Unvaccinated six-year-old boy gets tetanus; treatment costs US$800K

Leslie Hanson
March 9, 2019

This was the first pediatric tetanus case in OR in more than 30 years. Doctors diagnosed him with tetanus and gave him a dose of the vaccine.

The report states the 6-year-old contracted the bacterial disease in 2017 after sustaining a forehead laceration while playing outside on a farm.

In the case in OR, the boy cut himself on the forehead while playing and his family stitched up the wound themselves. The boy's jaw began clenching, and his neck and back were arched - a trademark indication of tetanus called opisthotonus that is caused by involuntary muscle spasms.

It was only when his breathing became more hard later that day that his parents contacted emergency services, and he was air-transported to the nearest paediatric hospital. It's rare among children; those over 65 are the most vulnerable.

"Fortunately, the emergency department physicians immediately recognized the symptoms of severe tetanus", Judith Guzman-Cottrill, an author of the report and a pediatrics professor at Oregon Health & Science University, told The Washington Post in an email. He was admitted to the pediatric intensive care unit, and given treatments for tetanus, including a diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine.

The boy was also placed in a darkened room with earplugs and minimal stimulation, as stimulation increased the intensity of his spasms, the CDC report said. The result was eight weeks in inpatient care - 47 days of which were spent in intensive care - followed by several weeks of rehabilitation.

Tetanus is an acute neuromuscular disease caused by the bacterium Clostridium tetani.

During his treatment, the child's neck and back arching worsened, he developed hypertension or high blood pressure, and his body temperature soared to 40.5 C. The average body temperature is between 36 and 37 C. Six days later, he was able to walk a short distance with help.

The child's care - not including the air ambulance and inpatient rehabilitation - cost almost $1 million, about 72 times the mean for a pediatric hospitalization in the USA, the paper noted.

On day 57, he was transferred to a rehabilitation centre for 17 days. It took about a month after his rehab for the boy to return to "normal activities" such as running and bicycling, the report added. On day 44 of his hospital stay, he came off the ventilator and tolerated drinking clear liquids.

In the 1940s, there were about 500 to 600 cases of tetanus reported annually in the United States, according to the nonprofit Immunization Action Coalition.

Despite extensive review of the risks and benefits of tetanus vaccination by doctors, the family refused to vaccinate their son against tetanus after his hospital visit.

Routine administration of a 5-dose DTaP series is recommended for all eligible children at 2, 4, and 6 months of age, then a dose at 15-18 months of age, and a fifth dose at 4-6 years of age. The health agency said teenagers should get another booster shot at age 14 to 16.

The child's case "comes amid a measles outbreak in Washington and OR that has sickened 75 people, a lot of them unvaccinated children", the Oregonian reported.

"Most parents and guardians know that immunisation is still the best way to protect children against vaccine-preventable diseases such as whooping cough and measles".

The World Health Organization has identified "vaccine hesitancy" as one of the top 10 global health threats for 2019. Measles is also preventable with a vaccination.

Other reports by Iphone Fresh

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