Unvaccinated Child Developed Oregon's First Pediatric Tetanus Case In 30 Years: CDC Report

An unvaccinated child in Oregon developed the state’s first pediatric case of tetanus in over 30 years in 2017, according to a harrowing case study published this week by the Centers for Disease Control and Prevention.

The 6-year-old boy, who was not identified in the report, was playing outdoors at a farm when he cut his forehead. Six days later, the case study detailed, the child started exhibiting tell-tale signs of tetanus jaw and muscle spasms, arching of the neck and back and difficulty breathing.

His parents contacted emergency services, and the boy was airlifted to a pediatric medical facility.

“He was alert and requested water but was unable to open his mouth; respiratory distress caused by diaphragmatic and laryngeal spasm necessitated sedation, endotracheal intubation, and mechanical ventilation,” the report noted.

The child, who had never received any immunizations, was given an initial dose of the DTaP vaccine, which protects against diphtheria, tetanus and pertussis.

“Fortunately, the emergency department physicians immediately recognized the symptoms of severe tetanus,” Judith Guzman-Cottrill, a pediatrics professor at Oregon Health & Science University who co-authored the report, told The Washington Post in an email . “Physicians have all read about tetanus, and we have seen pictures of people suffering from tetanus. ... It is profound.”

Tetanus is an infection caused by spores of Clostridium tetani bacteria that enter the body through a wound. Toxin from the bacteria causes painful muscle spasms, often in a person’s neck and jaw, hence the common name for tetanus: lockjaw. When the muscles lock, it can be difficult for infected people to open their mouth or swallow.

The boy received inpatient acute care for 57 days, 47 of which he spent in the intensive care unit, the case study said. It took 44 days after he developed the disease before he was able to sip clear liquids and 50 days before he was able to walk on his own. 

The case was the first incidence of pediatric tetanus that Oregon witnessed in over 30 years and resulted in $800,000 in inpatient charges. At the end of the ordeal, the report said, the boy’s parents refused further vaccinations before taking him home.

“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,” the case study’s authors wrote.

The report’s publication comes amid multiple outbreaks of measles, another disease that can be prevented with a common childhood vaccine. Scientists believe the rise of the anti-vaccination movement in recent years is partly to blame for the resurgence of these infectious diseases, whose incidence had sharply declined because of widespread immunization.

Widespread use of vaccines that protect against tetanus has resulted in a 95 percent decline in cases of the disease and a 99 percent decrease in the number of tetanus-related deaths since the 1940s, according to the CDC. 

The CDC recommends children receive a five-dose DTaP series , at 2, 4 and 6 months of age, then at 15 to 18 months and finally at 4 to 6 years. Booster doses of diphtheria and tetanus immunization are recommended every 10 years after that.