PORTLAND, Ore. (CBSNewYork/AP) — An unvaccinated six-year-old Oregon boy was hospitalized for two months for tetanus and almost died of the bacterial illness after getting a deep laceration on his forehead while playing on a farm, according to a case study published Friday by the U.S. Centers for Disease Control and Prevention.
The 2017 case is the first case of pediatric tetanus in Oregon in more than 30 years and alarmed infectious disease experts who said tetanus is almost unheard of in the U.S. since widespread immunization began in the 1940s.
The child received an emergency dose of the tetanus vaccine in the hospital but his parents declined to give him a second dose — or any other childhood shots — after he recovered, the paper said.
"When I read that, my jaw dropped. I could not believe it. That's a tragedy and a misunderstanding and I'm just flabbergasted," said Dr. William Schaffner, an expert in infectious diseases and chair at the Department of Preventive Medicine at the Vanderbilt University School of Medicine in Nashville, Tennessee.
"This is an awful disease, but ... we have had a mechanism to completely prevent it and the reason that we have virtually no cases anymore in the United States is because we vaccinate, literally, everyone."
The paper did not provide any details about the child, his family, or where they live in Oregon.
News about the tetanus case comes as lawmakers in Oregon and Washington are considering bills that would end non-medical exemptions for routine childhood vaccines as the Pacific Northwest weathers its third month of a measles outbreak. Seventy people in southwest Washington, most of them unvaccinated children, have been diagnosed with the highly contagious viral illness since Jan. 1, as well as a handful of people in Portland, Oregon.
Unlike measles, which is a virus, someone who has survived a case of tetanus is not immune and can get the illness again if they remain unvaccinated. Tetanus also isn't transmitted person-to-person by sneezing or coughing like the measles, but instead comes from bacterial spores that are found in the environment.
Tetanus spores exist everywhere, particularly in the soil. When an unvaccinated person gets a deep, penetrating wound, those spores can invade the cut and begin producing the bacteria that causes the illness.
The tetanus bacterium secretes a toxin that gets into the bloodstream and latches onto the nervous system.
Anywhere from three to 21 days after infection, symptoms appear: muscle spasms, lockjaw, difficulty swallowing and breathing and seizures. The disease can cause death or severe disability in those who survive, Schaffner said.
About 30 people contract tetanus each year nationwide, according to the CDC, and 16 people died of it between 2009 and 2015.
In the case in Oregon, the boy cut himself on the forehead while playing and his family reportedly stitched up the wound themselves. Six days later, he began clenching his jaw, arching his neck and back, and had uncontrollable muscle spasms.
When he began to have trouble breathing, his parents called paramedics and he was transported by air to Oregon Health & Science University in Portland. When he arrived, he asked for water but could not open his mouth.
The boy spent another three weeks in inpatient rehabilitation and a month at home.
The incident and his parent's decision not to vaccinate their son wasn't just life-threatening, it turned out to be financially crippling. The child's care — not including the air ambulance and inpatient rehabilitation — cost nearly $1 million
That's about 72 times the average for a pediatric hospitalization in the U.S., the paper noted.
"The way to treat tetanus is you have to outlast it. You have to support the patient because this poison links on chemically and then it has to be slowly metabolized," Schaffner said.
Cases of tetanus have dropped by 95 percent in the U.S. since widespread childhood vaccination and adult booster shots became routine nearly 80 years ago; deaths have dropped 99 percent.
The CDC recommends a five-dose series of tetanus shots for children between the ages of two months and six years and a booster shot every 10 years for adults.
(© Copyright 2019 CBS Broadcasting Inc. All Rights Reserved. The Associated Press contributed to this report.)
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