Tetanus: First pediatric case in >30 years in Oregon
Mar 10 2019
The child spent more than two months in the hospital fighting for his life.
The case of an OR boy diagnosed with Tetanus shows how vaccination can save lives and almost a million dollars, too.
An unvaccinated 6-year-old OR boy was hospitalized for two months for tetanus and nearly died of the bacterial illness after getting a deep cut while playing on a farm, according to a case study published Friday by the U.S. Centers for Disease Control and Prevention.
He got a cut on his forehead while playing on his family's farm in 2017. At that point, he was observed to cry, clench his jaws, and had unintentional muscle spasms in his upper limbs.
As his back and neck spasming worsened, the boy developed a racing heartbeat, high blood pressure, and a fever of 105 degrees Fahrenheit. Later that day, when the boy began having trouble breathing, his parents called for medical help.
When he arrived at the hospital he was suffering jaw muscle spasms. The problem was he could not open his mouth.
The charges totaled $811,929, although this excludes additional costs of air transportation, inpatient rehabilitation, and ambulatory follow-up costs, according to the report.
What Happened During The Hospitalization?
It would be only the start of a downward spiral and lengthy hospital stay for the boy. They also included rehabilitation in the care plan, before he could go back to his normal activities. On day 47, he was moved out of the ICU and into an intermediate care unit at the hospital. The boy had to spend weeks in a dark room, on a respirator. Tetanus also isn't transmitted person-to-person by sneezing or coughing like the measles, but instead comes from bacterial spores that are found in the environment.
All told, the boy spent 57 days in inpatient acute care, including 47 days in the intensive care unit, the report stated. Seven days later, his rehabilitative care began.
The tetanus bacterium secretes a toxin that gets into the bloodstream and latches onto the nervous system. In the case of this boy, the bacterium C. tetani was not detected from wound culture testing.
Doctors gave the child diphtheria and tetanus toxoids, and acellular pertussis vaccine (DTaP) during his eight-weeks of treatment, which the CDC estimated to cost over $800,000 and this cost doesn't include air travel and other expenses. The decision was made even after the doctors presented a thorough education on the benefits and possible risks of the vaccine.
This is the first case of tetanus in an OR child in more than 30 years, the doctors noted. His scalp wound was cleaned by medical professionals. The fact that the bacteria is passed on through direct contact from an infected person, unlike flu, the public can not rely on other people being immunized.
Dr. Judith Guzman-Cottrill, a pediatric infectious disease doctor at OHSU, says she had never before seen a case of tetanus and never expected to see one in her career.
The CDC recommends a five-dose series of tetanus shots for children between the ages of 2 months and 6 years and a booster shot every 10 years for adults. The first three doses are given to eligible children during the second, fourth, and sixth months of age. On day 44 of his hospital stay, he came off the ventilator and tolerated drinking clear liquids.
According to the CDC, from 2009 through 2015, there were a total of 197 cases of tetanus and 16 tetanus-related deaths in the United States.