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August 20, 1982

Toxic Shock and Tampons: Evaluation of the Epidemiologic Evidence

Author Affiliations

From the Robert Wood Johnson Clinical Scholar Program, Yale University School of Medicine, New Haven, Conn (Drs Harvey, Horwitz, and Feinstein); and the Cooperative Studies Program Support Center, Veterans Administration Hospital, West Haven, Conn (Dr Feinstein). Dr Harvey is a Robert Wood Johnson Clinical Scholar. Dr Horwitz is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.

JAMA. 1982;248(7):840-846. doi:10.1001/jama.1982.03330070028025

The main evidence that tampons are an etiologic cofactor in the development of toxic shock syndrome (TSS) comes from epidemiologic case-control studies. The patients chosen as cases in those studies were assembled from reports submitted to health agencies in response to publicity that may have influenced physicians to diagnose TSS and to submit reports particularly in situations where the patient was a menstruating tampon user. When the submitted reports were checked for fulfillment of TSS diagnostic criteria, and when cases or controls were asked about antecedent tampon usage, suitable scientific precautions were not used to achieve "blinded" objective decisions. Since these biases would have distorted the statistical relationships, the etiologic role of tampons in TSS has not been scientifically proved.

(JAMA 1982;248:840-846)