NPR’s Mary Louise Kelly talks with Dr. Carl Eriksson, assistant professor of pediatrics at Oregon Health & Science University School of Medicine, about treating a case of tetanus in a 6-year-old boy.

MARY LOUISE KELLY, HOST:

If you step on a nail or get bitten by a dog, one of the first questions you will be asked is this. Are you up to date on your tetanus vaccination? Tetanus is a bacterial infection that affects the nervous system. It causes muscles to tighten up. It can make it hard to swallow. It is considered a medical emergency. Fortunately cases of it are extremely rare thanks to the tetanus vaccine, so rare that a write-up about a single case of tetanus in 2017 is now getting a lot of attention.

Dr. Carl Eriksson of the Oregon Health and Science University was one of the physicians who treated that case. He joins me now. Welcome.

CARL ERIKSSON: Thank you for having me.

KELLY: So you and your colleagues write about this case in the CDC’s Morbidity and Mortality Weekly Report. The case was a 6-year-old boy who’d gotten a cut on his forehead. He was playing outside on a farm. Would you describe his symptoms, what his condition was?

ERIKSSON: He started having severe muscle spasms both of his arms and legs, also of his jaw, which is a very classic symptom of tetanus. He started then developing difficulty breathing because of unrelenting spasm of his diaphragm and also of muscles of his larynx and his neck.

KELLY: And I was reading in the CDC report he became very sensitive to stimuli to the extent that you darkened the room he was in; you kept your voices low.

ERIKSSON: Exactly. We had to whisper when we were in the room to try to decrease stimuli as much as possible because stimuli can worsen spasms for a patient with severe tetanus.

KELLY: So he ended up being hospitalized for 57 days. He spent more than a month on a ventilator. I read his hospital bill came to more than $800,000. As a doctor, what was going through your head? I mean, what emotions does that prompt?

ERIKSSON: Well, it’s always hard to watch a child suffer when they’re critically ill obviously. I would say it’s harder when you know that they’re suffering from a disease that is relatively easily preventable. And I think that was also on our minds while we were treating this boy. Another reason why it was really difficult is because quite frankly, we see tetanus in the U.S. so rarely that we had to look hard for the best treatment for this child and turn to literature from the developing world and other ideas for the best way to take care of him.

KELLY: Oh, really? What countries were you looking at?

ERIKSSON: Brazil is a country that has had a lot of relatively recent experience with tetanus and actually even performed some trials of specific treatments for tetanus. And a few other reports helped us to develop the best strategy for caring for this child.

KELLY: I understand after all of that, the many days of treatment, he was eventually able to resume normal activities – running, riding his bike, all the things a 6-year-old boy wants to do. Still his parents declined a second dose of the tetanus vaccine and all other vaccinations. Was that puzzling to you?

ERIKSSON: Unfortunately no. There are a lot of families who refuse vaccination for a variety of reasons. Some just need more information. I know a lot of parents struggle with finding the right source of information and knowing what’s true and what’s not true. Meanwhile, there are others who feel very strongly against vaccination and, even when presented with really clear guidance and information the risks and benefits of vaccines, will continue to refuse vaccination. What this boy reminds us of is that these are really terrible diseases with deadly consequences, and that’s a really important voice to add to the vaccine debate.

KELLY: That’s Dr. Carl Eriksson. He cares for critically ill infants and children at Doernbecher Children’s Hospital, which is part of the Oregon Health and Science University. Dr. Eriksson, thank you so much.

ERIKSSON: Pleasure to be here.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.