The above letter suggests that some women are prompted to change their tampon use practices based upon knowledge of toxic shock syndrome. The general trends recited here are commensurate with other observations across the country. Others have observed that over time some of these women will revert back to the use of tampons as publicity about toxic shock syndrome wanes. Although the Center for Disease Control (CDC) has claimed that the incidence of toxic shock syndrome has decreased,1 they have a passive surveillance system and data from other, more complete, active surveillance programs (Michael Osterholm, personal communication) suggest that no decrease has occurred.

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