Tag: tetanus shots

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

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