Over a year after Sara Manitoski’s body was found by her friends, a coroners report has confirmed that the 16-year-old’s death was due to complications of toxic shock syndrome (TSS). The bacterial infection has been associated with the use of tampons and—although extremely rare—can be fatal.
In Manitoski’s case, it happened on an overnight camping trip to Hornby Island, British Columbia with her peers who were all in an explorer’s club. According to the coroner’s report (obtained by the Comox Valley Record), the high school junior complained to her friends about stomach cramps during the day, wasn’t hungry for dinner, and went to bed before 10 p.m.
When the group woke in the morning, they believed Manitoski to be asleep and went to breakfast. But when they returned to find her motionless with her phone alarm going off, they realized she wasn’t breathing and alerted teachers. Nine months after her death, Manitoski’s sister Carli took to Facebook to discuss TSS—by then, the suspected cause of her death.
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“My beautiful, incredibly healthy sister died because of this so please share, educate yourselves and be cautious whenever using tampons,” Carli wrote. “There is such little education on this and it needs to be brought to light.” The coroner’s report—dated March 23 of this year—says the teen’s symptoms leading up to her death were “consistent with the effects of toxic shock syndrome.”
The coroner, Courtney Cote pointed out that TSS can be caused in other ways. “The risk for toxic shock syndrome is increased with tampon use; however, tampon use is not the sole cause,” Cote said. “Therefore, it is not possible to definitively exclude the tampon as causative.”
So how does TSS occur and what can you do to prevent it? TSS is the result of toxins produced by Staphylococcus aureus (staph) bacteria or group A streptococcus (strep) bacteria. Although it can affect any age group or gender, because of its association with tampon use, it’s most commonly seen in women who use tampons.
That’s not to say the condition is caused by the tampons themselves. Both types of bacteria that cause TSS are already present on the body. They become dangerous when given a warm, moist environment to thrive—releasing toxins that can lead to shock, renal failure, and death.
The good news is, if caught early enough, TSS is treatable. According to the Mayo Clinic, common indicators to look for include a sudden high fever, low blood pressure, a rash resembling a sunburn (especially on your palms), seizures, and headaches. Even for someone in the late stages of this condition, survival is feasible.
Recently, TSS was brought into the news by model Lauren Wasser, who was taken to the ER with a 108-degree fever in 2012. Wasser had to be put into a medically-induced coma upon arrival, and undergo a leg amputation to survive. Years later, she’s thriving and calling on tampon advertisers to do a better job both protecting and informing their consumers.
“Women need more education about TSS,” Wasser wrote in a 2017 InStyle essay. “It is time that we, as consumers, demand safer products and more transparency about what is going into our bodies.”
Although the condition itself is extremely unsettling, it’s important to reinforce how rare TSS is today. After a spike in the 1980s, TSS has continued to decline, now affecting less than two out of 100,000 women in the U.S. Even in those cases, fatalities are rare. But if you are concerned, the best advice is to use low-absorbency tampons and change them every few hours.
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