How many children get Tetnus in a year? - Mothering Forums

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#1 of 22 Old 07-08-2007, 08:51 PM - Thread Starter
 
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This is basically unheard of in children, right? Are there ANY cases of Tetnus in kids? In all my research I've seen cases, but never in children. I'm just wondering if anyone knows statistics on it. Thanks!
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#2 of 22 Old 07-08-2007, 08:55 PM
 
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There are cases in children, it is extremley rare though.
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#3 of 22 Old 07-08-2007, 09:13 PM
 
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About one or two a year.

http://www.cdc.gov/mmwr/preview/mmwrhtml/00053713.htm

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Tetanus Surveillance -- United States, 1995-1997
Quote:
Data on age were reported for all 124 patients. Of these, 44 (35%) were aged greater than or equal to 60 years; 74 (60%) were aged 20-59 years; and six (5%) were aged less than 20 years, including one case of neonatal tetanus and four patients aged 1-14 years
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#4 of 22 Old 07-08-2007, 09:48 PM
 
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I've seen tetanus in a small boy, during my medical training. It was truly, truly awful, and he was left with permanent neurological injury.

That being said, it is profoundly rare, and almost doesn't occur in American children.
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#5 of 22 Old 07-08-2007, 10:38 PM
 
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Originally Posted by blessed View Post
I've seen tetanus in a small boy, during my medical training. It was truly, truly awful, and he was left with permanent neurological injury.

That being said, it is profoundly rare, and almost doesn't occur in American children.
I am imagining that that boy wasn't perfectly healthy?

I think drug users have the highest percentage of tetanus in the USA.
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#6 of 22 Old 07-08-2007, 10:57 PM
 
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With a severe enough injury of the right sort, even a perfectly healthy person could get tetanus.

Most of our problems on this forum are doctors recommending tetanus shots when the injury is not severe (sometimes the skin isn't even broken) and also recommending tetanus shots at the time of the injury. A booster at the time of an injury might work, but the first of the series is useless.

It is rather depressing when medical professionals don't even know how something is supposed to work.
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#7 of 22 Old 07-08-2007, 10:59 PM
 
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You know, he actually was just a normal five year old. His parents were nonvaxers and they lived on a farm. He stepped on a metal shard in a barnyard full of animal feces and had a deep puncture wound of his foot - kind of the classic route for infection.

He went into fullblown tetany and was on the ventilator. They had to chemically paralyze him because during tetany the muscles are all locked in spasm, so that breathing is impossible. It also wrenches the person into contorted, unnatural positions so that even bones can be broken.

The parents resisted all medications, including immunoglobulin injections against the tetanus toxin, which is standard of care. I thought it strange that they consented to mechanical ventilation but not an injection, but they had a lot of theories about the immune system and felt strongly that he not recieve it. Anyway, the hospital went to court and won a court order to give it, however they ended up respecting the parents wishes and not doing so. The docs were influenced by the knowledge that it wasn't proven effective in such an advanced case, and did carry risks. So with the parents strong objections, they decided not to push the issue.

The kid got out of the hospital after several weeks and was shaky, unable to walk unassisted. It wasn't clear if he was cognitively injured.

I'll always remember at discharge the parents telling me sort of triumphantly that they felt justified in their decision not to vax, because look what happens even if you do get one of the diseases - they can just treat it! :

And I am a selectively vaxing parent, by the way. And I probably won't do another tetanus on dd.
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#8 of 22 Old 07-08-2007, 11:28 PM
 
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Blessed, from your experience and research, if they'd given the TIG when he presented with the symptoms would the outcome have been different? I'm wondering if the TIG has to be given immediately after the wound, or if it's effective as a treatment after the disease has entered the picture.

thanks!

-Angela
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#9 of 22 Old 07-08-2007, 11:42 PM
 
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Originally Posted by alegna View Post
Blessed, from your experience and research, if they'd given the TIG when he presented with the symptoms would the outcome have been different? I'm wondering if the TIG has to be given immediately after the wound, or if it's effective as a treatment after the disease has entered the picture.

thanks!

-Angela

yeah i would like to know that too....

DS 5-11-06
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#10 of 22 Old 07-09-2007, 12:14 AM
 
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I'm interested in the TiG as well. AS far as I have ever seen, the vast majority of tetanus cases are in newborns in third world countries and they usually catch it by something very unsterile being used to cut the umbilical cord.

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#11 of 22 Old 07-09-2007, 12:23 AM
 
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blessed,
do you know how the parents cared for the wound?
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#12 of 22 Old 07-09-2007, 01:20 AM
 
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I don't know how the wound was cared for.

At the time, the Infectious Disease specialists indicated that the use of immunoglobulin was justified on scientific principles - it seemed as though it ought to help based on medical dogma - but that there were no trials to demonstrate it's effectiveness. This is because typically once tetanus is being actively treated, every possible treatment is given in an attempt to save the life of the patient. It would be unethical to withhold treatment for a comparison trial. Also numbers treated are small, making unreliable the process of comparing treatment arms.

I just did a pretty extensive literature search and I don't find any relative info on effectiveness of TIg given at time of injury or at development of tetany.

However, there are studies out of Africa which show that failure to follow treatment protocols which include wound care and debridement, antibiotics and tetanus Ig increased case mortality. Interestingly, in one trial the use of tetanus toxoid also increased mortality. http://www.ncbi.nlm.nih.gov/sites/en...ubmed_RVDocSum

Importantly, the use of tetanus toxoid at the time of injury has also been shown to NOT IMPROVE the outcome of tetanus if it subsequently develops. So if tetanus toxoid is being pushed on you in the ED, it is given only as prophylaxis for any future injury, and not because it helps at all with the current injury. http://www.ncbi.nlm.nih.gov/sites/en...ubmed_RVDocSum

ETA: I hope it's clear that I'm talking about tetanus immunoglobulin in the first paragraph. This is the injection of preformed antibodies given only in rare cases in which the doctors are very concerned about development of tetanus. This might be helpful when given as part of the comprehensive treatment of a tetanus prone injury.

Tetanus toxoid is the vaccine, and also the 'booster' given when you present with an injury. This booster shot they push so hard on you is shown not to help prevent tetanus when given at time of injury. It is simply given to try and vaccinate the individual while they've got you there in the ER, for the next injury, should one occur.

Vaccinated individuals are shown to contract tetanus less frequently and to have a less severe course with lower mortality.
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#13 of 22 Old 07-09-2007, 01:23 AM
 
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Near as I can tell, there were no cases of pediatric tetanus in the US during the years 1998, 1999, or 2000.
http://www.ncbi.nlm.nih.gov/sites/en...RVAbstractPlus
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#14 of 22 Old 07-09-2007, 01:28 AM
 
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Thanks! It's hard to sort out risk/benefit on things this rare.

-Angela
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#15 of 22 Old 07-09-2007, 01:29 AM
 
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Thank you for the info, blessed
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#16 of 22 Old 07-09-2007, 01:34 PM
 
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Blessed, have you read any of the studies on the use of magnesium in lieu of artificial paralysis? I've read more than one showing that it reduces the need for medication to control spasms (although only rarely to the point that they become totally unnecessary) and at least one that shows it can reduce the need for mechanical ventilation. Do you know if magnesium sulphate was used at all in the boy's case? My assumption is that it wasn't, because I think by my reading that it's viewed more as something that's useful in the third world where they aren't "fortunate" enough to have easy access to drugs that can completely paralyze them. Kind of the same stupid attitude they used to have about breastfeeding - that it was done by people too poor to afford formula.
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#17 of 22 Old 07-09-2007, 02:32 PM
 
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I wish I could link this full article for you, as it looks like a good discussion of latest treatment approaches to tetany.

These authors (out of the UK, which typically parallels US medicine pretty closely) do list intravenous magnesium along with paralytics and sedatives in the algorithm to control tetany.

There has been an overall recognition of the important role of magnesium homeostasis in the role of caring for the critically ill in the last decade or so, and now magnesium levels are routinely followed and replaced as indicated in hospitalized patients.

http://www.ncbi.nlm.nih.gov/sites/entrez
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#18 of 22 Old 07-09-2007, 05:47 PM
 
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http://www.cdc.gov/mmwr/preview/mmwrhtml/00053713.htm

This link is a little frightening to me. I see that a 3 1/2 yr old got it after an insect sting? I had no idea that was possible. But I guess insect stings really don't bleed. So, what would you do if your child got stung by a bee?

The link also mentioned splinters, which makes sense since splinters do not always bleed. Again, WWYD if your unvaxed child got a splinter?
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#19 of 22 Old 07-09-2007, 05:55 PM
 
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Quote:
Originally Posted by DQMama View Post
http://www.cdc.gov/mmwr/preview/mmwrhtml/00053713.htm

This link is a little frightening to me. I see that a 3 1/2 yr old got it after an insect sting? I had no idea that was possible. But I guess insect stings really don't bleed. So, what would you do if your child got stung by a bee?

The link also mentioned splinters, which makes sense since splinters do not always bleed. Again, WWYD if your unvaxed child got a splinter?
Personally? I wouldn't worry.

-Angela
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#20 of 22 Old 07-09-2007, 06:14 PM
 
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I spent about three years of my childhood getting stung by everything going.

Three hornet stings.
A bee sting.
Two nasty stings from unidentified flying critters.

Major swelling and misery in all cases. But I didn't get tetanus in spite of not having the vaccine.

Anything can happen, but if it is rare enough it isn't worth worrying about.
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#21 of 22 Old 07-09-2007, 07:12 PM
 
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Quote:
Originally Posted by DQMama View Post
http://www.cdc.gov/mmwr/preview/mmwrhtml/00053713.htm

This link is a little frightening to me. I see that a 3 1/2 yr old got it after an insect sting? I had no idea that was possible. But I guess insect stings really don't bleed. So, what would you do if your child got stung by a bee?

The link also mentioned splinters, which makes sense since splinters do not always bleed. Again, WWYD if your unvaxed child got a splinter?
Given that tetanus can not withstand being exposed to oxygen, wouldn't rubbing some hydrogen peroxide on the splinter site be enough to kill it off? I think I recall angela saying something about hydrogen peroxide being a good treatment for puncture wounds, but I can't remember for sure.

M : proud mama to B (16) : and G (8) and : x 2 :
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#22 of 22 Old 07-09-2007, 10:01 PM
 
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Forgive my ignorance but...how does one avoid tetanus if it's everywhere (as someone said)? What are the steps for prevention (other than not stepping on rusty nails)?
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