More than 100 people at OHSU Hospital worked to help an unvaccinated Oregon boy survive when he contracted life-threatening tetanus on the family farm. Not one of them had ever seen a child with the bacterial disease before.

An OHSU doctor offered more details this week about how the medical team dealt with the case that drew national attention after federal health officials revealed the boy spent 57 days in the hospital at a cost of nearly $1 million and whose parents declined to vaccinate him after the ordeal.

Dr. Carl Eriksson, who works in OHSU’s pediatric intensive care unit, couldn’t reveal any more about the family but offered insight into the rarity of the disease and the challenges in treating it.

OHSU doctors and nurses had nearly no hands-on knowledge on what to do, he said, because tetanus cases have dropped to about 30 per year in the U.S. since a vaccine became available to prevent it. And the cases that do develop are often in adults because children are most likely to be fully vaccinated against the disease.

Eriksson and others had to consult medical literature from countries where vaccines aren’t prevalent and tetanus is a common health risk, he said.

The boy’s tetanus was severe from his earliest symptoms, he said.

“And it is absolutely life-threatening,” he said.

During the boy’s eight weeks at OHSU’s Doernbecher Children’s Hospital, he stayed in a dark room with ear plugs and other ways to block stimulation, connected to a long-term ventilator to help him breathe through a tube.

With as many procedures and interventions the boy received, he could have easily had complications that killed him. Eriksson said that’s partly why he and his colleagues chose to publish the case study last week for the federal Centers for Disease Control and Prevention.

“It’s always hard to watch a child suffer,” Eriksson said. “It is harder when we know they are suffering from something that’s preventable and obviously we do everything we can to try to avoid those situations.”

The boy, then 6, cut his forehead while playing, according to the case study. The wound was cleaned and sutured at home. Tetanus lives in the soil and apparently was too deeply embedded in the wound to be cleared out in time.

Once the bacteria that causes tetanus is in the blood system, the toxin circulates throughout the body and binds to certain locations in the nervous system. That’s what causes the lockjaw and neck and back muscle spasms commonly seen in tetanus cases.

Within days, the boy couldn’t open his mouth and was constantly arching backward with involuntary spasms. The muscles in his airway also started to spasm, which required doctors to give him a tracheostomy and breathing tube. Because of the extreme pain he was in, the boy also dealt with anxiety, Eriksson said. He was given large suffusions of medications through an IV system to help with the symptoms and side effects.

Several respiratory specialists were involved because of his trouble breathing, Eriksson said, in addition to the nurses and doctors who cared for him.

They also had to reopen the home-administered suture to re-clean the wound. Eriksson that is standard care for these types of infections – they want to rid the wound of as much bacteria as possible because even a little bit could make it impossible to stop the infection.

Eriksson said he and others tried to talk the parents into fully vaccinating the boy because a tetanus infection doesn’t make someone immune to it for life. The vaccine also wanes after a decade or so, which is why even adults who received all five doses of the DTaP -- diptheria, tetanus and pertussis vaccine -- as children are encouraged to get booster shots every decade or so.

The family declined. If the boy had been on a federally recommended vaccination schedule, he would have been fully immunized to tetanus by the time he was infected. He received one dose in the hospital, as is common for treating many vaccine-preventable diseases, but the parents refused a second dose or any other vaccinations, according to the case study.

According to the Oregon Health Authority, just under 93 percent of teenagers were vaccinated against tetanus, diptheria and whooping cough -- one of the lowest in the country.

Eriksson said he and other doctors often will try to convince parents about the risks of not vaccinating a child -- especially in cases where the risk is so apparent.

The family also faced nearly $1 million in hospital bills, as well as having to pay for air transportation to the hospital and 17 days in a rehabilitation facility.

An OHSU spokeswoman said she couldn’t comment on how the family plans to pay, but said there are a number of grants and organizations that help defray medical costs for people who can’t afford them.

The case study came in the midst of the largest measles outbreak in Washington since the measles vaccine was widely adopted. Seventy-five people between Oregon and Washington have caught measles, bringing attention to some of the country’s lowest vaccination rates.

Inquiries about tetanus boosters have increased at OHSU since the case study was published, said the spokeswoman. She also said that people have come to get measles shots in far greater numbers.

Multnomah and Clark counties have both reported higher than usual measles vaccination rates. Clark County doctors have reported more than 400 times the amount given out in a typical year.

“It reminds us that vaccine-preventable illnesses are terrible disease that are often life-threatening and we’re not used to seeing them so when a case like this does come along it’s definitely eye-opening to a lot of people,” Eriksson said.