Doctor who treated Oregon child with tetanus wants vaccines to be mandatory

An unvaccinated six-year-old boy almost died after he contracted tetanus from a deep cut on his forehead that his parents cleaned and sutured at home. It was the first pediatric case of tetanus in Oregon state in more than 30 years.

KIRO Radio’s Colleen O’Brien spoke with Dr. Carl Eriksson, a critical care pediatrician in Portland, Oregon, for Seattle’s Morning News. Dr. Eriksson was part of the child’s care team and a co-author of the report on the case released by the Centers for Disease Control and Prevention (CDC) Friday.

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Six days after the child cut his forehead while playing on a farm, he began crying, clenching his jaw, and experiencing severe muscle spasms that caused him to arch his neck and back uncontrollably. The parents contacted emergency medical services when their son began struggling to breathe. He was airlifted to Doernbecher Children’s Hospital where he spent 47 days in the Intensive Care Unit (ICU) and a total of eight weeks in the hospital, a stay which totaled $811,929. That number does not include air transportation to the hospital or the 17 days the child spent in an inpatient rehabilitation program, learning to walk again.

Vaccines for tetanus are so effective that most pediatricians in the United States never see a case like this, Dr. Eriksson said. He and the rest of the child’s team of doctors, several of whom specialize in infectious diseases, had to rely on studies from the developing world to come up with a treatment plan.

Before leaving the hospital, the parents declined a dose of the tetanus vaccine DTaP, as well as all other recommended immunizations. Dr. Eriksson said it was a challenging conversation for many of the doctors and nurses caring for the child, who saw firsthand how painful tetanus can be.

“It’s always hard for us to watch a child suffer,” Dr. Eriksson said. “It’s harder when you know they’re suffering from a disease that is easily preventable.”

Unlike the majority of vaccine-preventable illnesses, tetanus does not offer any significant immunity to those who have contracted the disease in the past. And because tetanus is found in soil, herd immunity doesn’t work.

“If everyone else around you is vaccinated but you’re not, you are just as much at risk as if nobody were vaccinated,” Dr. Eriksson said.

In February, the Washington state House passed a bill that will eliminate personal or philosophical exemptions from the MMR vaccine. The vote came amidst a measles outbreak in southwest Washington, one that prompted Gov. Jay Inslee to declare a state of emergency on January 25.

That bill has now moved to the Washington state Senate, where lawmakers are also considering a broader measure that would end parents’ ability to claim personal exemption from all vaccines required by schools. The legislative session will end April 28.

Dr. Eriksson said he supports ending personal and philosophical exemptions from otherwise mandated vaccines.

“I do support that legislation, as somebody who is dealing on a regular basis with these diseases and the terrible effects that they have on kids,” Dr. Eriksson said.

The CDC recommends a 5-dose tetanus vaccine series for all children under the age of 6. Adults should receive a tetanus booster every ten years.

“I think one of the things this case illustrates is that these diseases are absolutely terrible, they are or at least can be deadly, and that not vaccinating your child can have deadly consequences,” says Dr. Eriksson. “[Tetanus] is a terrible disease and we tend to forget that because we don’t ever see it.”

Uninsured or underinsured eligible children may receive vaccines at no cost through the Vaccines For Children program.