Category: Vaccine Preventable Diseases

What Happens if You Skip a Tetanus Shot?

Since tetanus spores are essentially everywhere, a tetanus shot is important if you have a wound and are not up to date on your vaccines.

Can you see any tetanus spores on the thorns of this rose bush?
Can you see any tetanus spores on the thorns of this rose bush? Photo by Cherrie Mio Rhodes. (CC BY 2.0)

Unbelievably, some parents still decide to skip this important shot for their kids though.

What Happens if You Skip a Tetanus Shot?

What could happen if your child doesn’t get a tetanus shot?

You only have to look at what has happened since the pre-vaccine era to know that skipping a tetanus shot is not a good idea.

“From 1995 through 1997, a total of 124 cases of tetanus were reported from 33 states and the District of Columbia, accounting for an average annual incidence of 0.15 cases per 1,000,000 population… Only 13% of patients reported having received a primary series of TT before disease onset. Previous vaccination status was directly related to severity of disease, with the case-fatality ratio ranging from 6% for patients who had received one to two doses to 15% for patients who were unvaccinated. No deaths occurred among the 16 patients who previously had received three or more doses. Tetanus occurred following an acute injury in 77% of patients, but only 41% sought medical care for their injury. “

Tetanus Surveillance — United States, 1995-1997

Tetanus is deadly.

This unvaccinated girl is lucky that she didn't develop tetanus.
This unvaccinated girl is lucky that she didn’t develop tetanus.

Sure, not every unvaccinated child who gets a wound develops tetanus.

And not every unvaccinated child who develops tetanus dies.

This unvaccinated child developed tetanus after a toe nail injury.
This unvaccinated child developed tetanus after a toe nail injury. Photo by Petrus Rudolf de Jong (CC BY 3.0)

But why take the chance that your child will develop tetanus when there is a safe and effective vaccine that will prevent it.

There have been several cases of tetanus among unvaccinated Amish kids.
Why aren’t there more cases? Most kids are vaccinated and protected!

These parents, very recently, took that chance and their kids suffered the consequences, weeks and months in a pediatric intensive care unit:

  • an unvaccinated boy in Oregon spent nearly two months in the ICU after cutting his forehead on his family farm (2019)
  • an unvaccinated 10 year old in Italy fell and skinned her knee and ended up in the ICU (2018)
  • an unvaccinated 10-year-old in Sardinia, Italy who cut his forehead after crashing his bike (2017)
  • an unvaccinated 7-year-old in Australia who cut her foot while playing in the garden (2017)
  • a 22-month-old in Australia (2017), their first case in a child since 2000.
  • an unvaccinated child in Slovenia, their first case in 20 years (2016)
  • an unvaccinated 6-year-old in Ontario who was in the ICU (2015)

Their parents were wrong that their kids didn’t need a tetanus shot.

Just like you are wrong if you think that the tetanus spores or bacteria will wash away if the wound bleeds enough, that it is too late to get a tetanus shot with TBIG when your child gets hurt, or that your child can’t die or get seriously ill because of tetanus.

And you are especially wrong if you think that the risks of the tetanus vaccine are greater than the risks of having tetanus.

Vaccines are safe, with few risks, and are obviously necessary.

More on Skipping a Tetanus Shot

When is Measles Season?

For a while, especially once we eliminated the endemic spread of measles, we weren’t thinking about measles seasons anymore.

In addition to the recent rise in measles cases, this slide shows the patterns of measles seasons in different parts of the world.
In addition to the recent rise in measles cases, this slide shows the patterns of measles seasons in different parts of the world.

Unfortunately, with ongoing outbreaks and rising cases, many people are asking again – just when is measles season?

When is Measles Season?

Traditionally, the time when measles case counts are the highest occurs:

  • during the late winter and early spring (temperate climates, like the United States)
  • after the rainy season (tropical climates)
  • when kids are in school

So just like flu season, it’s always measles season somewhere…

And in areas of the world where measles is still highly endemic, you can expect cycles of larger measles epidemics every 1 to 4 years.

Can you guess why?

“As higher uniform population immunity is achieved the scale of epidemics, both their duration and absolute number of cases, progressively decreases. Epidemic frequency simultaneously decreases with increasing time intervals between epidemics. Another uniform feature as elimination is approached is the loss of epidemic seasonality.”

Durrheim et al on Measles – The epidemiology of elimination

I’ll give you a hint – there is nothing different about the measles virus during those years.

Eventually though, as the number of people susceptible to measles builds up, there is the opportunity for bigger outbreaks. Of course, that doesn’t happen if most people are vaccinated and protected.

When is Measles Season in the United States?

What about in the United States in the post-vaccine era?

Visiting a place with a lot of measles, especially if you aren't vaccinated and protected, increases the risk that you will bring measles home with you and start an outbreak.
Visiting a place with a lot of measles, especially if you aren’t vaccinated and protected, increases the risk that you will bring measles home with you and start an outbreak.

We don’t really have a measles season, as all of our cases are now imported from other parts of the world.

  1. Where and when are folks traveling?
  2. Where is measles on the rise?

That’s when we will see more measles cases here.

“Source countries included Philippines (14 cases), Ukraine (8), Israel (5), Thailand (3), Vietnam (2), Germany (2), and one importation each from Algeria, France, India, Lithuania, Russia, and the United Kingdom.”

Increase in Measles Cases — United States, January 1–April 26, 2019

In the early part of 2019, we saw a lot of cases because unvaccinated travelers were returning from Philippines, Ukraine, and Israel, countries in peak measles season.

Are Europe's measles outbreaks slowing down yet?
Are Europe’s measles outbreaks slowing down yet?

As cases in those countries hopefully slow down over the summer, unfortunately, we might see a rise in other parts of the world.

Of course, there is an easy way to end our measles seasons once and for all.

Two doses of MMR is your best protection against measles.

Get vaccinated and protected, especially before traveling out of the country.

More on Measles Season?

An Unvaccinated Girl in Italy Has Tetanus

Remember the story of the unvaccinated boy in Oregon who recently had tetanus?

He spent nearly two months in the hospital, nearly all of it in the ICU, and his care cost just over $800,000. All for a disease that is easily vaccine-preventable.

An Unvaccinated Girl in Italy Has Tetanus

That boy in Oregon wasn’t the first intentionally unvaccinated kid to have tetanus recently and tragically, he won’t be the last.

An Unvaccinated Girl in Italy Has Tetanus
The girl fell and skinned her knee. Unvaccinated, she ended up in the ICU with tetanus.

The latest case is an unvaccinated girl in Verona, Italy.

An Unvaccinated Girl in Italy Has Tetanus

The girl, from Povegliano, is intubated and sedated and in critical condition.

Her family is being investigated to see why she wasn’t vaccinated.

Unbelievably, she joins a growing list of kids who have gotten tetanus for no good reason in the post-vaccination era.

  • an unvaccinated 4-year-old who developed tetanus after a toenail injury. He was intubated for over two weeks.
  • an unvaccinated 10-year-old in Sardinia, Italy who cut his forehead after crashing his bike
  • an unvaccinated 7-year-old in New Zealand who had a small cut his foot
  • an unvaccinated 7-year-old in Australia who cut her foot while playing in the garden

Wondering why it doesn’t happen more often?

Most kids are vaccinated and protected!

And most parents, even those who are scared to vaccinate their kids, understand that tetanus is basically everywhere and almost impossible to avoid.

More on Unvaccinated Kids with Tetanus

Do Vaccinated Kids Who Get Sick Have Milder Disease?

There is another benefit of vaccines that you might not be aware of.

Vaccines are typically very effective, but of course, they aren’t perfect.

Fortunately, even when they don’t work and you do get sick, vaccinated kids will often have milder disease than those who are unvaccinated.

Do Vaccinated Kids Who Get Sick Have Milder Disease?

While no one expects to get a vaccine-preventable disease if they have been vaccinated, it is nice to know that often, you will at least have a milder disease.

“Disease may occur in previously vaccinated individuals. Such breakthroughs are either primary – due to vaccine failure – or secondary. In such cases, the disease is usually milder than in the non-vaccinated.”

Vaccination greatly reduces disease, disability, death and inequity worldwide

Milder mumps and pertussis?

“The number of previous vaccine doses was inversely associated with clinical severity.”

Zamir et al on Characteristics of a large mumps outbreak: Clinical severity, complications and association with vaccination status of mumps outbreak cases

Yes!

And that’s good news for all of the folks concerned about waning immunity with these vaccines.

“A protective effect of vaccination was noted when mean duration of symptoms and hospital stay are analysed, comparing unvaccinated, partially vaccinated and fully vaccinated children. We showed a vaccination dose effect trend, with fully vaccinated children having less-severe RVGE than not vaccinated and partially vaccinated children.”

Justino et al on Clinical Severity and Rotavirus Vaccination among Children Hospitalized for Acute Gastroenteritis in Belém, Northern Brazil

Consider that, in addition to preventing disease:

  • two doses of MMR has been found to have a significant preventive effect against mumps complications, including orchitis, meningitis, and encephalitis, and hospitalization for mumps
  • two doses of the chickenpox vaccine has been found to be very effective at preventing severe disease, in fact, kids with breakthrough chickenpox often don’t have fever, have fewer than 50 spots, and they go away quicker than kids who are unvaccinated.
  • vaccinated kids who get pertussis typically don’t cough as long as those who are unvaccinated
  • the rotavirus vaccine series, in addition to protecting most kids from getting rotavirus infections in the first place, protected all of the vaccinated kids from getting severe infections
  • the flu vaccine reduces the risk of severe disease, especially if you are hospitalized with the flu

What does this all mean?

Two kids with smallpox - one vaccinated and one unvaccinated. Can you guess which is which? The vaccinated child on the right only has one or two spots...
Two kids with smallpox – one vaccinated and one unvaccinated. Can you guess which is which? The vaccinated child on the right only has one or two spots…

It means that vaccines work, even when they don’t work as well as we would like them to!

More On the Severity of Breakthrough Infections