Mapping Pediatric Tetanus Cases in Central Pennsylvania and Analyzing Hospital Costs Associated with Treatment

BACKGROUND: Pennsylvania is home to Amish and Mennonite communities with an estimated combined population of over 90,000 people. Under-immunization is common with vaccine preventable diseases, including tetanus, periodically presenting among children from these communities. Nearly 20% of nationally reported pediatric tetanus cases in the past 10 years were treated at our institution, the tertiary care center which serves these unique populations. We characterize demographics and costs of treating this rare, but largely preventable infection. METHODS: Chart review based on ICD-9 codes for tetanus infection in patients aged 0–17 years treated for clinically diagnosed tetanus infection between January 2006 and December 2015. Cost data were extracted from Horizon Business Insight software and analyzed in Microsoft Excel. Cases were mapped using UDS Mapper. RESULTS: Four cases of pediatric tetanus infection were identified with 100% occurring in unimmunized patients and 3 of 4 (75%) in Amish individuals. Treatment costs amounted to $121,170 with estimated payment of $80,664 resulting in a net loss to the hospital of $40,506 over the course of 10 years. Each case treated resulted in a median loss of $4,402 to the hospital. CONCLUSION: The costs of treating this vaccine preventable disease for both hospitals and under-immunized Amish and Mennonite communities, who tend to pay out-of-pocket, should be emphasized in targeted outreach and education programs at the population level. DISCLOSURES: All authors: No reported disclosures.