An unvaccinated Oregon boy almost died from tetanus, the first case of the bacterial infection in the state in 30 years. The 6-year-old's harrowing illness and painful, two-month treatment — which cost close to a million dollars — were detailed by doctors in a case report published Friday by the Centers for Disease Control and Prevention.
The boy became infected in 2017 after cutting his head while playing outdoors on the family's farm. His wound was cleaned and stitched by his family at home, according to the Oregon doctors who treated the child and wrote the CDC report. All seemed fine, until six days later when he started crying and experiencing involuntary muscle spasms and clenching his jaw. Soon he was arching his neck and suffering back and muscle contractions throughout his body.
When he began to have trouble breathing, his parents called for emergency services and the child was airlifted to a pediatric medical center. Upon arrival at the hospital, the child was alert but unable to open his mouth due to lockjaw and severe muscle spasms, critical care pediatrician Dr. Carl Eriksson of the Oregon Health and Science University and the OHSU Doernbecher Children’s Hospital told NBC News via email.
"He required mechanical ventilation (a respirator) through a breathing tube in his mouth, and multiple medications to control severe muscle spasms, pain and agitation," Eriksson said.
In the pediatric intensive care unit, the boy was cared for in a darkened room and fitted with earplugs because stimulation of any kind seemed to intensify the spasms.
When doctors learned the boy had received no immunizations, he was given a medication that contained tetanus toxin antibodies, along with the standard vaccine against tetanus, diphtheria and pertussis, DTaP.
As the arching of his neck and back worsened, the boy started to experience “dramatic swings in his heart rate, blood pressure and temperature,” Eriksson said, adding that this condition “can be very dangerous and is often difficult to treat.”
He was given medications to help control his muscle spasms, blood pressure and pain, and he remained in the ICU for another 35 days.
“Because tetanus causes such severe muscle spasms, it also causes severe pain,” Eriksson said. “It can also be frightening to have uncontrolled muscle spasm, especially when it is so severe.”
It wasn’t until the 44th day that the boy was disconnected from the ventilator and able to take a few sips of clear liquid. After 57 days in the hospital, the boy was transferred to a rehabilitation center where he would spend the next 17 days.
The hospital bill for the boy’s care totaled $811,929, excluding the cost of air transportation, inpatient rehab and follow-up costs.
After the boy was finally released, he returned to normal activities, including running and bicycling, the CDC report stated. His parents chose not to have him vaccinated further.
"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 doctors wrote.
Tetanus, also known as lockjaw, is a vaccine-preventable infection caused by the bacteria Clostridium tetani. When the bacteria enters the body through a scrape or cut, it produces a poisonous toxin that causes painful muscle contractions, including in the neck and jaw, making it hard for the patient to swallow.
Children are immunized against tetanus with the DTaP vaccine, designed to protect against diphtheria, tetanus and acellular pertussis. It's usually given in five doses: at 2, 4 and 6 months of age and between 4-6 years. Booster doses of diphtheria and tetanus vaccines are recommended every 10 years for everyone.
Ericksson declined comment on the patient’s insurance status due to privacy concerns.
“But what I can say is that this hospitalization would almost certainly have been prevented if the patient had been vaccinated against tetanus,” he said via email. “Most school-aged children have received five doses of tetanus vaccine, with each dose costing approximately $30.”
There are so many things wrong with what happened to this boy, “it’s hard to know where to start,” said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.
“This was entirely preventable — an unnecessary episode of torture for this poor child," Wu said. "Tetanus is a truly deadly disease. There are still in the neighborhood of 100,000 deaths from tetanus worldwide, accounting for 5 percent of neonatal and maternal deaths.”
And then, there is the cost.
“This is a self-inflicted wound and an expensive one at that,” Wu said. “And it cost someone — whether it’s an insurance company or the public — over a million dollars.”