Tetanus Remains a Threat to Unvaccinated

Nicola M. Parry, DVM

March 07, 2019

A recent case of tetanus in an unvaccinated child highlights the continued threat of this rare but dangerous disease among the unvaccinated individuals in the United States.

"Unvaccinated or inadequately vaccinated persons are at risk for tetanus, irrespective of age, and recovery from tetanus disease does not confer immunity," write Judith A. Guzman-Cottrill, DO, from the Oregon Health and Science University, Portland, and colleagues. The case report was published online March 7 in Morbidity and Mortality Weekly Report.

The case involved a 6-year-old boy who suffered a scalp laceration while playing outdoors. Although his wound was cleaned and sutured at home, the boy was unvaccinated.

After 6 days, he developed symptoms of jaw clenching, involuntary upper extremity muscle spasms, opisthotonus, generalized spasms, and breathing difficulty. He was airlifted to a hospital, where a clinical diagnosis of tetanus was made.

He underwent 8 weeks of inpatient care, including administration of tetanus immune globulin, as well as diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). His wound was irrigated and debrided, and he received intravenous metronidazole.

He required neuromuscular blockade to manage his muscle spasms, continuous intravenous medication infusions to control his pain and blood pressure, and a tracheostomy for ventilator support.

After 8 weeks, his condition improved enough for transfer to an inpatient rehabilitation center, where he remained for 17 days. One month later, he was able to resume his normal active lifestyle. His family refused the second dose of DTaP and other vaccinations recommended by clinicians.

Because of continued use of tetanus immune globulin for wound management and widespread vaccination with tetanus toxoid, tetanus cases have dropped in the United States by 95% since the 1940s, and the number of tetanus-related deaths have dropped by 99%.

In this case, the boys inpatient care alone cost $811,929, which is about 72 times the mean cost of $11,143 for a child's hospital stay, according to a 2012 study.

This is the first case of tetanus in a child in Oregon in more than 30 years, the authors emphasize, but it highlights the importance of vaccination for this preventable disease.

The Advisory Committee on Immunization Practices recommends a five-dose DTaP series for all eligible children at 2, 4, and 6 months of age, followed by a fourth dose at 15 to 18 months of age, and a fifth at 4 to 6 years of age.

"Booster doses of diphtheria and tetanus toxoids are recommended every 10 years throughout life," the authors stress.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. Published online March 7, 2019. Full text

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