Toxic Shock Syndrome in Utah: A Case-Control and Surveillance Study

women hospitalized with toxic shock syndrome and 91 neighborhood controls showed a statistically significant association between the use of tampons, in particular, the use of a single brand of tampons, Rely (Procter & Gamble), and the illness. A decline in cases of toxic shock syndrome in Utah has been noted since September 1980, when Rely tampons were withdrawn from the market. Changes in surveillance activities and reporting do not appear to be important contributors to this decline. The annual attack rate based on cases occurring in the first 9 months of 1980 was 12.3 per 100 000 female subjects aged 12 to 49 years; during the subsequent 9 months, the illness rate declined to 4.8 cases per 100 000. IN EARLY 1980, little was known about toxic shock syn-drome. The illness had been noted previously in children infected with Staphylococcus aureus (1); however, no ex-planation was apparent for the appearance of the syn-drome in presumably healthy menstruating women. A case-control study therefore was conducted in Utah to identify possible risk factors associated with the develop-ment of toxic shock syndrome in this group (2). This report presents a summary and critical examination of that study; in addition, methods and results of surveil-lance activities in Utah regarding toxic shock syndrome are examined to evaluate potential changes in incidence