Epidemiology

Staphylococcal toxic shock syndrome

Toxic shock syndrome (TSS) is most frequently caused by gram-positive staphylococcus. In 2019, there were 44 cases of staphylococcal TSS reported in the US.[18]​ The incidence of menstrual staphylococcal TSS ranges from 0.03 to 0.50 cases per 100,000 women; overall mortality of menstrual staphylococcal TSS is approximately 8%.[19]​ ​Non-menstrual TSS is now more common than menstrual TSS.[20]​ The incidence of menstrual TSS has declined since the 1990s owing to changes in tampon manufacture and increased public awareness. In the US, non-menstrual cases may account for approximately 55% of all staphylococcal TSS.[21][22]​​​​​ Non-menstrual cases occur more often in non-white, older women but can occur in either sex and are associated with a staphylococcal abscess or recent surgery.[4][21][23]​​​​​ Postnatal TSS has been recognised occurring after vaginal and caesarean deliveries and also resulting from various postnatal infections.

Most cases of staphylococcal TSS are due to methicillin-sensitive Staphylococcus aureus (MSSA). However, the incidence of TSS from the more virulent community-associated MRSA strains is increasing.[24][25]

In the UK, the average annual incidence of staphylococcal TSS cases is estimated to be 0.07 per 100,000 population.[20]

Streptococcal toxic shock syndrome

Approximately 14,000 to 25,000 cases of invasive group A streptococcal disease are estimated to have occurred each year between 2017 and 2022 in the US.[26]​​ Based on preliminary 2022–2023 data, the Centers for Disease Control and Prevention (CDC) announced in February 2023 that it is looking into an increase in invasive group A streptococcal infections among children in the US.[27]​ In a March 2023 UK Health Security Agency (UKHSA) report, notifications of invasive group A streptococcal infections in England were higher than the range expected for the time of year.[28]​ Invasive group A streptococcal infections include streptococcal TSS. Between 2004 and 2014, the reported incidence of streptococcal TSS in the US ranged from 0.06 to 0.12 cases per 100,000 people.[29] ​There were 416 cases reported in 2019.[18] Some studies suggest rates of TSS are higher among young children and adults aged ≥65 years.[30][31]​​ However, people of all ages are affected and most do not have underlying diseases.[32]

Approximately 85% of invasive infections occur sporadically in the community, 10% are hospital acquired, 4% occur in residents of long-term care facilities, and 1% occur after contact with an infected person.[33][34]​ One population-based study reported a rate of secondary infection of approximately 2.9 cases per 1000 household contacts.[33] Secondary invasive disease in household contacts and hospital personnel has been reported to occur several hours to weeks after the index case.[33][34][35][36] Outbreaks in closed environments such as hospitals, military bases, and nursing homes have been reported.[36][37][38][39][40]

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