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PORTLAND, Ore. — A 6-year-old boy in Oregon fell down while playing on a farm and cut his forehead—and if he’d had his standard childhood shots, you wouldn’t be reading about him.

But the boy was unvaccinated, and he ended up suffering greatly and almost dying from the first childhood case of tetanus doctors in the state had seen in more than 30 years, the Oregonian reports.

A report from the Centers for Disease Control and Prevention says the boy was airlifted to a hospital after suffering symptoms including jaw clenching, muscle spasms, and arching of the neck and back. He spent 57 days in the hospital, including 47 days in intensive care, and had to breathe through a tube inserted into his windpipe. Doctors diagnosed him with tetanus and gave him a dose of the vaccine.

The boy was able to return to normal activities around a month after leaving the hospital. His family—who received a bill for more than $800,000—declined the necessary second dose of the tetanus vaccination and all other vaccines. Infectious-disease expert Dr. William Schaffner tells Live Science that the boy’s illness was a “tragic event” that was “completely preventable”—and the parents’ decision not to vaccinate him even after the illness was a “second tragedy.” Schaffner says the bacterium that cause tetanus is “everywhere,” including in soil, and vaccination is the only real protection. (Oregon is also experiencing a measles outbreak caused by failure to vaccinate children.)