Need a pep talk please - tetanus - Mothering Forums
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#1 of 41 Old 01-17-2008, 12:05 AM - Thread Starter
 
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Hi all

We're non vaxxers, done heaps of research, and don't worry about things usually...

However, today ds stood on a sharp old metal thing down in the garden buried in the grass. He has a thin cut about 2inchs long in the arch of his foot and reasonably deep (kind of like a decent paper cut). I bled the wound as much as I could but could only get a thin line of blood out of the wound. The wound is clean, but I came in and soaked his foot in warm water with some tea tree oil in it. Then swabbed the area down with hydrogen peroxide and have left the wound uncovered.

I then gave a ledum 30c homeopathic remedy, put a call in to my homeopath and switched to hypericum 30c and have repeated this an hour later.

I felt ok about all of this until I had a drop in from my stepdad who just did a fleeting comment on "tetanus shot" (not a lecture, and they know we don't vax, but a comment none-the-less that has me wavering).

DS is healthy, I'd say he has good circulation providing oxygen to his foot, but the fact that it didn't bleed out a lot kind of makes me concerned. I have also given him some SA and will give him a few more doses over the course of the day.

Any thoughts?

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#2 of 41 Old 01-17-2008, 12:21 AM
 
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I would absolutely not worry about it.
Kids don't get tetanus. And it is not deep plus it does not have to bleed, blood just has to be in the vicinity.

Tetanus can only grow on dead tissue. Not even inside your body, deep inside, where there is blood present (not bleeding, just present) tetanus can not grow.

That is one reason why crush wounds are in danger of tetanus. There is dead tissue inside the body and blood can't flow around it.

Truthfully I wouldn't have done half of what you did aside from cleaning it. There is no danger of tetanus in such a young child.
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#3 of 41 Old 01-17-2008, 12:53 AM
 
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I would absolutely not worry about it.
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-Angela
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#4 of 41 Old 01-17-2008, 01:51 AM - Thread Starter
 
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Thanks!

Oh, and I forgot to mention it was really rusty - but rust isn't any more of a tetanus issue than anything else anyway is it?

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#5 of 41 Old 01-17-2008, 01:55 AM
 
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Tetanus can only grow in an oxygen free environment.

In order for anything to rust, it need oxygen. So just because it was rusty makes no difference.

A rusty dirty thing could cause an infection. But not tetanus.

I have always questioned where the 'rusty nail' tale came from?
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#6 of 41 Old 01-17-2008, 02:03 AM - Thread Starter
 
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Thanks so much Gitti!

It does make you wonder about the rusty nail theory?!

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#7 of 41 Old 01-17-2008, 12:26 PM
 
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Originally Posted by nathansmum View Post
Thanks so much Gitti!

It does make you wonder about the rusty nail theory?!
I just read in Aviva Jill Romm's vaccination book that the rusty nail thing comes from horseshoe nails falling out of horse's feet in barns and into piles of horse manure .. and a puncture wound from an old nail in the presence of horse manure could be a problem, obviously, but the story eventually boiled down to *just* rusty nails, which aren't necessarily a risk by themselves.
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#8 of 41 Old 01-17-2008, 03:26 PM
 
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Originally Posted by Gitti View Post
Kids don't get tetanus.
Statistically, that's true to a first approximation. But when considering the implications of statistical data, it's important to make sure you aren't confusing cause with effect. Almost all reported cases of tetanus are in persons who have either never been vaccinated or who have not had a booster in the preceding 10 years. In the U.S., the numbers of children aged 19-35 months who have recieved at least three doses of the DTaP are estimated to be in the mid to high ninety percentiles. If it's reasonably accurate to say "kids don't get tetanus", it's because most of them are vaccinated against it before they're old enough to start running around getting poked with stuff lying around in the yard, and they haven't lived long enough for their protective titers to have waned.

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Tetanus can only grow on dead tissue. Not even inside your body, deep inside, where there is blood present (not bleeding, just present) tetanus can not grow.
I'd be interested to see what you're using as a source of information for that, because it's not consistent with anything I've ever read about tetanus. Tetanus occurs most often in puncture wounds, yet this type of injury seldom produces significant tissue necrosis directly. It's lack of oxygen that creates conditions favorable to growth of the bacteria, not lack of blood.

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I have always questioned where the 'rusty nail' tale came from?
Tetanus is most often caused by stepping on something sharp; it's most often a nail; and nails rust. If the something was in contact with soil, this increases the risk -- partly because soil is where tetanus spores hang out, and partly because rust gives them something to grab onto. Things rust faster in damp soil, but not immediately. They'll rust in open air, too, it just takes a little longer. So, by itself, the absence or presence of rust ends up not being a very reliable measure of the risk. A more reliable indicator is the fact that the object was "down in the garden buried in the grass".

Because of that, the presence of tetanus spores in the wound may be regarded as a virtual certainty (though it's more prevalent in warm, damp climates, it exists pretty much everywhere). The depth of the wound is probably the most important factor at this point. Had the child been vaccinated, the risk would be effectively zero. As it is, it may not be much greater than that, but it's the sort of call that should really be made by a doctor. This is one lottery you don't want to win.
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#9 of 41 Old 01-17-2008, 04:25 PM
 
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Originally Posted by Neldavi View Post
I just read in Aviva Jill Romm's vaccination book that the rusty nail thing comes from horseshoe nails falling out of horse's feet in barns and into piles of horse manure .. and a puncture wound from an old nail in the presence of horse manure could be a problem, obviously, but the story eventually boiled down to *just* rusty nails, which aren't necessarily a risk by themselves.



Makes sense!
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#10 of 41 Old 01-17-2008, 04:27 PM
 
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If it's reasonably accurate to say "kids don't get tetanus", it's because most of them are vaccinated against it before they're old enough to start running around getting poked with stuff lying around in the yard, and they haven't lived long enough for their protective titers to have waned.

Can you prove that?

http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5203a1.htm

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During 1998--2000, an average of 43 cases of tetanus was reported annually; the average annual incidence was 0.16 cases/million population. The highest average annual incidence of reported tetanus was among persons aged >60 years (0.35 cases/million population), persons of Hispanic ethnicity (0.37 cases/million population), and older adults known to have diabetes (0.70 cases/million population). Fifteen percent of the cases were among injection-drug users. The case-fatality ratio was 18% among 113 patients with known outcome; 75% of the deaths were among patients aged >60 years.
What's the incidence of tetanus in unvaccinated kids?

If the reason kids don't get tetanus is because they're getting the vaccine, then the incidence of tetanus in unvaccinated kids should be quite high, right? One in 5, one in 10,one in 100, or one in 1,000 etc...

If the incidence is extremely low in unvaccinated kids, the kids getting the DTaP can not be "the" reason why kids, as a general rule, don't get tetanus.
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#11 of 41 Old 01-17-2008, 06:03 PM
 
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Originally Posted by mamakay View Post
Can you prove that?
What, that most kids in the U.S. are vaccinated against tetanus? If you doubt the accuracy of coverage estimates of mid to high ninety percentiles, among 19-35-month-olds, I could link to the stats, but I'd be surprised to see you even dispute it. Are you questioning whether it's true that very nearly every case reported involves a person not protected by vaccination at the time?

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If the incidence is extremely low in unvaccinated kids, the kids getting the DTaP can not be "the" reason why kids, as a general rule, don't get tetanus.
The fact that "as a general rule" kids don't suffer deep puncture wounds probably has quite a bit to do with it as well. What I find most pertinent is that while incidence in unvaccinated kids is very low, in vaccinated kids, it's nonexistent.
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#12 of 41 Old 01-17-2008, 07:31 PM
 
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What, that most kids in the U.S. are vaccinated against tetanus?
No, I meant...can you prove that the reason kids generally don't get tetanus is because they're getting the DTaP.

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The fact that "as a general rule" kids don't suffer deep puncture wounds probably has quite a bit to do with it as well.
That might be a little of it, too.
Do you think good circulation plays a part?
Proper wound management?

If vaccination is the one and only reason kids don't get tetanus, the attack rate in unvaccinated kids should be about 100%.
Right?

So, what's the incidence in unvaxed kids?

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What I find most pertinent is that while incidence in unvaccinated kids is very low, in vaccinated kids, it's nonexistent
Well, that's true.

GBS from tetanus vaccination is nonexistent in unvaccinated kds, too.
As is anaphylaxis from vaccination.
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#13 of 41 Old 01-17-2008, 07:40 PM
 
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in vaccinated kids, it's nonexistent
Not according to the CDC's own tetanus surveillance:

http://www.cdc.gov/mmwr/preview/mmwr...053713.htm#top

(13%) of the 122 non-neonatal patients with supplemental data were reported to have received at least a primary series (i.e., three or more doses) of TT before onset of illness (Table_1), including two (40%) of the five non-neonatal patients aged less than 20 years. Three (60%) of the non-neonatal patients aged less than 20 years were unvaccinated because of their parents' religious objections. The fourth case occurred in a boy aged 14 years who was bitten by a dog and who had received his last dose 2 years previously.
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#14 of 41 Old 01-17-2008, 07:54 PM
 
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Not according to the CDC's own tetanus surveillance:

http://www.cdc.gov/mmwr/preview/mmwr...053713.htm#top

(13%) of the 122 non-neonatal patients with supplemental data were reported to have received at least a primary series (i.e., three or more doses) of TT before onset of illness (Table_1), including two (40%) of the five non-neonatal patients aged less than 20 years. Three (60%) of the non-neonatal patients aged less than 20 years were unvaccinated because of their parents' religious objections. The fourth case occurred in a boy aged 14 years who was bitten by a dog and who had received his last dose 2 years previously.
Interesting...
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#15 of 41 Old 01-17-2008, 09:06 PM
 
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No, I meant...can you prove that the reason kids generally don't get tetanus is because they're getting the DTaP.
No. I was expressing my opinion that the evidence speaks for itself. If you look at what happened to tetanus incidence following the introduction of a vaccine against it in the 1940's, I don't see how you could conclude anything but that the vaccine was responsible for the decline.

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Do you think good circulation plays a part?
Don't see why it would.

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Proper wound management?
Yes.

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If vaccination is the one and only reason kids don't get tetanus, the attack rate in unvaccinated kids should be about 100%
Tetanus isn't contagious between hosts, so I don't see how you can even speak meaningfully about attack rate.

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GBS from tetanus vaccination is nonexistent in unvaccinated kds, too.
As is anaphylaxis from vaccination.
Ok, you got me there. What are those rates?


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Originally Posted by attachedmamaof3
Not according to the CDC's own tetanus surveillance:
Well, look closer. Only two of the 16 were under 20. Maybe they were under, say, seven. It doesn't say, but figure 3 shows them in the 5-19 group. Call that kids, and note that two out of, say, eighty million is still not "nonexistent", and you win the point. Might note that there were zero fatalities among the fully vaxed, though; as well as this:

"Previous vaccination status was directly related to severity of disease, with the case-fatality ratio ranging from 6% for patients who had received one to two doses to 15% for patients who were unvaccinated."
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#16 of 41 Old 01-17-2008, 09:21 PM
 
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Actually, 2 were 0-4, 3 were 5-19...but whatever.

My point is:

Your statement was that tetanus in vaccinated children is nonexistant.

In this report there exists a whopping FIVE children under 19 who reported tetanus infection.

2 of those 5 were vaccinated. 3 weren't.

What makes the vaccinated children "non-existant" and the unvaccinated children a national emergency? Semantics.

If you want to agree that reported unvaccinated children are just as NON-EXISTANT than I'll concede.
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#17 of 41 Old 01-17-2008, 09:27 PM
 
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Additionally, the fatal cases for the under 20 age group was exactly ZERO.

Good job pulling in all the stats on the older/diabetic/high risk/IV drug user population though.
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#18 of 41 Old 01-17-2008, 09:46 PM
 
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Originally Posted by dymanic
No. I was expressing my opinion that the evidence speaks for itself. If you look at what happened to tetanus incidence following the introduction of a vaccine against it in the 1940's, I don't see how you could conclude anything but that the vaccine was responsible for the decline.
Well, the vaccne is effective, but there were about 500 cases a year in the 1940's, right? Now we have about 50 a year.

Now we have antibiotics, OSHA to make working safer, better access to medical care for wounds, etc.

The CDC thinks the vax brought it down as well as...

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

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(TIG) for postexposure prophylaxis in wound treatment, and c) improved wound care management. In addition, increased rural to urban migration (2), with consequent decreased exposure to tetanus spores, may have contributed to the decline in tetanus mortality noted during the first half of the century.
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Don't see why it would.
Why do you think people with diabetes are more prone to get tetanus?
http://www.cdc.gov/diabetes/news/docs/hcp_materials.htm
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Reported tetanus is about 3 times more common in people with diabetes and fatalities are about 4 times more common.
http://natamcancer.org/page183.html
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How does diabetes affect the body? If the blood sugar (glucose) is not controlled, it can lead to a number of complications:
Quote:
Poor circulation

Poor circulation prevents nutrients and oxygen from reaching the cells to help heal wounds and infections.
Cells without oxygen or nutrients die.
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Poor circulation and infections

A cut or wound will not heal well or quickly if there is high blood sugar The germs feed off the sugar and multiply.
The damaged blood vessels are not able to transport enough infection-fighting cells, natural antibodies, antibiotic medicine or nutrition to the wound to heal well.
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Originally Posted by dymanic
Tetanus isn't contagious between hosts, so I don't see how you can even speak meaningfully about attack rate.
Since when does "attack rate" only refer to contagious diseases?
http://care.diabetesjournals.org/cgi...tract/28/2/296
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Ok, you got me there. What are those rates?
I can't find the fulltext of the IOM ruling, so I don't know. The actual rate is probably unknown, anyway.
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#19 of 41 Old 01-17-2008, 09:52 PM
 
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What makes the vaccinated children "non-existant" and the unvaccinated children a national emergency?
I never said it was a national emergency, and nathansmum didn't express any concerns about that when she started the thread. She wants to know how much to worry about tetanus with the wound she described. All of us here pretty much agree that she shouldn't worry about it too much. I know I never have, but then all of my kids were vaccinated.

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If you want to agree that reported unvaccinated children are just as NON-EXISTANT than I'll concede.
If you want to agree that unvaccinated children are practically nonexistent, I'll concede. Actually, I pretty much did that already when I said:

"Had the child been vaccinated, the risk would be effectively zero. As it is, it may not be much greater than that"

and I'm quite comfortable with the advice I followed that with, which is the only advice I'm prepared to offer:

"it's the sort of call that should really be made by a doctor"
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#20 of 41 Old 01-17-2008, 10:05 PM
 
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Egad.
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#21 of 41 Old 01-17-2008, 10:18 PM
 
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3 dose DTaP coverage hangs out aroud 95%
http://www.cdc.gov/vaccines/pubs/pin...G/coverage.pdf

2,000 unvaxed kids a year under 1 each year...

Till age 4 will be 8,000...

At age 8, that would be 16,000 if they remain unvaxed...some will vax for school, though, leaving the religious/philo exemptors.

Either way, I wouldn't say unvaxed kids parctically don't exist.
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#22 of 41 Old 01-18-2008, 05:03 PM
 
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Originally Posted by mamakay View Post
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Originally Posted by CDC
(TIG) for postexposure prophylaxis in wound treatment, and c) improved wound care management
None of which is going to do Nathan any good unless Mum takes him to the doc. Ditto antibiotics.

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Originally Posted by CDC
increased rural to urban migration, with consequent decreased exposure to tetanus spores, may have contributed to the decline in tetanus mortality noted during the first half of the century.
Makes perfect sense. Millions of people, living out their lives in artificial environments made of concrete and steel, seldom get anywhere near anything you'd really call "soil", and the same is likely to be true of any type of object they're likely to get poked with. The risk to Nathan would be considerably less had he been injured on a bolt sticking out of a fifth-floor railing in his New York apartment building. But he wasn't. It was "a sharp old metal thing down in the garden buried in the grass", remember?

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Originally Posted by mamakay
Why do you think people with diabetes are more prone to get tetanus?
I wouldn't be so quick to assume that it was due to anaerobic conditions caused by poor circulation. In addition to being statistically just as prone to injury as anyone else (and maybe a little bit more), diabetics don't even have to experience a puncture wound, because they are especially prone to ulcers and lesions on the feet which can provide a point of entry for the bacterium.

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Since when does "attack rate" only refer to contagious diseases?
Here, we're talking about a risk factor that's virtually impossible to track. For tetanus infection to occur, the bacterium requires a point of entry. This is most often provided by a puncture wound. It doesn't have to be big, it just needs to be kinda deep. A sufficiently deep splinter has been known to do it. Of all the children in the U.S. who recieved such a wound, what percentage were untreated? Until you know that, I don't see how you can talk about attack rate.

There are basically two things that will render a person's chances of getting tetanus effectively zero. One is to get vaccinated. The other is to not get poked with anything, especially not anything that's been in contact with soil. Nathan is out of the box on both of those scores. There are several other things that can also reduce those chances, at least the chances of dying from tetanus: antibiotics; post-exposure prophylaxis; proper wound care. The only one possible without professional intervention is the wound care. I don't know if anyone else here is prepared to make specific recommendations on that and accept a share of the responsibility for the outcome, but I know I'm not.
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#23 of 41 Old 01-18-2008, 05:08 PM
 
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We're non vaxxers, done heaps of research, and don't worry about things usually...
How is your son doing?
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#24 of 41 Old 01-18-2008, 07:00 PM
 
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Originally Posted by dymanic
I wouldn't be so quick to assume that it was due to anaerobic conditions caused by poor circulation. In addition to being statistically just as prone to injury as anyone else (and maybe a little bit more), diabetics don't even have to experience a puncture wound, because they are especially prone to ulcers and lesions on the feet which can provide a point of entry for the bacterium.
The ulcers are caused by poor circulation, too.

http://orthoinfo.aaos.org/topic.cfm?topic=A00148
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Minor injuries become major emergencies before you know it. With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight can cause a lot of damage. Diabetes decreases your blood flow, so your injuries are slow to heal. When your wound is not healing, it's at risk for infection. As a diabetic, your infections spread quickly.
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#25 of 41 Old 01-18-2008, 09:48 PM
 
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The ulcers are caused by poor circulation, too.
Right. That was pretty much my point.

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Originally Posted by orthoinfo
Diabetes decreases your blood flow, so your injuries are slow to heal.
But that's not the same as saying "diabetes decreases your blood flow, thereby creating an anaerobic environment".

The intuitive assumption underlying the comment (by Gitti) that initiated this exchange ("tetanus can only grow on dead tissue. Not even inside your body, deep inside, where there is blood present (not bleeding, just present) tetanus can not grow") is that an anaerobic environment can't exist where oxygenated blood is present. You haven't explicitly subscribed to this notion, but your attempts to lend it support (both with the above snippet and with another on the first page: "Poor circulation prevents nutrients and oxygen from reaching the cells to help heal wounds and infections") suggest that you are also inclined to accept this assumption. But it is free oxygen that inhibits the growth of the bacteria, and oxygen in blood is bound to hemoglobin.
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#26 of 41 Old 01-18-2008, 11:59 PM
 
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You haven't explicitly subscribed to this notion, but your attempts to lend it support (both with the above snippet and with another on the first page: "Poor circulation prevents nutrients and oxygen from reaching the cells to help heal wounds and infections") suggest that you are also inclined to accept this assumption.
I'm supporting the assumption that part of why kids don't generally get tetanus is because of their good circulation.
Are you still going to argue that you can't think of why that has anything to do with it?
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#27 of 41 Old 01-19-2008, 02:22 AM
 
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I'm supporting the assumption that part of why kids don't generally get tetanus is because of their good circulation.
In the strictest sense, I suppose that's true. But it seems like a sort of bassackwards way of looking at things, and implies that good circulation offers some affirmative protection against tetanus aside from being a good indicator that diabetes is not a factor -- a conclusion which quickly fails on the simple observation that the vast majority of tetanus cases aren't diabetics, and therefore may be assumed to have normal circulation.

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Are you still going to argue that you can't think of why that has anything to do with it?
I'll continue to dispute the implication that it has anything directly to do with creating an anaerobic environment, yes.
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#28 of 41 Old 01-19-2008, 04:17 PM
 
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a conclusion which quickly fails on the simple observation that the vast majority of tetanus cases aren't diabetics, and therefore may be assumed to have normal circulation.
The highest incidence is in those over 60.
Do you think poor circulation could have anything to do with that (along with declining immune function)?

Or do you dispute that those over 60 are more prone to have poor circulation?

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I'll continue to dispute the implication that it has anything directly to do with creating an anaerobic environment, yes.


I'm a little confused by your wording.

Are you saying poor circulation can't lead to the kinds of lingering wounds that can house anaerobic bacteria? The logical extension of that would be that excellent circulation makes one less inclined to have those kinds of lingering wounds.
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#29 of 41 Old 01-19-2008, 04:35 PM
 
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Originally Posted by dymanic View Post
What I find most pertinent is that while incidence in unvaccinated kids is very low, in vaccinated kids, it's nonexistent.
Can you please provide the research/stats/statistics on that on CDC or some other standard website?
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#30 of 41 Old 01-20-2008, 04:07 AM
 
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Originally Posted by mamakay View Post
The highest incidence is in those over 60.
Do you think poor circulation could have anything to do with that (along with declining immune function)?
No, I don't. It's pretty clear from the statistics that vax status is the most significant factor as far as incidence is concerned, and coverage among the elderly is poorer than in other groups. The case fatality rate (roughly 50% in elderly patients) is surely influenced by declining immune function, but also represents a lower tolerance for the toxins produced by the bacteria (one of which is, by weight, among the most potent toxins known). I wouldn't be quick to dismiss the role of immunosenescence, but as tetanus vaccination is highly efficient by comparison with some other vaccines, it seems clear to me that this is not the main cause for the bias in rates of incidence toward the elderly.

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Are you saying poor circulation can't lead to the kinds of lingering wounds that can house anaerobic bacteria?
Yes. Tetanus requires a wound. It doesn't require that the wound be "lingering", just that it be deep enough to create an anaerobic environment. The incubation period is 3-21 days, the average being 8 days. I don't know how you'd define "lingering", but to me, it's more than 8 days. By itself, poor circulation doesn't lead to wounds, lingering or otherwise. (I'll grant that a wound which remained open for a long time could provide a longer window of opportunity for the bacteria to enter, but statistically my money would be on entry most often occurring right away.)

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Originally Posted by anewmama
Can you please provide the research/stats/statistics on that on CDC or some other standard website?
This pdf has information on age distribution:
http://www.cdc.gov/vaccines/pubs/pin...ds/tetanus.pdf

Here's an interesting tidbit:
Only 4 of 520 persons dying from tetanus (0.7%) had a history of at least 3 TT doses
http://cdc.confex.com/cdc/nic2005/te...paper_7813.htm
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