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Acute Communicable Disease Control
Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a rare, life-threatening bacterial infection that is usually caused by exotoxin producing strains of Staphylococcus aureus. In 1980, an outbreak of TSS occurred that mostly involved young women who had been using a particular brand of ultra-absorbent tampons. Since the removal of ultra-absorbent tampons from the US market, cases are rarely linked to tampons anymore. In addition to women, TSS can also occur in men and children. Other risk factors for infection include skin wounds and surgery.

Toxic Shock Syndrome became a nationally reportable disease in 1980 and is a reportable condition in California. In Los Angeles County, approximately one to three cases are confirmed each year. The surveillance case definition as recommended by the CDC and Council of State and Territorial Epidemiologists (CSTE) includes both clinical and laboratory data. Cases are defined as probable if five of the six clinical findings described below are present while cases are confirmed if all of the criteria described below are present, including desquamation, unless the patient dies before desquamation occurs.

Case Criteria:
    Fever
    Rash
    Desquamation
    Hypotension
    Multisystem involvement (in three or more organ symptoms)
    Negative results on the following tests, if obtained:
         Blood, throat, or cerebrospinal fluid cultures
          (blood culture may be positive for Staphylococcus aureus)
         Rise in titer to Rocky Mountain spotted fever, leptospirosis, or measles
Additional Resources
  • CDC: Technical Information
  • KidsHealth.org
  • Hajjeh RA, Reingold A, Weil A, et al. Toxic shock syndrome in the United States: surveillance update, 1979-1996. Emerg Infect Dis J. 1999;5:no. 6.
  • Gavanta S. Reingold AL, Hightower AW et al., Active surveillance for toxic shock syndrome in the United States. 1986. Rev Infect Dis 1989:2(suppl1):S28-34.
  • CDC. Toxic-shock syndrome United States. MMWR 1990;39:421-24.
  • CDC. Toxic-shock syndrome-United States. MMWR 1980:29-30.
  • Schuchat A, Broome CV. Toxic Shock Syndrome and Tampons. Epidemiologic Reviews 1991:13:99-112.
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