Measles: Historical Highlights

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Speaker 1: Welcome to Stuff You Missed in History Class, a production of iHeartRadio. Hello, and welcome to the podcast.

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Speaker 2: I'm Tracy V.

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Speaker 1: Wilson and I'm Holly Frye.

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Speaker 2: Right after I got back from that trip to Philadelphia to see that Marine Laura sign exhibit, there were some headlines about a measles outbreak happening there, and then right at the same time also warnings about a potential measles exposure for travelers who had passed through Dulles or Reagan Airports in Washington, d C. So measles was declared eliminated in the United States more than twenty years ago, meaning that there is no longer sustained transmission of the disease happening here. But outbreaks do obviously still happen. They're usually related to travel to and from places where it's a lot more common. Outbreaks can spread really quickly if they reach an area where a lot of people are unvaccinated. So, of course I do not like that there are measles outbreaks happening anywhere. It's a highly contagious virus. It can put people in the hospital. An estimated one hundred and thirty six thousand people died of it worldwide in twenty twenty three, and in the years just before vaccines for it became widely available, measles killed an estimated two point six million people around the world every year. Uh but as a vaccinated person living in a highly vaccinated area, I am not at a lot of risk for measles myself. So these headlines for me, they sparked more curiosity than fear, and they also reminded me a little bit of the things that led me to write an episode on scarlet fever last year. People seem to really like the scarlet Fever episode, so I thought I would take a look at the history of measles heads up. They we will have just a little bit of questionable slash unethical research stuff happening this episode, and a tiny bit about ways that we used to inoculate people that's potentially gross. Neither of these are very long discussions, but they are there.

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Speaker 1: In the US, there are two different diseases that are commonly called measles. One caused by the measles morbilivirus also called rubiola, is usually just called measles. The other is caused by the rubella virus, and it is sometimes called German measles. These diseases have some similar symptoms, and they're both targeted by the measles mumps rubella or MMR vaccine, which is used in much of the world. But measles and German measles are different illnesses caused by different viruses. This episode is primarily about the one caused by measles morbilivirus, although German measles will come up occasionally as we're talking this through. The virus that causes measles is highly contagious. Between eighty five and ninety percent of people who are exposed to it and are not already immune will contract it. It's also something that can spread really easily before people realize they have it. Measles causes a characteristic rash, but it is also contagious for up to four days before that rash actually appears, and before that happens, people might just think they have something like a cold. In most cases, it takes about two weeks between exposure to measles and the development of that rash, and the virus can linger in the air and on surfaces for a couple of hours. This can make outbreaks really challenging to track, since health officials have to try to piece together who a person had contact with about two weeks before, or who may have moved through a space that person had even briefly been in day.

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Speaker 2: That's why these warnings about Dulles and Reagan Airports were on specific days for like a six sish hour window when a person might have been exposed had they gone through there. If you are Hollies in my age or younger, and you're from the United States or Europe, which is most of our listeners, you probably have not seen a case of the measles in person, even though it has become more common in these places over the last several years. And as is the case with a lot of illnesses, there is some variation and exactly what symptoms people experience, but most of the time, measles starts with a fever and cold like symptoms like a running nose and a cough, possibly accompanied by pink eye. Most people, but not all, then develop white spots in their mouth, known as Coplic spots. These are named after American physician Henry Koplick, who first described them in eighteen ninety six. Then that's followed by the rash, which usually starts on the face and the neck, and then progresses to the rest of the body. On people with light skin, this rash is usually red and flat, although there may also be raised bumps. The rash can be harder to see on people who have darker skins. Sometimes it appears as a darker shade of that person's regular skin color. Usually the person's fever spikes after the rash develops, and the rash usually peels as it goes away.

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Speaker 1: There's no treatment for measles. It's just rest, supportive care and treatment of specific symptoms if needed, like oatmeal bass if a person's rash is itchy, which it may or may not be.

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Speaker 2: Obviously, this is not medical advice. If you think you have measles.

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Speaker 1: See darker.

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Speaker 2: Most people recover from measles without any apparent issues, but there's increasing evidence that the virus causes immune system damage that can last for at least two years. This is described as immune amnesia, meaning the body kind of forgets how to fight pathogens that it previously knew how to handle, and between five percent and fifteen percent of people who contract measles also develop some kind of more immediate complication. Some of these are relatively mild like, since measles can lower a person's resistance to other pathogens. Ear infections and sinus infections are common, but others are more acutely serious, like pneumonia and inflammation of the internal organs, including the heart. One of the most serious complications of measles is encephalitis, or inflammation of the brain, which can develop weeks after a person seems to have recovered. This is fatal in ten to fifteen percent of people who develop it, and it can also cause long term issues like seizures and cognitive disabilities. There is also a very rare fatal complication of the central nervous system called subacute sclerosing panacephalitis, which can develop seven to ten year years after recovering from measles. Measles can also be particularly dangerous during pregnancy, and that includes carrying a risk of low birth weight, pregnancy loss, and stillbirth. German measles or rebella, is also particularly dangerous during pregnancy, and congenital rebella syndrome is associated with heart problems, hearing loss, developmental delays, and other issues. Today, measles outbreaks in wealthy countries make a lot of headlines but that isn't where measles is most common. There's a very effective vaccine for measles, one that's about ninety six percent effective with two doses, with that immunity lasting for a person's whole life. So places that have a robust healthcare system with broad vaccine coverage aren't likely to see huge outbreaks of measles, and even if there are outbreaks in communities that have religious or cultural or philosophical objections to vaccines, health officials are more likely to be able to respond to them effectively. But places without that infrastructure, without the resources to coordinate widespread vaccination campaigns, and places that are experiencing some kind of civic unrest or war are a lot more likely to see large outbreaks of measles and also less likely to be able to respond to them effectively. People who are already malnourished or sick, or aren't able to get enough food or water or rest while they're recovering are just more likely to develop measles complications. This means mortality rates from measles can really vary from country to country, with the countries that are facing the most poverty and unrest seeing the worst outcomes from measles, so globally, measles is still a leading cause of childhood death. So that is the basics of measles, and we're going to get into more about its history after we pause for a sponsor break. Measles more bili viruses than the pyramics. The virus family of viruses, and that also includes the viruses that cause para influenza, mumps and rsv rsv I feel like has been in the headlines so much over the last few years. That stands for respiratory sensicial virus. This family also includes a number of viruses that primarily affect animals, including the viruses that cause canine distemper and render pest. Two prevailing theories about the origin of measles have been that it evolved from canine distemper as people started domesticating dogs, or that it diverged from render pest as people started domesticating cattle. Measles morbilivirus is most closely related to render pest, and most of the recent research into this has focused on render pest. Render pest was declared eradicated in twenty eleven, and we are going to have our episode on that as an upcoming Saturday Classic. A lot of this research into the question of exactly where measles came from and when has involved molecular clock analysis. That's basically looking at mutations over time to try to pinpoint when two organisms diverged from one another. Studies conducted in the twenty teens concluded that measles diverged from render past quite recently, it's just the eleventh or twelfth century CE, but then research published in twenty twenty suggests that it was centuries earlier than that, possibly as early as the sixth century BCE. A lot of papers written in the twenty teens framed the idea of like the eleventh or twelfth century divergence of measles is basically settled knowledge, but then that twenty twenty research called that timeline into question.

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Speaker 1: This, of course, makes it tricky to pin down some of the early history of measles. There are a lot of illnesses that cause fever and a rash, and a lot of historical accounts just aren't specific enough to say for sure whether they're describing smallpox, scarlet fever, measles, or something else. Measles is one of the diseases that has been proposed as the cause of the Antonine plague, also called the plague of Galen, which took place between the years one sixty five to one eighty CE. If measles didn't diverge from render pest until the eleventh century, it couldn't have been the cause. But if that divergence really took place around the sixth century BCE, it could have been. There are also clinical descriptions of measles that date back to before the eleventh or twelfth centuries. The most well known is by Abu Baker Mohammad ibn Zakaria. Al Razi, known in some Western accounts as Ross Alrazi, was a physician during the Islamic Golden Age. He lived from about eight sixty four to nine thirty five CE. Alrazi wrote at least two hundred medical and philosophical tree, including his Catab Alhawi, or Comprehensive Book on Medicine, and one of these treatises was a treatise on smallpox and measles.

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Speaker 2: This is the first known medical text to clearly differentiate between these two diseases.

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Speaker 1: Of course, this was also written during a time when medicine was focused on the idea of humors and keeping those humors in balance. So Alrasi's thoughts on the causes of smallpox and measles don't align with today's evidence based ideas of medicine. As translated into English in the nineteenth century, he wrote, quote, every man, from the time of his birth till he arrives at old age is continually tending to dryness. And for this reason the blood of children and infants is much moister than the blood of young men, and still more so than that of old men. Now the smallpox arises when the blood putrefies and ferments so that the superfluous vapors are thrown out of it, and it is changed from the blood of infants, which is like must, into the blood of young men, which is like wine perfectly ripened. And the smallpox itself may be compared to the fermentation and the hissing noise which take place in must at that time.

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Speaker 2: So this offered an explanation for why it seemed like most people contracted smallpox before reaching adulthood, because under this arose from the process of transforming the blood from the blood of a child into the blood of an adult. He thought adults were only likely to contract smallpox if they were exposed to quote pestilential, putrid, and malignant constitutions of the air in which this disease is chiefly prevalent. He also claims that quote bodies that are lean, bilious, hot, and dry are more disposed to the measles than to the smallpox, and quote when the summer is excessively hot and dry, and the autumn is also hot and dry, and the rains come very late, then the measles quickly seize those who are disposed to them, that is, those who are of a hot, lean, and bilious habit of body. In terms of symptoms, Selrazi wrote that quote inquietude, nausea, and anxiety are far more frequent in the measles, and he recommended treatments for measles that included barley water mixed with acid, pomegranate juice, as well as expectorants to make it easier for people to cough up any chest congestion. But Arazi also understood that smallpox was a more serious disease than measles, and a lot of this volume is devoted to recommendations for the treatment of smallpox, regardless of the questions around exactly when measles may have diverged from render pest. It was clearly widespread in Europe, Northern Africa, and much of Asia by the medieval period, especially in places where cities were large enough to sustain ongoing epidemics. Measles was introduced into the Americas through colonization in the fifteenth and sixteenth centuries. Although smallpox gets a lot of the focus in terms of introduced diseases and their devastating impact on the continent's indigenous peoples, other diseases, including measles, proved to be deadly as well. There were huge deadly measles outbreaks described in Cuba, Honduras, and Brazil in the fifteen twenties and thirties. The first written record of an outbreak in North America was in Boston in sixteen fifty seven. A lot of medical writing in Europe and North America in the seventeenth and eighteenth centuries focused on both measles and smallpox, as al Razi had done back in the ninth century. Doctors and other researchers wrote about how to tell these two diseases apart, and how to treat each of them. One example is Englishman Thomas Sydenham, who had a chapter on the measles in his sixteen ninety three complete Works, which was followed by a chapter on smallpox. Sydonham's description of measles is thorough, describing it as generally attacked children with chills, followed by fever, loss of appetite, running eyes and nose. And then on the fourth day or the fifth quote, there appear on the face and forehead small red spots, very like the bites of fleas. These increase in number and cluster together so as to mark the face with large red blotches. They are formed by small papules so slightly elevated above the skin that their prominence can hardly be detected by the eye, but can just be felt by passing the fingers lightly along the skin. The spots take hold on the face first, from which they spread to the chest and belly, and afterwards to the legs and ankles. On these parts may be seen broad red macule on but not above the level of the skin. This is so much more detailed than so many ancient historical texts that are sort of like the Great plague passed through the town, bringing a rash and death and it's like, okay, what rash though.

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Speaker 1: Them.

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Speaker 2: Goes on to describe the way that this rash developed over the days that followed, and then made recommendations for treatment, including syrups of violet and maiden hair and a draft made of black cherry water and syrup of poppies for use at night. He also recommended bleeding for patients who developed diarrhea after the rest of the disease had resolved. In seventeen forty, German physician Friedrich Hoffmann differentiated rubiola from rubella or German measles. It's not entirely clear whether the German moniker came from the diseases description in German medical texts, or if it's from the Latin germanus meaning similar. In seventeen fifty seven, Scottish physician Francis Holme tried to develop a vaccine for measles. He was inspired by the use of variolation to prevent smallpox. That is, intentionally exposing someone to smallpox in a more controlled way, with the goal of giving them a milder case of the disease that would leave them immune to it. Later. In Holmes's words, quote considering how destructive this disease is in some seasons, considering how many die, even in the mildest epidemical constitution, considering how it hurts the lungs and eyes, I thought I should do no small service to mankind if I could render this disease more mild and safe, in the same way as the Turks have taught us to mitigate the smallpox. Here's the potentially gross bit, So hit that skip ahead button if you are particularly squeamish. Smallpox produces sores, and variolation involved introducing matter from those sores into another person's skin, but a measle's rash doesn't produce anything comparable that could be used in this way. So Home tried to use the blood of sick patients to expose other people. Obviously, there are other bloodborne diseases, so this is not aut a medically safe thing to do, and people were hesitant to try it at the time. In Homes's words quote from the prejudices of mankind, I found it difficult to get the blood as I wanted it, and much more difficult to find subjects for inoculation. Okay, this was the reasonable concern. It's like fancy that h Holmes experiments with measles inoculation. They were limited. It's maybe fifteen total people he tried this on, and they weren't particularly successful. Those who did get sick with what seemed like it could have been measles generally had a mild case of it, but some of them later contracted measles from some other exposure. Others did not get sick from Holmes's attempt to expose them. But this experiment did lead Home to conclude that measles was definitely caused by some sort of contagion, one that could be carried in the blood in sufficient quantities to cause the disease in another person, not by something like miasma's or bad air, which was still a common idea at the time. As we said earlier, measles is incredibly contagious, and that can make it difficult to track the progression of an outbreak. But in the nineteenth century, an outbreak started in a remote location and researchers were able to gain some insights by tracking how it moved, and we're going to talk more about that after a sponsor break. By the end of the nineteenth century, measles had been introduced to virtually the entire world, including northwest North America in the early nineteenth century, Australia and New Zealand in the eighteen fifties, and more distant Pacific islands in the late nineteenth century. In places where measles was already endemic, there were typically major outbreaks every few years, so the disease usually affected children under the age of five because virtually everybody else still living had already gotten it in an earlier outbreak. Babies also had some protection in their first months of life due to antibodies that they got in utero, but in virgin soil epidemics, meaning that when the virus was introduced to places where nobody was immune, the disease affected virtually everybody at the same time, no matter their age. One such outbreak took place in the Faroe Islands in the North Atlantic between Norway and Iceland in eighteen forty six. It wasn't technically a virgin soil epidemic since there had been an earlier outbreak in the islands in seventeen eighty one, but the vast majority of the island's residents had not been born when that earlier epidemic took place. There were seven eight hundred sixty four people living in the Faroe Islands in eighteen forty six, and about sixty one hundred contracted measles. In this epidemic, one hundred seventy people died, for a mortality rate of about two point eight percent. The government of Denmark sent physician and pathologists Peter Ludvigpayanum to the islands to try to control the outbreak, and he personally treated about one thousand of the sixty one hundred people who became ill, and he also studied how the disease spread through the islands. Unlike in a city where there are a lot of people living very close together, continually interacting with people from other neighborhoods through things like work and school and errands, the pharaoh Islands were made up of small villages on a collection of islands that were largely isolated from one another. People did travel between the different villages and the different islands, or people from multiple villages might all come together for some reason, but this was not just like a continual daily occurrence.

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Speaker 1: Paynham pinpointed how measles was introduced to the Pharaohs in eighteen forty six writing quote. The first person on the Pharaohs who took the measles was a cabinet maker now living in Thorsham. He left Copenhagen on the twentieth of March and reached Thorsham on the twenty eighth. On the way, he had felt quite well, but was attacked by measles early in April, on what day he did not know. Shortly before his departure, he had visited some measles patients in Copenhagen. About fourteen days later, his two nearest associates were attacked, so.

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Speaker 2: Painam acknowledged that these men's accounts weren't entirely accurate, like one of them was saying, I don't remember what day this started, and they were also just trying to reconstruct where they had been two weeks previously. But their description of the basic timeline quote determined me to give attention in my travels about the islands to the length of the stage of incubation.

00:23:41
Speaker 1: Paynam was able to identify the index case in fifty two villages in the Faroe Islands, that is, the first person to develop measles. From there, he traced when and where they had been exposed to the disease, and how long it had taken other people in their village to get sick. With these observs, he narrowed down the illness's incubation period to about fourteen days on average. That was a far more precise estimate than had been in use before.

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Speaker 2: He also found that there were ninety eight people in the islands over the age of sixty five who had survived that earlier seventeen eighty one outbreak. None of those ninety eight people got measles in eighteen forty six. There were already doctors and others who thought that people were immune to measles after recovering from it, but there were also various reports of people getting it a second time. So Paydam thought that what he observed in the Faral Islands outbreak offered clear evidence that there really was lifelong immunity to measles. So he thought that these other reports where people seem to have gotten measles more than once, the people involved may have actually contracted some other illness. Painam reported one village in which people believed a midwife had carried measles. She herself had previously had it in Debat, but she had spent several days taking care of measles patients and everyone she came into contact with. In the next village she visited developed measles fourteen days later. That included the girl who laundered the clothes that the midwife had been wearing. Painam's account included a list of communities that were spared from measles because they had kept a strict quarantine. About fifteen hundred residents of the island's avoided measles because their communities cut off all contact with the ones where measles was circulating. This outbreak happened just as European medicine was starting to move toward the germ theory of disease, and there was still debate about exactly what caused measles. Painam's report on this outbreak concluded, quote, if among six thousand cases of which I myself observed and treated about one thousand, not one was found in which it would be justifiable on any grounds whatever to suppose a miismatic origin of measles, because it was absolutely clear that the disease was transmitted from man to man and from village to village by contagion, whether the latter was received by immediate contact with a patient, or was conveyed to the infected person by clothes or the like. It is certainly reasonable, at least to entertain a considerable degree of doubt as to the miismatic nature of the disease. By the early twentieth century, researchers had concluded that measles was caused not by just some contagion, but specifically a virus, and they were trying to learn about and isolate it. That finally happened in nineteen fifty four, when John F Enders and Thomas C. Peebles collected samples from patients during a measle's outbreak in Boston. They isolated the virus from samples collected from an eleven year old patient named David Edmonston. The next step was to try to weaken or attenuate this virus into a form that would confer immunity to measles without making the people who received it sick. Enders, Peebles and their collaborators went through a process that involved human kidney cells, human amniotic cells, and chicken eggs. Researchers tested the vaccines on monkeys before moving on to human trials, and the first humans they tested the vaccine on were themselves. This is probably more of a safety check because presumably all of them at this point had already had measles when they were children. In October of nineteen fifty eight, the team tested their vaccine on eleven children, and all of them developed antibodies to measles morbilivirus, but nine of them also developed a rash, and they did not want this vaccine to cause any kind of illness in people, so after working to further attenuate the virus, the team started larger trials in the nineteen sixties.

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Speaker 1: There are ethical questions around these larger trials. Some of them were carried out at institutions for disabled children, the Walter E. Fernald State School in Waltham, Massachusetts, and Willow School in Staten Island, New York. Both of these institutions were also home to research that was obviously and inherently unethical. This included children at Fernaud State School being fed oatmeal containing radioactive trackers in the late nineteen forties and early nineteen fifties, and children at Willowbrook being intentionally given hepatitis in the nineteen fifties and sixties to study the progression of the disease and efficacy of gamma globulin injections. Neither of these studies had the potential to benefit the children involved, and the full nature of the experiments was not explained to the parents who gave permission for their children to participate. So these early measles trials were conducted on an inherently very vulnerable population and a group that doctors often perceived as less than human at institutions that were also already involved in unethical research. That said, there were a couple of different between those studies and the measles vaccine trials. Being immune to measles would benefit the children involved. Since they lived in close quarters with other children in facilities where disease outbreaks were common, they were at an even greater risk for measles than a lot of other kids would be. A severe measles outbreak had started at Willowbrook in the spring of nineteen sixty and so the vaccine was given to children who were actively at risk from this ongoing outbreak, and Enders and the rest of his collaborators seemed to have been ahead of their time around ideas of informed consent, explaining the vaccine to the parents getting their permission and administering the vaccine only when that permission was actually given. Other trials were carried out in Nigeria through the University of Ibadan. At that time, the university hospital was seeing more than one thousand measles cases annually with a mortality rate of about percent, so measles was a particular threat there as well. One phase of these trials was on the children of the university's faculty and staff, who were invited to participate.

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Speaker 2: The trials in the US and Nigeria demonstrated that this vaccine was highly effective at preventing measles, and it was licensed for use in the US on March twenty first, nineteen sixty three. A team led by Maurice Hillman developed a more attenuated version of the vaccine in nineteen sixty eight. This more attenuated strain became known as the Edmonston Enders strain, and it ultimately became the only measles vaccine distributed in the US.

00:30:41
Speaker 1: The development of a measles vaccine marked something of a shift in how vaccines were approached in most of the world. Prior to this, the focus had been on diseases that were extremely serious and deadly, including smallpox and polio, but especially in the US and Europe, measles had come to be seen as a root disease of childhood and not a deadly scourge that needed to be stopped. On top of that, people typically only got measles once in their lives, and many people had fears about the safety of the vaccine, as has been the case with every vaccine, so this made it harder for health officials to convince people to have their children vaccinated. But even with those challenges, measles cases dropped dramatically in the United States after the start of a coordinated vaccine campaign. In nineteen sixty seven, there were four hundred and fifty thousand cases of measles reported in the US. It was a reportable disease.

00:31:39
Speaker 2: Health officials were required to report all the cases, but in nineteen sixty eight, just a year later, there were only twenty two thousand. But there were also some clear disparities and who had access to this vaccine. It was mostly being administered by doctors who were working in private practice, meaning that most of the people who were getting it were middle or upper class. So while the total number of measles cases dropped precipitously, cases became really clustered among the populations that were underserved by the medical community, including non white communities and people living in poorer areas. It did not take long after the introduction of measles vaccines for nations to start looking at the idea of eliminating the virus entirely, especially as it became clear that the vaccine conferred long term immunity, and initially researchers thought it might be possible to eradicate measles if as little as fifty five percent of the population was vaccinated. That turned out to be way too low a target. Measles is so contagious that roughly ninety to ninety five percent of the population needs to be immune to keep it from spreading, but nations started efforts to eliminate the disease pretty quickly. In nineteen seventy eight, the US Centers for Disease Control announced a plan to eliminate measles in the US by nineteen eighty two. That did not happen, but the number of measles cases in the US did drop another eighty percent between nineteen eighty and nineteen eighty one. That was so ambitious of a goal to me, especially considering like living through however, many years of like COVID nineteen pandemic response, the idea of like, we're going to eliminate this in three years, and like that's wild.

00:33:26
Speaker 1: Uh.

00:33:26
Speaker 2: In nineteen ninety eight, though, efforts to eradicate measles worldwide faced a huge setback when The Lancet published an article by Andrew Wakefield and various co authors which claimed that the measles mumps rubella or MMR vaccine caused a form of colitis that then caused autism. This paper was not just wrong, it was fraudulent, and Wakefield had been funded by an attorney who was representing parents who were trying to sue vaccine manufacturers. The Lancet retracted this article in twenty eleven after in depth reporting on the many many problems with it, and Wakefield was ultimately struck from the medical register in the UK. Numerous follow up studies since then have concluded that there's no link between the MMR vaccine and autism, and autism advocates have also noted that it's extremely offensive to suggest that it's better to risk a potentially fatal disease than to be autistic. Measles was declared eliminated in the United States in the year two thousand, but there have been outbreaks since then when measles has been reintroduced from other places. One of the most high profile outbreaks was connected to Disneyland in California. The first case of measles associated with this outbreak was reported to the California Department of Public Health on January fifth, twenty fifteen. Four other measles cases were reported to the department on the same day, and two were reported in Utah. Everyone involved had been to Disneyland or a neighboring park between December seventeenth and twentieth, twenty fourteen. Most cases involved in this outbreak were in southern California, but there were also cases in sixteen other states, Canada, and Mexico. Under vaccination was cited as a key factor in this outbreak. Of the unvaccinated patients in California, twelve were infants who were too young to be vaccinated, but almost seventy percent of the patients who got it and were eligible for the vaccine had not been vaccinated because of their personal beliefs. This outbreak contributed to the passage of a law in California that removed personal beliefs as a reason for people to be exempt from vaccine requirements to attend schools and daycares in California.

00:35:42
Speaker 1: On September twenty seventh, twenty sixteen, the Pan American Health Organization declared measles to be eliminated in the Americas, but this only lasted for a couple of years. Venezuela lost its measles free status in twenty eighteen and Brazil in twenty nineteen in the wake of civil unrest and an anti vaccine movement.

00:36:04
Speaker 2: I'm just sort of continually waiting for the US also to lose its measles free status, because we just keep on having outbreaks and at some point they're they're going to call it stopped. According to a report from the Centers for Disease Control, as of twenty twenty two, there were eighty three countries around the world that have achieved measles free status, most of them in the Americas and Europe. But deaths from measles also increased forty percent worldwide in twenty twenty two, with epidemics in thirty seven countries. That is up from twenty two countries that experienced outbreak the year before. In January of twenty twenty four, the World Health Organization warned of a sharp uptick in measles cases in Europe, with thirty thousand cases reported in forty of the European region's World Health Organization members states. That is up from less than one thousand cases in twenty twenty two. The European Center for Disease Prevention and Control reported that in twenty twenty two, only eighty nine point seven percent of people in Europe had had their second dose of vaccine, that is below the level needed to maintain heard immunity. Health officials in various parts of the world has cited the COVID nineteen pandemic is a big reason for this increase in measles cases in epidemics, both because of people not having access to routine medical appointments in the first years of the pandemic and being fearful of going to those appointments once they were available, and because of increasing vaccine hesitancy in connection to the rollout of COVID nineteen vaccines. There's also some conjecture about the impact that the SARS CoV two virus, which causes COVID nineteen has had on the immune system, and whether it is similar to the immune amnesia that can follow measles infection. But there's a pretty clear connection between an overall drop in vaccination rates and increasing rates of measles. Yeah, we're still very early in understanding long term effects of COVID nineteen on the body, but the like, there's just obvious lines that can be drawn in decreasing numbers of people who were fully vaccinated for measles and increasing numbers of measles cases. It is absolutely a disease that is possible to eradicate around the world. But only but you gotta participate. Yeah, only with everyone vaccinated.

00:38:38
Speaker 1: Uh yeah, do you have contagious listener, ma'am?

00:38:42
Speaker 2: I have listener mail. I would not call it contagious. It is about healthcare though.

00:38:48
Speaker 1: Uh.

00:38:48
Speaker 2: This is from Judy and Judy's subject line made me laugh. It says you made me realize I'm old, not a bad thing. In relation to mammograms, uh. And Judy wrote, Dear Holly and Tracy, listening to the mammogram episode in your Friday comments, I was amused by your amazement of the changes in your lifetime then I started thinking and realizing that I am too. I'm in my seventies and remember when mammograms could not only squish your breasts but cause burns from the X rays if the tech wasn't careful and the texts were usually males back then then you had to wait for days, sometimes weeks to get results. The new digital machines with mostly lovely female texts as a joy. Some differences with PAP exams actually general medical interactions for women. Now I now I'm thinking I should make lists of things I've seen changed, usually for the better, in my lifetime. It could be scary fun by the way. This includes color TVs, email, walkman CDs and audio books, a great thing for gardening, and backup cameras in cars. All in all, things are better. I hope you can make a similar list for your lives. Maybe everyone who listens should do that and send it to you, and miss in History could start a new segment changes in our lives as you trace the technology or organization or person. This, of course, is in addition to all the other research you too. I've attached photos for pet tax in the vein of history. I have attached a baby picture of JJ, an abandoned neonate kitten I fostered. The second picture is JJ, now still in my house as I couldn't give him up as an eighteen pound cat. Enjoy. Thanks for all the learning and joy and giving me a new way to look at the world, Judy, So thank you Judy.

00:40:33
Speaker 1: This.

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Speaker 2: I love this idea. Kitty What a tiny little kitty cat face reminds me? I mean, my cats we brought home at a reasonable age to bring kittens home, right, but this little kitten face really reminds me of their kitten faces, even though they were a bit bigger than this one. And then of course this uh, very large I moved I moved the picture to underneath my window that it has Holly Holly's face on it. Uh. And then of course adult black cat reminds me of my adult black cats, especially because this one is on like a fluffy bed type thing and we have a very similar bed that uh. Sometimes kitty cats at my house like sometimes not. Uh. So I love these cat pictures. I love all these stories. I do think pretty often having been born and starting to go to school at an age where there was no email, there was like prototype email, but like not not in the actual things that consumers had.

00:41:51
Speaker 1: Actually we did, yeah, we were not using it.

00:41:53
Speaker 2: We were not. We were not in the worlds of universities or the military who were like working on early prototypes of what would become the World Wide Web. But like, you know, having been a kindergartener when there was nobody was emailing reports home, having not had a cell phone as a child, carrying quarters to put in the payphone, being dropped off at the mall, to walk around there with a quarter to call my mom if I needed her anyway, I think about these things all the time. The world has changed so so so much in Holly's in my lifetimes in memory. So yeah, one of my favorite lists of this nature was not a list per se, but Brian's aunt Beth, who I loved dearly, died three weeks before her hundredth birthday. Oh goodness, and she was really sharp and wonderful right to the end. And I remember and I just had a soft spot for her. We just I adored that woman.

00:42:54
Speaker 1: And I remember one point when she was in her early nineties sitting down and talking about everything that existed that was common that when she was like you know, I know I'm old and that sometimes when I'm in the car because she wasn't driving anymore and you and Brian are driving, I get very nervous about the speed and She's like, I remember when there weren't cars, and I was like, whoa. Yeah, she was pretty amazing and had an encyclopedic knowledge of the area she grew up in and of the world, and she was world traveled, so she was a great one for that. And I wish I had written down that entire conversation or recorded it. Yeah, but we have lots of great pictures of her doing things that I'm like, Aunt Beth is the human encyclopedia from like the late eighteen hundreds to you know, the the I think I forget what year she was born. I want to say it was nineteen oh four, but they lived on a farm, so they did not have a lot of modern stuff, so it was little. Yeah, she was amazing, amazing.

00:44:05
Speaker 2: It's in my house somewhere, I'm pretty sure a video of my grandmother and one of her sisters talking about their childhood being raised in a rural parsonage during the Great Depression reminds me of that a little bit. So anyway, Thank you again, Judy for this email. Honestly, I love this whole idea of thinking of ways that the world has changed during our lifetimes, and I know that that's going to be vastly different recollections for different people with different experiences, But thank you so much for sending that and sharing it with us. If you would like to send us some notes about this or any other podcast or history podcast at iHeartRadio dot com and we're on social media's miss and History on Facebook and Instagram and the thing that used to be Twitter. You can subscribe to our show on the iHeartRadio app and wherever else you'd like to get your podcasts. Stuff You Missed in History Class is a production of iHeartRadio. For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.