On the first day, a six-year-old boy from Oregon cut his forehead.
On the seventh day, he started crying, his jaw clenched up and he started having muscle spasms.
This unvaccinated boy became the state’s first tetanus case in approximately 30 years, according to a report released by the Centers for Disease Control and Prevention (CDC) on Wednesday.
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The infection put him in acute care for 57 days and rehabilitation for another 17 days — and cost over US$800,000.
The case emerges as Canadian cities grapple with outbreaks of measles that could be prevented through vaccination.
The Oregon case unfolded in 2017.
The six-year-old boy was playing outside on a farm when he suffered a laceration to his forehead.
His wound was cleaned and sutured, the CDC said.
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Then his symptoms worsened six days later.
His jaw tightened, he started suffering upper-muscle spasms and his neck and back started arching.
Then, once he had difficulty breathing, his parents called emergency medical services and he was taken into care.
It would be over 70 days before he could play again.
Once in care, the boy requested water but he couldn’t open his mouth, the CDC said.
Diagnosed with tetanus, he was given a diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. Then he was taken into a darkened room and given ear plugs to minimize stimulation, which was aggravating his spasms.
He developed hypertension, his heart started beating faster and his body temperature grew to 40.5 C. The normal temperature is 37 C.
Doctors administered a tracheostomy — a cut in the neck through which they could place a tube, just to help him breathe.
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Finally, on his 35th day in care, he could be weaned off treatment for his muscle spasms. On the 44th day, he could “tolerate sips of clear liquids” again.
On his 50th day in care, he could walk 20 feet with help.
Then, once he had spent 57 days in treatment, he was sent to a rehabilitation centre where he would spend the following 17 days.
Then he could play again — one month after rehab.
And yet still, after all that, “the family declined the second dose of DTaP and any other recommended immunizations.”
The inpatient charges of treating the child were pegged at US$811,929 — and this didn’t account for his air transportation to a care centre, nor rehabilitation or any follow-up costs.
The expense of treating him exceeded the average cost by about 72 times. An average pediatric hospitalization in the United States cost about $11,000.
Adult tetanus cases, however, can cost over $1 million, the CDC said.
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The Centers noted that tetanus vaccines have led to a 95 per cent decline in the number of cases and a 99 per cent decline in the number of related deaths since the 1940s.
Anyone who hasn’t been vaccinated, or hasn’t been adequately vaccinated, runs the risk of contracting tetanus, and all the costs that attend its care.
Catching tetanus does not make you immune, the CDC added.
The Centers recommend DTaP vaccinations for kids at the ages of two, four and six months. Further doses are recommended when a child reaches between 15 and 18 months of age, then another when the kid is between four and six years old.
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Boosters are recommended every 10 years.