March 12, 2019

An unvaccinated 6-year-old's fight against tetanus took 8 weeks and $800K. (His parents still won't vaccinate him.)

Daily Briefing

    In the first case of its kind in more than 30 years, a six-year-old boy from Oregon who'd never been vaccinated entered an 8-week long fight for his life after falling ill with tetanus in 2017, according to a CDC report published last week.  

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    What is tetanus?

    Tetanus, caused by Clostridium tetani bacteria commonly found in soil, can paralyze muscles and trigger spasms so powerful they can break bones. The paralysis and spasms often begin in the jaw, which is why the illness is sometimes called "lockjaw," and can quickly spread to throughout the body, causing breathing problems chest, bone fractures, and bowel control loss.  According to the CDC report, the illness is fatal in about 10% of cases, and for those who live the treatment can be long, hard, and costly. One adult racked up a $1 million hospital bill.

    But the illness is also relatively uncommon in the United States. Between 2009 and 2015, there were just 197—and of those cases, 16 were fatal.

    In the 1920s, scientists developed a vaccine that virtually eliminated tetanus in developed nations.

    Most people in the United States are fully vaccinated by the time they enter school.

    A preventable 'gut-wrenching medical marathon'

    But CDC in the report noted that the anti-vaccine movement has led to an uptick in unvaccinated children—and it describes the case of the six-year-old Oregon to highlight how important vaccines are to prevent disease. The report marks the first pediatric case of tetanus in Oregon in more than 30 years, doctors said.

    The case began when a six-year-old boy got a cut on his forehead while playing on a farm. The boy's parents cleaned and stitched the cut at home, but a few days later, the boy started to show symptoms of tetanus, including involuntary muscle spasms, jaw clenching, and an arching back. When the boy's parents realized he was having trouble breathing, they contacted emergency medical services and an air ambulance transported him to the hospital.

    At the hospital, the doctors diagnosed the boy with tetanus, which was so severe that he couldn't open his mouth. To improve the boy's breathing, the doctors performed a tracheostomy and attached him to a ventilator. The doctors then gave him muscle relaxants to reduce his muscle spasms, drugs to stabilize his blood pressure, and medication to combat the tetanus infection, according to the case report.

    Even with the muscle relaxants, the infection made the boy so sensitive to muscle spasms that the sound of a person's voice would cause his whole body to stiffen. As a result, the boy spent weeks lying sedated in a dark room, wearing earplugs to block out sounds, according to Judith Guzman-Cottrill, a pediatric infectious diseases specialist at Oregon Health and Science University Doernbecher Children's Hospital and one of the doctors who cared for the patient. "He was really sick and it was really difficult to watch," said Guzman-Cottrill. "He was suffering."

    The boy spent 54 days in the hospital—47 of which were spent in intensive care—and 17 days in a rehab facility before going back to his normal activities. The hospital bill for what STAT News calls a "gut-wrenching medical marathon" totaled $811,929—and that doesn't include the air ambulance, rehab stay, or any follow-up care, according to CDC.

    But even after receiving a large bill and an "extensive review of the risks and benefits of tetanus vaccination by physicians," the boy's parents refused to allow the doctors to give him a full course of tetanus vaccinations or "any other recommended immunizations," including vaccinations for mumps, measles, rubella, chickenpox, polio, and other potentially lethal diseases, according to the CDC report.

    Vaccines are 'very important to prevent disease,' expert says

    "I never thought I would see a case of severe tetanus in the United States," Guzman-Cottrill said. "That was an astounding point for me."

    Given that the boy's infection was most likely preventable, Guzman-Cottrill said the case should serve as a reminder that "routine vaccination for all, plus boosters, are very important to prevent disease." She added it's particularly important in this case because tetanus is spread through contact with soil, not other people, meaning relying on herd immunity or immune boosting from prior infections will not protect unvaccinated people from the bacteria.

    In fact, if the boy remains unvaccinated, he could contract tetanus again, STAT News reports (Branswell, STAT News, 3/7; Cara, Gizmodo, 3/7; Folley, The Hill, 3/7).

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