The case of 2017 is the first case of pediatric tetanus in Oregon for over 30 years and experts in infectious diseases in alarm who have said that tetanus is almost unknown in the United States since widespread immunization began in the years & # 39; 40.
The child received an emergency dose of the tetanus vaccine in the hospital, but his parents refused to give him a second dose – or any other infant spurt – after he recovered, the newspaper said.
"When I read it, my jaw dropped, I could not believe it, it's a tragedy and a misunderstanding, and I'm just stunned," said Dr. William Schaffner, an infectious disease expert and president of the Department of Preventive Medicine at the Vanderbilt University School of Medicine in Nashville, Tennessee.
"This is a terrible disease, but … we had a mechanism to stop it completely, and the reason we have practically no more cases in the United States is because we literally vaccinate everyone."
The doctors in Portland, Oregon, who cared for the child refused to provide more information about the family at a press conference on Friday, citing medical privacy laws.
It was the first time that Dr. Judith Guzman-Cottrill, the pediatric infectious disease expert who had been treating the baby, had ever seen tetanus because of the widespread vaccination against it in the United States.
When the boy came to the emergency room, his muscle spasms were so severe that he could not speak, he could not open his mouth and was struggling to breathe, he said.
"We had trouble taking care of this child – watching him suffer – and it's a preventable disease," said Guzman-Cottrill.
News on the tetanus case comes when Oregon and Washington lawmakers are considering invoices that will end the non-medical exemptions for routine childhood vaccines, while the northwest Pacific is dries up the third month of a measles epidemic. Seventy people in southwest Washington, most of their unvaccinated children, have been diagnosed with highly contagious viral disease since January 1, as well as a handful of people in Portland, Oregon.
Unlike measles, which is a virus, someone who has survived a case of tetanus is not immune and can try the disease again if it remains unvaccinated. Tetanus is also not transmitted from person to person through sneezing or coughing like measles, but instead derives from bacterial spores that are found in the environment.
Tetanus spores exist anywhere in the soil. When an unvaccinated person receives a deep and penetrating wound, those spores can invade the cut and start producing the bacteria that cause the disease.
The tetanus bacterium secretes a toxin that enters the bloodstream and attaches itself to the nervous system.
Everywhere from three to 21 days after infection, symptoms appear: muscle spasms, trismus, difficulty swallowing and breathing and convulsions. The disease can cause death or severe disability in those who survive, said Schaffner.
About 30 people contract tetanus each year nationally, according to the CDC, and 16 people died there between 2009 and 2015. It is rare among children; those over 65 are the most vulnerable.
In the case of Oregon, the boy cut his forehead while he was playing and his family sewed up the wound. Six days later, he began to tighten his jaw, arching his neck and back and had uncontrollable muscle spasms.
When he started having trouble breathing, his parents called the paramedics and he was airlifted to the Doernbecher Pediatric Hospital of the University of Oregon Health & Science in Portland. When he arrived, he asked for water but could not open his mouth.
The baby has been sedated, put on a ventilator and taken care of in a dark room while wearing earplugs because any stimulation has worsened his pain and muscle spasms. His fever has increased to about 105 degrees (40.5 degrees Celsius) and has developed high blood pressure and a rapid heartbeat.
Forty-four days after being admitted, the boy was able to sip clear liquids. Six days later, he was able to walk a short distance with help. After another three weeks of hospital rehabilitation and a month at home, he could ride a bike and run – a remarkable recovery, experts said.
Child care – excluding air ambulance and hospital rehabilitation – cost nearly $ 1 million, about 72 times the average for pediatric hospitalization in the United States, notes the document.
"The way to treat tetanus is that you have to survive." You have to support the patient because this poison connects chemically and then has to be slowly metabolized, "said Schaffner.
Cases of tetanus have decreased by 95 percent in the United States since childhood vaccination and adult immunization became routine almost 80 years ago; the deaths have dropped by 99 percent.
The CDC recommends a series of five tetanus shots for children aged 2 months to 6 years and a booster dose every 10 years for adults.
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