Tag: laceration

An Unvaccinated Child in Oregon Recently Had Tetanus

I recently wrote about how there was a case of diphtheria in Oklahoma last year.

It was a good reminder that we aren’t just seeing measles outbreaks these days.

Need another reminder?

An Unvaccinated Child in Oregon Recently Had Tetanus

An unvaccinated 6-year-old in Oregon developed tetanus.

Can an unvaccinated child really get tetanus after a toe nail injury?
In a similar case, an unvaccinated 4-year-old got severe tetanus after a minor toe nail injury. (CC BY 3.0)

“In 2017, a boy aged 6 years who had received no immunizations sustained a forehead laceration while playing outdoors on a farm; the wound was cleaned and sutured at home. Six days later, he had episodes of crying, jaw clenching, and involuntary upper extremity muscle spasms, followed by arching of the neck and back (opisthotonus) and generalized spasticity. Later that day, at the onset of breathing difficulty, the parents contacted emergency medical services, who air-transported him directly to a tertiary pediatric medical center. The boy subsequently received a diagnosis of tetanus and required approximately 8 weeks of inpatient care, followed by rehabilitation care, before he was able to resume normal activities.”

Notes from the Field: Tetanus in an Unvaccinated Child — Oregon, 2017

Many folks will recognize the “jaw clenching” from the alternative name for tetanus – lockjaw.

“Upon hospital arrival, the child had jaw muscle spasms (trismus). He was alert and requested water but was unable to open his mouth; respiratory distress caused by diaphragmatic and laryngeal spasm necessitated sedation, endotracheal intubation, and mechanical ventilation. Tetanus immune globulin (3,000 units) and diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) were administered for presumed tetanus. He was admitted to the pediatric intensive care unit and cared for in a darkened room with ear plugs and minimal stimulation (stimulation increased the intensity of his spasms). Intravenous metronidazole was initiated, and the scalp laceration was irrigated and debrided.”

Notes from the Field: Tetanus in an Unvaccinated Child — Oregon, 2017

Wait, wasn’t it too late to vaccinate him at this point?

Of course not.

Remember, tetanus vaccine doesn’t actually kill the tetanus bacteria. Or even prevent a tetanus infection, believe it or not. The tetanus shot is a toxoid vaccine directed against the toxin that the tetanus bacteria makes.

Once tetanus spores germinate, the bacteria have to grow and then produce exotoxins. The exotoxins then have to travel to different sites in your nervous system, where they act as neurotoxins.

At this point, although he was treated with antibiotics and tetanus immune globulin, there is still a chance that spores will germinate and becteria will eventually grow and produce more exotoxin. Getting the vaccine helps ensure that you will make some of your own antibody to fight them.

“His opisthotonus worsened, and he developed autonomic instability (hypertension, tachycardia, and body temperatures of 97.0°F–104.9°F [36.1°C–40.5°C]). He was treated with multiple continuous intravenous medication infusions to control his pain and blood pressure, and with neuromuscular blockade to manage his muscle spasms. A tracheostomy was placed on hospital day 5 for prolonged ventilator support. Starting on hospital day 35, the patient tolerated a 5-day wean from neuromuscular blockade. On day 44, his ventilator support was discontinued, and he tolerated sips of clear liquids. On day 47, he was transferred to the intermediate care unit. Three days later, he walked 20 feet with assistance. On day 54, his tracheostomy was removed, and 3 days later, he was transferred to a rehabilitation center for 17 days.”

Notes from the Field: Tetanus in an Unvaccinated Child — Oregon, 2017

And since you don’t develop natural immunity to tetanus, getting vaccinated helps protect you from future exposures.

After an episode like this, you wouldn’t want to risk your child getting this sick again, would you?

“The boy required 57 days of inpatient acute care, including 47 days in the intensive care unit. The inpatient charges totaled $811,929 (excluding air transportation, inpatient rehabilitation, and ambulatory follow-up costs). One month after inpatient rehabilitation, he returned to all normal activities, including running and bicycling. Despite extensive review of the risks and benefits of tetanus vaccination by physicians, the family declined the second dose of DTaP and any other recommended immunizations.”

Notes from the Field: Tetanus in an Unvaccinated Child — Oregon, 2017

Well, most of us wouldn’t…

Hopefully other parents learn a lesson though.

Remember, you can wait too long to vaccinate your kids. You can skip or delay a vaccine long enough that they end up getting measles, tetanus, diphtheria, or meningococcemia, etc., before you get caught up.

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