A new case report from the Centers for Disease Control released Thursday starkly highlights the costs of not vaccinating children. It details an unvaccinated 6-year-old boy’s encounter with tetanus—and the hugely expensive, two-month-long effort it took to save his life.
Tetanus is caused by the namesake bacteria Clostridium tetani. More accurately, it’s what happens when the soil-loving C. tetani gets into your body—usually through an open cut—and spews out an extremely potent toxin. This toxin can quickly paralyze and send your muscles into constant spasms, beginning with the jaw (if you know anything about tetanus, it’s probably that it causes lockjaw). These spasms can then spread to the chest, back, and gut, leading to painful fractures, problems breathing, and even the complete loss of bowel control. It’s a brutal disease, one that can take months to fully recover from. Even with treatment, 10 percent of victims ultimately die.
Thankfully, we’ve had a working vaccine for tetanus since the 1920s, and vaccination has virtually eliminated the disease in countries with decent healthcare. Most every person in the U.S. is fully vaccinated for tetanus by the time they enter school, with the first of five shots happening at the age of 2 months (booster shots every 10 years afterward are recommended). Unfortunately, that wasn’t the case for the unnamed child in this report, since his family had chosen to not vaccinate him for any condition.
According to the authors, the 6-year-old boy from Oregon had gotten a forehead scrape while playing outside on a farm sometime in 2017. The wound was cleaned and sutured at home, but six days later the boy began experiencing lockjaw and muscle spasms. He then started arching his back and neck involuntarily and eventually could barely breathe, prompting his family to call for help.
The boy was airlifted to the hospital, unable to even drink water because he couldn’t open his mouth. There, he was given several tetanus shots. He then spent the next 47 days in intensive care, needing a ventilator to breathe and constant medications through an IV to control his pain, blood pressure, and muscle spasms. Three days later, he was able to walk 20 feet with help, but he still needed two more weeks of rehab to fully recover the use of his legs and body.
All told, he ended up spending 57 days in the hospital, with a bill of $811,929, and that’s excluding the air transport and rehab care. For context, that’s about 72 times the average cost of a hospital stay for a kid, according to research cited by the authors. And it’s monumentally more expensive than the childhood diphtheria, tetanus, and pertussis vaccine (DTaP), which can cost around $30 per dose without insurance (the adult boosters are around $60).
The doctors say it’s the first case of childhood tetanus reported in Oregon in 30 years. Between 2009 to 2015, though, there were 197 tetanus cases and 16 deaths reported in the U.S. And some of these rare cases have been even more expensive, with hospital bills for one adult victim reaching over $1 million.
The report doesn’t go into why his family was against vaccination in the first place. And lead author Judith Guzman-Cottrill, a professor of pediatrics at Oregon Health and Science University, told Gizmodo that she couldn’t disclose any family-specific details about the case, including their reasons for abstaining. But she noted the case should provide an important reminder about getting your shots, especially for tetanus. That’s because tetanus is only spread by direct contact with contaminated surfaces, and not from person-to-person like the flu. So relying on others to be vaccinated—otherwise known as herd immunity—won’t protect you from the bacteria, which is practically everywhere in soil.
“Thus, routine vaccination for all, plus boosters, are very important to prevent disease,” Guzman-Cottrill told Gizmodo.
The story ends mostly happily for the boy. A month later, he was completely back to normal, running and using his bike again. But it seems no lessons were learned on his family’s part. Despite the brutal ordeal and pleading by the doctors, they again chose not to vaccinate him for tetanus or any other diseases.