Tetanus -- need help!

[bczmama]

My husband and I are very afraid...

DSS's mother is on vacation with DSS -- visiting relatives who have a small "hobby" farm in south georgia. We learned today that DSS sat on the ground in the horse corral and picked up a puncture wound from an old nail. His mother has refused to take him to the hospital to have wound professionally cleaned (b/c she's "really" cleaned it) or for a tetanus shot. Since this is the classic scenario for picking up tetanus we are very, very concerned.

Please -- we would really appreciate any thoughts or persuasive info from otherwise non-vaxing mothers who would get tetanus in this situation. The injury happened today, and we plan to call again first thing tomorrow morning to try and get DSS into the doctor's ASAP.

Thanks!

[Gitti]

I would make sure the wound had at least blood at the surface. It doesn't really have to bleed much. Just as long as blood is there.

[alegna]

I wouldn't worry at all. Really. Children have very good circulation. Circulation brings oxygen. Oxygen kills tetanus.

Children don't get tetanus. It is incredibly incredibly rare- always has been.

-Angela

[nwmom]

Originally Posted by alegna

I wouldn't worry at all. Really. Children have very good circulation. Circulation brings oxygen. Oxygen kills tetanus.

Children don't get tetanus. It is incredibly incredibly rare- always has been.

-Angela

Really, "children don't get tetanus"?? How would you explain these photos?

http://www.vaccineinformation.org/tetanus/photos.asp

[nwmom]

Originally Posted by bczmama

My husband and I are very afraid...

DSS's mother is on vacation with DSS -- visiting relatives who have a small "hobby" farm in south georgia. We learned today that DSS sat on the ground in the horse corral and picked up a puncture wound from an old nail. His mother has refused to take him to the hospital to have wound professionally cleaned (b/c she's "really" cleaned it) or for a tetanus shot. Since this is the classic scenario for picking up tetanus we are very, very concerned.

Please -- we would really appreciate any thoughts or persuasive info from otherwise non-vaxing mothers who would get tetanus in this situation. The injury happened today, and we plan to call again first thing tomorrow morning to try and get DSS into the doctor's ASAP.

Thanks!

Here is some info on tetanus. Wishing you all the best!

http://www.mayoclinic.com/health/tetanus/DS00227
http://www.cdc.gov/nip/publications/pink/tetanus.pdf

[bczmama]

I did discover this:

"Castor oil is a natural remedy that can be used to clean out a wound and prevent tetanus. When a wound is sustained, a cotton ball dunked in castor oil should be placed on the wound, and then fixed on the wound with a bandage. Castor oil has tremendous drawing power and can pull out rust and other infectious agents. The dressing should be changed every two hours the first day of treatment and twice a day for the next three days."

Maybe she can be convinced to try this. I feel like a freaking witch doctor.

[bczmama]

"Children don't get tetanus. It is incredibly incredibly rare- always has been."

In the developed world. However, since DSS has not been vaccinated (and is apparently not to receive any medical attention at all), I do not consider developed world infection rates to be an appropriate comparison.

Currently I am driving myself nuts by discovering "fun" facts like an estimated 500,000 people per year die of tetanus, including some 270,000 babies from neo-natal tetanus infections.

[alegna]

Originally Posted by bczmama

"Children don't get tetanus. It is incredibly incredibly rare- always has been."

In the developed world. However, since DSS has not been vaccinated (and is apparently not to receive any medical attention at all), I do not consider developed world infection rates to be an appropriate comparison.

Currently I am driving myself nuts by discovering "fun" facts like an estimated 500,000 people per year die of tetanus, including some 270,000 babies from neo-natal tetanus infections.

It doesn't have anything to do with vax status. It has to do with things like birth attendants not washing their hands. And packing dirt around the umbilical cord.

Rates in the US prior to the vax would be a good comparision. If you find them (not easy to come by) you will find that tetanus was ALWAYS very very rare. INCREDIBLY rare among children (other than simple lack of hygiene as mentioned above)

You'll find many children of moms here are totally unvaxed and tetanus is never a worry.

-Angela

[sophiekat]

a tetanus shot wouldn't be of any benefit now (post-injury) anyway. if anything the tetanus immunoglobulin (TIG) would be the treatment protocol. however, if the wound bled *at all* then it has been thoroughly cleaned by oxygen-rich blood. it can also be cleaned with hydrogen peroxide to bring more oxygen into it. so says my ER doc husband

[LongIsland]

Originally Posted by bczmama

"Children don't get tetanus. It is incredibly incredibly rare- always has been."

In the developed world. However, since DSS has not been vaccinated (and is apparently not to receive any medical attention at all), I do not consider developed world infection rates to be an appropriate comparison.

Currently I am driving myself nuts by discovering "fun" facts like an estimated 500,000 people per year die of tetanus, including some 270,000 babies from neo-natal tetanus infections.

You're comparing babies whose umbilical cords are cut with nonsterile instruments and then smeared with dirt/clay to your SS? Were you aware that at one time in the United States one could get tetanus from unsanitary surgical equipment?

The tetanus vaccine is not keeping the incidence of tetanus low in the United States. It's proper wound managment and sanitary conditions . . . which is lacking in un/underdeveloped countries.

Is the wound clean?
Was is cleaned with clean water?
Is the wound showing signs of infection?

What do you think a doctor is going to do for the wound that your SS's mother can't do?

FTR, I've had several puncture wounds, including a nail in the foot from the backyard. My son is the resident "carpenter." My last tetanus shot was more than three decades ago.

[bczmama]

"Is the wound clean?
Was is cleaned with clean water?
Is the wound showing signs of infection?

What do you think a doctor is going to do for the wound that your SS's mother can't do?"

Knowing how resistent DSS is to having his cuts and scrapes cleaned, and having seen how his mother has handled it in the past, I very strongly doubt that more than the most superficial cleaning of the wound took place. Since this is a fairly deep (as far as I can tell) puncture wound made by a rusty nail, I am concerned that flakes of rust or remnants of animal feces may remain in the wound.

Last time we spoke was about 1 and a 1/2 hours after it happened -- no infection as of yet.

[AlbertaJes]

Any chance you know the vax status of the horses who use that corral?

I do know that tetanus is very much a concern around horses, that's something that I have to be aware of as a horse owner. However, the vax won't do any good post-injury. He'd have to get immune globulin. Personally, I would make sure the wound bled and wait it out. He should show symptoms soon if he's contracted tetanus, and I believe that the treatment is the same after symptoms show as it is before.

[alegna]

Originally Posted by bczmama

Knowing how resistent DSS is to having his cuts and scrapes cleaned, and having seen how his mother has handled it in the past, I very strongly doubt that more than the most superficial cleaning of the wound took place. Since this is a fairly deep (as far as I can tell) puncture wound made by a rusty nail, I am concerned that flakes of rust or remnants of animal feces may remain in the wound.

Even superficial cleaning with soap and water is great. Really. Rust is not harmful (and contrary to popular opinion has nothing to do with tetanus)

The body is really pretty good at cleaning things like that out with just a little bit of help.

-Angela

[bczmama]

Every article I've read tonight has indicated that foreign objects in the wound (such as rust flakes) are an increased risk for tetanus and that appropriate and thorough wound cleansing is an important preventative measure.

[LongIsland]

Originally Posted by bczmama

Every article I've read tonight has indicated that foreign objects in the wound (such as rust flakes) are an increased risk for tetanus and that appropriate and thorough wound cleansing is an important preventative measure.

Tetanus is caused by a bacterial toxin, not rust. The fact that the nail is rusty has no affect on whether or not tetanus develops.

The "rusty nail" scenerio is a common misconception though.

ETA: CDC Pink Book chapter on tetanus http://www.cdc.gov/nip/publications/pink/tetanus.pdf

[alegna]

Well, anything in the wound is an increased infection risk, but honestly tetanus is such an incredibly low risk- he's probably more likely to be killed in a car wreck on the way to the ER for them to look at it.

-Angela

[LongIsland]

Originally Posted by AlbertaJes

However, the vax won't do any good post-injury. He'd have to get immune globulin.

But the thing is - if he was brought into the doctor or ER, they would give him the vaccine. When it's a minor wound and clean and the person has not been immunized (or is underimmunized), the vaccine is given. Not the immune globlulin. That's the official protocol in the Pink Book (see the chart at Wound Management).

In other words, it's just a chance to get the person boosted, but there's no risk of tetanus. If the doc thought there was a risk, it would be the TIG they would give - with or without a dose of the vaccine.

So if the doc says, let's give him a DTaP/Td/DT or TT but no TIG (and that's exactly what they would do if the wound is clean), I would run outta there. What's the point when the vax is not going to do anything? If your SS's mother does take him to the doctor and they recommend "a shot" - MAKE SURE she asks them if it's the vaccine or the immune globlulin. If it's not the TIG, then she should walk out of there.

Again, this situation would just be an opportunity to get the person "boosted" or to jump start the series if unvaccinated.

[bczmama]

I am aware that rust does not cause tetanus. However, the environment provided by a rusty nail is an excellent one for harboring tetanus. Especially where the ground on which the nail has lain is covered with animal feces.

My feeling is that even if the odds are slim, where the potential harm is very great -- go to the god-d*mn doctor, for which we pay all the freaking medical insurance, and have him take a look. This is DH's child and his risk calculus is different than yours and not unreasonable.

However, none of this is the point of the thread. I simply asked if anyone else here would follow up with medical treatment based on my described scenario. This was the wrong place to ask -- having now reviewed the threads here, it is pretty clear that only one viewpoint is deemed acceptable.

[LongIsland]

Originally Posted by bczmama

I am aware that rust does not cause tetanus. However, the environment provided by a rusty nail is an excellent one for harboring tetanus. Especially where the ground on which the nail has lain is covered with animal feces.

An environment with little or no oxygen is the "excellent environment." You can get tetanus from a paper cut, a burn, a crush wound and even an insect bite. Tetanus spores are everywhere.

I gave you a link to the Pink Book if you'd like more information on tetanus.

Originally Posted by bczmama

However, none of this is the point of the thread. I simply asked if anyone else here would follow up with medical treatment based on my described scenario. This was the wrong place to ask -- having now reviewed the threads here, it is pretty clear that only one viewpoint is deemed acceptable.

I take it you didn't read my post above your last one. That was the one where I explained the official treatment protocol.

"None of this is the point of the thread?"
"Acceptable viewpoints?"


Perhaps you shouldn't let YOUR "viewpoints" get in the way of the relevant facts necessary for SS's mother to make an informed decision.

Finally, if you believe this was "the wrong place to ask," why don't you contact your ped tomorrow and see if he gives you the same facts and references you received in this thread.

[bczmama]

"But the thing is - if he was brought into the doctor or ER, they would give him the vaccine. When it's a minor wound and clean and the person has not been immunized (or is underimmunized), the vaccine is given. Not the immune globlulin. That's the official protocol in the Pink Book (see the chart at Wound Management). "

Your scenario assumes that it is a minor wound and clean -- what I am saying is that I would like someone to take a look and verify that...then determine whether the immune globulin should be given.

The last sentence of my original post indicates the purpose:

Please -- we would really appreciate any thoughts or persuasive info from otherwise non-vaxing mothers who would get tetanus in this situation. The injury happened today, and we plan to call again first thing tomorrow morning to try and get DSS into the doctor's ASAP.

Since 5 million other people on these boards ask for information that only supports their point of view, I'm not sure why I can't as well.