For more than 30 years in Oregon, cases of tetanus in children were almost mythical — studied in textbooks but never seen in person — thanks to the effectiveness of pediatric vaccination programs.
That streak ended in 2017 when an unvaccinated 6-year-old boy arrived at a hospital in the state, experiencing jaw spasms and struggling to breathe, according to a new case study from the Centers for Disease Control and Prevention.
The child was playing on a farm when he cut his head on something, the report said. His parents cleaned and stitched the wound at home, but alarming symptoms emerged six days later. The boy’s jaw began clenching, and his neck and back were arched — a trademark indication of tetanus called opisthotonus that is caused by involuntary muscle spasms.
He was airlifted to a pediatric hospital, where he was diagnosed with tetanus. It was the first instance of the life-threatening neuromuscular disease in a child in Oregon in more than three decades.
“Fortunately, the emergency department physicians immediately recognized the symptoms of severe tetanus,” Judith Guzman-Cottrill, an author of the report and a pediatrics professor at Oregon Health & Science University, told The Washington Post in an email. “Physicians have all read about tetanus, and we have seen pictures of people suffering from tetanus. … It is profound.”
It would be only the start of a downward spiral and lengthy hospital stay for the boy. When he was first admitted to the hospital, he was alert — but couldn’t open his mouth, the report said. Physicians sedated and intubated him because the spasms of his diaphragm and larynx were causing breathing problems.
The boy was given an anti-tetanus immunoglobulin for his wound, as well as the DTaP vaccine, which protects against diphtheria, tetanus and pertussis. He was also placed in a dark room with ear plugs, which helped reduce the intensity of his spasms. His scalp wound was cleaned by medical professionals.
Still, the arching of the boy’s neck and back worsened. His blood pressure shot up, and he became feverish. Doctors inserted a tube in his windpipe so a ventilator could help with his breathing, and treated him with neuromuscular-blocking drugs to reduce his muscle spasms. He would remain on those drugs for more than a month, and in the intensive care unit for a total of 47 days.
By the time he was transferred out of the ICU, the boy needed help walking 20 feet. His tracheal tube was removed on Day 54, the report said. On Day 57, he was transferred from the pediatric hospital to a rehabilitation center, where he spent two-and-a-half weeks.
In all, the boy’s medical charges in the hospital amounted to $811,929 — which did not include the cost of being airlifted to the hospital or of inpatient rehabilitation, according to the CDC. It’s unclear from the report who covered his hospital expenses. It took about a month after his rehab for the boy to return to “normal activities” such as running and bicycling, the report added.
“The patient was in the intensive care unit, in critical condition, for over six weeks,” Guzman-Cottrill said. “The complex and prolonged care led to the high treatment cost. In contrast, the cost of one DTaP dose is somewhere around $24-$30 a dose, and this illness could have been prevented with five doses of DTaP vaccine.”
Notably, physicians counseled the boy’s family to bring the child up to date on all of his vaccinations, as well as receive a follow-up dose of the DTaP vaccine.
His family said no.
The parents who are worried or sure about grave risks from vaccines reflect a broader horror that has flickered or flared in everything from the birther movement to “Pizzagate,” that nonsense about children as Democratic sex slaves in the imagined basement of a Washington pizza joint. Their recklessness and the attendant re-emergence of measles aren’t just a public health crisis. They’re a public sanity one, emblematic of too many people’s willful disregard of evidence, proud suspicion of expertise and estrangement from reason.
–Again and again, until blue in the face, medical authorities have debunked the renegade assertion that there’s a link between the M.M.R. vaccine, so named because it inoculates against measles, mumps and rubella, and autism. On Tuesday, a group of Danish researchers who looked at more than 650,000 children over 10 years announced that they had found no such association.
Again and again, until out of breath, those same medical authorities have also explained why making sure that all or nearly all children are vaccinated is so crucial: It creates a critical mass of resistance, known as herd immunity, that doesn’t give a disease the chance to spread.
Nonetheless, enough parents plug their ears that the World Health Organization lists “vaccine hesitancy” — a euphemism if ever I heard one — among 10 global health threats in 2019.
They choose their own alternative facts. Take Darla Shine, the wife of Bill Shine, who just announced his resignation as the White House communications director. Last month, amid alarms about new cases of measles, she took to Twitter with the cockamamie claim that not being vaccinated and coming down with measles or mumps was a big-picture plus, a hardiness builder that could help a person fight cancer down the line.
“I had the #Measles #Mumps #Chickenpox as a child and so did every kid I knew,” she tweeted, adding that her own kids were, regrettably, vaccinated. “They will never have the lifelong natural immunity I have. Come breathe on me!” Thanks but no thanks. I suspect my breath is better spent elsewhere.
A week and a half ago, a Republican state representative in Arizona said on her Facebook page that pressure on parents to vaccinate children “is not based on American values but, rather, Communist.” Bet you didn’t know that the original symbol of the Russian Revolution wasn’t a hammer and sickle. It was a syringe.
I shouldn’t joke, and I should add that anti-vaxxers run the political gamut. They’re on the left, their professed concern for social welfare proven hollow by the risk that their unvaccinated children pose to newborns and others who haven’t yet been — or can’t be — vaccinated. They’re on the right, among people who see the government and its edicts as oppressive forces. Paranoia has no partisan affiliation.
For example, anti-vaccine propaganda — some of which was spread by Russian trolls and bots as part of their sowing of discord before the 2016 election — can look as official and trustworthy as legitimate information. “And as websites get better and Twitter becomes something that people not only look at but rely on, it’s very difficult to get away from falsehoods and conspiracies,” Specter told me. “We’re living in a world where facts are just another element of your decision-making process.”
One of the best explanations of that came in a 2016 essay in The Times Magazine by Jonathan Mahler, who noted “a radical new relationship between citizen and truth.” He wrote that millions of people “are abandoning traditional sources of information, from the government to the institutional media, in favor of a D.I.Y. approach to fact-finding.”
“Why are parents not vaccinating their kids? What the hell is wrong with people?”
As a father of two young children, I’ve had outbursts like this on more than one occasion as I sit in my Play-Doh- and Lego-littered family room, reading the latest news about measles and other preventable viruses making a global comeback.
This week, Senator Rand Paul, who has previously fueled the dangerous myth that vaccines cause harm by saying in 2016 that it’s “wrong to say there are no risks to vaccines,” spoke out against government-mandated vaccines at a Senate Health Committee hearing, saying, “I believe that the benefits of vaccines greatly outweigh the risks, but I still do not favor giving up on liberty for a false sense of security.” This was just days after the news that passengers might have been exposed to measles at Chicago’s Midway Airport, even though the virus has been considered eradicated in the United States since 2000.
With a measles outbreak affecting over 200 people this year and arecent study proving yet again that there is no reason to believe that the measles, mumps and rubella vaccine, known as M.M.R., causes autism, it’s infuriating to know that parents still resist vaccinating their children. But I know people whom I think of as otherwise intelligent and well intentioned who aren’t convinced that vaccines are safe. In the face of their dangerous choices, I’ve been thinking seriously about what I can do to get through to them.
Medical professionals refer to these parents as “vaccine-hesitant.” As much satisfaction as it might offer to bring my family-room rants — What is wrong with you? — to my conversations with them, I’m starting to believe I can’t simply write them off as idiots. Even presenting facts might not be enough. Those of us who understand how important and safe vaccines are might need to meet them where they are, trying to express empathy for the misguided fear they’re obviously experiencing, if we’re to break through to them and encourage them to make choices that can save lives.
This outlook is inspired by conversations I’ve had at home. My wife, Sarah, is a family medicine physician with a public health degree. She has told me that most of the skeptical parents she sees each week aren’t raving conspiracy theorists — bug-eyed stereotypes who write manifestoes in crayon, listen to Alex Jones and live off the grid. They’re people who seem to make rational choices in most other areas of their lives. “Parents are worried about the vaccine side effects,” she said. “They believe they might cause autism in their children or some debilitating illness.”
“Vaccine-hesitant” parents are often influenced by a thoroughly debunked, nearly two-decade-old study that erroneously concluded that the M.M.R. vaccine is linked to autism in children. Since then, a small but highly organized and zealous group referred to as the “anti-vaxx” movement has promoted this misguided propaganda and also intimidated and harassed pro-vaccine doctors. Russia has strategically weaponized this doubt, unleashing bots on social mediato spread disinformation and promote discord, creating a false equivalency between “both sides” of the debate and “eroding public consensus on vaccination.”
All of this has influenced friends of mine from the Bay Area and Virginia, otherwise highly informed individuals who pride themselves on sniffing out fake news, to remain skeptical about vaccines. Sarah described their mind-set and those of the patients she sees: “The parents don’t trust big pharma. They don’t trust scientific studies, and they think evidence is always changing. They don’t understand how vaccines work. Some will be like ‘I don’t want to overload my kid’s immune system with too many shots at once.’”
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I’ve begun to agree with Sarah, who believes education, personal relationships and counter-narratives are the long-term keys to success and rebuilding trust in health professionals and experts. Her mantra: “Don’t vilify, bully or mock the parents, but try to empathize and teach, and then empower them.” She encourages doctors to actually listen to their patients’ unfounded fears before jumping in with the kind of harsh critiques or judgment that can backfire and solidify their false beliefs. Instead, she suggests doctors acknowledge their concerns and build trust over time, while also providing correct information, facts and relatable personal stories.
It’s obviously difficult to empathize with parents who are “vaccine-hesitant,” as they engage in reckless behavior that is far too dangerous to be left unchecked. The World Health Organization listed vaccine hesitancy as one of the top 10 global threats of 2019. And it’s important to remember that these parents are not making choices that endanger just themselves or even just their children — they’re putting vulnerable groups at risk. People who can’t receive vaccines depend on herd immunity to protect them from diseases.
Still, I try to remember that some vaccine-hesitant parents are victims themselves — of misinformation spread through social media. When I meet parents who don’t believe vaccines are safe, it reminds me of my experiences talking to people who believed conspiracy theories about President Barack Obama being a Muslim born in Kenya. I’m not naïve enough to think I can change the minds of all, but I hold on to the hope that by establishing a relationship and offering facts, we can get many of them to come around. (For those who don’t, I hope they enjoyed having a Muslim president.)
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