Unvaccinated Oregon boy had 'severe' tetanus

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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. I could not believe it.

Infectious-disease expert Dr. William Schaffner tells Live Science that the boy's illness was a "tragic event" that was "completely preventable, and the parents' decision not to vaccinate him even after the illness was a "second tragedy".

Liberal-leaning OR and Washington have some of the nation's highest statewide vaccine exemption rates, driven in part by low vaccination levels in scattered communities and at some private and alternative schools.

Case study co-author Dr. Carl Eriksson, an assistant professor of pediatric critical care at Oregon Health & Science University, who was involved in the boy's treatment, wrote in an email to TIME that severe tetanus cases are very rare in the US, where vaccination effectively prevents such conditions. Seventy people in southwest Washington, a lot of them unvaccinated children, have been diagnosed with the highly contagious viral illness since January 1, as well as a handful of people in Portland, Oregon.

The health agency said people who contract tetanus aren't immune to it in the future. At the same time, he was given the tetanus vaccine and antibodies to fight off the bacteria.

The boy was playing outdoors when he got a cut on his forehead. The disease can cause death or severe disability in those who survive, Schaffner said.

In the 1940s, there were about 500 to 600 cases of tetanus reported in the United States annually, according to the nonprofit Immunization Action Coalition. It's rare among children; those over 65 are the most vulnerable. According to the report, "the wound was cleaned and sutured at home".

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The boy would have symptoms including jaw clenching, involuntary upper extremity muscle spasms, followed by arching of the neck and back and difficulty breathing.

The child's parents contacted paramedics when he began to have trouble breathing and he was airlifted to a tertiary pediatric medical center.

During his time at the hospital, the boy requested water but couldn't drink it because of his lockjaw.

In this particular case, however, the boy had not received his tetanus vaccine, or any other recommended vaccinations for that matter.

Nevertheless, the spasms causing his back and neck to arch worsened, and he developed hypertension, a speeding heart rate and a fever. On Friday, a Centers for Disease Control and Prevention report discussed an unvaccinated child in OR who spent weeks at a hospital in 2017 after getting a tetanus infection.

After spending 57 days in the hospital, the child was moved to a rehabilitation center where he regained the ability to walk, run and bike within 17 days. "You have to support the patient because this poison links on chemically and then it has to be slowly metabolized", Schaffner said. (The CDC recommends three DTaP doses for babies, with booster shots given at 15 to 18 months and four to six years of age.) Between 2009 and 2015, according to CDC data, only 197 tetanus cases were recorded nationwide, resulting in 16 deaths.

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