(listed in immune function, originally published in issue 201 – December 2012)

At the beginning of the year, the 9 year old son of a friend of mine was complaining of a pain under his big toe. The father was told that the offending source of pain was a wart. Unfortunately, it was a misdiagnosis with serious consequences, as there was no wart to ward off but only a splendid splinter which had provoked an abscess needing urgent attention.

From tiny beginnings that needed only tweezers, soap and water and, to be on the safe side, hydrogen peroxide, the splinter that was mistaken for a wart became responsible for the boy’s hospitalization where he was pumped with high doses of antibiotics before and after he went under the knife.

That was worrisome enough but, knowing the medical profession, my friend was expecting another source of worry to come. And, as predicted, it did come via the sound of the ‘v’ word being pronounced more and more insistently. Questioning the value of the ‘v’ word is a taboo and anathema. ‘V’ stands for vaccination and in this story the vaccination that was deemed to be necessary was the tetanus one.

When my friend made it known that he didn’t want his son to be injected with the tetanus vaccine, the medical establishment began its attack. First, the surgeon summoned him and asked him why he was opposed to his son being vaccinated. After he explained succinctly his reasons, the surgeon became impatient and resorted to the ultimate emotional blackmail: no vaccine, no operation. Faced with such a dilemma, the beleaguered man reluctantly agreed for his son to get the shot. At least, the surgeon had the courtesy to ‘discuss’ the matter in private.

It didn’t stop here though. Later on in the day, a young consultant and nurse came to the boy’s bed, next to which his father was seated. Without much of an introduction, she started to aggressively ask him why he didn’t want his son to be vaccinated ‘against’ tetanus and when he tried to explain the reasons she became red in the face and displayed symptoms of an acute form of medical hubris, ignorance, arrogance and insensitivity.

First she recited the usual mantra that vaccination is one of the greatest discoveries made by medicine. As a parenthesis, I would rather choose the medical profession’s adoption of hand-washing between patients, after years of rejection of and hostility towards it. This simple practice saved and is still saving countless lives as does any other means of hygiene and sanitation.

Then she said, in front of this man’s boy, that if he was not vaccinated he might die and quickly ‘corrected’ herself by adding “he will die”. That was scare-mongering at its best, delivered in the most insensitive manner. Finally, she uttered other inaccuracies that only proved that she didn’t know much about the topic apart from the usual information fed to her by pharmaceutical companies. The only way to stop her hubristic harangue was to tell her that, anyway, he had already given, under duress, his consent to his son being vaccinated.

Tetanus is for sure a dreadful disease with scary symptoms. Wherever the site of infection is, the first main symptom will always be the trismus (tonic spasm of muscle) of the jaw causing the mouth to remain tightly closed. This is why tetanus is commonly known as lockjaw. Risus sardonicus (a sardonic smile) caused by facial muscles spasms is another characteristic feature. In generalized tetanus, muscle spasms progress to the whole body which can go into opisthotonus (arching of the back). These contractions can be powerful to the point of breaking bones and dislocating joints. In severe cases when breathing muscles are involved, death can be the outcome if there is no medical intervention (mechanical ventilation with a respirator).

After this graphic description of tetanus maybe one should not be too surprised that the collective imagination is filled with fear of this disease. And this is why, among people who shun vaccines, there are some who would make an exception for tetanus. It is ironic though because the tetanus vaccine is use-less, a mere placebo if it was not for the fact that a placebo is a harmless substance while the tetanus vaccine carries serious and sometimes fatal risks of adverse reactions.

Tetanus is caused by a toxin (tetanospasmin) secreted by the bacillus Clostridium tetani. It has been estimated – don’t ask me how – that one gram of this toxin would kill the worldwide rat population. The spores (kind of seed) of Clostridium tetani are ubiquitous: they are found in soil, manure, street dust, intestines of herbivores and in their faeces, even in the dust and air of surgical operation theatres. Not only they are everywhere but they are also very tough and can stay alive for years in extreme conditions. Cold, heat and even chemical agents such as phenol and mercurochrome do not destroy them. Most cuts and wounds, especially deep puncture wounds, are likely to contain some spores of Clostridium tetani. But when was the last time you heard of someone who developed the disease? And if you think that if you haven’t heard of anybody it is thanks to vaccination I would urge you to think twice.

It seems to me that the fear of tetanus tends to tetanize the reasoning muscle because this fear is irrational. For a start, tetanus is neither a contagious nor an immunising disease. Moreover, in developed countries tetanus is a rare disease with less than 50 cases per year in France, mostly found in the elderly. In France, there are less than 10 cases per year among people below the age of 50. According to the UK Department of Health, between 1984 and 1995 there were 145 cases in England and Whales. It is extremely rare in children.

In my next column I will tell you what the consultant should have learnt before speaking to my friend.

References

Docteur Jean Meric, Vaccinations, je ne serai plus complice!, Marco Pietteur, editeur, 2004.Neil Z. Miller, Vaccine Safety Manual For Concerned Families and Health Practitioners, 2nd Edition, New Atlantean Press, 2012.