A British Columbia teen died as a result of toxic shock syndrome while on a class trip, a newly-released coroner’s report says.

In a report released to the public, the death of 16-year-old Sara Manitoski has officially been confirmed as resulting from a deadly strain of staphylococcus aurea (staph) bacteria.

B.C. Coroner’s Services released information stating that the teen had died during a school trip to Tribune Bay Provincial Park, located a short distance off of Vancouver Island, in March 2017.

The day before her death, Manitoski had reportedly complained of menstrual cramps and not feeling well. Friends noticed that she didn’t eat much dinner, and say she went to bed shortly after attending a bonfire.

The next morning, believing Manitoski to be asleep, her classmates went for breakfast. When they returned the teen was found still in bed and unresponsive while her alarm was going off.

Coroner Courtney Cote states in the report that students immediately alerted staff and that both teachers and paramedics attempted cardiopulmonary resuscitation (CPR) but were unable to revive her.

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Classmates of the Grade 11 student from G.P Vanier Secondary School, reported hearing rapid, shallow breathing coming from her bed.

Cote notes that Manitoski was found with redness on her neck, upper arms, chest, lower abdomen and thighs.

The coroner performed several tests, including tests of Manitoski’s in place tampon, which revealed the presence of the dangerous staphylococcus (staph) bacteria, consistent with toxic shock syndrome.

While the coroner was able to confirm the presence of staph bacteria in Manitoski, the report does not rule the teen’s tampon as the method in which she contracted the dangerous staph bacteria.

“The risk of toxic shock syndrome is increased with tampon use; however, tampon use is not the sole cause,” the report reads. “Therefore, it is not possible to definitively exclude tampon use as causative.”

What is Toxic Shock Syndrome (TSS)?

Although often attributed to the use of tampons, toxic shock syndrome is not a disease in itself, but rather a bacterial infection that can occur in non-menstruating women, children and men.

When this particular strain of staph bacteria enters the bloodstream, whether through viral infection such as chickenpox, contraceptive sponges and diaphragms, cuts, burns or after surgery.

TSS often presents with flu-like symptoms of fever, nausea, dizziness and sore throat, accompanied by a sun-burn like rash. Left untreated, the infection can lead to organ failure, and can become fatal in as little as two days.

TSS is considered a rare condition. In 2016, the Centre for Disease Control reported 323 cases of TSS in the United States and 26 deaths of both men and women.

Why is TSS often attributed to tampon use?

This bacterial infection became linked to tampons after a sudden rise of TSS cases during the 1970s. Almost three-quarters of the reported cases during this time were deemed tampon related, and attributed to the materials and chemicals that were being used to manufacture super-absorbing tampons.

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These super-absorbant sanitary products caused women to leave their tampons inserted for longer periods of time, which allowed for more moisture to collect and become the perfect breeding ground for bacteria.

With tampons able to absorb more moisture, many women began finding these super absorbant tampons too drying, and were developing small scratches to the inside of their vaginal wall which could allow for the spread of bacteria into the body.

As a result of the spike in TSS cases, the US Federal Drug Administration ordered all tampon manufacturers to include a warning for TSS.

Since then, there have been regulations to materials used to manufacture tampons, such as carboxymethylcellulos (CMC) that has resulted in tampons being less absorbent than they were in the 1970s.

Although contracting TSS is rare, the tragic death of Sara Manitoski is a reminder that it can still happen.

While anyone can contract TSS, young women who begin their period should be educated on proper menstrual hygiene, and know their options when it comes to sanitary products.

Experts recommend women change their tampon every 4-8 hours, and using light absorbency tampons when possible. The use of sanitary napkins at night, or during days with a lighter flow is also encouraged.

The ongoing education and dialogue of women’s reproductive health is crucial to helping women understand and be conscious of any changes to their bodies.

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