News Article: 6 Year Old Unvaccinated Oregon Boy Gets Tetanus, Spends 47 Days in ICU

NationalTitles18

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44 of those days on a ventilator at a cost of >$800k and his parents still refused more than the initial vaccine he was given in hospital.

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.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.
This is the first pediatric tetanus case in >30 years in Oregon (unpublished data, Oregon Health Authority, 2018). The diagnosis of tetanus is made based on clinical findings because the bacterium C. tetani is difficult to grow from wounds. A wound culture from the child’s laceration did not grow C. tetani. However, a negative wound culture does not rule out disease. The health care costs to treat this child’s preventable disease were approximately 72 times the mean (2012) cost of $11,143 for a U.S. pediatric hospitalization (1). A recent report describing adult tetanus cases included hospital charges ranging from $22,229 to $1,024,672 (2).
Widespread use of tetanus toxoid–containing vaccines (tetanus toxoid inactivated vaccine or a combination vaccine that contains tetanus toxoid) and tetanus immune globulin for wound management has led to a 95% decline in the number of tetanus cases and a 99% decrease in the number of tetanus-related deaths since the 1940s (3). From 2009 to 2015, 197 tetanus cases and 16 tetanus-associated deaths were reported in the United States (4). Unvaccinated or inadequately vaccinated persons are at risk for tetanus, irrespective of age, and recovery from tetanus disease does not confer immunity (5).
This child's unnecessary suffering makes me angry.
 

TIDE-HSV

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I'm surprised the cost wasn't higher. It seems to me that I get an outside, non-bleeding wound about every ten years, or so close to it, I feel like I have to get the booster shot. I really ought to keep better records...
 

TIDE-HSV

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"Dirty" outside wounds require a booster every 5 years now. Inside, "clean" wounds (or none) every 10 years.
Good to know. It's for sure been more than five years. I've always heard that copious bleeding (aerobic) is OK. I got a weird inside wound the other day. My teeth build up calculus at a rapid rate, so I keep a dental scaler in my lap drawer and scale my lower teeth every couple of days. It's also handy for opening some pills which come in foil packets. Well, I missed and stuck that sucker right into my index finger, with, naturally, no bleeding. A day later, I noticed it festering up. I just thought "good grief, injected that SA right off my skin and in deep." I expressed the pus and put Neosporin on it and it was OK in a couple of days. Liz just reminded me that the last booster she got, she didn't even wait the five years. Her best friend, an RN, reminded her of that. Liz said she didn't care; she got the wound working down at Santa's Village at Constitution Hall (annual event) and there was reindeer poop all over the place... :D
 

NationalTitles18

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Why did the recommendation change? The tetanus toxoid itself hasn't changed, has it?
http://www.immunize.org/catg.d/p4220.pdf
A person with a documented series of three tetanusand diphtheria-containing shots (Td or Tdap) who hasreceived a booster dose within the last ten years shouldbe protected. However, to ensure adequate protection,a booster dose of vaccine may still be given if it hasbeen more than five years since the last dose and thewound is other than clean and minor.
There are still about 30 or so cases a year in the US. I haven't delved deeply into the epidemiological data, but most were never vaccinated and most who were and received a booster in the last 10 years will not become ill. I imagine the few remaining cases in that group spurred the change a number of years ago. Clean and minor wounds in your house most likely will not require a booster if you are otherwise UTD. Wounds occurring outside will.
 

TIDE-HSV

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http://www.immunize.org/catg.d/p4220.pdf


There are still about 30 or so cases a year in the US. I haven't delved deeply into the epidemiological data, but most were never vaccinated and most who were and received a booster in the last 10 years will not become ill. I imagine the few remaining cases in that group spurred the change a number of years ago. Clean and minor wounds in your house most likely will not require a booster if you are otherwise UTD. Wounds occurring outside will.
I bleed freely, partially because of the daily aspirin. I don't really worry even with an outside wound, if it bleeds. I still wash it carefully and copiously with soap and water...
 

jthomas666

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I had a bad reaction to a tetanus shot when I was a toddler--my mom tells me my arm swelled up like a balloon so I was exempted from the shot while I was in school. While in grad school I stepped on a nail, so I went in to the health center. The doctor said that when I was a kid, the vaccine was made from horse serum, but that the current vaccine was synthetic. I got the shot in stages, just in case, but I had no reaction. The doctor recommended the shot because surviving tetanus is a 50/50 proposition.
 

Bamaro

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Another idiot:

Kentucky Governor Matt Bevin said he deliberately exposed his kids to chickenpox, instead of vaccinating them against the common childhood illness. Speaking to local radio station WKCT on Tuesday, Bevin said all nine of his children had chickenpox.

"They got the chickenpox on purpose," Bevin said, "because we found a neighbor that had it and I went and made sure every one of my kids was exposed to it, and they got it." Bevin and his wife, Glenna, have five biological children and four adopted children.
https://www.cbsnews.com/news/matt-b...ox-on-purpose-instead-of-getting-vaccination/
 

4Q Basket Case

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Sounds crazy today, but that wasn't uncommon in the '50s and '60s. The thinking was that the child would get chicken pox anyway, so moms wanted to control the timing. Often did it in the summertime so they didn't miss school.

Moms were kind of split on it. My mother didn't do it, but a lot of them did. FWIW, as most children do, I got the chicken pox...during school, and missed a week.
 

NationalTitles18

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Sounds crazy today, but that wasn't uncommon in the '50s and '60s. The thinking was that the child would get chicken pox anyway, so moms wanted to control the timing. Often did it in the summertime so they didn't miss school.

Moms were kind of split on it. My mother didn't do it, but a lot of them did. FWIW, as most children do, I got the chicken pox...during school, and missed a week.
He married his wife in 1996 - one year after the varicella vaccine hit the market.
 

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