Why You Should Second Guess the Tetanus Vaccine

On Wednesday, February 23, 2005, my daughter was bitten pretty severely by a cat. Since the wound was gaping, I immediately called the pediatrician to see if they do stitches. "No," the nurse said, "but is your child up to date on vaccines?" I told her no; the last shots she had were at the age of six months. "She will need to have a tetanus shot, then. Make sure you tell the doctor in the ER that her vaccines are not up to date."

Thinking that her arm was going to fall off if we didn't get this shot, we took off for the hospital with a child you would never guess was wounded at all. It's really hard to get a two year-old to lie on the floor, moaning and groaning, to get us in faster, so we sat in the waiting room and watched lots of people go ahead of us. She danced around, entertaining the moaners and groaners. Oddly, they were just not amused.

Finally, it was our turn. At our closest hospital, the pediatric services do not open until 4 pm. So when the ER doctor looked at her arm and said she didn't need stitches, I was very interested in having a pediatrician look at the wound. Maybe this doctor was used to looking at large, gaping adult wounds and didn't realize that our son had gotten stitches for a smaller wound a couple of years before. I became even more alarmed when he said she did not need a tetanus shot. He was going to just let her arm fall off!

Once the doctor left the room, my husband and I went back and forth a little bit, then asked for a pediatrician when the nurse came in. Of course, the original doctor came back when he heard this request and wanted to know what the "problem" was. I missed most of this dialogue as I was already on the phone with the pediatrician to find out about the vaccine...but we did find out that standard protocol for cat bites is to not sew the wound. It would be taped with steri-tape so that any infection could drain out of her wound; sewing it closed would leave no escape for fluids (pus) to leave her body, causing more problems. Okay, I could buy that.

Now keep in mind that I am against vaccinations. So why I had the pediatrician on the phone to make sure she DID need the vaccine is beyond me. Maybe it was the stress. Maybe I had horror stories in my mind, and just "knew" that when you have an injury such as this, you are supposed to get a tetanus shot...right? What I picked up from the phone conversation with the pediatrician's office is that they weren't concerned that she get a tetanus shot for her injury. They just wanted her updated on her shots.

It then occurred to me that I could ask for just the tetanus portion of the DTaP vaccine. Then I came to my senses...how do I know the tetanus vaccine is safe? I'd heard about the pertussis vaccine problems, but never did I worry about  the tetanus vaccine. I decided to go home and read on the internet about this vaccine before heading to the pediatrician.

And guess what I found? Lots of interesting information that I am going to share with you. One site in particular, and I will share some information below from various sources on this site. Needless to say, my daughter did not get the tetanus vaccine.

http://www.nccn.net/~wwithin/tetanus.htm

From http://66.70.140.217/v/tetanus.html : (Link no longer works; my apologies)

Tetanus as a clinical entity is linked to a bacteria, Clostridium tetani. Obviously, the germ is not as malicious as one may think because it lives as a harmless commensal in the animal and human intestinal tract (1). It is not the very presence of the bacteria which causes the trouble, but the toxins that are produced by the bacteria under anaerobic conditions, that is, where the bacteria operates in an environment free of oxygen. These toxins can be spread through the blood vessels and finally affect the nervous system causing tetanic muscle contraction and pain. The condition is extremely painful and potentially lethal.

Tetanus morbidity is very low in industrial countries. In the USA, for example, there are only about 50 cases a year (2); in Germany, 17 (3).

Mortality figures range between 33% (4) and 20% (2). The incidence is higher in tropical countries and under poor hygienic conditions. Mortality is 135 times higher in developing countries compared to developed countries. In those countries, tetanus in newborns plays a very important rote. Most of those cases are caused by using dirty, rusty scissors when cutting the umbilical string of the newborn.

Prophylaxis against tetanus raises serious theoretical and, above all, practical questions, since the disease itself is known not to induce immunity. If the disease cannot induce protection, how can a vaccine?

Antibody levels do not rise until 4 days after vaccination (5), so vaccination at the time of injury is of no use.

My daughter's wound did get infected, as most cat bite wounds do. She was on an antibiotic (another thing I'm not crazy about) but we loaded her up with vitamins to counteract the effect the antibiotics would have on her body. The infection quickly improved and she is now almost completely healed. I am sharing this information with you because if you are reading from my site, you likely have a child. And you probably already know that there will be boo-boos, and blood will be shed at some point in your child's life. Whether you decide to vaccinate your child or not, do not do it without reading all the facts, and PLEASE don't do anything because your doctor said so. These doctors didn't agree...and for that I am glad because it made me check a third source!

Update, 2017

A few years ago, we adopted a dog from the Humane Society that had some issues. He was high anxiety and nipped a lot out of instinct (he no longer does this at all). My daughter went to kiss him good night and he had been sleeping and instinctively nipped, catching the corner of her lip in the process. It was a small tear, but needed repair.

At the ER, of course they went through their litany of questions regarding the dog, but then came the vaccine questions. And again came the "tetanus" discussion. But this time, my daughter was older and could understand when the doctor actually said to her, "Your mom said 'no,' so we can't help you," as if she was going to get sick from the dog bite and I was going to let her!

Oddly, my son has needed stitches at least two times in the past five years, and neither time do I remember tetanus even coming up. Perhaps it's only with animal bites, or perhaps it just depends on the doctor and what s/he was "programmed" to know. Either way, I'm glad I know better...