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home : columns : ask the doctors June 24, 2019

4/19/2019 9:28:00 AM
Tetanus easily prevented with vaccine

DEAR DOCTOR: We're used to hearing about the measles outbreaks that happen in areas where parents have refused to let their kids get childhood vaccinations. Is it true that now a kid wound up with tetanus for the same reason? That sounds so dangerous.

DEAR READER: You're referring to the case of a 6-year-old boy in Oregon who developed tetanus after getting a gash on his forehead while playing on his family's farm. The event actually took place in 2017, but a recent write-up of the case has pushed it into the headlines.

About a week after the parents cleaned and stitched up the boy's cut, he developed troubling symptoms. In addition to involuntary muscle spasms, he couldn't unclench his jaw and had difficulty breathing. Doctors at a regional medical center diagnosed him with tetanus, a disease for which he had not been vaccinated. His was the first case of tetanus in the state in more than 30 years.

Tetanus is a disease of the nervous system caused by one of two toxins that are released by a bacterium called Clostridium tetani. Spores of C. tetani are found in the feces of a number of animals, including cattle, horses, sheep, dogs, cats and chickens, and in contaminated dust and soil. The bacterium enters the body via a wound that has broken the skin, like a cut or a puncture, then releases a toxin called tetanospasmin, which impairs the motor neurons.

As the neurotoxin travels through the circulatory system, it binds to nerve endings in certain sites throughout the body. Once this occurs, there is no known way to clear the toxin from the nerve endings. The only treatment is to manage the painful and dangerous symptoms that the toxin causes while waiting weeks -- or even months -- for new nerve endings, which are toxin-free, to grow.

The effects of the tetanus neurotoxin are severe and life-threatening. The muscle spasms it causes can be sustained and powerful enough to cause a bone to break. Spasms of the muscles of the respiratory system and of the vocal cords interfere with breathing and often require an alternative airway and mechanical breathing support.

In the case of the Oregon boy, he experienced muscle spasms so severe they caused his spine to arch backward. His breathing was compromised, and he spent more than a month on a ventilator.

Over the course of the eight weeks he spent in the hospital, he was tended by more than 100 nurses and doctors, none of whom had ever seen a case of tetanus before. Although having tetanus does not confer immunity, the boy's parents reportedly refused to immunize him.

Tetanus is a preventable disease, and the Centers for Disease Control and Prevention recommend vaccines for people of all ages.

Children receive tetanus protection via the DTaP vaccine, which covers diphtheria, tetanus and pertussis (whooping cough). It is recommended for babies at ages 2, 4 and 6 months, and again at 15 through 18 months old. The CDC also recommends a booster shot for children ages 4 through 6 years old. Adults need a tetanus booster every 10 years to stay protected.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.





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