Rare case of tetanus from Oregon requiring care of 100 doctors, nurses



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More than 100 people from the OHSU hospital have been working to help an unvaccinated Oregon boy survive when he contracted a life-threatening tetanus on the family farm. None of them had ever seen a child with bacterial disease before.

An OHSU doctor provided this week more details on how the medical team handled the case that drew national attention after federal health officials revealed that the Boy had spent 57 days in the hospital at a cost of nearly $ 1 million and whose parents had refused to vaccinate him torture.

Dr. Carl Eriksson, who works at the OHSU Pediatric Intensive Care Unit, could not say more about the family, but gave an overview of the rarity of the disease and the challenges for the treat.

OHSU doctors and nurses have virtually no practical knowledge of what to do, he said, as the number of tetanus cases has dropped to about 30 per year in the United States since a vaccine became available to prevent it. And the cases that develop often occur in adults because children are more likely to be fully vaccinated against the disease.

Eriksson and others have had to consult the medical literature of countries where vaccines are not widespread and where tetanus is a common health risk, he said.

The boy's tetanus was severe from the first symptoms, he said.

"And that's life-threatening," he said.

During the boy's eight-week stay at Doernbecher's OHSU Children's Hospital, he stayed in a dark room with ear plugs and other means of blocking stimulation, connected to a long-lasting ventilator for help him breathe through a tube.

With so many procedures and interventions that the boy has received, he could easily have had complications that killed him. Eriksson explained that this was partly the reason why he and his colleagues had chosen to publish the case study last week for the Federal Centers for Disease Control and Prevention.

"It's always hard to watch a child suffer," Eriksson said. "It's harder when we know they're suffering from something that's preventable, and we're obviously doing everything in our power to try to avoid these situations."

The boy, then aged 6, cut his forehead while playing, according to the case study. The wound was cleaned and sutured at home. Tetanus lives in the soil and was apparently too deeply rooted in the wound to be cleaned in time.

Once the bacteria that causes tetanus is present in the bloodstream, the toxin circulates throughout the body and binds to certain parts of the nervous system. This causes the spasms on the arm, neck and back that are common in tetanus cases.

A few days later, the boy could not open his mouth and constantly buckled with involuntary spasms. The muscles of his airways also began to contract, forcing doctors to administer a tracheotomy and a breathing tube. Because of the extreme pain he was in, the boy was also anxious, Eriksson said. He has been given large amounts of intravenous medication to alleviate symptoms and side effects.

Several respirologists were involved because of his difficulty breathing, said Eriksson, in addition to the nurses and doctors who cared for him.

They also had to reopen the suture at home to clean the wound. Eriksson, the standard treatment for this type of infection, wants to rid the wound of as many bacteria as possible, because even a tiny bit of it could prevent the infection from stopping.

Eriksson said that he and others tried to convince the parents to fully vaccinate the boy because a tetanus infection did not protect him for life. The vaccine has also declined after about a decade. That is why even adults who have received the five doses of DTaP – diphtheria, tetanus and pertussis vaccine – have encouraged children to be vaccinated every ten years or so.

The family refused. If the boy had followed a federally recommended vaccination schedule, he would have been completely immunized against tetanus by the time he was infected. According to the case study, he received a dose at the hospital, as is often the case for the treatment of many vaccine-preventable diseases, but the parents refused a second dose or any other vaccination.

According to the Oregon Health Authority, just under 93% of adolescents have been vaccinated against tetanus, diphtheria and whooping cough, one of the lowest rates in the country.

Eriksson said he and other doctors often tried to convince parents of the risks of not vaccinating a child, especially in cases where the risk was so obvious.

The family also had to deal with nearly $ 1 million in hospital bills, airfare to the hospital and 17 days in a rehabilitation center.

A spokeswoman for the OHSU said she could not say how the family was planning to pay, but that there are a number of grants and organizations that help cover the medical expenses of people who do not can not afford to pay them.

The case study took place in the middle of the largest measles outbreak in Washington since the adoption of the large-scale measles vaccine. Seventy-five people between Oregon and Washington have caught measles, drawing attention to some of the country's lowest vaccination rates.

Inquiries regarding tetanus recalls have increased at OHSU since the publication of the case study, said the spokeswoman. She also said that many people came for measles immunization.

Multnomah and Clark counties both reported higher than usual rates of measles immunization. Clark County physicians reported more than 400 times the amount donated each year.

"It reminds us that vaccine-preventable diseases are terrible, life-threatening diseases that we are not used to seeing. Therefore, when a case like this occurs, it definitely opens the eyes to many people, "Eriksson said. .

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