A 6-year-old boy from Oregon who had never received a single vaccine got a cut on his forehead while playing on his family’s farm in 2017. The wound was cleaned and sutured at home.

Six days later, doctors were treating the child for tetanus, an enormously painful, sometimes fatal infection that is caused by bacterial spores found in the soil and that is completely preventable with vaccine. It was the state’s first pediatric tetanus case in more than 30 years.

The boy did survive. But after a weeks-long, gut-wrenching medical marathon — which cost well over $800,000 — his parents refused to allow the hospital to give him a full course of vaccines to protect him against tetanus. Nor would they allow doctors to vaccinate their son against measles, mumps, rubella, chickenpox, polio, and a range of other diseases that are dangerous for and can be lethal to young children, despite the fact the team spent a great deal of time trying to persuade them of their benefits.

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Dr. Judith Guzman-Cottrill, a pediatric infectious diseases specialist at OHSU Doernbecher Children’s Hospital in Portland, helped care for the boy, who had to spend weeks sedated in a darkened room, wearing earplugs to block out noise. Even though he’d been given paralytic drugs to stop the racking spasms that tetanus causes, his whole body would tense up if someone near him spoke in even a normal voice, she told STAT.

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“He was really sick and it was really difficult to watch,” said Guzman-Cottrill. “He was suffering.”

The entire team caring for the boy found his condition agonizing, she said, adding that they also found it extraordinary to be dealing with a tetanus case in 2017.

“I never thought I would see a case of severe tetanus in the United States,” she said. “That was an astounding point for me.”

2017 tetanus graph
CDC

Guzman-Cottrill and several colleagues outlined the boy’s case in a report in this week’s issue of Morbidity and Mortality Weekly Report, an online journal published by the Centers for Disease Control and Prevention.

The cautionary tale of the consequences of not vaccinating children comes at a time when several states are in the grips of measles outbreaks among unvaccinated children.

Tetanus infection is also known as lockjaw, because the powerful toxins created by the Clostridium tetani bacteria do just that. They rack the body with intense spasms, powerful enough sometimes to break bones. The infection was more common before effective vaccines started to be used in the 1930s and 1940s, but is now rare. There were only 197 cases reported in the United States between 2009 and 2015. But 16 of those people died.

In this case, the boy began to display alarming symptoms — jaw clenching, general spasticity and involuntary muscle spasms in his limbs, followed by arching of his neck and back — a few days after suffering the cut.

He began to have trouble breathing, and his parents contacted emergency medical services. An air transport was arranged to the children’s hospital.

The child had to be sedated. A tracheostomy was performed so that he could be put on a mechanical ventilator to help him breath. He remained on the ventilator for more than five weeks. Because of the pain caused by the spasms, he required muscle relaxants as well as drugs to stabilize his blood pressure in addition to the medications to counter the tetanus toxins.

The boy spent 54 days in hospital — 47 of them in intensive care.

His recovery was slow. Fifty days after he entered the hospital he could walk 20 feet with help. After leaving hospital, he spent 17 days in a rehabilitation facility. A month after leaving it — and 3 1/2 months after the fateful cut — he was back to normal activity.

The bill for the hospital care came to $811,929, and that didn’t include the cost of the air ambulance, the stay in the rehabilitation facility, or follow-up care that was needed.

Children are supposed to receive five doses of a vaccine that contains tetanus protection in the early years of life, and another between the ages of 11 or 12. Adults need a booster dose every 10 years to maintain protection.

Neither vaccination nor infection confers lifelong immunity against tetanus, which means that if this boy remains unvaccinated, he could contract tetanus again.

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