My soon to be 4-year-old son was bitten Saturday evening by neighbor's indoor, well cared for, small-middle sized dog who has all vaccines. Although rabies is of little concern, and we're taking care of infection with antibiotics (Augmentin), I'm worried about tetanus.
The wound seemed to be about a 0.5 cm penetration of the dog's canine tooth into my son's shoulder. There was no external bleeding. I washed outside and even cleaned externally with hydrogen peroxide thinking the oxygen would somehow kill the spores.
My first concern was that the wound did not bleed out, and there was no easy way to clean deep inside the wound, only outside. The wound has healed up cleanly in a matter of hours, which was actually a second concern now that there is a totally anaerobic environment for the anaerobic bacteria to thrive in.
My son does not have any tetanus vaccines.
The urgent care doctor, after scolding me on my decision to not vaccinate my child, prescribed a ten-day course of Augmentin (7.5 mL bid) and told me to go as soon as possible to nearby children's hospital to have Tetanus Immunoglobulin (TIG) administered along with a Tetanus (DTaP) vaccine.
He informed me that the TIG would be available only in the ER at our local children's hospital (CHOC). I'd hate to have an ER visit for an intramuscular injection; isn't there another place this can be administered without all the ER hassle and cost?
It's now almost two days later, and I'm still struggling with whether to take him to get his TIG. Is it critical to take him right away, or is there some window of time where we can go in (e.g. within 24 hours or 72 hours)? I know there is a small risk that my son will even get tetanus but then there is a small risk that he will have a reaction to the TIG or vaccine. Which risk do I want to confront?
TIG has two classes of problems and there are no safety studies for children for this drug:
- immediate reactions: e.g. anaphylactic shock
- delayed, long-term effects from problems associated with plasma medium: e.g. hepatitis C, CJD
Then after getting the TIG, what are the options? Can I wait to give him the tetanus vaccine? If I decide on the tetanus vaccine, can he get the tetanus-only (T) vaccine, or does he need to get a combined vaccine because that's all that's available? If they have tetanus-only, is there a choice, and if so, which is best? I know the choice varies by location and country. I am in the Los Angeles, California, USA metropolitan area. My understanding is that if he's undervaccinated, then the booster would confer some protection, but if he's totally unvaccinated, than getting the shot would do very little if any for this particular injury.
Another question: Does the antibioitic he's taking help at all to fight the Clostridium tetani bacteria that may cause tetanus? Is he "safe" while taking the antibiotics? Is there risk then that after he stops the spores that survived the antibiotics will activate?
I'm still struggling on what to do next. I decided on the vaccine-free route with my children, but I'm disappointed by the lack of support for those who are faced with decisions like this when their children are either sick with the disease the vaccines are intended to prevent or the children face a higher risk of contracting those diseases because of an incident such as the dog bite my son suffered.