Since December 2015, five TSS cases have been reported among young women in four different local health department jurisdictions: Kent, Mid-Michigan, District Health Department 10 and Oakland. None of the cases were fatal. The previous ten years averaged fewer than four cases reported annually.
TSS is a rare but serious clinical syndrome typically caused by bacterial infection due to Staphylococcus aureus or Streptococcus pyogenes. Toxic shock progresses quickly. Its symptoms include: sudden fever, vomiting, diarrhea, dizziness, muscle aches, low blood pressure, rash, and shock with multi-organ dysfunction. The case fatality rate is reported as four percent nationally.
“Although Toxic Shock Syndrome cases are rare, this recent cluster is an important reminder to always review product safety information,” said Dr. Eden Wells, chief medical executive with the MDHHS.
Historically, tampon-associated TSS has been attributed to improper use, for example leaving a tampon in too long. You should never leave a tampon in longer than six to eight hours. Additionally, the risk of TSS is higher with higher absorbency tampons – always use the lowest absorbency needed.
Symptoms of TSS can feel like the flu. If you experience sudden fever, vomiting, diarrhea, dizziness or muscle aches, immediately discontinue tampon use and consult with your doctor.
MDHHS is working closely with the local health departments to monitor cases, provide clinical guidance, and coordinate with the Centers for Disease Control and Prevention. A Michigan Health Alert Network notification was sent to health care providers to encourage enhanced surveillance, and collection of clinical specimens and product history during evaluation. Providers are also encouraged to talk with patients about proper tampon usage and the risk of TSS.
To date, the only commonalities found between these cases have involved product selection. Four out of five cases were using super absorbency tampons and four out of five were using the Playtex Sport brand. One case was using U by Kotex. The Food and Drug Administration has been notified regarding product information.