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August 21, 1987, Vol 258, No. 7 >
ARTICLE | August 21, 1987

The Relationship of Tampon Characteristics to Menstrual Toxic Shock Syndrome FREE

Seth F. Berkley, MD; Allen W. Hightower, MS; Claire V. Broome, MD; Arthur L. Reingold, MD
[+] Author Affiliations

Reprint requests to Meningitis and Special Pathogens Branch, Centers for Disease Control, Bldg 1, Room 5413, 1600 Clifton Rd, Atlanta, GA 30333 (Dr Broome).


JAMA. 1987;258(7):917-920. doi:10.1001/jama.1987.03400070055034
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References

The pathogenic basis for the association of tampons with toxic shock syndrome (TSS) has not been explained adequately. Absorbency and chemical composition of tampons are related, and no prior study has had a sufficient number of cases to evaluate these independently as risk factors for disease. We compared national TSS passive surveillance data on the 285 tampon-associated menstrual cases of TSS reported from 1983 to 1984 with data on age- and year-matched controls from national surveys of tampon usage. Users of all brands of tampons had elevated risks when compared with non—tampon users (odds ratio, 32.8; 95% confidence interval, 15.5,69.6). Regardless of the chemical composition of the tampon, increasing absorbency increased the odds ratio for TSS. Chemical composition also influenced odds ratios. Polyacrylate-containing tampons had odds ratios that were elevated but, once controlled for absorbency, that were lower than the odds ratios for cotton, rayon, and cotton/rayon tampons. The strong association of absorbency with risk of illness would suggest that as a public health measure the use of a low-absorbency tampon is likely to reduce the risk of TSS in the user.

(JAMA 1987;258:917-920)

REFERENCES

1 +
Todd J, Fishaut M, Kapral F, et al:  Toxic-shock syndrome associated with phage-group-1 staphylococci . Lancet 1978;;2:1116-1118.
2 +
Stevens FA:  The occurrence of Staphylococcus aureus infection with a scarlatiniform rash . JAMA 1927;;88:1957-1958.
3 +
Shands KN, Schmid GP, Dan BB, et al:  Toxic-shock syndrome in menstruating women . N Engl J Med 1980;;303:1436-1442.
4 +
Davis JP, Chesney PJ, Wand PJ, et al:  Toxic-shock syndrome: Epidemiologic features, recurrence, risk factors, and prevention . N Engl J Med 1980;;303:1429-1435.
5 +
Latham RH, Kehrberg MW, Jacobson JA, et al:  Toxic shock syndrome in Utah: A case-control and surveillance study . Ann Intern Med 1982;;96: 906-908.
6 +
Schlech WF, Shands KN, Reingold AL, et al:  Risk factors for development of toxic shock syndrome: Association with a tampon brand . JAMA 1982;;248:835-839.
7 +
Osterholm MT, Davis JP, Gibson RW, et al:  Tristate toxic-shock syndrome study: I. Epidemiologic findings . J Infect Dis 1982;;145:431-440.
8 +
Osterholm MT, Forfang JC:  Toxic-shock syndrome in Minnesota: Results of an active-passive surveillance system . J Infect Dis 1982;;145:458-464.
9 +
Mills JT, Parsonnet J, Tsai Y, et al:  Control of production of toxic-shock-syndrome toxin-1 (TSST-1) by magnesium ion . J Infect Dis 1985;;151: 1158-1161.
10 +
Tierno PM, Hanna BA, Davies MB:  Growth of Toxic Shock Syndrome strain of Staphylococcus aureus after enzymatic degradation of Rely tampon component . Lancet 1983;;8325:615-619.
11 +
Reingold AL, Hargrett NT, Shands KN, et al:  Toxic shock syndrome surveillance in the United States, 1980 to 1981 . Ann Intern Med 1982;;96:875-880.
12 +
Breslow NE, Day NE (eds):  Logistic regression for large strata , in Statistical Methods in Cancer Research . Lyons, France, IARC Scientific Publications, 1980;, vol 1, pp 192-246.
13 +
Gustafson TL, Swinger GL, Booth AL, et al:  Survey of tampon use and toxic shock syndrome, Tennessee, 1979 to 1981 . Am J Obstet Gynecol 1982;;143:369-374.
14 +
Irwin CE, Millstein SG:  Emerging patterns of tampon use in the adolescent female: The impact of toxic shock syndrome . Am J Public Health 1982;; 72:464-467.
15 +
Petitti DB, Reingold A, Chin J:  The incidence of toxic shock syndrome in northern California: 1972-1983 . JAMA 1986;;255:368-372.
16 +
Todd JK, Wiesenthal AM, Ressman M, et al:  Toxic shock syndrome: II. Estimated occurrence in Colorado as influenced by case ascertainment methods . Am J Epidemiol 1985;;122:857-867.
17 +
Harvey M, Horwitz RI, Feinstein AR:  Toxic shock and tampons . JAMA 1982;;248:840-846.
18 +
O'Gilvie v International Playtex, 609 F Supp 817, 817-820 (DC Kan 1985).
19 +
O'Gilvie v International Playtex, No. 83-1845, vol 37 (DC Kan March 21, 1985) (posttrial motions and court findings).

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1 +
Todd J, Fishaut M, Kapral F, et al:  Toxic-shock syndrome associated with phage-group-1 staphylococci . Lancet 1978;;2:1116-1118.
2 +
Stevens FA:  The occurrence of Staphylococcus aureus infection with a scarlatiniform rash . JAMA 1927;;88:1957-1958.
3 +
Shands KN, Schmid GP, Dan BB, et al:  Toxic-shock syndrome in menstruating women . N Engl J Med 1980;;303:1436-1442.
4 +
Davis JP, Chesney PJ, Wand PJ, et al:  Toxic-shock syndrome: Epidemiologic features, recurrence, risk factors, and prevention . N Engl J Med 1980;;303:1429-1435.
5 +
Latham RH, Kehrberg MW, Jacobson JA, et al:  Toxic shock syndrome in Utah: A case-control and surveillance study . Ann Intern Med 1982;;96: 906-908.
6 +
Schlech WF, Shands KN, Reingold AL, et al:  Risk factors for development of toxic shock syndrome: Association with a tampon brand . JAMA 1982;;248:835-839.
7 +
Osterholm MT, Davis JP, Gibson RW, et al:  Tristate toxic-shock syndrome study: I. Epidemiologic findings . J Infect Dis 1982;;145:431-440.
8 +
Osterholm MT, Forfang JC:  Toxic-shock syndrome in Minnesota: Results of an active-passive surveillance system . J Infect Dis 1982;;145:458-464.
9 +
Mills JT, Parsonnet J, Tsai Y, et al:  Control of production of toxic-shock-syndrome toxin-1 (TSST-1) by magnesium ion . J Infect Dis 1985;;151: 1158-1161.
10 +
Tierno PM, Hanna BA, Davies MB:  Growth of Toxic Shock Syndrome strain of Staphylococcus aureus after enzymatic degradation of Rely tampon component . Lancet 1983;;8325:615-619.
11 +
Reingold AL, Hargrett NT, Shands KN, et al:  Toxic shock syndrome surveillance in the United States, 1980 to 1981 . Ann Intern Med 1982;;96:875-880.
12 +
Breslow NE, Day NE (eds):  Logistic regression for large strata , in Statistical Methods in Cancer Research . Lyons, France, IARC Scientific Publications, 1980;, vol 1, pp 192-246.
13 +
Gustafson TL, Swinger GL, Booth AL, et al:  Survey of tampon use and toxic shock syndrome, Tennessee, 1979 to 1981 . Am J Obstet Gynecol 1982;;143:369-374.
14 +
Irwin CE, Millstein SG:  Emerging patterns of tampon use in the adolescent female: The impact of toxic shock syndrome . Am J Public Health 1982;; 72:464-467.
15 +
Petitti DB, Reingold A, Chin J:  The incidence of toxic shock syndrome in northern California: 1972-1983 . JAMA 1986;;255:368-372.
16 +
Todd JK, Wiesenthal AM, Ressman M, et al:  Toxic shock syndrome: II. Estimated occurrence in Colorado as influenced by case ascertainment methods . Am J Epidemiol 1985;;122:857-867.
17 +
Harvey M, Horwitz RI, Feinstein AR:  Toxic shock and tampons . JAMA 1982;;248:840-846.
18 +
O'Gilvie v International Playtex, 609 F Supp 817, 817-820 (DC Kan 1985).
19 +
O'Gilvie v International Playtex, No. 83-1845, vol 37 (DC Kan March 21, 1985) (posttrial motions and court findings).

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