In October of 2016, I returned to Bernard Mevs Hospital in Port Au Prince, Haiti. Hurricane Matthew, a category 4 hurricane, had touched down near Jeremie only four days prior. Hurricane Matthew caused significant devastation with over 2 million people directly affected, and over 500 reported deaths. As local health care facilities in southwest Haiti had limited capabilities to care for pediatric trauma patients, Bernard Mevs had arranged transport for the most critically injured. That is how I came to meet A.J. He was a 12-year-old boy who had been severely injured when he was pinned under a fallen tree during the hurricane. When he arrived, he was febrile and anemic with a shattered femur, a transected spine, and a large open wound to his back. Initially, the team’s biggest concern was sepsis and inevitable paralysis. However, as his case progressed, A.J. experienced much worse complications. Within an hour of arrival, we started to notice unusual changes. His face contorted into an awful grimace and his body jerked, almost throwing him from the bed. Our initial concerns for untreated pain progressed to horror as we realized he was developing uncontrollable muscles spasms from tetanus. Despite our use of all available resources, A.J continued to have painful spasms wrack his body and close off his airway until he was incapable of breathing on his own. He eventually passed away not from the unforeseen trauma of the hurricane but from the preventable infection that had worked its way through his open wound to overtake his nervous system and ultimately kill him.
The bacteria Clostridium tetani is endemic in soil and thereby poses a risk to individuals with contaminated wounds. While tetanus is easily preventable with vaccinations and boosters, after injuries, it continues to pose a significant health risk in low and middle-income countries where access to medical care and vaccinations are limited. Approximately one million cases of tetanus occur worldwide each year with fatality rates reported as greater than 40 percent in developing countries.
The incidence of tetanus in high-income countries is almost nonexistent due to widespread vaccination. However, the recent measles epidemic is alarming evidence of waning vaccination compliance. With the measles outbreak currently affecting the United States with more than 1,000 cases this year, I feel obligated to tell parents what horrors vaccines are shielding their children from and what risks they are taking when choosing not to vaccinate their children. The fact that this generation of parents has grown up in a world mostly protected from the devastation of vaccine-preventable illness does not mean they do not exist. I doubt parents of the unvaccinated children who contracted measles have ever seen a case of measles encephalitis or respiratory failure from tetanus. I feel like Lois Lowry’s The Giver, remembering the terrible outcomes these parents are lucky enough not to have seen. Although I don’t need to remember these terrible illnesses from a time before vaccinations, all it takes is a short plane ride to a less affluent country.
While I hope no one ever has to see a child suffer and die from any illness, I do think people should know the real risks of the diseases that vaccines prevent. I don’t think anyone who’s had to see a child die from a vaccine-preventable disease would think twice about protecting their child. I think if A.J’s parents had had the opportunity to protect him, they would have taken it.
Alice Ruscica is a pediatric emergency physician.
Image credit: Shutterstock.com
