Vaccine-preventable diseases

A DO treated Oregon’s first child with tetanus in more than 30 years

Judith Guzman-Cottrill, DO, shares details about being on the team of physicians who treated the unvaccinated patient.


In 2017, a 6-year-old Oregon boy got a deep cut on his forehead while playing outside. His parents treated the wound at home. But less than a week later, he had to be air-transported to Oregon Health & Science University. The child, who had never been vaccinated, could not open his mouth.

Judith Guzman-Cottrill, DO, diagnosed the patient with tetanus, an acute neuromuscular disease. He was suffering from muscle spasms in his jaw and respiratory distress which required sedation, endotracheal intubation, and mechanical ventilation.

The child was admitted to the pediatric intensive care unit and cared for in a darkened room with earplugs and minimal stimulation because of the intensity of his spasms, according to Dr. Guzman-Cottrill’s CDC case report. He spent 57 days in the hospital. The inpatient charges were $811,929.

The DO spoke with Dr. Guzman-Cottrill, a pediatric infectious disease specialist at Oregon Health & Science University, about her role in treating the 6-year-old boy with tetanus and the ongoing controversy surrounding vaccination. Following is an edited Q&A.

What advice do you give parents who are considering not vaccinating their children?

As a pediatric infectious disease specialist, I provide vaccine guidance whenever possible. Parents should consult with physicians they trust, who will provide evidence-based guidance for all preventive health care, including vaccinations. I am also able to share the true stories about my patients who have unfortunately suffered or died from vaccine-preventable diseases. They are compelling stories.

What systems (educational, social, economic) will help to provide a greater understanding of the need for vaccines?

The level of vaccine hesitancy has become so high across the developed world. I am worried that there will not be a big shift until we hear about American children dying of a vaccine-preventable disease.

What is the biggest misconception that people have about vaccines?

There are so many misconceptions about vaccines’ safety and efficacy. When teaching medical students and residents about effective communication with vaccine-hesitant parents, I always say the first question should be, “Why are you hesitant? What are you worried about?”

In this case, how did the cost of treating the patient compare to the cost of vaccinating?

It cost over $800,000 to treat this one child with severe tetanus. To put that into perspective, one tetanus vaccine costs about $25. CDC guidelines recommend that children receive five doses of tetanus vaccine by age 6.

What was your biggest fear while treating this child?

My biggest concern was that he would not survive this life-threatening disease. He was critically ill for a very long time. He suffered greatly and it was not easy to watch him suffer.

More case details

This was the first pediatric tetanus case in more than 30 years in Oregon, Dr. Guzman-Cottrill noted in her CDC case report. Since the introduction of the tetanus vaccine in the 1940s, there has been a 95% decline in the number of tetanus cases and a 99% decrease in the number of tetanus-related deaths.

The 6-year-old patient received his first dose of tetanus vaccine when he was diagnosed. Following an extensive review of the risks and benefits of tetanus vaccination with physicians, his family declined his second dose of DTaP and other recommended immunizations.

For further reading

Rare and eradicated diseases making a resurgence in the U.S.

Less than 62 percent of Americans know there is a vaccine for shingles

From agony to advocacy: How two DOs survived the loss of their 2-year-old daughter


  1. Scott Boydman

    So even after the child recovered from life threatening disease, the family continued to resist/refuse vaccinations after a single dose of tetanus. Unbelievable!

  2. Robert Beckman, D.O.

    Case reports like this are not that helpful unless they included more pertinent information like living environment (farm community with horses nearby?), the mode of injury, what wound care was done and if it was appropriate. A clean wound is not susceptible to infection with Clostridium tetani.

Leave a comment Please see our comment policy