Tetanus and rural families (with research and sources) - Mothering Forums

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#1 of 8 Old 07-16-2011, 03:38 PM - Thread Starter
 
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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

 

 

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#2 of 8 Old 07-16-2011, 03:51 PM
 
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wow, great post.

 

Here are somethings I have been wondering.

 

1) I have read twice on Mothering that one can get tetanus from splinters etc. I have never read that anywhere else. I am not particularly well read however. I find it hard to beleive considering you always are told and generally read you get tetanus for large punctures wounds, although theoretically it does make sense. A splinter is a puncture but pople of all ages, all over the world get millions of splinters.

 

2) IF you can get tetanus only vax then  A) are the risks very low (op mentioned no seizures if P left out.)?

                                                            B) is there a just D vax?

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#3 of 8 Old 07-19-2011, 10:59 PM - Thread Starter
 
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Re: tetanus from splinters that was mentioned on the cdc site under the puncture wounds.  Aviva Romm says up to 50% of tetanus cases are from splinters but I don't think it's cited and I question that high of a number.

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#4 of 8 Old 07-20-2011, 04:33 AM
 
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We get the dtap for the tetanus. My ped is awesome, but she wont give tetanus alone either. Honestly, I wish there as a way to get just tetanus and pertussis.

I live in an old general store full of rusty metal and unfinished hardwood floors, on 11 acres of land that an old railroad used to run through (meaning that there are a few hidden sharp, rusty, objects around).

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#5 of 8 Old 07-20-2011, 05:31 PM
 
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We live in the city.  And I mean IN THE CITY.

 

However, Tetus is the one vax on which my husband is not willing to budge.  We do have 3 chickens, 2 dogs, 1 cat and our first LO due earlier this week!

 

I feel on our stairs 2 years ago and required stitches b/c I landed on the heat lamp for brooding our chicks.  The Dr was VERY cool about me waffling on the vax.  NO PRESSURE.  However, my husband made it perfectly clear that due to the circumstances, he expected me to get the vax.  He wasn't a jerk or anything...just very firm.

 

For our LO, I would LOVE to find the T alone...but I think that will be the one vax in which we take and just keep moving.

 

Mr sB

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#6 of 8 Old 07-20-2011, 05:51 PM
 
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Tetanus is one I will do as soon as reasonable for my kids.  My oldest is fully vaccinated as I was very young and pressured- I didn't know then how to say no to a doctor- particularly as we were part of Tricare and military doctors are very pushy about vaccines. 

 

However, just recently she was out running around and drove a rusty nail through the bottom of her shoe and into her foot.  I called to find out about whether a booster was a good idea in that situation.  She was JUST at the edge of needing one or not needing one but we decided to go with a tetanus only booster (she's nine, it's advised for 10 and over.)  I didn't have a second thought about it. For us, it was the right decision.

 

My younger guys, due to immune system quirks are not going to start their vaccinations until they are older- and then only selectively.  However if there is a  risky exposure like the one cited above, we will probably chance the dtap at that time. 

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#7 of 8 Old 07-28-2011, 07:56 PM
 
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My midwife and pediatrician (naturopathic md) told me that she can get a single tetanus vax for my daughter whenever I wish to use it. It's not officially recommended for under age 7 but because she is a naturopathic doctor, she is able to administer it younger adjusting for weight. Has anyone else heard of this and do you think its safe? We live on a farm and I vaxed my son until 15 months (when he had a horrible reaction to DTAP) and discontinued the rest. Now, I will be waiting to selectively vax my daughter until at least 2 or 3 BUT I think the tetanus vax is very important for us... she is 6 months right now.

 


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#8 of 8 Old 07-29-2011, 10:51 PM - Thread Starter
 
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I have heard of using the tetanus only vax for younger children and it was mentioned in a mothering article, though the author said that the mds who were doing it in a very liberal area wouldn't disclose what dosage they were giving.  We asked our ped last year if he would adjust for weight and he said he wouldn't know how to (md ped, very conventional but open).  I know they vary the diptheria dosage by age as well as weight (hence the TDap vs DTap I believe) I can't remember exactly how that works but I think it was something like older kids get less diptheria vax because of reactions (?).  If it were me I'd be wanting to know where she's getting her info about dosage (and it may be that it's info shared at good naturopathic schools - I'm a former student of one of the accredited schools).  And if you get the info please share it!! We're happy with our decision now to not vax but I'd be interested in the brand and dosage and how she determined that if you're willing to share.

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