid would expand and freezing and it would pop off the bottle top, exposing the milk to some sort of contamination.

00:32:46
Speaker 2: How interesting because then it would only happen in places that get cold enough to freeze. It's not happening here.

00:32:53
Speaker 3: Yeah, okay, you know it's not happening in the future because of global warming. So but the milk hypothesis was not right Zahorski. In a later report describing a multi thousand strong outbreak in Saint Louis in nineteen forty, he agreed that milk, yeah, it's probably likely to blame, and that it was probably something to do with an over abundance of bacteria despite pasteurization in the winter months. It was this was a hunch, like, there was no evidence to back this up, and his idea, this idea of his was not born out in subsequent outbreaks, where investigators could find no single food item or exposure linking everyone together. And that particular characteristic of these outbreaks. It's sort of the randomness of it, or the not so much randomness, but just like, how did everyone get sick and the timeline of things that called into question whether or not this was a distinct clinical entity or just coincidence. So I came across a paper from nineteen forty three titled is there an epidemic vomiting disease of winter?

00:34:07
Speaker 2: Question mark, like, just like does is that even a thing doesn't exist?

00:34:11
Speaker 3: And I think their conclusion was, like, maybe interesting research. Yeah, And then there was another paper that I read that detailed and outbreak in Charleston, South Carolina in nineteen forty one and nineteen forty two. And at the end of it, the author of this paper writes, quote, this account adds very little to the knowledge of the vomiting disease.

00:34:38
Speaker 2: We did all of this work, and we know nothing more than we did before. Honestly, Like, I can empathize a lot with that feeling.

00:34:48
Speaker 3: I can, But I also cannot imagine a paper today getting that does not overstate like and then this has the potential to greatly influence our knowledge of so I and.

00:35:00
Speaker 2: See that's really funny, but I loved it.

00:35:04
Speaker 3: But yeah, and then the paper does go on to say that hopefully, though this will get people more interested in winter vomiting disease, and it did. There continued to be sporadic reports about winter vomiting from all over the globe, trying to make sense of an acute gastroenteritis that seemed to strike members of a family at random, where there seemed to be no central point of contamination, and where no one had found consistently an infectious agent responsible for the infection. But for the most part, epidemic winter vomiting was kind of like a background player on the food borne illness outbreak scene for decades, and it just didn't draw nearly as much attention or resources as bacterial contaminants like salmonella or E. Coli, which were much more easily detectable, which also made them the biggest targets for food safety measures. And this lack of appreciation continued even after the causative agent of winter vomiting disease or acute infectious non bacterial gastrient ritis, which is also such a mouthful. I mean, let's go back to winter vomiting disease. I guess neurovirus is fine, But the causative agent of this was discovered in nineteen seventy two, and still people didn't really care that much about it at the time, huh interesting, And so when it was discovered, it was given the name the Norwalk Agent. Later it was called norovirus, but at the time the Norwalk Agent. Do you want to know how it got the name Normalk agent?

00:36:41
Speaker 4: Okay?

00:36:42
Speaker 3: In October of nineteen sixty eight, at an elementary school in Norwalk, Ohio. It was right around Halloween time. Fifty percent one hundred and sixteen of two hundred and thirty two of the students and teachers at this elementary school came down with acute gastro intestinal illness fifty percent.

00:37:08
Speaker 2: All like within a day or like what the back was, within forty eight hours.

00:37:14
Speaker 3: But I think it was like not over a very long period of time, right, it's not a slow burn? Yeah, blood, I guess.

00:37:24
Speaker 2: Just imagine the smells.

00:37:26
Speaker 3: Yeah, oh my god. I mean an.

00:37:29
Speaker 2: Elementary school there can hold that.

00:37:32
Speaker 3: There's not enough sawdust to cover the.

00:37:37
Speaker 2: Oh the elementary sawdust.

00:37:39
Speaker 3: Yeah yeah, yeah, smell. I can still picture it and smell it exactly.

00:37:44
Speaker 4: Oh yeah.

00:37:45
Speaker 3: And then but of course, because it's neurovirus, the illness didn't stop there. It spread to other family members and then friends and other contacts in the community, and so public health investigators were like, oh god, what is happening. We let's test everything we can. We're testing water, we're testing food, we're testing poop for bacterial agents. And they also surveyed the students and the teachers for any sort of commonality, and they came up empty. To the researchers, this strongly suggested a viral origin. But how do you prove that back then?

00:38:23
Speaker 2: Not filtering something something right? No, not not that well.

00:38:30
Speaker 3: My answer here was two words. Human volunteers. Oh oh yes, m m mm hmmmmm.

00:38:37
Speaker 2: There was a surprising to me number of papers that talked about all of the human volunteer studies that they did with neurovirus. What were they were like? And then these twelve people, we fed them poop, and then we fed them poop again and then again, And I was like, who are these people?

00:38:53
Speaker 3: Who are these people? How can you be saying this so casually? Fecal oral administration of dual filtraits is the technical words.

00:39:03
Speaker 2: Yeah, it's just poop in mouth, dude.

00:39:05
Speaker 3: Poop in mouth. Horrible, okay. And so in this specific instance, they took poop, like actual poop or rectal swabs from people in the nor walk and other outbreaks, and they added some special ingredients like veal infusion, broth, fauvine, serum, albumin, and then they shook it all up and then filtered so that at the end result was this nice little cocktail of filtered poop. The filterrit the liquid that came through was then treated with antibiotics and then yeah, fed to the volunteers, which in this study was a mix of you asked, who are these people? A mix of male prisoners volunteers, uh huh. And then they also said, so we had I think I don't remember the exact phrasing, but it was like these fifty male prisoners and then quote normal volunteers. Oh dear, oh, actually, yeah, informed content was obtained. They clarified that pretty much everyone who was fed samples from Norwalk got sick within forty eight hours. A few remained a symptomatic interesting and one person in the study vomited approximately twenty times within a twenty four hour period and needed like fluid administration. Huh yeah, just twenty times. I just how Yeah. And I'm not sure if it was this paper or a different paper, because this like we talked about this fecalid or this administration of fecal whatever was done multiple times, but in one of those studies, the researchers wanted to test for immunity, and so they tested the volunteers again. They exposed them again to more poopy samples.

00:40:56
Speaker 4: Yep.

00:40:57
Speaker 3: I mean, can you imagine like vomiting to twenty times in an hour and then getting better and then a few I don't know how long it was afterwards being like, so, do you want to go through that again? We don't know the likelihood, yeah, but yeah, but fortunately there was enough immunity that the person or the people who were tested again a second time didn't get sick. Okay, at least in that instance. With the help of these volunteers, researchers were able to demonstrate that yes, winter vomiting disease was a viral infection, and it also helped to lay out some of the infection characteristics like incubation period, like how many times you can hope to vomit or poop your pants in a twenty four hour period, stuff like that. And because these samples were from Norwalk, are the ones that got people the most consistently ill, hence Norwalk Asian or Norwalk virus yep. A few years later, researchers Kapikian and colleagues visualized the virus for the first time, and that was fantastic news because it meant that if you suspected an outbreak of Norwalk virus or neurovirus, you didn't have to spin down poop and then get a bunch of volunteers to feed it to them to prove that you had a virus on your hands, or this virus on your hands. You could just like look for it in the samples.

00:42:14
Speaker 2: Right actually find the virus.

00:42:17
Speaker 3: The virus, unsurprisingly being able to test for Norwalk like viruses or neuroviruses as they were soon to be called, led to the virus being detected in more and more outbreaks of acute gastr enteritis, but it still remained a really underappreciated cause of age acute gaster enteritis because I don't want to keep saying that until the late nineteen nineties, perhaps because of the long standing belief that viruses were rarely responsible for age and that most cases were down to E. Coli or salmonella, but also because nourovirus infections tended to be self limiting and so not everyone sought treatment for them, so that a lot of cases went underreported or undetected.

00:43:03
Speaker 2: Right, you don't appreciate the full scale or scope.

00:43:06
Speaker 3: Of it exactly. Yeah, yeah, yeah, and there could be entire outbreaks that you just completely miss too, right. But this also meant that the food safety measures targeted primarily food born bacteria and weren't necessarily effective against neurovirus, which is a different beast entirely things like I think chlorination or refrigeration, some of these things. I mean, like we talked about hand sanitizer. Norovirus is like okay, nob Like I'm not bothered at all, So and we can kind of see this in action. So, between nineteen ninety three and nineteen ninety seven, more than twenty five hundred food born outbreaks were reported to the CDC in the US, and sixty eight percent were labeled as unknown etiology, like great question, we don't know, And less than one percent were attributed to neuroviruses.

00:44:03
Speaker 2: That just means that they didn't look for neurovirus in sixty eight percent, and they would have found neuro or another virus exactly of those. Yeah.

00:44:11
Speaker 3: Yeah. And then though the advent of reverse transcription PCR in the nineteen nineties made detection of neuroviruses even easier. You didn't even have to look under a scope, and they began to draw more and more of the spotlight. And so today they're estimated to cause about fifty percent of all food born acute gastroentthritis cases in the US, which is a lot.

00:44:34
Speaker 2: The numbers are wild, errand.

00:44:38
Speaker 3: They are truly and to borrow from the title of a two thousand and five paper, are neuroviruses emerging? Probably they're making up a bigger piece of the food born illness pie, partly because of better detection, partly because of food safety measures leading to a drop in bacterial food born outbreaks, and partly because our behaviors are changing around the globe global travel, the cruise ship industry, which I know makes up only part of the nourovirus story. And also probably is we have such that link because the reporting is mandated, Whereas I think it's not like at home neurovirus.

00:45:17
Speaker 2: Yeah, no, like especially not like single out like single cases are not. Nourovirus is not a reportable illness.

00:45:24
Speaker 3: Right, But if there's an outbreak on a cruise ship, that's definitely reportable. So I think it just sort of like underlines the link between neurovirus and cruise ships is that it's just like, yeah, important to identify what it is. Yeah, But then there's also things like irrigating crops with sewage contaminated water, the globalization of food distribution, contamination of fresh and seawater leading to higher accumulation by shellfish, And as neurovirus continues to grow, as we enable it to grow and spread, it's also evolving. We've already seen genetic changes in globally circulating strains, which may impact transmission efficiency. Neurovirus isn't going anywhere anytime soon unless there's a vaccine on the brink of introduction. And you're about to tell me about that, Aaron, fingers crossed.

00:46:16
Speaker 2: No, it's not going anywhere anytimes scene.

00:46:18
Speaker 3: Cool, great, awesome, Well, until there is a vaccine or something that we can do, our best bet is in controlling the virus, preventing exposure, cleaning contaminated surfaces, and that takes a better understanding of what exactly it is doing and how it is being spread. Let's talk about vomit. Okay, yeah, okay, if you have ematophobia. I think that's how you say it. It's extreme fear of vomiting. Now might be the time to fast forward if you have made it this far somehow, because I felt so nauseous in writing this and reading about this, like I I had to stop several times and be like I got to take a breather. This is making me feel actually ill. But as a physiological response, vomiting or emesis is an ancient one, like deep time ancient. So so many animals vomit, reptiles, fish, amphibians, birds, primates, so many mammals. It's incredibly widespread in the animal kingdom, with some surprising exceptions like rodents and lagomorphs, which either never evolved the response in the first place or lost it somewhere along their evolutionary journey. And this you talked about how we don't have a good animal model for neurovirus. It might be in part because like this has been a challenge because rodents, like our go to is rats, lab mice, they don't vomit, So that's been a challenge overall in understanding the physiological mechanisms of vomiting and how that pathway is formed, and how different stim affect different things, and so on with the neural responses and linking. Is nausea different from vomiting? Are they on the same pathway or different pathways? All of this stuff, which is really fascinating, has been difficult to do. Also, horses don't vomit? What? Yeah, and probably more animals that I missed, but those are the ones that I can't.

00:48:21
Speaker 2: Gee. I don't think I've ever wondered if animals vomit, because I've always just assumed. I bought my niece a book called does It Fart? Yeah? When she was younger like that, someone wrote, that's a hilarious book examining who farts in the animal Kingdom? Because not all animals fart, but I just assumed that all animals vomit. We need a sequel, Yeah, we do.

00:48:45
Speaker 3: I feel like my Google skills are pretty good. I'm pretty good at searching for things. I found it difficult to find a review on vomit. Well, then, well.

00:48:57
Speaker 2: That's another book idea for you, Aaron.

00:49:00
Speaker 3: I don't know if I could make it through.

00:49:02
Speaker 2: It's like you can get a little it might yeah, well interesting, yeah, but.

00:49:10
Speaker 3: It's also it's surprising that it's not more widespread right, because vomiting is a super helpful defensive response. Like let's say we eat something poisonous, something that bypasses our other defensive barriers like taste and smell. Our vomiting response can protect us from being harmed by those ingested toxins morning sickness, which is like nausea and vomiting in the early months of pregnancy. That's thought to be beneficial because it helps to avoid certain foods that might contain more pathogens. Nausea and vomiting evolved in a very different setting than most of us find ourselves today. Compared to the past, we're not doing too bad when it comes to food born illness and save food practices, but we still have these super sensitive responses that may at times feel very unwelcome, like see sickness or motion sickness, reactions to certain medications or anesthesia. There are occasions where that vomit pathway is activated where it might not be protecting us from food born toxins, but it still happens because evolutionarily it was so beneficial. And of course, too much of a good thing can be a bad thing, like vomiting that goes on for long periods or happens too frequently during pregnancy that can be harmful to both the pregnant person and the fetus. So like seems to be beneficial up to a point. Motion sickness still seems to be a bit of a mystery in terms of why that response would evolve, Like, does it provide any evolutionary advantage? Unclear. We're going to maybe do an episode about it. And of course, if I think it's on our list, ared, I feel anxious. And of course if you're barfing a lot after about a food poisoning or a GI infection, you're at risk of dehydration and just like full body system collapse. And sometimes this vomit response can be co opted by our little pathogen friends so that they can get to know everyone in your close circle or on your cruise ship. Researchers have for a long time recognized how important vomiting is in the transmission of neurovirus, but it was only relatively recently that they were able to directly measure just how important, and they did it using vomiting Larry.

00:51:33
Speaker 2: Vomiting Larry, I need to know so much more.

00:51:36
Speaker 3: It's a capital V capital l of course, it is yes, proper. Now, so let me introduce you to Vomiting Larry.

00:51:44
Speaker 1: So.

00:51:45
Speaker 3: Vomiting Larry was created by the UK's Health and Safety Laboratory. Picture a CPR mannequin, you know, like from the one episode of the Office or Aaron. You've seen them, I'm sure all over.

00:51:56
Speaker 2: The place, but that's the reference.

00:51:59
Speaker 3: Yep, that's what comes to my head. You can call him Airway Larry. That's actually his real brand name. Airway Larry is great for teaching things like intubation, ventilation, CPR, et cetera. Because he has teeth, he has a tongue, he has a larynx, he has trachia, vocal cords, just the full shebang of you know, upper torso gear. Yeah, and what you want to do is now remove Airway Larry's head from the plastic organs he came with, like lungs and stomach, and then you want to attach Larry to a pressurized set of tubes basically like a mannequin head mouth fully agape sitting on top of a long, clear plastic tube which you can fill with fluid to then be forcefully ejected through vomiting Larry's mouth. Okay, it's incredible to see.

00:52:51
Speaker 2: There's videos I assume we can find.

00:52:53
Speaker 3: Of course there are videos. And so what researchers did is that they filled Larry's tube with his his stomach, his food pathway with fluorescent fluid and letter rip and when they flip on the black light UV bulbs, they can see just how far his projectile vomit made it. And so you can do this with differing amounts of vomit. You can do this with like different force, you can do this with different I would assume consistency of vomit.

00:53:24
Speaker 2: These or like different trajectories like towards the toilet versus, and make it.

00:53:29
Speaker 3: Versus just pure projectile like came on suddenly.

00:53:33
Speaker 2: Yeah, like my kid all over the couch.

00:53:35
Speaker 3: Excellent, yep, exactly, Oh you'll be yep, like okay. So but they did this with one leader of barf, of fluorescent barf, which is a lot.

00:53:49
Speaker 2: That's a lot.

00:53:50
Speaker 3: It's like kind of a worst case scenario. Yeah, but in neurovirus sometimes it maybe feels worst case. So one leader, most of the one leader that was ejected through Larry's mouth hung around in an area of around one point two by one point six meters, So like four by five feet, which still a lot, but there were splashes that made it over three meters in front of Larry over nine feet like splashes, and seven feet to the sides.

00:54:23
Speaker 2: Gross.

00:54:24
Speaker 3: Absolutely horrific, but probably not surprising to anyone that has experienced or witnessed projectile vomiting before. But what that means is that you have a tremendously huge area that you need to disinfect an estimated eighty four square feet or seven point eight meters squared.

00:54:43
Speaker 4: Yeah.

00:54:44
Speaker 3: I watched a YouTube video of vomiting Larry and another vomiting machine which is like a mini one.

00:54:49
Speaker 2: It's very cute.

00:54:50
Speaker 3: I don't know if this one has the name, but it's created at North Carolina State University. And in one of the vomiting Larry videos, a researcher let Larry spe his fluorescent liquid all over the you know arena, and then cleaned it up the best that they could under normal lighting.

00:55:08
Speaker 2: Oh love this, uh huh.

00:55:10
Speaker 3: And then when they were like, okay, all done, this looks clean. I think I got it all up, flip on the black light and there's like still fatter everywhere, and so I know that vomit doesn't contain quite as much neurovirus particles as poop the poop, but still it's there, and if it's going to live on that surface for a while, it is rough. But even even more was that this researcher looked down at themselves and was like, oh, it's on my gloves, Okay, it's on my cuffs, it's on my face. Because you can imagine if you're cleaning up and let's say that your hair falls into your face, you just yeah. And it's not like this person wasn't trying, like they really were trying to clean up every bit possible. It's just that vomit really goes everywhere, and neurovirus is so so dang infectious. And then of course you mentioned the aerosolized particles. So part of how we know more about this is creatures like vomiting. Larry and the NC State one one study detected per cubic meter of air between fourteen and twenty four hundred genomes of human neurovirus in health care facilities experiencing an outbreak like actual transmissible amounts in the air. Just there. Arin, I am like both in awe and still terrified of neurovirus and I would really love for you to tell me that there's some good news on the horizon for this bug. I do have to mention that I have a list of vomit trivia that I didn't know how to squeeze into the rest of the narrative. So if you would like to hear any of those, I can share them with you, or we can just chat later.

00:57:09
Speaker 2: I think I'd like to at least hear some of this vomit trivia.

00:57:12
Speaker 3: Okay, okay, it's just a few. Number one, you know, the so called like vomitorium, the vomitoria from ancient Rome, where people would allegedly go to vomit after eating a bunch of you know, yeah, they would food.

00:57:27
Speaker 2: Gorge themselves and then bulimia.

00:57:29
Speaker 3: Yeah yeah, that's not Apparently there's no actual unsurprisingly, like yeah, evidence for this. Vomittoria is a real term that used to be used, but it was what the entrances and exits of like theaters or public arenas were called because people would just like spew forth to get good seats, or when they're all leaving in a rush. Oh that's really funny, isn't that great?

00:57:53
Speaker 2: That's good trivia?

00:57:57
Speaker 3: These are all over the place.

00:57:58
Speaker 2: I love it.

00:57:59
Speaker 3: In ninety two, George hw Bush barfed on the Japanese Prime Minister during a visit. There was a new slang word created, basically meaning to pull a bush, So like, if you vomited, it was you're pulling a bush.

00:58:19
Speaker 2: Oh that's really funny.

00:58:22
Speaker 3: I liked that one. According to the Guinness World Records, the oldest vomit is one hundred and sixty million years old and is from an icthyosaur petrified petrified vomit. Yeah, fun Did you know that there is a diterpenoid substance, like a secondary metabolite produced by certain types of corals in subtropical waters, and this compound scientists named it pukalide. Do you know what? Do you know what pukalide does? It induces vomiting in fish that consume it, and so it's a great defensive mechanism for these corals because fish will come up, eat a small amount of it and then just vomit a lot large. I really like, Yeah, you really like that, Aaron. I do like that. And speaking of vomit as a defense mechanism, I guess. Vultures are well known for their defensive vomiting. This is a quote that I pulled from a paper, and older paper.

00:59:26
Speaker 2: I did not know this about future, thank you.

00:59:30
Speaker 3: I think I've just been deep in the vomit literature, so it feels like familiar.

00:59:34
Speaker 2: Knowledge, like as everyone knows.

00:59:37
Speaker 3: As everyone knows of course, those old vultures and their vomit. Okay, this is a quote that I pulled when wounded or entrapped. The turkey vulture has two means of defense. It ejects at the enemy the putrid contents of its gullet, and if this is not enough, the bird can play possum. Apparently, dying doesn't actually die, just tends to die, right right, right? Play?

01:00:01
Speaker 2: I know what plain part means that I do know.

01:00:04
Speaker 3: I've just been deep in the possible literature, so I wasn't sure. Oh wow, okay, fun one last one, give it to me. Okay, this one makes me nauseous. This is when I was like really feeling sick. It's so fascinating though. It turns out that our perception of odors can be greatly influenced by verbal cues. So what do I mean by that? There was a study from two thousand and one where researchers exposed participants to various smells that aren't super specific, you know what I mean, Like they can be found in multiple different things or sources. And on the first exposure they said, okay, the source was one thing. And on the second exposure, they exposed the participants to the same exact scent, but they said it came from a different source.

01:00:52
Speaker 2: Okay.

01:00:53
Speaker 3: Then they asked whether the participants believed that the two cents were the same or different.

01:00:58
Speaker 2: Okay.

01:00:59
Speaker 3: One of the sense was a one to one combination of isovaleric and butyic acids. On the first exposure of ib acid and this is the compounds, participants were told that they were spelling parmesan cheese. On the second exposure, they were told that they were spelling vomit. Eighty three percent of them thought that they were smelling two different things. Wow, which as a parmesan cheese eater I find really disturbing. But like, also how amazing that your perception of smell or like your response to it can be so influenced by words.

01:01:39
Speaker 2: That is really interesting.

01:01:41
Speaker 3: Yeah, there were some other ones like patuli. They said this is either a musty basement or incense.

01:01:48
Speaker 2: Well, I mean, that's that's six and one half dozen in the other to me. So, oh that's really funny.

01:02:00
Speaker 3: Oh my gosh. But yeah, those are all of my vomit trivia that I gathered.

01:02:06
Speaker 2: I really loved it. I really hope that we have a trivia night sometime soon so that I can really pull those out, because the.

01:02:12
Speaker 3: Full true one.

01:02:16
Speaker 2: Well, uh, I can move us a little bit forward from vomit if you like.

01:02:22
Speaker 3: Please do. I'm ready to leave this behind.

01:02:26
Speaker 2: We'll take a quick break and then I'll tell us what's up with neurovirus in the world today. Norovirus is a very big deal worldwide, and even though most of the time, as we talked about, it is self limited, it is also the today leading cause of epidemic gastroenteritis worldwide across every single age group. What this means, and you mentioned this a little bit aarin, is fifty percent of outbreaks are estimated at least fifty percent of outbreaks are estimated to be caused by gastroenteritis, which means anytime that there's like a cluster of people who get sick from a single source, fifty percent of the time that's neuro and ninety percent of non bacterial gastroenteritis outbreaks. So anything that's not bacterial gastroenteritis, it is neurovirus.

01:03:50
Speaker 3: I want to know what the other ten percent is.

01:03:52
Speaker 2: Other other viruses most likely, and then sometimes toxins. Okay, okay, yeah, and it causes countless I don't have an exact number of the number of outbreaks, but so many outbreaks every year in hospitals, in schools, in military facilities, at fancy resorts, and on cruise ships, literally everywhere. But neurovirus is not just limited to outbreaks. Neurovirus is a cause of regular old gastorenteritis as well, and it's estimated that overall, neurovirus causes close to twenty percent of all cases of acute gastor enteritis worldwide. Like, every time that someone gets sick and starts vomiting and having diarrhea, twenty percent of the time it's probably neurovirus. So what does that number look like? At least six hundred and eighty five million cases every year, So we're talking over half a billion cases every year.

01:04:58
Speaker 3: Okay.

01:05:00
Speaker 2: And while this is most of the time self limited, we know that this infection can also cause more serious illness. So it's estimated that neurovirus results in two hundred thousand deaths worldwide, fifty thousand of which are in children under age five, every year. And these deaths are primarily in low and middle income countries that don't have access to as much supportive care. If you want data from just the US, it's estimated that neurovirus causes twenty one million cases every year of acute gastor enteritis just in this country. And that's about sixty percent of all cases where we know what the cause was, Like, where we're able to identify the cause, this results in seventy one thousand hospitalizations and over four hundred thousand er visits. Wow, but this is not minor because all of that also has an economic burden, and globally, the total economic burden of neurovirus is estimated at sixty billion dollars every year due to both health care costs and economic losses.

01:06:09
Speaker 3: I have a question about Okay, I'm sorry, vomiting again, but like, at what point what are the signs to be like now you should go to urgent care er whatever.

01:06:21
Speaker 2: Yeah, that's a really good question. Certainly if you're not peeing. If you go the day and you're vomiting and you haven't peyed all day, that's not normal.

01:06:30
Speaker 3: Okay.

01:06:30
Speaker 2: So if you have like a reduction in or if you're looking at your kid's diaper, for example, and they have like one or two wet diapers in a day, that's not normal. So that's very worrisome. So we think about urine output. But also just if you are every time that you try and take a sip of water you're barfing it back up, then you're not retaining any of that liquid. So then that's a reason that you would want to seek care. Or similarly, if every time you take a sip of water you're just pooping your brains out, because it could go either direction, especially with neurovirus. Those are the main It's not like an exact number because it's also going to be different for every person depending on how hydrated were you before you got sick, how tiny are you, how young are you, how old are you? Yeah, okay, so what do we do about it? I have a little niche fun fact since we're doing fun facts in this episode Trivia fun. One of the things I found that is so interesting and cool about neurovirus when it comes to like the current research is that there exists a thing called neuroonet and this is a data sharing network that is this international, quite informal network of people that you can like join, You can like submit your information to try and join neuronet. I don't know what the vetting process is like, but it exists and it's been around since the mid nineties, and it's just this international network of people who study neurovirus and share all of the deats that they find about. So it's mostly genomic data from all over the world. There's like twenty five countries that are represented on every single continent. And this data sharing network has led to some really important advancements in knowledge with regards to things like the changes in genotype that we're seeing with some genotypes being more prevalent now than they were before, or maybe is the virus becoming more virulent like things like that, and all of this is really important for the biggest area of research in neurovirus than vaccine development. There's a lot of interest in the development of a vaccine, but we don't have one yet. That's the short answer. And what I think is there's a few things that make it really hard. One is that and you kind of mentioned this Aaron, like, we do have data that people can develop immunity to neurovirus, but what we don't really know is how long this lasts. We also don't know how robust that immunity is when we're talking about so many different genotypes and an RNA virus that does mutate fairly rapidly, and because most people don't get that sick from neurovirus. From an economic perspective, it's hard to maybe think of the incentives for vaccine developers, which is a huge downside when you have capitalism, etc. But what I found really interesting is that there was a cost analysis that they did, this simulation model that said that even if a vaccine were only about fifty percent effective, so that's like our best flu shot for example, and only lasted for about twelve months. So think you'd have to get a neurovirus vaccine every year like you do the flu shot, and you'd only have about partial protection. It was estimated that even a vaccine that met those criteria would say one to two thousand dollars in healthcare costs per case averted of neurovirus, and again there's six hundred and eighty five million cases. So if you could have adequate vaccine uptake, you could have some pretty significant cost savings. But how do you get good vaccine uptake? How many people get their flu shots, covid shots, et cetera. But that being said, there are a lot of people who are working on vaccines, and the World Health Organization has a great website actually that you can see a list of a whole bunch of different vaccines of various types, so using different like vaccine platforms, a lot of which are in phase two or three clinical trials as of this recording in twenty twenty four. So that's pretty exciting stuff. Yeah, someday, someday we could maybe prevent neurovirus with more than just washing your hands and bleaching the world.

01:10:58
Speaker 3: But until then, wash your hands and bleach the world.

01:11:01
Speaker 2: Yeah, you filed the animals. It's not the end of the episode though, because we got to tell you about our sources.

01:11:11
Speaker 3: Okay, I will go. I have got erin. I have so many sources for this. If you want to read about vomiting, Larry got a couple papers. One is from Mackison Booth in twenty fourteen titled Vomiting Larry, a Simulated vomiting system for assessing environmental contamination. And then in terms of sort of some of the history of neurovirus or like the future of neurovirus, there's a paper by Widowson from two thousand and five, are Neuroviruses Emerging? And then if you want to read some of the early work on neurovirus, there's a paper from nineteen forty two by Warring titled the Vomiting Disease. And there's a whole lot more that I'll post.

01:11:50
Speaker 2: I did the opposite erin I found a couple really great review papers, so I my list is surprisingly short for this episode, but there was. It's a great review paper from twenty fifteen simply titled Neurovirus from Clinical Microbiology Reviews, and another one from Nature Reviews Microbiology from twenty sixteen called Human Neurovirus Transmission and Evolution in a Changing World. And there were a few other ones looking at the epidemiology of neurovirus. You can find the list of our sources from this episode and every single one of our episodes on our website. This podcast will Kill You dot Com under the episode STAB.

01:12:26
Speaker 3: Thank you again so much to the provider of our first hand account for sharing your awful neurovirus story. Thank you and sorry.

01:12:35
Speaker 2: Yeah, thank you. Thank you also to Bloodmobile for providing the music for this episode and all of our episodes.

01:12:42
Speaker 3: Thank you to Tom Brifogel and Leanna Skualacci for our fantastic audio mixing.

01:12:47
Speaker 2: And thank you to Exactly Right Network.

01:12:50
Speaker 3: And thank you to you listeners. I really hope that this was enlightening and not just nauseating.

01:12:56
Speaker 2: And thank you, as always to our incredible patrons. Thank you so much for your support. It really means the world to us.

01:13:03
Speaker 3: It does well. We've said it before, but we really really mean at this time, wash your hands.

01:13:11
Speaker 2: You filled the animals