Tag: 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 t etanus 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.

Can You Treat Tetanus Without a Tetanus Shot?

Why would anyone want to try and treat tetanus without a tetanus shot?

That’s a good question…

Misinformation about tetanus from the PIC.

Why would a doctor tell others that tetanus could be treated without a tetanus shot?

That might be a question for a state medical board…

Can You Treat Tetanus Without a Tetanus Shot?

As most people will notice, even looking at the ironically named Physicians for Informed Consent’s own post, you don’t treat tetanus without a tetanus shot.

“Tetanus is a medical emergency requiring hospitalization, immediate treatment with human tetanus immune globulin (TIG), agents to control muscle spasm, aggressive wound care, antibiotics, and a tetanus toxoid booster. If tetanus immune globulin is unavailable, Immune Globulin Intravenous (IGIV) can be used.”

CDC on Tetanus for Clinicians

Even in the study that they used as a reference clearly used both tetanus immune globulin and a tetanus shot.

What might be confusing to some folks, is that tetanus toxoid, is synonymous (has the same meaning) as:

tetanus vaccine
tetanus shot
Td (tetanus toxoid + diphtheria toxoid)

So like most people with tetanus, this patient received both tetanus immune globulin and a tetanus vaccine, a fact I tried to point out so that visitors to Physicians for Informed Consent could get true informed consent about their vaccine choices.

The comment that got me banned from posting on Phyicians for Informed Consent. — As often happens on anti-vaccine sites, my comment was quickly deleted and I was banned from posting further messages.

And fortunately, the patient, who’s previous immunization history was unknown, got better!

Treating Tetanus With a Tetanus Shot

Why did he have tetanus?

The case they are talking about occurred in Japan, and again, it isn’t known if the patient had ever received a tetanus vaccine.

“In Japan, tetanus toxoid was introduced in 1968, so elderly adults who were born before 1968 have high risk of tetanus.”

Tomoda et al. on Tetanus without apparent history of trauma

He was born in 1950 and although he had no history of recent trauma, “he grew vegetables in a field as his hobby.”

As most people know, gardening is a risk factor for getting tetanus.

And with such a long incubation period, it is very likely that he had a minor wound or injury while gardening, was exposed to tetanus spores, and later developed tetanus symptoms.

Over 100 years ago, we did treat tetanus with just tetanus immunoglobulin, but that was before the tetanus vaccine was developed.

The long incubation period is also the reason that giving a tetanus vaccine works to prevent you from getting tetanus even after you have been exposed. Tetanus spores have to germinate, the bacteria have to grow and then produce exotoxins. And then the exotoxins have to travel to different sites in your nervous system, where they act as neurotoxins.

Hopefully, before they do, the dose of tetanus vaccine you got when you pricked your finger on a thorn, stepped on a nail, or cut your leg, etc., will have already induced you to start making antibodies against the exotoxins – antitoxin. Just in case they don’t, in a high risk case, you also would have gotten a dose of tetanus immune globulin for an immediate dose of antitoxin – antibodies against the exotoxins.

The same thing happens if you have already developed tetanus symptoms. A dose of tetanus immune globulin helps to neutralize neurotoxins that haven’t already started doing damage, and you get supportive care until you recover. Plus antibiotics to kill the bacteria so they won’t make more exotoxins and a tetanus shot.

Why not just give tetanus immune globulin, as the post from Physicians for Informed Consent implied you can do?

It is mostly because a tetanus infection doesn’t stimulate any natural immunity and the immunity you get from tetanus immune globulin is temporary, so won’t prevent a relapsing or recurrent case.

Before the use of tetanus vaccines became standard, it was well known that tetanus relapses were possible.

And because no one would substitute a treatment that is known to work well, a tetanus vaccine with tetanus immune globulin, and switch it out for one that might be riskier and have no extra benefits.

Using immune globulin alone was once the recommended treatment. That was before the tetanus vaccine was developed though. Back then, in the late 19th century and early 20th century, folks with suspected tetanus got treated with anti-tetanic serum that was made in horses. The main problem with this tetanus antitoxin was that it could sometimes trigger serum sickness.

Fortunately, a tetanus vaccine was soon developed and it’s use with tetanus immune globulin helped make deaths from tetanus very rare.

Of course, tetanus is still around. Although it is a vaccine-preventable disease, it will never be eradicated, like smallpox.

“This case had no apparent portal of entry; there was no history of trauma, and no site was found on physical examination. However, this is not uncommon; no obvious entry site was reported in approximately 26% of cases in Japan.”

Tomoda et al. on Tetanus without apparent history of trauma

And not specific to Japan, that you can get tetanus without a history of trauma should be what really concerns folks in this article that the Physicians for Informed Consent has decided to spotlight.

It is a great reminder that vaccines are necessary.

The Benefits and Risks of Delaying Vaccines

Believe it or not, some pediatricians think it is a good idea to delay vaccines.

“Wait until a child is clearly developmentally “solid” before vaccinating because we just don’t know which children will react badly to immunizations.”

Dr. Jay Gordon

In fact, Dr. Bob wrote a whole book pushing his own immunization schedule!

Not surprisingly, there are no benefits to skipping or delaying your child’s vaccines, but there are plenty of risks.

What Are the Risks of Delaying Vaccines?

Of course, the biggest risk of delaying your child’s vaccines is that they will get a disease that they could have been vaccinated and protected against.

“In 1989, the Haemophilus influenzae type b vaccine was relatively new and not yet routine. I was aware of the vaccine’s availability, but, busy mom that I was, I had not yet made the trip to the health department to get the immunization for my two-year-old daughter, Sarah. I will always regret that bit of procrastination and the anguish that it caused.”

Peggy Archer

Although we are much more used to hearing vaccine injury scare stories, if you are thinking of delaying your child’s vaccines, there are also many personal stories of parents who regret not vaccinating their children that you should review.

You can wait too long to get a tetanus shot... — You can wait too long to get a tetanus shot… Photo by Petrus Rudolf de Jong (CC BY 3.0)

It is true that the risk may be very small for a disease like polio, which is close to being eradicated worldwide, but it is not zero.

Consider that the last case of polio occurred in 2005, when an unvaccinated 22-year-old U.S. college student became infected with polio vaccine virus while traveling to Costa Rica in a university-sponsored study-abroad program.

So you might not get wild polio unless you visit specific regions of Afghanistan or Pakistan, but you might want to be concerned about vaccine-associated polio if you go to a country that is still giving the oral polio vaccine.

And the risk is certainly much higher than zero for most other vaccine-preventable diseases, as we see from the regular outbreaks of measles, mumps, and pertussis, etc.

Some studies even suggest that delaying your child’s vaccines puts them at more risk for side effects once you do start to get caught up!

“…in the second year of life, delay of the first MMR vaccine until 16 months of age or older resulted in an IRR for seizures in the 7 to 10 days after vaccination that was 3 times greater than if administration of MMR vaccine occurred on time.”

Hambridge et al on Timely Versus Delayed Early Childhood Vaccination and Seizures

Why would that be?

It’s probably because that’s when kids are most at risk for febrile seizures.

What Are the Benefits of Delaying Vaccines?

Again, there are no real benefits of delaying vaccines, except that your child gets out of one or more shots. Of course, that means your unvaccinated child is left unprotected.

And it is going to mean more shots later, once you do decide to get caught up.

Will it mean a lower risk of autism, ADHD, eczema, peanut allergies, or anything else?

Nope.

“The prevalence of allergic diseases and non-specific infections in children and adolescents was not found to depend on vaccination status.”

Schmitz et al on Vaccination Status and Health in Children and Adolescents Findings of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

Unvaccinated kids are not healthier than those who are vaccinated. They are just at higher risk of getting a vaccine-preventable disease.

Why do some folks think that there are benefits to delaying vaccines? Because they have been scared into thinking that vaccines are harmful and that they don’t even work.

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

Obviously, that put us all at risk. If too many people skip or delay their child’s vaccines, we will see more outbreaks.

Get educated. Vaccines work. Vaccines are safe. Vaccines are necessary.

What to Know About the Risks of Delaying Vaccines

Delaying your child’s vaccines offers no benefits and lots of increased risks, especially an increased risk of getting the diseases that the vaccines protect us against.

What Are Hypotonic-Hyporesponsive Episodes?

Just about any side effect after a vaccine can be scary for parents.

What if your child suddenly became limp, wasn’t responsive, and was pale?

That would be scary for any parent.

What Are Hypotonic-Hyporesponsive Episodes?

But that’s just what can happen when a child has a hypotonic–hyporesponsive episode (HHE).

“A hypotonic-hyporesponsive episode (HHE) is the sudden onset of hypotonia, hyporesponsiveness, and pallor or cyanosis that occurs within 48 hours after childhood immunizations.”

DuVernoy et al on Hypotonic-hyporesponsive episodes reported to the Vaccine Adverse Event Reporting System (VAERS), 1996-1998

These types of episodes were once thought to happen once for every 1,750 DTP vaccines given.

HHE is much more rare since we switched to a new pertussis vaccine. — HHE is much rarer since we switched to a new pertussis vaccine.

Fortunately, although they certainly do sound scary, the episodes stop on their own and don’t cause any permanent harm.

Hypotonic-hyporesponsive episodes were even removed as table injuries after DTP back in 1995. It is not that HHE can’t occur after DTP, DTaP, or other vaccines, but rather that HHE doesn’t then cause any permanent neurological damage to the child.

And it is rare for kids to have a second episode, so they can continue to get vaccinated. HHE is not a good reason to skip or delay all of your child’s vaccines. While not a contraindication to getting vaccinated, having an episode of HHE “within 48 hours after receiving a previous dose of DTP/DTaP,” is listed as a precaution to getting another dose of DTaP or Tdap though.

“In general, vaccinations should be deferred when a precaution is present. However, a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk for an adverse reaction.”

CDC on Vaccine Contraindications and Precautions

Also, HHE has become even more rare since we switched to using DTaP, instead of the older DTP vaccine. So being worried about HHE is definitely not a good reason to skip or delay any vaccines.

What to Know About Hypotonic-Hyporesponsive Episodes

Hypotonic-hyporesponsive episodes were more common after the older DTP vaccines, but still didn’t cause any long term problems and aren’t a good reason to skip or delay your child’s vaccines.

More About Hypotonic-Hyporesponsive Episodes

Tetanus and Tetanus Shots

Tetanus is a vaccine-preventable disease that is caused by the Clostridium tetani bacteria.

Unlike most other infections though, tetanus isn’t contagious. Instead, spores of Clostridium tetani get into dirty wounds and then begin to grow into active bacteria.

The now “awake” Clostridium tetani bacteria then begin producing exotoxins that cause the symptoms of a tetanus infection.

In the pre-vaccine era, there were about 500 to 600 cases of tetanus in the US each year and about 165 deaths.

Fortunately, tetanus is rare now, as most folks are vaccinated, but we do see some cases in kids who are intentionally not vaccinated or in seniors who haven’t gotten a tetanus booster in a long while.

The unvaccinated child with the toe nail injury?

“A 4-year-old Caucasian boy presented with a one-week history of general malaise, mild fever, indolence and anorexia. He subsequently developed dysphagia, sialorrhoea, difficulties opening the mouth and eventually dehydration… Together with the lack of immunization and a toe nail infection, this lead to the suspicion of a generalized tetanus infection… The frequency and severity of paroxysmal muscle spasms increased progressively during his PICU stay, despite high doses of sedatives. Not before two weeks after admittance, extubation and careful weaning off sedatives was achieved.”

Generalized tetanus in a 4-year old boy presenting with dysphagia and trismus: a case report

He was unvaccinated “based on religious grounds” and had recently injured his toe, resulting “in a small local hematoma and loose toenail.” It also resulted in his getting tetanus and a 30 day stay in the hospital.

What Are the Symptoms of Tetanus?

Unvaccinated children can develop symptoms of tetanus two days to two months (average incubation period is two weeks) after getting a wound that is contaminated by tetanus spores.

“It was hideous. He was spasming every three minutes. He was biting his tongue and bleeding. His arms were spasming and he was arching his back and his whole face and jaw was completely locked.”

Linda Williams on her unvaccinated 7-year-old son’s bout of tetanus

The most characteristic symptoms are painful muscle spasms that gradually get worse over a week, including:

spasms of the muscles around their mouth, giving the typical “lockjaw” appearance of tetanus
spasms of the muscles around the throat, which can make it hard to swallow
spasms of the chest muscles, making it difficult to breath
spasms of the muscles in the neck, back, arms, legs, and abdomen

Other associated symptoms can include fever, headache, irritability, tachycardia (high heart rate), urinary retention (secondary to bladder muscle spasm), low blood pressure or high blood pressure.

How Do You Diagnose Tetanus?

Tetanus is usually diagnosed in someone with painful muscle spasms and history of a dirty wound.

It is important to keep in mind that your child is not only at risk for tetanus following the classic case of stepping on a rusty nail – a classic myth about tetanus.

Tetanus spores live in the soil and so almost any dirty wound can lead to tetanus infections. Although puncture wounds are the most common that lead to tetanus, scrapes, burns, snake bites, dog bites, and even spider bites can also cause tetanus if the wounds becomes contaminated with dirt or feces.

Testing for the Clostridium tetani in the original wound is sometimes possible, but is not necessary for a diagnosis of tetanus, since it is technically difficult to do.

Neonatal tetanus can occur in newborns if their mother isn’t immunized against tetanus and their umbilical cord stump gets contaminated.

How Do You Treat Tetanus?

The treatments for tetanus can include sedation and mechanical ventilation and:

human tetanus immunoglobulin (TIG) to try and neutralize the tetanus toxin
antibiotics, such as penicillin G, metronidazole, erythromycin, or tetracycline
muscle relaxants, such as diazepam, magnesium sulfate, midazolam, and baclofen
neuromuscular blocking agents, such as vecuronium and pancuronium, which cause paralysis

If you have ever read a story about a child who has needed treatment for tetanus, you will likely opt for a tetanus shot instead.

Do I Need a Tetanus Shot?

Like other vaccine-preventable diseases, keeping up-to-date on your child’s immunizations can help to prevent your child from ever getting tetanus.

One thing that complicates tetanus is that your child may still need a tetanus shot, even if they are fully vaccinated, if it has been five or more years since his last tetanus shot and he has:

a wound that is contaminated with dirt, feces, or saliva
a puncture wound
an avulsion wound, in which part of the wound is pulled away from the other part
a wound caused by crush injury, burn, or frostbite

So if your child had a tetanus shot at age four (the DTaP vaccine kids get before starting kindergarten), then he may need a tetanus shot if he gets a dirty wound before he gets a tetanus booster when he is 11 or 12 years old (the Tdap vaccine).

And yes, a tetanus shot will work in these situations, even if you have already been exposed to the tetanus spores. But no, letting a wound bleed a lot won’t flush out the spores. These are other myths about tetanus and tetanus shots that you might hear.

What to Know About Tetanus and Tetanus Shots

See your pediatrician as soon as possible if your child needs a tetanus shot after getting a dirty wound.

More About Tetanus and Tetanus Shots

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? 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. 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.

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

Obstetric Tetanus Is Still a Thing in the United States

Yes, even though we have had a tetanus vaccine for over 80 years, obstetric tetanus is still a thing in the United States.

Obstetric Tetanus in Kentucky

According to a report from the CDC, in July 2016, an unvaccinated Amish woman in Kentucky developed “facial numbness and neck pain, which progressed over 24 hours to stiff neck and jaw and difficulty swallowing and breathing” about nine days after “she delivered a child at home, assisted by an unlicensed community childbirth assistant.”

She was hospitalized for a month, during which time she had seizures and was on a mechanical ventilator to help her breath for a “prolonged” amount of time.

Fortunately, her baby didn’t also develop tetanus, even though the family refused a recommended dose of tetanus immunoglobulin that could prevent neonatal tetanus from developing.

Surprisingly, after this incident, only 12% of community members agreed to be vaccinated with a tetanus vaccine. One pregnant woman even refused to get vaccinated. This is even less than the response to the Ohio measles outbreak in 2014, when up to 28% of unvaccinated Amish members got vaccinated with an MMR vaccine.

Neonatal Tetanus

In addition to obstetric tetanus, getting tetanus during or right after a pregnancy, neonatal tetanus is a big concern for unvaccinated mothers. Just like if their mothers don’t get a flu or pertussis containing vaccine, without a tetanus vaccine, newborn babies don’t get any passive immunity and protection against tetanus.

In 2015, 34,019 newborns died from neonatal tetanus worldwide. Amazingly, that is down from 787,000 newborns in 1988 “through immunization of children, mothers, other women of reproductive age (WRA) and promotion of more hygienic deliveries and cord care practices.”

It is not all about hygiene though. Tetanus spores are everywhere. For example, in the Kentucky case, the CDC found no evidence of “birth trauma, unsterile conditions, or other complications.”

In Montana, the baby of an unvaccinated mother developed tetanus that was linked to a non-sterile clay that was given to them by a midwife for home umbilical cord care.

Fortunately, these kinds of cases are rare. There have probably been less than 40 cases of neonatal tetanus since the early 1970s, and only two since 1989, but they should still be a reminder of what could happen if we stop getting vaccinated.

Risky Umbilical Cord Practices

Adding to the risk of getting tetanus, the same moms who aren’t getting vaccinated and protected may be following unsafe umbilical cord care practices.

“…tetanus in neonates can result from umbilical cord colonization, particularly in countries with limited resources. This infection results from contamination of the umbilical separation site by Clostridium tetani acquired from a nonsterile device used to separate the umbilical cord during the peripartum period or from application of unhygienic substances to the cord stump.”

AAP – Umbilical Cord Care in the Newborn Infant – 2016

In countries that are still combating neonatal tetanus, we hear of mothers in rural areas putting herbs, herbal pastes, chalk, powders, clay, oils, and even butter on their baby’s umbilical cord.

These natural substances are certainly not safer than more standard care, as they can be contaminated with something else that is natural – tetanus spores.

What natural things, and risky, things can you see recommended for umbilical cord care in developed countries? How about honey, goldenseal powder, Frankincense and myrrh oil, and Aztec Healing Clay?

You don’t feed honey to infants because of the risk of botulism spores, but you are supposed to put it directly on their umbilical stump?

Some midwifes even recommend ground rosemary or other dried herbs that you are actually supposed to sprinkle directly on your baby’s umbilical stump. The use of dried herbs is especially problematic. It is well known that these products are not sterile.

“Spore forming bacteria (B. cereus, C. perfringens) that are capable of causing foodborne disease when ingested in large numbers are frequently found in spices and herbs, but usually at low levels.”

Food Microbiology. Volume 26, Issue 1, February 2009, Pages 39–43

If dried herbs are also contaminated with tetanus spores (C. tetani), and you place them on an umbilical cord stump of a child whose mother wasn’t vaccinated against tetanus, then you unnecessarily increase the risk for neonatal tetanus.

Not that you would ever hear about this risk from anyone who pushes these practices or tells these moms to avoid getting vaccinated. What happened to informed consent?

And what happens as Andrew Wakefield‘s kids continue to grow up, move beyond getting measles, and begin to have kids? If they still aren’t vaccinated, they and their babies will be at risk for diseases that we thought we had gotten well controlled, like obstetric tetanus, neonatal tetanus, and congenital rubella syndrome.

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An Unvaccinated Child in Oregon Recently Had Tetanus

An Unvaccinated Child in Oregon Recently Had Tetanus

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