Tetanus, a nearly forgotten killer, almost claimed the life of a Far North toddler and experts say low vaccination rates mean it will strike again.

The 15-month-old girl, who was discharged from Starship children's hospital in Auckland yesterday, nearly died from muscle spasms caused by a severe case of tetanus. The unvaccinated child is the first toddler to have contracted the disease in more than a decade.

Tetanus, also known as lockjaw because one of the first areas it causes to spasm is in the face, is usually contracted from bacteria spores in the soil.

A vaccination that immunises against the disease has been free in New Zealand for the past 40 years and only one person has died from the disease since 1988.

The girl was brought in to Whangarei Hospital last month by her parents.

Because of the rarity of tetanus, doctors initially did not know what was wrong with her but she began to spasm while in hospital and a tube had to be inserted down her throat to enable her to breathe.

She was taken to Starship and put on a ventilator. She spent more than two weeks in the hospital suffering from continued spasms.

Northland Medical Officer of Health Dr Jonathan Jarman said it was not known how the girl contracted the disease but a small wound containing a prickle under one of her toes could have been the entry point for the bacteria.

Dr Jarman said the child's plight was a strong argument for parents to have their children vaccinated against the disease. "This little girl is lucky to be alive."

The director of the Immunisation Advisory Centre, Dr Nikki Turner, said it was only a matter of time until another child fell ill or died from tetanus because of the low rate of immunisation against it and other diseases in New Zealand.

Dr Turner, who has seen children die from tetanus overseas, said it was horrifically painful for victims who, if not sedated, were fully conscious during the spasms.

They can cause the whole body to arch over backward, lock a grimace on their face as well as preventing them from breathing. "It is the stuff of nightmares."

A 1996 study by the Institute of Environmental Science and Research showed that in the northern region, which includes Auckland and Northland, the child vaccination rate against tetanus was only 71 per cent.

Overall immunisation against other diseases - including diphtheria, whooping cough, mumps, rubella, measles, meningitis, hepatitis B and polio - is only 63 per cent.

Public health physician Dr Michael Baker said the goal was for a 95 per cent immunisation rate.

He said the northern region is not alone in its low immunisation rate and most of the country would have similar statistics.

Dr Turner said New Zealand's immunisation rate was lower than the Pacific Islands and countries such as China and Cuba.

In 1998, Niue, Samoa and Tokelau recorded 100 per cent coverage.

"Tetanus is about personal protection," Dr Turner said.

"You will never eradicate it from the soil so you must get vaccinated to protect yourself from it."

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