Toxic-Shock Syndrome—United States

Abstract

A total of 1660 cases of toxic shock syndrome (TSS) have been reported to the Centers for Disease Control as of April 9, 1982, 88 of which have resulted in death. Of the 1588 cases involving women, at least 92% had onset during a menstrual period. The age range for female patients was 1-64 years, with a mean of 22.9 and a median of 21 years. Of the 1355 cases in which the patient's race was known, 1315 occurred in white non-Hispanics. Although TSS cases have been reported by all 50 states and the District of Columbia, 35% have come from 3 states: Minnesota, California, and Wisconsin. 492 cases with onset in 1981 have been reported compared with 867 cases with 1980 onset. Nonmenstrual cases accounted for 15% of the reported cases with onset in 1981 compared with 6% of cases with onset before 1981. Nonmenstrual TSS has been seen following childbirth by vaginal delivery and cesarean section and in association with induced abortion, infected surgical wounds, hydradenitis, lymphadenitis, deep abscesses, and infected cutaneous and subcutaneous lesions. This increase in the proportion of cases unassociated with menstruation is largely due to the decrease in the number of menstrual TSS cases reported. Factors that may have contributed to the decline in reported TSS cases since the summer and early fall of 1980 include changes in the number of tampon users, in the way in which women use tampons, in the availability and frequency of use of different brands of tampons, or in the rate of vaginal carriage of strains of Staphylococcus aureus capable of causing TSS. Increased recognition of the disease, waning media publicity, variable activity of state and local health department surveillance programs, changes in referral patterns, and changes in the treatment of TSS also may have affected the reporting of TSS. All suspected cases of TSS should be reported promptly to the state health department, and women should be advised to remove their tampons and seek medical attention if they develop symptoms of the disease.