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UTAH NO LONGER WILL MONITOR POSSIBLE TOXIC-SHOCK CASES

Utah's Department of Health will no longer actively monitor possible cases of toxic-shock syndrome, a bacterial infection that has drastically receded over the past 15 years.

In 1980, the state had 59 cases, one of the highest rates in the nation. Its symptoms mystified scientists and health-care professionals across the country and in Utah where years of studies eventually pinpointed its cause."It was very similar to hantavirus," said state epidemiologist Craig Nichols. "You had an explosion of illness. There were a few sporadic cases in the 1970s, but then it became very pronounced in 1980."

Researchers linked an overwhelming majority of the cases to women's use of superabsorbent tampons. The discovery led to changes in the product's materials and warning labels.

Since then, toxic-shock syndrome has dramatically declined across the country. There were just five cases in Utah last year and 212 nationwide in 1993.

As a result, the state Health Department has decided not to conduct active surveillance for toxic-shock syndrome, Nichols said. In past years, health officials have contacted all hospital infection control nurses twice a month.

But because of budgetary and time constraints and the decline in cases, the health department will review only those that are reported.

Most states had moved away from actively monitoring possible cases in the early '80s when the cause was determined. But Utah kept the checks in place as a precaution because of the high number of cases in the early 1980s.

During that time, the state conducted one of four major studies on toxic shock.

The Food and Drug Administration, Centers for Disease Control and three states including Minnesota, Wisconsin and Iowa also did research to try to find a cause.

"All of the studies came to the same conclusion - super-absorbent materials allowed the staph bacteria to grow and produce toxin," Nichols said.

But the reason for Utah's high number of cases? "That we could never figure out," he said.

Several "exotic" genetic tests were conducted in Utah, but all were inconclusive. Health officials have since decided that Utah's high incidence was due to good reporting by patients.

Although there have been no cases this year, and last year's five cases were the least since 1980, Utah's rate of toxic-shock syndrome remains at five times the national average, Nichols said.

About 90 percent of all cases have been women who were menstruating and used tampons, but men and children are not immune. Some male sufferers have been patients recovering from nasal surgery whose wounds become infected after they were packed with gauze.

The infection is caused by bacteria in a wound. As it spreads, the bacteria produces a toxin. Symptoms that result can include fever, vomiting, diarrhea, rash and high blood pressure that may result in dizziness.

Today it's rare that anyone dies of toxic-shock syndrome, which is treated with antibiotics. But in 1980, the fatality rate was 8 percent.