We are a non vaxing family contemplating tetanus vax for DS age 5 and DS age 3.
I realized, after reading a comment on one of the many tetanus threads where the mama stated that her child isn't running around barnyards or anything that a rural mama specific thread might be valuable.
What are you doing about tetanus vax and why? And can we please keep this thread pleasant :) some of them get ugly.
I am currently specifically researching tetanus, understanding that the likelihood of getting my ped to give it alone is virtually nonexistent. But I need to get my head around our tetanus decision before I look at diptheria too. Otherwise the whole thing is just too overwhelming.
So, tetanus specific information:
As I understand it from the CDC's information there is an 11% overall mortality rate from tetanus with a 22% mortality rate when the patient was not vaccinated at all (the 11% was from folks who's vaccination was incomplete or boosters were not up to date). The wound causing tetanus can be as minor as a splinter or an abrasion.
Almost all reported cases are in people who have never been vaxed or have not had a booster in the last 10 years, those for whom this is true have lowered antitoxin levels due to time so that even those with full vax should get a booster after 5 years if there's a wound. (though this is potentially contradicted by information below re: incidence in children)
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf
US children are 84-85% tetanus vax compliant.
http://www.whyy.org/news/ajpm_vac.pdf
1998-2000 there were an average of 43 cases of tetanus in the US.
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5203a1.htm
"From 1992 through 2000, 15 cases of tetanus in children <15 years of age were reported from 11 states. Twelve cases were in boys. Two cases were in neonates <10 days of age; the other 13 cases were in children who ranged in age from 3 to 14 years. The median length of hospitalization was 28 days; 8 children required mechanical ventilation. There were no deaths. Twelve (80%) children were unprotected because of lack of vaccination, including 1 neonate whose mother was not vaccinated. Among all unvaccinated cases, objection to vaccination, either religious or philosophic, was the reported reason for choosing not to vaccinate."
http://www.ncbi.nlm.nih.gov/pubmed/11773570
So 3 of the 15 children were supposedly protected by vaccination but still got tetanus. The abstract does not state if they were vaccinated but it had been a number of years and they perhaps needed a booster. Or if they were up to date and the vaccine simply did not work.
There are over 60 million under aged 15 in the US.
http://www.nationalatlas.gov/articles/people/IMAGES/int-tbl1.gif
15 cases/9 years= under 2 cases per year. So incidence of tetanus in children under age 15 is approximately 1 per 30 million each year.
If 85% of children are tetanus vax compliant then 9 million children are not tetanus vax compliant (I'm making an assumption here, with the 85% number from 2005 and specific to children under 35 months old and extrapolating that to the under 15 population). That means that of the rate for unvaccinated children is 13 cases/9 years=1.5/year per 9 million children or 1 per 6 million.
That would mean that unvaxed children are 5 times more likely to get tetanus than vaxed children, if my math is working.
However, we know that chance of risk will be much greater when our children are actually in contact with dirt. In another thread a mother mentioned how unlikely it was for someone to contract tetanus up 5 stories in an apartment building. A reality check for me for how lucky it is that my boys get to play in the dirt! And of course they therefore get hurt in the dirt all the time. One source (maybe the CDC?) talked about how drift of the population to urban areas was also correlated with decreased incidence of tetanus. Here's one of the problems in researching - it seems impossible to me to truly separate out what led to decreased incidence. We know wound care has helped and we all hope to do great wound care but honestly with active kids it sure varies for me some times. Vax may have had an impact. So may have the fact that the US changed from a largely farming country to an urban and suburban one.
Re: vaccine efficacy I haven't found research showing large numbers or even anecdotal stories of tetanus incidence with up to date vax and boosters. Anyone else? The info above could indicate that 3 of the 15 children with tetanus were up to date and thus 20% of children getting tetanus had been fully vaccinated.
Re: vax risk it seems like the scariest is the Guillain-Barre connection which even the CDC states seems to have a causal relationship with the vaccine.
However "No increased risk for GBS has been observed with the use of DTP in children. In a study of 0.7 million children of preschool-ages who were vaccinated with DTP during a 7-year period, three cases of GBS were expected by chance alone during the 6 weeks after vaccination, and only two cases were reported (17). "
"Recent data suggest that infants and young children who have ever had convulsions (febrile or afebrile) or who have immediate family members with such histories are more likely to have seizures following DTP vaccination than those without such histories (78,79). For those with a family history of seizures, the increased risks of seizures occurring within 3 days of receipt of DTP or 4-28 days following receipt of DTP are identical, suggesting that these histories are nonspecific risk factors and are unrelated to DTP vaccination (79)." Convulsions are not found when the Pertussis is kept out.
Table_6
Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 6. Adverse events * occurring within 48 hours after vaccination with diphtheria and tetanus toxoids and pertussis vaccine (DTP) ======================================================================================= Event Frequency of event + ----------------------------------------------------------------------------- Local reaction - Pain 1 per 2 doses - Swelling 2 per 5 doses - Redness 1 per 3 doses Systemic reaction - Fever >=100.4 F (>=38 C) 1 per 2 doses - Fretfulness 1 per 2 doses - Drowsiness 1 per 3 doses - Anorexia 1 per 5 doses - Vomiting 1 per 15 doses - Persistent, inconsolable crying (i.e., for >=3 hrs) 1 per 100 doses - Fever >=105 F (>=40.5 C) 1 per 330 doses - Collapse (hypotonic-hyporesponsive episode) 1 per 1,750 doses - Convulsions (with or without fever) 1 per 1,750 doses ----------------------------------------------------------------------------- * Adapted from Cody CL, Baraff LJ, Cherry JD, et al., 1981 (60). + Rate per total number of doses, regardless of dose number in DTP series.
More info on incidence and change of incidence since vaccination:
TABLE 1. The maximum number of cases of specified vaccine-preventable diseases
ever reported for a calendar year compared with the number of cases of disease and
vaccine adverse events reported for 1995 -- United States
===================================================================================================
Maximum
no. reported Year(s) Reported Percentage
cases during maximum no. no. cases change in
Category prevaccine era cases reported during 1995 * morbidity
-------------------------------------------------------------------------------------------------
Disease
Congenital rubella syndrome 20,000 + 1964-65 7 (-99.96)
Diphtheria 206,939 1921 0 (-99.99)
Invasive Haemophilus
influenzae 20,000 + 1984 1,164 (-94.18)
Measles 894,134 1941 309 (-99.97)
Mumps 152,209 1968 840 (-99.45)
Pertussis 265,269 1934 4,315 (-98.37)
Poliomyelitis (wild) 21,269 1952 0 (-99.99)
Rubella 57,686 1969 146 (-99.75)
Tetanus 601 1948 34 (-97.82)
Vaccine adverse events & 0 10,594
-------------------------------------------------------------------------------------------------
* Provisional totals.
+ Estimated because national reporting did not exist in the prevaccine era.
& Total number reported to the Vaccine Adverse Events Reporting System (VAERS).
http://www.cdc.gov/mmwr/preview/mmwrhtml/00046738.htm#00001898.htm
Follow Mothering