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Tetanus is an acute disease of the nerves and muscles caused by the bacterium Clostridium tetani. Its spores, found in soil, can enter through broken skin; illness begins 3 to 21 days later, usually within 8.
The case
In 2017, a 6-year-old boy in Oregon who had never been vaccinated cut his forehead playing outdoors on a farm. The wound was cleaned and stitched at home.
- Six days later: crying spells, jaw clenching, and involuntary spasms of the arms, then arching of the neck and back (opisthotonus) and stiffness throughout. When he began to have trouble breathing, his parents called emergency services, and he was flown to a pediatric hospital.
- On arrival: jaw spasms (trismus) — he was alert and asked for water, but couldn't open his mouth. Spasms of the diaphragm and larynx made breathing so hard that he was sedated, intubated and put on a ventilator. He was given tetanus immune globulin and a dose of DTaP vaccine.
- In intensive care: a darkened room, ear plugs and minimal stimulation, since stimulation made the spasms worse; intravenous metronidazole; and the wound was cleaned out.
- His arching worsened, and his nervous system grew unstable — high blood pressure, a racing heart, and temperatures from 97.0°F to 104.9°F. He needed continuous IV drugs for pain and blood pressure, and paralyzing drugs to control the spasms.
| Hospital day | |
|---|---|
| 5 | tracheostomy for long-term breathing support |
| 35 | began a 5-day wean from the paralyzing drugs |
| 44 | off the ventilator; sipped clear liquids |
| 47 | moved to intermediate care; three days later, walked 20 feet with help |
| 54 | tracheostomy removed; three days later, to rehabilitation for 17 days |
In all, he spent 57 days in acute care — 47 in intensive care — with inpatient charges of $811,929, not counting the flight, rehabilitation or follow-up. A month after rehabilitation he was back to running and cycling. Despite doctors' careful explanation of the risks and benefits, the family declined the second DTaP dose and all other recommended vaccines.
Why it matters
- It was Oregon's first child tetanus case in more than 30 years.
- Tetanus is diagnosed clinically: C. tetani is hard to grow, and his wound culture was negative — which doesn't rule it out.
- His care cost about 72 times the 2012 average U.S. child hospital stay ($11,143); adult tetanus stays have run from $22,229 to $1,024,672.
- Tetanus vaccines and immune globulin for wounds have cut U.S. tetanus cases by 95% and deaths by 99% since the 1940s. From 2009 to 2015, 197 cases and 16 deaths were reported.
- Anyone unvaccinated or under-vaccinated is at risk at any age — and having tetanus doesn't make you immune.
Vaccination
- DTaP for all children: five doses, at 2, 4 and 6 months, 15–18 months and 4–6 years.
- Boosters of diphtheria and tetanus toxoids every 10 years for life.
- Uninsured or underinsured children can get vaccines free through the Vaccines for Children program; CDC offers resources for providers on talking with families about vaccines.
Sources
Based on Guzman-Cottrill JA, Lancioni C, Eriksson C, Cho YJ, Liko J, "Notes from the Field: Tetanus in an Unvaccinated Child — Oregon, 2017," MMWR Morbidity and Mortality Weekly Report, volume 68, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licens: CC0 1.0 (allmän egendom) · Bearbetat efter www.cdc.gov
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