Shawn Vestal: A parent makes the choice, but it's not their consequence alone

March 17-- Mar. 17--I grew up in farm country, among people who lived and worked on farms, and lived a good part of my childhood on a farm.

Everyone I knew was aware of the possibility of getting tetanus -- though people usually called it lockjaw -- from stepping on a board with a rusty nail in it, or cutting your arm on barbed wire, or even picking up a splinter or being bitten by a dog.

Everyone knew, at least it seems in retrospect, that you needed to get your tetanus shots.

I don't recall any vaccine "hesitancy," as public health officials sometimes put it to spare the feelings of the anti-vaxxer contingent. I also don't recall any cases of lockjaw that I ever saw firsthand -- though I heard stories.

I would guess that's because my generation was raised by people who did have plenty of firsthand experience with tetanus, those who experienced the before and after eras of tetanus vaccinations.

What happened between those eras is that tetanus -- a disease that is not difficult to catch and which can be horrible and even deadly -- mostly went away, thanks to vaccination. According to the Centers for Disease Control and Prevention, the number of reported tetanus cases dropped 95 percent between 1947 and 2011, and the number of reported tetanus deaths fell 99 percent.

Maybe too many of us have forgotten what tetanus is like, in the same way too many of us have forgotten what the measles is like, or whooping cough or any of the other vaccine-preventable diseases that are making renewed inroads thanks to an anti-vaccination movement built largely on faux science and conspiratorial thinking.

As the Washington Legislature considers tightening up vaccine requirements for kids entering public schools, anti-vaxxer opponents have taken up the argument that it's a simple question of parental choice.

Rep. Matt Shea, the Spokane Valley's champion of the new state of Liberty and a proponent of the discredited belief that vaccinations cause autism, made that argument in Olympia recently: "Where there is a risk and a constitutional obligation, there should absolutely -- 100 percent -- be a choice," he said.

Absolutely. And the chooser, not everyone else, should bear the consequences of that choice. The idea that everyone else in the school system must share in the outcome of the decision not to vaccinate children is an affront to everyone involved. If, as currently proposed, parents who choose not to vaccinate for personal reasons also have to choose not to enroll their kids in public schools, that seems fair.

A recent case of tetanus in Oregon serves as a potent reminder that the consequences of not vaccinating kids are imposed on others. Tetanus is not communicable in the way that measles is. Measles is believed to be the most infectious of diseases; health officials say you can contract it by breathing the air in a room two hours after an infected person has been there.

And yet tetanus is vaccine-preventable, and the ramifications of ignoring that are by no means merely personal.

In 2017, Oregon recorded its first case of pediatric tetanus in 30 years. A 6-year-old boy who had never been vaccinated was outside playing on his family's farm when he was cut on the forehead. The wound was cleaned and sewed up at home, according to a case study issued last week by the CDC.

Within six days, the boy had "episodes of crying, jaw clenching, and involuntary upper extremity muscle spasms, followed by arching of the neck and back (opisthotonus) and generalized spasticity," which is the continuous contraction of muscles, the case study said.

Then he began having trouble breathing, and his parents contacted emergency services and the boy was airlifted to Oregon Health and Science University, where medical professionals were confronting something that most of them had literally never seen before.

Dr. Carl Eriksson, who works in the hospital's pediatric ICU, told the Oregonian he and his colleagues had to consult the literature from other countries where tetanus vaccination rates are low and cases are more common.

The boy couldn't open his mouth to drink water, was suffering "respiratory distress" from spasms in his diaphragm and larynx, and had to be put on a ventilator.

The subsequent eight weeks was a life-and-death battle. The boy was in the intensive-care unit for 47 days, and spent 10 more days in the hospital outside the ICU. He was treated with "multiple continuous intravenous medication infusions" to control his pain and blood pressure, and other drugs to manage the muscular spasms, the case study said.

It took 44 days until he was off the ventilator and able to "tolerate" sips of clear liquids. Three days later, he walked 20 feet with some help. He spent a month in rehab and "returned to all normal activities, including running and bicycling."

Nearly 100 people at OHSU worked on the case. The cost was nearly $1 million. It's not clear whether or how that cost was covered, but it was certainly socialized -- through insurance or charity care or as a result of diverted resources.

The boy had received a tetanus booster known as DTaP upon his initial admittance to the hospital.

But, "despite extensive review of the risks and benefits of tetanus vaccination by physicians, the family declined the second dose of DTaP and any other recommended immunizations," the case study concluded.

They made their choice.

But they shared the consequence.

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