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TOXIC-SHOCK SYNDROME

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Toxic-shock syndrome (TSS) surveillance began in the spring of 1980 after it was recognized that an illness affecting previously healthy young women in Wisconsin and Minnesota was TSS. As of June 1981, 823 cases of TSS meeting the current CDC case definition and having onset in 1980 had been reported. TSS is overwhelmingly a disease of menstruating women (96% of cases) and has been associated with the use of tampons, but cases have also been recognized in males (1.5% of cases) and nonmenstruating females (2.5% of cases). Menstrually-associated cases have been strongly associated with the presence of Staphylococcus aureus in the vagina, while nonmenstrually-associated cases have been associated with focal staphylococcal infections at a variety of sites, including abscesses, surgical wounds, burns, etc. Postpartum cases associated with vaginal infections have also been reported.

Menstrually-associated TSS is predominantly a disease of young women, with over 33% of the cases being reported in the 15 to 19-year-old group. Over 98% of the reported cases have occurred among whites, but cases have been recognized among blacks, Asian-Americans, American Indians, and Hispanics.

A disproportionately large number of reported cases of TSS have come from a small number of states. It is not possible to determine to what extent this difference in reporting between states is a result of true geographic differences in the incidence of TSS and to what extent it reflects the interests of local health officials and researchers.

While a large percentage of the cases of TSS reported in 1980 had onset in the summer and early fall, it is too early to determine whether or not TSS demonstrates seasonality. The extensive publicity regarding TSS may have contributed to the large number of cases reported with onset in August and September 1980.

124

TOXIC-SHOCK SYNDROME Reported cases by date of onset, United States,

January 1970-December 1980

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Maine

Area
New England

United States

TOXIC-SHOCK SYNDROME

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TOXIC-SHOCK SYNDROME – Reported cases by state and by age, United States, 1980

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Index

A
Abortions, legal 101,103, 104
Accidents 102
Actinomycosis 100, 101
Alcoholism 101
Amebiasis 3, 4, 11-17
Anencephaly 106
Anthrax 3, 11-17, 21
Arboviruses (see Encephalitis)
Aseptic meningitis 3, 4, 12-15, 22-24
Aspergillosis 101

E
Encephalitis

Arthropod-borne 31-33
Enteroviral 32, 33
Herpes simplex 33
Indeterminate 5, 12, 13, 32, 33
Post childhood infections 5, 12, 13,

14, 32, 33
Primary, infectious 5, 11, 12-17, 31-33

F
Fungal infections 101

B
Bacterial meningitis 99
Blastomycosis 100, 101
Botulism

Foodborne 3, 4, 11-17, 25
Infant 3, 4, 12-13, 26
Unspecified 4

Wound 4
Bronchitis, acute 101
Brucellosis 3, 4, 11-17, 27

G
German measles (see Rubella)
Giardiasis 99, 101
Gonorrhea 5, 11-17, 34-38
Granuloma inguinale 5, 11-17
Guillain Barré syndrome 108

C
Cancer 102
Cerebrovascular diseases 102
Chancroid 4, 11-17
Chickenpox 3, 5, 11-13, 28, 29
Childbirth, sepsis of 101
Cholera 3, 5, 10-17
Cirrhosis of liver 101
Cleft lip 106
Cleft palate 106
Clubfoot 106
Coccidioidomycosis 100, 101
Colorado tick fever 100
Crytococcosis 100, 101

H
Heart, diseases of 102
Heat-related illness 109
Hepatitis

A (infectious) 3, 6, 10-17, 39-41
B (serum) 3, 6, 10, 12-15, 39,

42, 43
Unspecified 3, 6, 10, 12, 13, 39,

44, 45
Herpes simplex 33
Herpes zoster 101
Histoplasmosis 99, 101
Historical development

(see Surveillance)
Hydatid disease 101
Hydrocephalus 106
Hypospadias 107
Hysterectomy 121, 122

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M
Malaria 3, 7, 11-17, 49
Measles 3, 7, 10-17, 50-53
Meningitis 99, 101
Meningococcal infections 3, 7, 10-17,

54-57
Moniliasis 101
Mononucleosis, infectious 99, 101
Mumps 3, 7, 10-14, 58-60

S
Salmonella isolations 73, 74
Salmonellosis 3, 8, 10-17, 75
Sepsis

Abortion 101

Childbirth 101
Shigella isolations 76
Shigellosis 3, 8, 10-17, 77
Smallpox 12-17
Sources of data ix
Spina bifida 106
Sterilization, surgical 121-123
Streptococcal sore throat 99, 101
Surveillance, historical development vii
Syphilis

Congenital 82
Primary and secondary 3, 8, 10-16,

78-82
Total, all stages 8, 11-17, 80-81

N

Nocardiosis 100

Р
Pertussis 3, 7, 10-17, 61, 62
Plague 3, 7, 10-17, 63
Pneumonia 101, 102, 112-115
Poliomyelitis 3, 7, 10-17, 64, 65
Population estimates ix, 4, 12, 14-17
Psittacosis 3, 7, 11-17, 66
Pulmonary diseases, chronic

obstructive 102

Q
Q fever 100
Quarantinable diseases vii, 3, 5, 7,

10-17, 63

T
Tetanus 3, 9, 10-17, 83, 84
Toxic-shock syndrome 124-126
Toxoplasmosis 99, 101
Tracheo-esophageal fistula 107
Trachoma 100
Trichinosis 3, 9, 11-17, 85
Tuberculosis 9-17, 86-88, 118, 119
Tularemia 3, 9, 11-17, 89, 90
Typhoid fever 3, 9-17, 91, 92
Typhus fever

Flea-borne (murine) 3, 9, 11-17, 93
Tick-borne (Rocky Mountain

Spotted) 3, 9, 11-17, 94, 95

U
Undulant fever (see Brucellosis)

R
Rabies

animal 8, 12, 14-17, 67, 68

human 3, 8, 11, 12-17, 67
Rectal atresia 107
Reduction deformity 107
Refugees 116-119
Renal agenesis 107
Renal disease 101
Respiratory infections 101
Reye syndrome 120
Rheumatic fever 3, 8, 11-17
Rheumatoid arthritis 101
Rocky Mountain spotted fever

(see Typhus fever)
Rubella 3, 8, 10-14, 69-72
Rubella congenital syndrome 3, 8, 12-14
Rubeola (see Measles)

V
Venereal diseases 3-6, 8, 10-17, 34-38,

78-82

W
Whooping cough (see Pertussis)

Y

Yellow fever 12-17

128

15N145098105

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