Reporting & Investigation of Toxic Shock Syndrome

Table of Contents

A. Purpose of Surveillance and Reporting

  • To identify household and other close contacts for possible culture and treatment of the underlying bacterial cause.
  • To identify transmission sources of public health concern (e.g., contaminated food or a healthcare worker who is a GAS carrier) and to stop transmission from such sources.

B. Laboratory and Healthcare Provider Reporting Requirements

Iowa Administrative Code 641-1.3(139) stipulates that the laboratory and the healthcare provider must report. The preferred method of reporting is by utilizing IDSS.  However, if IDSS is not available, the reporting number for IDPH Center for Acute Disease Epidemiology (CADE) is (800) 362-2736; fax number (515) 281-5698, mailing address:

Iowa Department of Public Health, CADE
Lucas State Office Building, 5th Floor
321 E. 12th St.
Des Moines, IA 50319-0075

Laboratory Testing Services Available

The State Hygienic Laboratory (SHL) does not provide services for the testing to confirm TSS. However, SHL will test specimens for the presence of S. aureus or Beta Strep Group A. In some outbreak circumstances, isolates may be sent to Centers for Disease Control and Prevention (CDC) for toxin testing. For more information contact SHL at (319) 335-4500, or visit: www.shl.uiowa.edu/

C. Hospital Infection Preventionist will have the information necessary to initiate case follow-up.

The hospital Infection Preventionist usually completes the investigation, utilizing the Iowa Disease Surveillance System (IDSS).

Use the following guidelines to complete the investigation:

  • Record the demographic information, date of symptom onset, and hospitalized dates. If the case is a menstruating woman, collect information on tampon and sanitary napkin/minipad use, including the brand and style of product, as well as date of onset of last menstrual period.
  • Clinical findings, laboratory data and culture information are all important in defining a case. Collect the data for these sections of the case investigation as completely as possible.
  • If several attempts have been made to obtain case information, but have been unsuccessful, fill out the form with as much information as possible.  Enter into the Notes section the reason why it could not be filled out completely.   If using IDSS, select the appropriate reason under the Event tab in the Event Exception field.
  • After completing the investigation, enter the information into IDSS or fax to (515) 281-5698 or mail (in an envelope marked “Confidential”) to IDPH/CADE, mailing address:

Iowa Department of Public Health
Center for Acute Disease Epidemiology
Lucas State Office Building
321 East 12th St.
Des Moines, IA 50319-0075

  • Local public health shall assist with case follow-up as necessary and review the investigation and assure it is complete.

Institution of disease control measures is an integral part of case investigation. It is the LPHA responsibility to understand, and, if required by IDPH, to institute the control guidelines listed in Controlling Spread.