Myrl Jeffcoat myrlj@jps.net

7 mars, 2005 09:45

Nearly forgotten, toxic shock may be on the rise

Los Angeles Times

Toxic shock syndrome linked to tampon use, which made headlines 25 years ago when the dangerous illness sickened thousands of U.S. women and killed dozens, may be re-emerging as a public health threat, according to physicians and other experts.

Two leading researchers say the number of cases reported to them by doctors nationwide has increased during the last three years, though the levels are not thought to be nearly as high as they were in 1980, the peak year for toxic shock cases. And a U.S. Food and Drug Administration official said recently that the agency had received an increasing number of reports of toxic shock syndrome linked to tampon use.   The suspected increase is still largely anecdotal, and government statistics are unavailable because federal researchers stopped actively monitoring TSS cases in 1987.

In Los Angeles County, five cases of TSS have been discovered in teenage girls using tampons in the last year -- four since September, according to physicians who treated the girls.   Some health officials are concerned about the possible reappearance of the illness, thought to have largely disappeared when a brand of tampon linked to TSS was withdrawn from the market in 1980. The illness can strike swiftly, and cases could easily be missed if people assume that tampon-related TSS is no longer a threat, experts said.

The apparent rise in TSS cases is ''really surprising,`` said Dr. Jay M. Lieberman, chief of pediatric infectious diseases at Miller Children's Hospital in Long Beach, Calif., where four of the cases were treated. ''It can quickly be fatal. I think it's important that teenage girls and their parents be aware of the potential for TSS if the girl wears tampons. I don't want to scare people, but the disease is still around.``

At the University of California, Los Angeles Medical Center, doctors who treated a teenager last fall with toxic shock syndrome thought the diagnosis was so unusual they submitted a report to a medical journal. ''People don't think of this as a diagnosis today,`` said Dr. James Cherry, a professor of pediatric infectious diseases at the David Geffen School of Medicine at UCLA.

All of the teenagers at UCLA and Miller Children's Hospital were critically ill but survived. However, a 16-year-old girl in Santa Clara County died in November from probable TSS, according to the county's medical examiner.   ''I've gotten calls from doctors from a variety of places around the country,`` says Patrick Schlievert, a professor of microbiology and immunology at the University of Minnesota who has studied TSS. ''They say, `Gee, all of a sudden I'm seeing cases again,' and they ask me what's going on. Basically, what we're seeing is a steady rise in incidence such that (the rate of TSS) is one-third to one-half of what it was when the incidence peaked around 1980.``

Even as rates may be increasing, TSS remains a rare illness. At its peak in the early '80s, about 10 cases were reported for every 100,000 menstruating women. In 1980, 772 U.S. women developed the illness and 38 died, a development that generated headlines and caused many women to question the safety of tampons. The cause of the illness was eventually attributed to highly absorbent tampons made with synthetic materials.   After the Rely tampon was removed from the market, rates fell to about one case per 100,000. Schlievert now estimates the rate is 3 to 4 cases per 100,000 menstruating women.

Schlievert, who has studied TSS for decades, reported last year that cases of the illness, in menstruating women and others, in the Minneapolis-St. Paul area climbed from 15 cases in 2000 to 50 in cases in 2003. The study was published in the Journal of Clinical Microbiology.   The U.S. Centers for Disease Control and Prevention, which keeps statistics on infectious diseases, said it had no evidence that tampon-related TSS was increasing. Dr. Nancy Rosenstein, of the CDC's National Center for Infectious Diseases, acknowledged that the agency's methods for tracking TSS rates -- national mandatory reporting of cases by states was dropped in 1987 -- were insufficient to detect an increase in a relatively rare disease.

Last May, in remarks to the North American Society for Pediatric and Adolescent Gynecology, Dr. Judith U. Cope of the FDA's Center for Devices and Radiological Health, told an audience of physicians that tampon-related TSS reports to the FDA were increasing, though the overall rates were still small. The remarks were published in the June issue of the society's medical journal.