How refusing a $150 vaccine turned into an $800,000 medical bill
For a 6-year-old boy on a farm in Oregon, a cut to the forehead while playing outdoors shouldn’t have been a big deal. Instead, the wound resulted in a medical catastrophe costing nearly $1 million and requiring weeks on a ventilator.
And it all could have been prevented — with a routine tetanus vaccine.
This case, which occurred in 2017, is documented in a new report by the Centers for Disease Control and Prevention (CDC).
Within six days of receiving the cut, which was cleaned and sutured at home, the boy began episodes of muscle spasms and jaw clenching, followed by opisthotonus, arching of the neck and back.
Soon he was having trouble breathing, at which point his parents contacted emergency services and the boy was airlifted to the hospital.
The source of distressing symptoms: tetanus, a neuromuscular disease caused by the bacterium Clostridium tetani. Tetanus spores are everywhere in the environment, including dust and soil. Infection is commonly caused by spores entering the body through broken skin — even if wounds are superficial, scrapes and cuts can be enough for transmission.
Tetanus is part of the CDC’s recommended vaccine schedule, but in this case the boy was unvaccinated.
At the hospital, the boy developed jaw muscle spasms — one of the primary symptoms of tetanus, and from which the disease draws its more common name: lockjaw. He requested water, but couldn’t open his mouth to drink.
The boy’s muscle spasms became so bad that he had to be sedated. He was moved to a dark room and had to use earplugs in an effort to keep his body from spasming.
“We minimized stimulation because the child was exquisitely sensitive to light, touch, sound,” Dr. Judith Guzman-Cottrill, a pediatric infectious diseases specialist at OHSU Doernbecher Children’s Hospital in Portland who helped care for the boy, told Healthline. “The opisthotonus (severe muscle spasms) would worsen with any stimulation. Thus, he was kept in a dark, quiet room for weeks. Blocking the neurologic stimulation of his muscles was the only method to get his muscles to relax.”
But the necessary medical interventions didn’t stop there. He required medicine to control his pain. His blood pressure had to be controlled. The boy’s body temperature would fluctuate between 97 and 105ºF (36.1 and 40.6ºC).
His heart would race.
Doctors gave him neuromuscular-blocking drugs, which cause paralysis of the affected muscles to prevent spasms. They performed a tracheostomy and inserted a tube into his lungs for a mechanical ventilator to help him breathe.
In total the boy was sedated for weeks, with 44 days spent attached to a ventilator. The child spent more than six weeks in critical condition in the intensive care unit.
The cost of his care, (excluding emergency air transportation, rehabilitation, and follow-up costs): $811,929.
Tetanus is a rare and completely preventable disease.
“The cost of one DTaP [diphtheria, tetanus, and pertussis vaccine] dose is somewhere around $24 to $30 a dose, and this could have been prevented with five doses of DTaP vaccine,” said Guzman-Cottrill.
Just $150 spent on a vaccine could have prevented a medical nightmare.
The boy’s story is incredibly sad and frustrating, said Dr. Sophia Jan, chief of pediatrics at Cohen Children’s Medical Center, New Hyde Park, NY, and medical director of Northwell Health’s Health Homes Serving Children, after reading the report.
“The amount of trauma that this little boy underwent and will probably continue to feel for a very long time is just tragic. Given that we have vaccines that can completely prevent this, I’m just so frustrated,” she said.
Tetanus in the United States is almost unheard of today. Since theCDC began surveillance of the disease in 1947, cases have dwindled from more than 500 annually to fewer than 100. Tetanus cases have declined more than 95 percent. Tetanus-related deaths have declined more than 99 percent.
“Very rarely do you ever hear about tetanus occurring because the vaccine is so effective,” Jan said. “We get vaccines for tetanus as a child, there’s a series, but after you complete that series as a young child you just need a booster dose every 10 years, that’s it. That’s why you never hear about it because it’s such an easy infectious disease to avoid.”
Parts of Oregon and Washington have been described as anti-vaccination “hotspots,” areas where the number of “philosophical belief” non-medical vaccine exemptions have grown in recent years.
Currently a measles outbreak in that area has resulted in more than 71 infections.
The World Health Organization lists “vaccine hesitancy,” defined as “the reluctance or refusal to vaccinate despite the availability of vaccines,” alongside the deadly Ebola virus as one of the 10 biggest threats to global health in 2019.
“It is within all parents’ rights to ask questions about procedures that kids get. However, vaccines have been the one thing that we’ve had in pediatrics that have completely changed the face of kids’ health. It completely revolutionized children’s quality of life and being able to live disease free,” said Jan.
The CDC, American Academy of Pediatrics, and the larger scientific community, have repeatedly stressed that childhood vaccines are safe and effective.