Wisconsin Sees Spike in Toxic Shock Syndrome Cases

The Wisconsin state office building housing the Department of Health Services (DHS), previously the Department of Health and Family Services before the agency was split into separate departments. Photo by Baylor Spears/Wisconsin Examiner.

Five cases of toxic shock syndrome (TSS) — a rare but serious condition often associated with tampon use — have been reported in Wisconsin since July 2022, according to the Wisconsin Department of Health Services.

The cluster of cases is a significant increase compared with previous years, causing concern for the agency. DHS usually records one or fewer cases per year and the last time multiple cases were recorded in Wisconsin in a single year was 2011, though officials say there isn’t a clear reason behind the rise.

“It’s not unusual to see a small number of cases per year, so when you take a very rare phenomenon that happens one or two times a year in a state of six million people and you see four cases in a six month period that could just be a chance, a coincidence, or there could be some underlying causes,” said Ryan Westergaard, chief medical officer for the DHS Bureau of Communicable Diseases, at a Tuesday press conference. “Maybe people are less aware of the risks of prolonged tampon use than they were in the past, so we are investigating that.”

Four of the five recent cases were associated with the use of super absorbency of varying brands by teenage girls, according to a release. All cases resulted in hospitalization, though no deaths were recorded.

Westergaard emphasized that no one tampon brand was to blame for the infections.

“We don’t have any information that brands are unsafe, and it’s been well recognized that super absorbency tampons can have this risk regardless of brands,” Westergaard said. Tampons, especially the super absorbent kind, left in for too long — more than four to six hours — can increase the risk of the disease, he added.

Toxic shock syndrome is caused by staphylococcus or streptococcus bacteria entering the body and releasing harmful toxins. Tampons left in for too long can become breeding grounds for bacteria.

Symptoms of the condition include sudden fever, diarrhea, vomiting, rash, hypotension and multiorgan dysfunction.

According to DHS, toxic shock syndrome was first recognized as a condition in 1978. While most widely associated with tampon use in adolescents, the condition is now associated with other factors like surgical wounds and childbirth.

One of the five recent cases was associated with a surgical wound infection.

DHS is urging parents, guardians, school nurses and other Wisconsinites to help protect the health and safety of teenagers by talking to them about the proper use of tampons.

“Toxic shock syndrome can progress rapidly leading to complications such as shock, organ failure, and death,” Paula Tran, a state health officer, said in a release. “It’s important for those who use tampons to use the lowest absorbency, change their tampon every four to six hours and avoid using tampons overnight.”

Anyone with symptoms of TSS should seek immediate medical care, according to DHS. Treatment includes the use of antibiotics and supportive treatment to prevent dehydration and organ failure.

The agency is also asking providers to be especially aware of the symptoms of TSS and ask that they report cases to their local health department.

Wisconsin sees spike in toxic shock syndrome cases, officials urge education about tampon use was originally published by the Wisconsin Examiner.