title: Philosophic objection to vaccination as a risk for tetanus among children younger than 15 years.
abstract: OBJECTIVE
  Although safe and effective vaccines are available to protect against tetanus in the United States and vaccination rates are high, cases of tetanus among children continue to occur. The objectives of this article are to describe reported cases of tetanus in children in the United States and to identify the reasons for lack of protection against tetanus.
  
  
  METHODS
  We reviewed all cases of tetanus in children <15 years of age that were reported to the National Notifiable Diseases Surveillance System from 1992 through 2000. Cases were defined by physician diagnosis. We verified the information in the case reports with state and local health departments.
  
  
  RESULTS
  From 1992 through 2000, 15 cases of tetanus in children <15 years of age were reported from 11 states. Twelve cases were in boys. Two cases were in neonates <10 days of age; the other 13 cases were in children who ranged in age from 3 to 14 years. The median length of hospitalization was 28 days; 8 children required mechanical ventilation. There were no deaths. Twelve (80%) children were unprotected because of lack of vaccination, including 1 neonate whose mother was not vaccinated. Among all unvaccinated cases, objection to vaccination, either religious or philosophic, was the reported reason for choosing not to vaccinate.
  
  
  CONCLUSIONS
  The majority of recent cases of tetanus among children in the United States were in unvaccinated children whose parents objected to vaccination. Parents who choose not to vaccinate their children should be advised of the seriousness of the disease and be informed that tetanus is not preventable by means other than vaccination.
authors.affiliation: Division of Epidemiology, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fair
authors.forename: Trudy V
authors.initials: TV
authors.lastname: Murphy
authors.forename: Anne
authors.initials: A
authors.lastname: Golaz
authors.forename: Melinda
authors.initials: M
authors.lastname: Wharton
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D012068:Religion and Medicine; D018570:Risk Assessment; D013742:Tetanus / Q000453:epidemiology*; D016312:Treatment Refusal; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000331:legislation & jurisprudence