Toxic shock syndrome (TSS) is an uncommon but potentially serious illness that occurs when poisonous substances (toxins) produced by certain bacteria enter the bloodstream. The toxins cause a type of blood poisoning caused by staphylococcal, or less commonly streptococcal, infections in the lungs, throat, skin or bone, or from injuries. Women using super-absorbent tampons during menstruation were found to be most likely to get toxic shock syndrome.
TSS first came to the attention of the public in the 1970s. Shortly after the introduction of a super-absorbent tampon, young women across the United States experienced an epidemic of serious but unexplained symptoms. Thousands went to emergency rooms with high fever, vomiting, peeling skin, low blood pressure, diarrhea, and a rash resembling sunburn. The only thing they had in common was that they all were menstruating at the time they felt sick, and all were using tampons—especially super-absorbent products.
At its height, the epidemic affected 15,000 people in the United States each year between 1980 and 1984; 15% of the women died. Since the offending products were taken off the market, the numbers of TSS cases have declined sharply. As of 1998, only about 5,000 cases are diagnosed annually in the United States, 5% of which are fatal. The decline is most likely due to the tampon manufacturers' discontinuing the use of some synthetic materials, and the removal from the market of the brand of tampon associated with most cases of TSS. As of the early 2000s, most of these products are made with rayon and cotton.
In spite of TSS's association with menstruating women, the disease can affect anyone of either sex or any age or race. The infection may occur in children, men, and non-menstruating women who are weakened from surgery, injury, or disease, and who cannot fight off a staphylococcal infection. New mothers are also at higher risk for TSS, particularly if they had a caesarean section or if they are breastfeeding their infants.
Most cases reported in Western countries still involve menstruating women under age 30. TSS still occurs in about 17 out of every 100,000 menstruating girls and women each year; more than half of these cases are related to tampons. Between 5% and 10% of patients with TSS die.
In the developing countries, however, toxic shock syndrome often affects children. A recent report of staphylococcal TSS from Saudi Arabia concerned a four-month-old infant. Burns appear to increase the risk of TSS in children in all countries.
Paula Ford-Martin, Rebecca J. Frey PhD, The Gale Group Inc., Gale, Detroit,