Tag: immune globulin

What to Do If Your Child Is Exposed to Hepatitis A

Hepatitis A is a vaccine preventable disease.

The hepatitis A vaccine was first added to the immunization schedule in 1996, but wasn’t made a universal recommendation for all children until 2006. At first, it was just given to high risk kids.

Now all toddlers begin to get a two dose hepatitis A vaccine series beginning when they are 1 to 2 years old, with 6 to 18 months between the doses.

Unfortunately, unlike many other vaccines, there was never a catch-up plan for those who were unvaccinated, so some teens and many adults are still not vaccinated and still not protected against hepatitis A infections.

Getting Exposed to Hepatitis A

How do you get hepatitis A?

“The hepatitis A virus is able to survive outside the body for months. High temperatures, such as boiling or cooking food or liquids for at least 1 minute at 185°F (85°C), kill the virus, although freezing temperatures do not.”

CDC on Hepatitis A Questions and Answers

Unlike hepatitis B, which is spread through blood and body fluids, people who are infected with hepatitis A shed the virus in their stool.

So you can get infected by having close contact with someone who has hepatitis A or by eating or drinking contaminated food or water.

How do you know if you have been exposed?

While an employee in the produce department at a Kroger in Kentucky recently exposed folks to hepatitis A, back in 2016 it was a Whole Foods in Michigan that was linked to an outbreak.
While an employee in the produce department at a Kroger in Kentucky recently exposed folks to hepatitis A, back in 2016 it was a Whole Foods in Michigan that was linked to an outbreak.

Exposures are most common in local common-source outbreaks caused by sick food handlers at restaurants and grocery stores and multi-state hepatitis A outbreaks caused by contaminated foods. These types of exposures are usually announced by your local or state health department.

Other exposures occur if you are living with someone who develops hepatitis A or travel to a country where hepatitis A is still common.

What to Do If Your Unvaccinated Child Is Exposed to Hepatitis A

If your unvaccinated child is exposed to hepatitis A, you should talk to your pediatrician or local health department about starting post-exposure prophylaxis as soon as possible and not longer than 14 days, including either:

  • the first dose of hepatitis A vaccine, with plans to get the second dose of vaccine in 6 months, or
  • a dose of immune globulin (provides a passive transfer of antibodies)

In general, getting the hepatitis A vaccine is preferred over getting immune globulin for most healthy people between 12 months and 40 years of age. For infants less than 12 months (too young to be vaccinated) and unvaccinated adults over age 40 years, immune globulin is preferred after an exposure to hepatitis A.

Immune globulin is also preferred for anyone who is immunocompromised or chronic liver disease.

What if it has been more than 14 days since the exposure?

While it is likely too late for immune globulin, your unvaccinated child should still likely get a dose of hepatitis A vaccine to protect against future exposures. And watch carefully over the next 15 to 50 days (the incubation period) for symptoms of hepatitis A, which can include jaundice, fever, and vomiting, etc. Many children don’t have symptoms though, so your child could develop hepatitis A, and be contagious and expose others without your even knowing it.

If post-exposure vaccination works, can’t you just wait until your child is exposed to get vaccinated? That might work – if you could be sure about each and every exposure that your child will ever have. Since that’s not possible, don’t delay getting vaccinated and put your child at risk of getting hepatitis A.

What to Do If Your Vaccinated Child Is Exposed to Hepatitis A

The hepatitis A vaccine is very effective.

One dose provide 95% protection against hepatitis A infections and the second dose boosts the efficacy rate up to 99%.

If your child is partially vaccinated, with just one dose and has been exposed to hepatitis A, get the second dose if it has been at least six months since he was vaccinated. Otherwise, talk to your pediatrician or local health department, but your child is likely considered protected.

What to Know About Getting Exposed to Hepatitis A

Learn what to do if your child is exposed to hepatitis A, especially if they aren’t already vaccinated and protected.

More on Getting Exposed to Hepatitis A

What to Do If Your Child Is Exposed to Mumps

Although things are much better than they were in the pre-vaccine era, we still have mumps outbreaks in the United States.

How does that work?

Waning immunity and folks who are unvaccinated.

How Contagious is Mumps?

Mumps is contagious, but not nearly as contagious as other vaccine-preventable diseases, such as measles.

“Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.”

CDC on Transmission of Measles

Unlike measles, which is so contagious that you can get it if you are simply in the same room with someone that is sick, mumps typically requires prolonged, close contact.

“When you have mumps, you should avoid prolonged, close contact with other people until at least five days after your salivary glands begin to swell because you are contagious during this time. You should not go to work or school. You should stay home when you are sick with mumps and limit contact with the people you live with; for example, sleep in a separate room by yourself if you can.”

CDC on Mumps Outbreak-Related Questions and Answers for Patients

How do you get mumps?

Since the virus spreads through saliva and mucus, you can get sick if you are in close contact with someone with mumps and they:

  • cough or sneeze
  • use a cup or eating utensil that you then use
  • touch an object or surface that you then touch (fomites)

And like many other vaccine-preventable diseases, people with mumps are usually contagious just before they begin to show symptoms.

“The mumps virus replicates in the upper respiratory tract and spreads through direct contact with respiratory secretions or saliva or through fomites. The risk of spreading the virus increases the longer and the closer the contact a person has with someone who has mumps.”

CDC on Mumps for Healthcare Providers

The need for prolonged, close contact is likely why most outbreaks these days are on college campuses.

Is Your Child Protected Against the Mumps?

Tips to prevent getting sick with the mumps.
You can prevent the mumps.

The MMR vaccine protects us against mumps – and measles and rubella.

One dose of MMR is 78% effective at preventing mumps, while a second dose increases that to 88%. Unfortunately, that protection can decrease over time.

Kids get their first dose of MMR when they are 12 to 15 months old. While the second dose of MMR isn’t typically given until just before kids start kindergarten, when they are 4 to 6 years old, it can be given earlier. In fact, it can be given anytime after your child’s first birthday, as long as 28 days have passed since their first dose.

“Evidence of adequate vaccination for school-aged children, college students, and students in other postsecondary educational institutions who are at risk for exposure and infection during measles and mumps outbreaks consists of 2 doses of measles- or mumps-containing vaccine separated by at least 28 days, respectively. If the outbreak affects preschool-aged children or adults with community-wide transmission, a second dose should be considered for children aged 1 through 4 years or adults who have received 1 dose. In addition, during measles outbreaks involving infants aged <12 months with ongoing risk for exposure, infants aged ≥6 months can be vaccinated.”

CDC on Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices

And although it won’t count as their first dose, in special situations, kids can get an early MMR once they are six months old.

What to Do If Your Unvaccinated Child Is Exposed to Mumps

To be considered fully vaccinated and protected against mumps, kids need two doses of MMR – one at 12 to 15 months and another when they are 4 to 6 years.

“Although mumps-containing vaccination has not been shown to be effective in preventing mumps in persons already infected, it will prevent infection in those persons who are not yet exposed or infected. If persons without evidence of immunity can be vaccinated early in the course of an outbreak, they can be protected prior to exposure.”

Surveillance Manual

If your unvaccinated child is exposed to mumps, you should talk to your pediatrician or local health department, but unlike measles and chicken pox, there are no recommendations to start post-exposure prophylaxis.

Mumps quarantine sign

Unfortunately, neither a post-exposure dose of MMR nor immune globulin work to prevent mumps after you are already exposed. They should still get an MMR though, as it will provide immunity against measles and rubella, and mumps if they don’t get a natural infection.

“Persons who continue to be exempted from or who refuse mumps vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”

Manual for the Surveillance of Vaccine-Preventable Diseases

Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.
Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.

Unvaccinated kids who are exposed to mumps will likely need to be quarantined, as you watch for signs and symptoms of measles developing over the next 12 to 25 days.

If your exposed child develops mumps, be sure to call your health care provider before going in for a visit, so that they can be prepared to see you and so you don’t expose other people to mumps. Your child with suspected mumps should be wearing a mask before going out in public and if possible, will be put in a negative pressure room in the emergency room or doctor’s office.

It is very important to understand that simply wearing a mask doesn’t eliminate the risk that your child with mumps could expose others, it just reduces the risk. You still want to avoid other people!

What to Do If Your Vaccinated Child Is Exposed to Mumps

If your fully vaccinated child is exposed to mumps, does that mean you are in the clear?

Again, it depends on what you mean by fully vaccinated.

It also depends on what you mean by exposed. Is it someone in the same school that your child has had no real contact with or a sibling that he is around all of the time?

And is your child fully vaccinated for his age or has he had two doses of MMR?

Since kids get their first dose of MMR at 12 to 15 months and the second when they are 4 to 6 years old, it is easy to see that many infants, toddlers and preschoolers who are following the immunization schedule are not going to be fully vaccinated against mumps, even if they are not skipping or delaying any vaccines.

“In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age 4 through 6 years.”

Ask the Experts about MMR

In most cases, documentation of age-appropriate vaccination with at least one dose of MMR is good enough protection. That’s because the focus in controlling an outbreak is often on those folks who don’t have any evidence of immunity – the unvaccinated.

And one dose of MMR is about 78% effective at preventing mumps infections. A second dose does increase the vaccine’s effectiveness against mumps to over 88%.

An early second dose is a good idea though if your child might be exposed to mumps in an ongoing outbreak, has only had one dose of MMR, and is age-eligible for the second dose (over age 12 months and at least 28 days since the first dose). Your child would eventually get this second dose anyway. Unlike the early dose before 12 months, this early dose will count as the second dose of MMR on the immunization schedule.

“Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications.”

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

And in some cases, folks should now get a third of dose of MMR.

This third dose of MMR is not for post-exposure prophylaxis though, which again, doesn’t work for mumps. It is to prevent mumps from ongoing exposures.

You should still watch for signs and symptoms of mumps over the next 12 to 25 days though, as no vaccine is 100% effective. Your vaccinated child won’t need to be quarantined though.

Most importantly, in addition to understanding that vaccines are safe and necessary, know that the ultimate guidance and rules for what happens when a child is exposed to mumps will depend on your local or state health department.

What to Know About Getting Exposed to Mumps

Talk to your pediatrician if your child gets exposed to mumps, even if you think he is up-to-date on his vaccines, as some kids need a third dose of the MMR vaccine during on-going mumps outbreaks.

More on Getting Exposed to Mumps

What to Do If Your Child Is Exposed to Measles

Although the endemic spread of measles was eliminated way back in 2000, we still have measles outbreaks in the United States.

How does that work?

They are usually imported from outside the country, often by an unvaccinated child or adult who travels overseas, gets measles, and returns while still contagious.

How Contagious is Measles?

Measles is highly contagious.

“Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.”

CDC on Transmission of Measles

In addition to the fact that people with measles are contagious for at least four days before they develop the classic measles rash until four days after, the measles virus can survive for up to two hours in the air and on contaminated surfaces wherever that person cough or sneezed. So you don’t technically need to even be in direct contact with the person with measles – simply entering a room or getting on a bus that the infected person recently left can do it.

An infant hospitalized during a measles outbreak in the Philippines in which 110 people died.
An infant hospitalized during a measles outbreak in the Philippines in which 110 people died. Photo by Jim Goodson, M.P.H.

Still, you are not going to get measles from simply being in the same city as someone else with measles.

The tricky part though, is knowing what to do if your child is exposed to someone with measles, even if you think they are up-to-date with their vaccines.

Remember, kids get their first dose of MMR when they are 12 to 15 months old. While the second dose of MMR isn’t typically given until just before kids start kindergarten, when they are 4 to 6 years old, it can be given earlier. In fact, it can be given anytime after your child’s first birthday, as long as 28 days have passed since their first dose.

“Evidence of adequate vaccination for school-aged children, college students, and students in other postsecondary educational institutions who are at risk for exposure and infection during measles and mumps outbreaks consists of 2 doses of measles- or mumps-containing vaccine separated by at least 28 days, respectively. If the outbreak affects preschool-aged children or adults with community-wide transmission, a second dose should be considered for children aged 1 through 4 years or adults who have received 1 dose. In addition, during measles outbreaks involving infants aged <12 months with ongoing risk for exposure, infants aged ≥6 months can be vaccinated.”

CDC on Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices

And although it won’t count as their first dose, in special situations, kids can get an early MMR once they are six months old.

What to Do If Your Unvaccinated Child Is Exposed to Measles

To be considered fully vaccinated and protected against measles, kids need two doses of MMR – one at 12 to 15 months and another when they are 4 to 6 years.

“During measles, rubella, or mumps outbreaks, efforts should be made to ensure that all persons at risk for exposure and infection are vaccinated or have other acceptable evidence of immunity.”

CDC on Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices

If your unvaccinated child is exposed to measles, you should talk to your pediatrician or local health department about starting post-exposure prophylaxis as soon as possible, including:

  • a dose of immune globulin (IGIM) if they are less than 6 months old
  • either a dose of immune globulin (IGIM) or the MMR vaccine if they are between 6 and 12 months old (this dose of MMR doesn’t count as the first dose of MMR on the immunization schedule and will need to be repeated when the child turns 12 months old)
  • a dose of the MMR vaccine if they are at least 12 months old
  • a dose of immune globulin (IGIV) if they are severely immunocompromised (even if they were previously vaccinated)

Immune globulin should be given within 6 days of exposure, while a dose of MMR vaccine within 72 hours of exposure can decrease their chances of getting measles.

“Persons who continue to be exempted from or who refuse measles vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”

Manual for the Surveillance of Vaccine-Preventable Diseases

Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.
Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.

What if your child is incompletely vaccinated, with just one dose of MMR? They could get their second dose of MMR, as long as they are over 12 months old and it has been at least 28 days since their first dose (see below).

Unvaccinated kids who don’t get post-exposure prophylaxis should be quarantined, as you watch for signs and symptoms of measles developing over the next 21 days. Your child might still need to be quarantined if they got immune globulin instead of the vaccine, and the quarantine might extend to 28 days, as immune globulin can prolong the incubation period.

If your exposed child develops measles, be sure to call your health care provider before going in for a visit, so that they can be prepared to see you and so you don’t expose other people to measles. Your child with suspected measles should be wearing a mask before going out in public and if possible, will be put in a negative pressure room in the emergency room or doctor’s office. If a regular exam room is used, it can not be used again for at least two hours. It is very important to understand that simply wearing a mask doesn’t eliminate the risk that your child with measles could expose others, it just reduces the risk. You still want to avoid other people!

What to Do If Your Vaccinated Child Is Exposed to Measles

If your fully vaccinated child is exposed to measles, does that mean you are in the clear?

Again, it depends on what you mean by fully vaccinated.

Is your child fully vaccinated for his age or has he had two doses of MMR?

Since kids get their first dose of MMR at 12 to 15 months and the second when they are 4 to 6 years old, it is easy to see that many infants, toddlers and preschoolers who are following the immunization schedule are not going to be fully vaccinated against measles, even if they are not skipping or delaying any vaccines.

“In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age 4 through 6 years.”

Ask the Experts about MMR

In some cases, documentation of age-appropriate vaccination with at least one dose of MMR is good enough protection, which means that toddlers and preschoolers don’t necessarily need an early second dose. That’s because the focus in controlling an outbreak is often on those folks who don’t have any evidence of immunity – the unvaccinated.

And one dose of MMR is about 95% effective at preventing measles infections. A second dose does increase the vaccine’s effectiveness against measles to over 99%, but it isn’t a booster. The second dose of MMR is for those kids that didn’t respond to the first dose.

“Available data suggest that measles vaccine, if given within 72 hours of measles exposure to susceptible individuals, will provide protection or disease modification in some cases. Measles vaccine should be considered in all exposed individuals who are vaccine-eligible and who have not been vaccinated or have received only 1 dose of vaccine.”

AAP RedBook

An early second dose is a good idea though if your child is exposed to measles, has only had one dose of MMR, and is age-eligible for the second dose (over age 12 months and at least 28 days since the first dose). Your child would eventually get this second dose anyway. Unlike the early dose before 12 months, this early dose will count as the second dose of MMR on the immunization schedule.

You should still watch for signs and symptoms of measles over the next 10 to 21 days though, as no vaccine is 100% effective. Your vaccinated child won’t need to be quarantined though.

Most importantly, in addition to understanding that vaccines are safe and necessary, know that the ultimate guidance and rules for what happens when a child is exposed to measles will depend on your local or state health department.

What to Know About Getting Exposed to Measles

Talk to your pediatrician if your child gets exposed to measles to make sure he doesn’t need post-exposure prophylaxis to keep him from getting sick, even if you think he is up-to-date on his vaccines.

More on Getting Exposed to Measles

A 6-year-old in Florida With Rabies Has Died

Never touch a bat that you find on the ground during the day, as it might have rabies.
Never touch a bat that you find in your home or on the ground during the day, as it might have rabies. Photo by Radu Privantu (CC BY 2.0)

As most people understand, rabies is a little different than most vaccine-preventable diseases.

Unlike other vaccines, you typically don’t get a rabies vaccine until after you are exposed to the rabies virus. That’s why the rabies vaccine isn’t on the routine childhood immunization schedule.

And that’s why we also try to routinely vaccinate all of the animals around us that might get rabies, especially our pets.

It’s also why it’s important to avoid animals that might have rabies, including unfamiliar cats and dogs, and wild animals, especially bats, raccoons, skunks, foxes, and coyotes.

A 6-year-old in Florida Has Rabies

Unfortunately, this strategy doesn’t always work.

A 6-year-old in Florida, Ryker Roque, was recently exposed to rabies when his father found a sick bat and placed it in a bucket on their porch. Little Ryker eventually put his hand in the bucket and was “scratched” by the bat, even though his father had warned him not to touch the bat.

Could someone search for advice on Google on treating a bite from a rabid animal and come away thinking their child doesn't need rabies shots from an anti-vaccine website?
Could someone search for advice on Google on treating a bite from a rabid animal and come away thinking their child doesn’t need rabies shots from an anti-vaccine website?

After searching for information on what to do if a child is bitten by a sick bat, Ryker’s parents decided to wash his hands with soap and hot water.

“If you think your pet has been bitten by a bat, contact a veterinarian or your health department for assistance immediately and have the bat tested for rabies.”

CDC on Coming in contact with bats

The Today Show reports that they didn’t take him for rabies shots, even though they “knew they should have,” because “Ryker cried at the thought of getting shots.”

In a more common scenario, or maybe what happened here, parents simply decide that the risk is low and they take their chances. This is even more common after a child is bitten by a stray cat or dog and you simply don’t have vaccination records or an animal to put in quarantine.

Experimental Treatments for Rabies

When traditional post-exposure prophylaxis isn’t used – human rabies immune globulin and a series of rabies shots to prevent someone from getting rabies, the disease is historically fatal. We have no good treatments for human rabies and rabies encephalitis.

“The poor prognosis in rabies may reflect the fact that infection induces immune unresponsiveness, characterized by impaired T-cell function, with altered cytokine patterns, inhibition of T-cell proliferation, and the destruction of immune cells.”

Alan C Jackson on Current and future approaches to the therapy of human rabies

Fortunately, some experimental treatments have been developed that can offer at least a little bit of hope when someone gets rabies, including:

  • The Milwaukee Protocol – developed for a 15-year-old girl in Wisconsin who developed rabies symptoms one month after picking up a bat that had fallen to the floor at church. The bat bit her as she carried it outside. As her symptoms progressed, she was put into a drug induced coma, put on a ventilator, and given antiviral medications. She eventually recovered with mild to moderate after-effects, but most others on the protocol do not recover at all.
  • use of rabies virus-neutralizing human monoclonal antibodies
  • new experimental vaccines

Tragically, reports about recovery from rabies and rabies encephalitis are rare.

Things that might point to a favorable outcome, in addition to being vaccinated, including being young and healthy, having mild symptoms when treatment is started, and being exposed to rabies from a bat, instead of a dog or other animal.

Unfortunately, like many others, Ryker died while on the protocol.

Anti-Vaccine Websites and Rabies Vaccines

Believe it or not, anti-vaccine websites even work to scare folks away from getting rabies vaccines after their kids are exposed to a rabid animal.

  • Age of Autism promotes a self published book about a child who “who regressed into autism following a series of rabies vaccines when he was three and a half”
  • The Healthy Home Economist claims that our pets are suffering from vaccinosis, that pet vaccines contain a toxic chemical cocktail, and that they are a scientific fraud.
  • GreenMedinfo published an article from Suzanne Humphries, MD warns that an ingredient in the rabies vaccine “could possibly throw children or adults onto dialysis and/or a kidney transplant”
  • Kelly Brogan, MD, in her “review article,” Psychobiology of Vaccination Effects: Bidirectional Relevance of Depression, continues to push the idea that the rabies vaccine can cause ADEM.

And of course, almost every anti-vaccine website and anti-vaccine expert pushes the idea that vaccines don’t work.

Get educated. While vaccines are always necessary, there are some situations when they are critically important.

What to Know About Bats and Rabies

Rabies is a vaccine-preventable disease, so be sure to seek quick medical attention if there is ever a possibility that your child was exposed to a rabid animal, whether it is a dog, cat, bat, raccoon, skunk, fox, or coyote.

More on Bats and Rabies

Updated January 15, 2018

5 Myths About Tetanus and Tetanus Shots

Think you know everything you need to know about tetanus and tetanus shots to make an informed decision about getting vaccinated?

Unfortunately, there is a lot of misinformation out there about tetanus that can scare you away from getting a tetanus shot or make you think that you don’t really need one.

You can only get tetanus from a rusty nail. (False)

Would a rose smell as sweet if you pricked your finger on a thorn and got tetanus?
Would a rose smell as sweet if you pricked your finger on a thorn and got tetanus? Photo by Cherrie Mio Rhodes. (CC BY 2.0)

Tetanus is caused by the Clostridium tetani bacteria.

Unlike most other vaccine-preventive diseases, tetanus is not contagious. Instead, you can get tetanus after being exposed to tetanus spores in dust, soil, and feces, which then grow and make a powerful neurotoxin. Tetanus spores can even be found in the mouth of many animals.

So why does everyone associate tetanus with rusty nails?

We likely think that an old, rusty nail  is more likely to be contaminated with tetanus spores simply because it has been outside for a long time. Especially as compared to a brand new one that you just took out of a box.

But tetanus is not just about nails.

You can get tetanus after a cat or dog bite, a burn, frostbite, a tractor falling on your leg (crush injury), or falling into a rose bush (puncture wounds from thorns), etc. Almost anything that can cause a non-superficial wound can cause tetanus, especially if the wound is contaminated with dirt, feces, or saliva.

A tetanus shot won’t help after you have already been cut, stabbed, or bitten. (False)

The reason we give the shot is because the tetanus spores take time to germinate.

We are not worried about tetanus bacteria being on a rusty nail, cat teeth, rose bush, or on your very dirty hands through which a clean knife went through.

It’s the tetanus spores on those things and everywhere else, because they are in dirt and dust. And then, after the spores germinate inside a wound, the C. tetani bacteria have to start producing the exotoxin that acts as a neurotoxin, which causes the symptoms of tetanus.

The tetanus vaccine is against this exotoxin.

Unfortunately, it only takes a very small amount of tetanus toxin to cause tetanus. That’s why you don’t get natural immunity after being exposed to tetanus, but you do after getting the vaccine. It would only take about 60 nanograms of tetanus toxin to kill a small child.

Once the spores germinate, start producing exotoxin, and the exotoxin finally reaches your nervous system, that’s when you will start having tetanus symptoms.

Still, if you are completely unvaccinated and are exposed to tetanus, you would get tetanus immune globulin (TIG) as part of your post-exposure prophylaxis, in addition to a tetanus shot.

If a puncture wound bleeds a lot, then you don’t need to get a tetanus shot. (False)

Many puncture wounds do not bleed a lot, but those that do are still at risk for tetanus.
Many puncture wounds do not bleed a lot, but those that do are still at risk for tetanus. Photo by James Heilman, MD

You don’t need to get a tetanus shot if you have a clean, minor wound and:

  • you have completed a primary tetanus series (a minimum of 3 tetanus containing vaccines), and
  • your most recent dose of tetanus vaccine was within the past 10 years

For most other wounds, including dirty wounds, animal bites, and puncture wounds, etc., you likely don’t need a tetanus shot if you have completed a primary tetanus series, and your most recent dose of tetanus vaccine was within the past 5 years.

In addition to a dose of tetanus vaccine, if has been less than 5 years since their last dose or they are unvaccinated or incompletely vaccinated, then they might also need to get tetanus immune globulin (TIG).

How much the wound bleeds has nothing to do with whether or not you need a tetanus shot. After all, a bleeding wound is not going to flush out all of the tetanus spores that might have contaminated your wound, or at least you have no guarantee that it did. What if the bleeding was more superficial and there was a deeper puncture wound that you couldn’t see?

This idea likely comes from the fact that tetanus is an anaerobic bacteria, meaning that it can’t survive around oxygen.

Tetanus is a mild disease. (False)

Tetanus, which people commonly think of as “lockjaw” is hardly a mild disease.

Can an unvaccinated child really get tetanus after a toe nail injury?
Thus unvaccinated child got  tetanus after a toe nail injury. Photo by Petrus Rudolf de Jong (CC BY 3.0)

According to the CDC, “Even with modern intensive care, generalized tetanus is associated with death rates of 10% to 20%.”

And tetanus will always be a problem – if you aren’t vaccinated.

Since tetanus isn’t contagious and the tetanus spores are in the dirt and dust around us, you can’t rely on the folks around you to get vaccinated and “hide in the herd” for this vaccine-preventable disease.

Some recent cases highlight this myth:

  • an unvaccinated 7-year-old in Australia who contracted tetanus through an open wound in her foot while playing in her family’s garden. She was in critical condition, remained in the ICU for a few weeks despite quick treatment, and will likely face months, if not years of rehab after being released. (2017)
  • an unvaccinated women who developed obstetric tetanus
  • an unvaccinated 6-year-old in Canada who developed tetanus symptoms 10 days after stepping on a nail (2015)
  • unvaccinated children in parts of the world where vaccines are not longer available, like Ukraine
  • an unvaccinated 7-year-old in New Zealand who developed tetanus after cutting his foot and was hospitalized for almost a month (2013)

Worldwide, there are still about 49,000 deaths a year from neonatal tetanus and 14,500 deaths in children and adults. The incidence of tetanus has dropped tremendously since 1980 though, as more and more people get vaccinated throughout the world.

There are easy, non-toxic ways to prevent tetanus.

This one is actually true, it’s called a tetanus vaccine.

It replaced the previous treatment for tetanus, giving folks tetanus antitoxin, a treatment which began in the late 19th century. The first tetanus vaccine followed soon after, in the early 1920’s. It became more widely used during World War II.

“I myself suffered a fairly severe and deep cut on my ankle from a freak accident a few years ago but the thought of getting a tetanus shot for the injury never even crossed my mind.  I simply soaked my foot and ankle in warm salt water a couple of times a day for about a week to ensure that it stayed clean and contamination free.

The injury healed up nicely and I never exposed myself to the toxins and lingering health problems that can and do result from a tetanus shot.”

The Healthy Home Economist

Of course, when anti-vaccine folks talk about ‘non-toxic’ ways, they mean holistic type treatments without vaccines or other standard medical treatments.

When they tell you to clean the wound and take “extra cod liver oil, natural vitamin C, lacto-fermented foods and plenty of bone broths,” they are basically saying to hope that you are lucky and you don’t get tetanus.

Not only is the tetanus vaccine not toxic, but it helps fight the toxin that tetanus bacteria could produce in a contaminated wound.

What about hydrogen peroxide or colloidal silver? Like simple cleaning, with a deep puncture wound, none of those things will likely get to the ‘bottom’ of the wound. If you have even seen a puncture wound, like when a child steps on a nail, there is not much to clean. The wound typically closes up as the nail or other object exits the skin. Even with other wounds, unless you surgically open and irrigate the wound, you likely won’t clean it well enough to get all of the spores out if they are there.

What to Know About Tetanus and Tetanus Shots

Keeping up-to-date on your tetanus vaccines, which might mean an early shot if you have a dirty wound, is the only way to avoid serious and potentially life-threatening tetanus infections.

More About Tetanus and Tetanus Shots