Friday, December 10, 2010

Tetanus in an unvaccinated teen

The availability and wide us of vaccines and the resulting low incidence of the diseases which these vaccines prevent make a lot of parents perceive the disease as "low risk" in general. In late 2008, we could "watch" online how wrong this perception is, when a mother turned to an anti-vaccine board, whose son was developing lock jaw. Here is the link (for those of you who speak German or want to put the text through a translation site - my translations and summaries of the board posts are in blue):

The thread is entitled "Jaw problems after Tetanus vaccination".

Mein Sohn (13 Jahre) hat sich am Knie eine mind. 1,5 cm tiefe Wunde zugezogen. Da es auch noch schmutzig war, (Sand etc.) habe ich den Hausartzt erlaubt ihn gegen Tetanus zu impfen. Er war bis jetzt noch gar nicht geimpft gewesen. 2 Tage später klagte mein Sohn das er sein Mund kaum öffnen könne, essen wurde schwierig, auch Zähneputzen. Alles ist verspannt, Kiefer und Hals tun Weh, vor allem beim kauen.
Meine Frage ist jetzt, ob das eine Folge von Impfen sein kann, oder eine Zufall?
Wenn, ist es alarmierend oder geht`s vorbei automatisch?
Wäre heilfroh, wenn jemand Erfahrung hat mit sowas. Ich würde ungern zu den Arzt gehen, er ist Impffanatiker und ich kämpfe schon seit Jahren mit diese Thema.

In the first post the mom describes that her 13 year old, unvaccinated son sustained a knee injury (1.5 cm deep, dirty, sandy) and because he had not been vaccinated, she allowed his GP to "vaccinate him against tetanus". Two days later, the boy has problems opening his jaw, neck and jaw hurt when he tries to eat or brush teeth. She fears vaccine damage and wonders whether this will pass alone. She is also afraid to take her son to the doctor, because he is "vaccine fanatic".

At this point, I am thinking "OMG, this boy has tetanus - go see a doctor, but I am just watching, never got a password on this board, since reason is being heavily "moderated" by the board owner and his little helpers. However, the mum's post is immediately being picked up by the resident vaxxaloons - a poster by the name of Gaston remarks:

"This sounds just like Tetanus Symptoms"
(wait if you think "well spotted, now he is going to send her to the doctor") - he continues "I would assume that your son would not have gotten these symptoms without the vaccine. After all, Tetanus Toxins are injected. So it is not surprising that here we are looking at something like beginning Tetanus."..

Mum responds "That is just what I thought. So I probably did the wrong thing again.
It is worse today. The boy can hardly eat. I will take him to the doctor at 6pm. I assume he will give a cortisone injection or something like that and tells me that he should have been vaccinated much earlier.
I really don't know what to do. This has been going on for 4 days and for the child it is very irritating. If at least I knew this is going to pass.
Well, at least I know for sure that none of my children will be vaccinated (this was the first time)

A poster called "Anke" confirms the mother in her feelings and encourages her to report this as an adverse vaccine event. She also claims to have "heard of such symptoms associated with the tetanus vaccine".

A day later, she is taking her son to the doctor again. The doctor does not diagnose tetanus, but a throat infection and (because mom does not want him on antibiotics) she takes her son to the local pediatric hospital where he stays for observation. Doctors there think vaccine reaction AND tetanus are "unlikely".

In the thread, a poster called "Uschi" then shares her experience with jaw problems which she assumes were from her tetanus vaccination, which she later "chelated with the help of her homeopath".

"Gaston" pitches in with a terrible rant about the doctor. I feel like ranting about that doctor, after all, he did not diagnose the tetanus in a rather unambiguous presentation, but that is not what "Gaston" means. He is on a roll "if this was my child, I would do everything to hold this scumbag accountable. .../... The penicillin treatment, which is counter-indicated in this case, is the worst, because your son could have sustained further damage from it!"

Most further posters share these sentiments, however, "Sonnenlicht" asks whether the boy had received active or passive immunisation, because post-exposure, the boy would have needed immunoglobulins.

Four days have passed since the mum's first post.

Finally, the child is transferred to the next large University Hospital as the doctors clue in that he has tetanus. The boy can still talk, but cannot eat or drink. In that post, mom also says that her son had the active and passive immunisation a week earlier (that post is on page 2 of the thread). She assumes, her son's illness is from either of the the two.

Poster "Babsi" refers the mum to a vaccine-critical doctor in Bavaria. Poster "Kat" "knows" from her naturopathic pediatrician that the tetanus vaccine given "in case it has become serious, is particularly critical, i.e. badly tolerated." She is also adamant that if the wound had been bleeding "it is impossible that this was tetanus, it is vaccine damage!!!"
(the three exclamation marks make it true, you know). Apart from that, she recommends a vaccine critical "expert" or "any naturopathic doctor for further help". "Gaston" totally shares her feelings. "The wound alone did not cause the problems, that was unambiguously the vaccine. It is generally known that vaccines cause the disease they are supposed to protect from in some. Some people are more susceptible for this." He suggests contacting the media "Tetanus after vaccination! Because Tetanus is really rare here in Europe." "Anke" pitches in and recommends Arnica globules in the 200C and consulting a homeopath. General rambling ensues.

A day later we get a chronological account. It appears that the wound was cleaned and sutured soon after the accident, but the immunisations were not given until the control visit 3 days later. The tetanus symptoms started another couple of days after that, so 5 or 6 days after the injury. Mum reports "Everyone in the University Hospital is convinced that he has tetanus from the wound, although it cannot be proven. I do believe it, too. The wound was very deep and got sutured = closed air tight. This disease is very rare. Even in the University Hospital no one had ever seen a single case. My son is better today. He was released from ICU and is on a normal ward now. He can still not open his mouth, but he could drink a little bit."

After this account, "Sonnenlicht" is also convinced that the tetanus was caused by the wound and that tetanus is an important vaccine after all. However, "presonic" would still not vaccinate in such a situation. S/he doesn't understand why "the dead flesh was not removed before the wound was sutured.". "Sonnenlicht" does not buy that. "Anke" just cannot believe that such a wound did not bleed profusely and the mother explains that her son had a bicycle accident on an asphalted path and a deep wound next to the knee that did bleed. She is unsure whether the doctor cleaned the would appropriately.

Two weeks later, we get the resolution that the boy is home again, after nearly two weeks in the hospital on antibiotics, tetanus immunoglobulins and "lots of other medicines". The mother describes that her son had "not fared as poorly as she was told to expect" - he could breathe on his own and did not get "bad" cramps. He could not open his mouth and his tongue hurt. He started to make an effort to eat when the doctors discussed giving him a stomach probe to feed him.

This story is shocking on several levels. Obviously, I pity the child. An injured knee should not put a 13 year old in the hospital with tetanus. He was obviously very uncomfortable the whole time and mum sounds very desperate, too. The doctors' reactions in hindsight (which is always 20/20 ;)) were not stellar, the reaction of the resident anti-vaccine posters on that board are so out-worldly that they look almost staged. They may even have contributed to the delay until the boy was taken to the hospital.

Tetanus in children is very rare - so rare in fact, that doctors do no longer necessarily clue in when they are faced with a child with a locked jaw. However, 80% of the few pediatric cases of tetanus occur in unvaccinated children. They don't need dramatic injuries, blunt trauma, or minor splinters can be enough of a cause. Tetanus in children is very rare, however, we need to remember that most toddlers (over 96% according to the latest US figures, European figures are similar) have had at least 3 vaccines against tetanus - protection up to the school booster is near perfect, see also here, and most kids in the US will get that first school booster that protects them into adolescence, when 75% of US kids are getting another booster.

So the bottom line is: parents who do not vaccinate against tetanus need to be aware that the low incidence of tetanus is in part due to the high vaccination coverage. They themselves need to keep tetanus in mind when their unvaccinated children have an accident, since doctors might not automatically assume that s/he is looking at one of the 4/100 children who does not have tetanus protection and will almost certainly not have experience with tetanus. If worrying about tetanus with every splinter is too stressful for the parents, the alternative is NOT to post on an anti-vaccine board for encouragement that "head in the sand" is the best option, because 1. vaccines are teh ebil and 2. they are particularly evil after exposure.

The reasonable alternative is to consider vaccination.

20 Aug 2014: links repaired


  1. Very illuminating post Catherina. I liken these anti-vaxx sites to 7 year old children having a conversation about sex. The wild speculation with merely grains of fact to work with lead to frightening results. I would like to note that post-exposure tetanus vaccination only works if the recipient has had the primary series at some point.

  2. Thank you Catherina. This is depressing and I feel very sorry for both the child and his mother, who is obviously seriously misled. What a shame. Science Mom, I love your comparison!

  3. @ Deleted profile, thanks. It really does appear that way to me and I would be able to laugh a lot more about it if it didn't have such negative repercussions.

  4. @Science Mom, your comment made me laugh! I am stealing it if you don't mind. 7 year olds. LOL!

  5. Hello Larian, by all means, share the joy.

  6. This post is incredibly enlightening.