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Tetanus: A Case Discussion

Tetanus: A Case Discussion

In 2017, a 6-year-old boy was playing outside on his family’s farm in Oregon. He cut his forehead. The wound was cleaned and stitched back together in his home. Six days later he got sick:

  • Episodes of crying

  • Jaw clenching

  • Uncontrollable upper arm muscle spasms

  • Arching of the neck and back

  • Generalized spasticity (muscles continuously tighten)

  • Difficulty breathing later that day

His parents contacted emergency services, who air-lifted him to a pediatric medical center. He was admitted to the Pediatric Intensive Care Unit. His diagnosis: Tetanus. Because the boy had not received tetanus vaccinations, he was given tetanus immune globulin to boost his immune system and a DTaP vaccine (Diphtheria, Tetanus, Pertussis).

The boy’s throat and chest spasms became so severe that he required sedation, a tube into his lungs, and mechanical ventilation by a respirator. Because any kind of stimulation worsened the spasms, he was cared for in a darkened room with ear plugs and minimal stimulation. But his condition worsened:

  • Worsened neck and back arching

  • High blood pressure

  • Rapid heart rate

  • Temperatures between 97.0°F–104.9°F

The boy required 57 days of hospital care, including 47 days in the intensive care unit, and 17 days in Rehabilitation. The hospital charges totaled $811,929 (not including air transportation, rehabilitation, and follow-up office visit costs). He returned to all normal activities one month after leaving rehabilitation. 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.

Tetanus, or ‘lockjaw’, is an infection caused by the bacteria Clostridium tetani. When bacteria invade the body, they produce a poison (toxin) that causes painful muscle contractions. The bacteria are usually found in soil, dust, and manure, and enter the body through breaks in the skin, usually through cuts or puncture wounds caused by contaminated objects, such as nails. In the U.S. there are about 30 reported cases each year.

Symptoms: The time from exposure-to-illness is usually between 3 and 21 days, but it may range from one day to several months, depending on the kind of wound:

  • Jaw cramping

  • Sudden, involuntary muscle tightening (spasms)

  • Painful muscle stiffness all over the body

  • Trouble swallowing

  • Jerking or staring (seizures)

  • Headache

  • Fever and sweating

  • Changes in blood pressure and heart rate

Complications

  • Uncontrolled/involuntary tightening of the vocal cords

  • Broken bones

  • Blockage of blood blow to the lungs by a blood clot

  • Pneumonia

  • Breathing difficulty

  • Possibly leading to death: 1 to 2 in 10 cases are fatal

Prevention: Tetanus Vaccine

The tetanus vaccine doesn’t provide lifelong coverage. And having tetanus doesn’t protect you from getting it again. (You can get re-infected with the bacteria again at any time.) Regular vaccinations are needed to keep a high level of protection against this serious disease.

Tetanus vaccine combinations:

  • DTaP: diphtheria, tetanus, and pertussis (whooping cough)

  • Tdap: tetanus, diphtheria, and pertussis

  • Td: tetanus and diphtheria

    (The difference between DTaP and Tdap is that Tdap contains a smaller dose of diphtheria and pertussis.)

Recommended Vaccine Schedule: A catch-up schedule is also available

Babies and Children: DTaP

  • 2 months

  • 4 months

  • 6 months

  • 15 through 18 months

  • 4 through 6 years

Preteens and Teens: Tdap

  • One dose between the ages of 11 and 12 years

Pregnant Women: Tdap

  • One dose in the 3rd trimester of every pregnancy to protect the baby from pertussis (whooping cough) in the first few months of life

Adults: Td

  • One dose of Td every 10 years. Adults who have never received Tdap should get one in place of a Td dose

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