There have recently been many news reports of children not being vaccinated against diseases such as measles, resulting in hot spots of measles epidemics in the United States.
What is left unsaid is whether a refusal to be vaccinated against tetanus might result in enhanced risk as a participant in Scouting.
In 2017 an unvaccinated 6 year old boy became infected with tetanus after having fallen and cut his forehead. Within 6 days the boy began to suffer the effects of tetanus, ultimately spending 57 days in a hospital at a cost of $800,000 to save his life. As one of his doctors said, “I honestly never thought I would see this disease in the United States.” Read his story here. Read similarly relevant stories here, and here.
Is this story relevant to one’s participation in Scouting? Clearly, yes. As an adult leader’s primary role is the health and safety of participating youth, the lack of tetanus immunization can make that role much more difficult to achieve.
It is reported that tetanus can be acquired from the following:
- Puncture wounds — including from splinters
- Compound fractures
- Burns
- Surgical wounds
- Animal or insect bites
- Infected foot ulcers
- Dental infections
Read more about tetanus and its vaccine here, where it is stated that 30% of soil samples in one survey contained tetanus spores, which have also been detected in street dust.
More than a few of the above are common risks during a Scouting activity. What should this mean to the Scouting volunteer?
Parents of youth and adult volunteers unvaccinated against tetanus should be made aware that current tetanus vaccinations are required for participation in Scouting events due to the risk of tetanus.
However, the word “required” has a different meaning for BSA apparently, as BSA provides a release form for those seeking exemption from immunization.
This means that a unit may be faced with participating youth (or adults) who are not vaccinated against tetanus (or other medical occurrences).
On the other hand, the Guide to Safe Scouting (2023 edition) provides the following guidance regarding vaccinations:
“The Boy Scouts of America encourages all members of the Scouting community to use available vaccines to fully protect themselves from infectious diseases that are dangerous for children and adults living in the United States. Participants who are not immunized are subject to identification so that they may be located in case of a necessity for isolation or quarantine as required by local public health official directives. Based on risk, a valid (within last 10 years) tetanus immunization is required to participate. State or local requirements for resident camping may be more restrictive.”
Does this raise a “duty of care” issue with respect to that those participants?
In my view, yes, resulting in the following recommendations:
First, parents of unvaccinated youth as well as unvaccinated adults should be made aware of the potential risk of tetanus during Scouting activities, and strongly encouraged to obtain a tetanus vaccination.
Second, unvaccinated adults and parents of unvaccinated youth should acknowledge in writing such risks, and sign the above BSA release form, as well as a form releasing from liability the unit, the chartering organization and the unit’s volunteers as a result of their participation. However, note that such waivers of liability are potentially not enforceable at least in Louisiana or Virginia under applicable state laws!
Third, it is possible that a youth or adult who is unvaccinated against tetanus may need to be prohibited from participating in an event such as disaster relief in which the exposure to tetanus far outweighs the benefit of participation, various service projects involving outdoor work, or steps may need to be taken to mitigate such potential exposure during more ordinary outdoor activities, such as protective clothing (long pants vs. shorts to minimize cuts/scrapes/wounds, etc.). Indeed, environmental conditions such as flooding may enhance the chance for tetanus infection. See, also, this flooding article and the risks of tetanus.
Activities such as mountain biking, where crashes are frequent, might also be placed on a banned list for those unvaccinated against tetanus by the prudent unit, as well as walking with unprotected feet (flip flops, barefoot). These restrictions might be particularly important if the planned activity is to occur in an area where professional medical treatment is not readily available, and may only be available upon some delay, such as a high adventure activity. Parents and adult participants should be made aware of the possibility of such restrictions.
Fourth, extra vigilance will be required as to the existence of cuts/scrapes, etc. with respect to unvaccinated youth, as such youth may not understand the risk attendant to such injuries, minor as they may seem, and may not make their existence known to adult volunteers in a timely manner.
However, it is reported that “up to 50% of tetanus cases occur after injuries not considered serious enough to seek medical treatment, and in 15-25% of cases, there is no evidence of a recent wound.” This obviously makes monitoring of such persons difficult, if not impossible.
Finally, the unit must recognize that, due to the potential risk of tetanus for an unvaccinated youth or adult, professional medical care may be immediately required for first aid incidents involving such youth which ordinarily might not be required for a youth who has been vaccinated against tetanus, which may result in the administration of a tetanus shot by the medical professional, and the parent(s) made aware that such may occur. The incubation period can be as short as 24 hours.
Indeed, the author was informed by a licensed physician serving as medical director at a council summer camp that, if presented with a scout who was not vaccinated against tetanus and who had suffered a wound that had become contaminated, the scout would be immediately transferred to a local hospital for prophylactic treatment for tetanus in consultation with the scout’s parents. Similar action by a unit during a troop outing under similar circumstances might be prudent.
Indeed, the unit may ultimately have to determine if it is prudent to permit a youth (or adult) who is unvaccinated against tetanus to participate in any aspect of its outdoor program, given the potential risk to the participant, and the burden placed on the unit in view of such risk, including the potential for liability for failure to provide sufficient medical care in view of knowledge of such risk to the participant, despite the providing of a waiver by the participant – – again, Virginia and Louisiana reportedly do not recognize waivers of liability as being enforceable.
In the end, requiring a tetanus vaccination of all unit members addresses all of the above concerns. Such a position would be consistent with the policy stated in the Guide to Safe Scouting, and made clear on the current BSA medical form.
And, remind your adult leaders that they need to have tetanus booster vaccinations at least every 10 years (their immunity may have lapsed), as vaccination boosters are not normally at the top of the list of things to do for adults.
Time for that serious talk with parents (and participating adults) in need of same . . . Safe Scouting!