An unvaccinated Oregon boy became the first person in over 30 years to contract the deadly tetanus infection in the state. The 6-year-old boy was playing on a farm when he cut his head, according to a 2017 case report by the CDC. His parents cleaned and stitched the wound at home, but a week later, he arrived at a hospital exhibiting advanced symptoms of tetanus, a serious bacterial infection that causes involuntary muscle spasms, difficulty breathing, lockjaw, and arching of the neck and back. Doctors inserted a tube in his windpipe, treated him with neuromuscular-blocking drugs, and placed him in a dark room with ear plugs to help reduce his spasms. Despite their best efforts, the arching of the boy’s neck and back worsened, and he was kept in an intensive care unit for over a month until he could be moved to a rehabilitation center. In total, the boy’s medical charges amounted to $811,929.

“The complex and prolonged care led to the high treatment cost,” said Judith Guzman-Cottrill, an author of the report and a pediatrics professor at Oregon Health & Science University. In contrast, the cost of one tetanus vaccination is $24-$30 a dose. Since the vaccination, tetanus has become extremely rare. Doctors counseled the boy’s family to bring the child up to date on all of his vaccinations, but they still declined them. “Despite extensive review of the risks and benefits of tetanus vaccination by physicians, the family declined the second dose of DTaP and any other recommended immunizations,” the CDC report stated.