Tag: tetanus shots

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

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.

More on Tetanus In An Unvaccinated Child in Oregon

Are the Tdap and DTaP Vaccines the Same Thing?

You have probably already figured out the Tdap and DTaP aren’t the same vaccine, after all, if they were, why would they have different names, right?

Are the Tdap and DTaP Vaccines the Same Thing?

I bet you don’t know the difference between the two vaccines though.

Yes, they both are both combination vaccines that protect against diphtheria, tetanus, and pertussis.

The difference is that one (DTaP) is used as the primary series for infants and younger children (age 6 years and under) and the other (Tdap) is given to older children (age 7 years and above), teens, and adults.

Okay, that’s not the only difference.

The DTaP vaccine actually contains more diphtheria and pertussis antigens than Tdap, which is why it has the capital “D” and “P” in its name. The amount of tetanus toxoid antigens are about the same in both vaccines.

So Tdap contains the same amount of tetanus toxoid, plus a reduced amount of diphtheria and acellular pertussis antigens, as compared to DTaP.

While you would think that older children and adults would get the vaccine with the higher amount of antigens, since they are bigger, that’s not how this works. Vaccines typically start working at the injection site, so body size isn’t a key factor in determining the amount of ingredients.

As a booster dose of vaccine, the lower amount of antigens works just fine and helps reduce the risk of side effects from repeated doses that you might get with higher antigen counts.

More on Tdap vs DTaP

What Are the Recommended and Minimum Ages and Intervals Between Doses of Vaccines?

Most parents likely don’t think about the minimum age or minimum intervals between vaccines, as they just get their kids vaccinated according to the routine immunization schedule.

Things don’t always go according to schedule though…

Recommended and Minimum Ages for Vaccines

After their birth dose of the hepatitis B vaccine, your baby’s next vaccines are usually at two months.

Can you get them earlier?

When necessary, many vaccines can be given earlier and faster than the standard schedule.
When necessary, many vaccines can be given earlier and faster than the standard schedule.

Yes. The minimum age for the first dose of rotavirus, DTaP, IPV, Hib, Prevnar, is 6 weeks.

Some other vaccines can be given earlier than their recommended age too, including:

  • the first MMR vaccine, which can be given as early as age 6 months in certain high risk situations, like traveling out of the country or in an outbreak situation, although this dose will have to be repeated once the child is 12 months old
  • the 4th dose of DTaP, which can be given as early as age 12 to 15 months, as long as at least 4 to 6 months have passed since the third dose
  • the 2nd dose of Varivax, which may be given as early as 1 to 3 months after the first dose
  • the Tdap vaccine, which can be given as early as age 7 years, instead of the more typical 11 to 12 years
  • the HPV vaccine, which can be given as early as age 9 years, instead of the more typical 11 to 12 years

Why would you get a vaccine early?

What if you are going to be traveling just before you infant is going to be 2 months old? Or your 9 year old stepped on a rusty nail, and it had been just over 5 years since his last tetanus (DTaP) shot?

Recommended and Minimum Intervals for Vaccines

In addition to earlier ages, you can sometimes get vaccines more quickly, on an accelerated schedule.

For example:

  • the minimum interval between the 1st and 2nd dose of rotavirus, DTaP, IPV, Hib, Prevnar is 4 weeks, instead of the standard 2 months
  • the minimum interval between the 2nd and 3rd dose of rotavirus, DTaP, IPV, Hib, Prevnar is 4 weeks, instead of the standard 2 months
  • the minimum interval between the 1st and 2nd dose of HPV is either 4 weeks (3 dose schedule) or 5 months (2 dose schedule)
  • the minimum interval between the 2nd and 3rd dose of HPV is 12 weeks
  • the minimum interval between the 1st and 3rd dose of HPV is 5 months, instead of the standard 6 months

Why give these vaccines more quickly than usual?

The usual reason is that a child is a little behind and is working to get caught up.

Absolute Minimum Ages for Vaccines

It is important to remember that in some cases, there are some hard and fast rules about minimum ages. That means that if you get these vaccines any earlier, they won’t count and you will likely have to repeat them, including getting :

  • the 3rd dose of hepatitis B before 6 months (24 weeks) or sooner than 8 weeks after 2nd dose and  16 weeks after 1st dose
  • the first dose of MMR, Varivax or hepatitis A before 12 months
  • the 4th dose of Hib before 12 months
  • the 4th dose of Prevnar before 12 months
  • the 4th dose of DTaP before 12 months
  • the 5th dose of DTaP before 4 years
  • the 4th dose of IPV before 4 years

Sticking to the routine schedule helps to avoid vaccine errors, like giving a vaccine too early. In some situations, the 4 day grace period helps if a vaccine is given a little early.

More on Recommended and Minimum Ages and Intervals Between Doses of Vaccines