it's tongues in America's heartland a strange and lethal disease that attacks women hospitals struggle to treat the victims as a regional outbreak turns into a national epidemic the crisis grows as the death toll rises public health officials must race to solve the mystery to track the source of this deadly infection before it can kill again [Music] [Music] some of the names in this program have been changed December 1979 a crosstown bus in Madison Wisconsin a young woman by all appearances in perfect health until collapse was sudden and terrifying unconscious barely breathing the young woman lay sprawled out in the aisle [Music] responding within minutes paramedics rushed to the scene [Music] [Music] and what they found concerned them the young woman had a high fever her pulse was weak and her blood pressure was dropping rapidly fortunately the University of Wisconsin Medical Center was only moments away by the time they reached the emergency room she was going into shock the ER staff would have to work fast [Music] [Music] they had no clues to work with only a driver's license with her name Emily Marie and her age just 18 years old meanwhile her blood pressure was continuing to plummet and an odd beat rash had appeared on her face and hands as the ER team fought to stabilize her throat in blood cultures as well as blood samples were sent off to the lab the cultures would take 24 hours to grow Emily was moved to the intensive care unit where she was placed on kidney dialysis and her vital signs could be closely monitored she seemed to stabilize and then her case took a strange turn the mysterious rash became more pronounced it now covered her entire body urologist dr. Russell Chesney was called in his first priority to bring her out of shock to figure out what was going on I knew that I'd never seen anybody look quite like this she had this rash this sunburn rash and it was spreading it was something that was affecting all of her organs she had bad lungs she had shock she had profound diarrhea she had kidney failure the sudden onset of Emily's symptoms and the bizarre red rash made dr. Chesney suspect she had contracted a severe infection there was no time to wait for lab results he had to act immediately and aggressively do you know where you are so he treated her with a very broad spectrum of antibiotics gentlemen shotgun approach if you will and we wanted to make sure that if this were an infection that we were preventing it from spreading him that we were preventing the organisms from persistent the doctors called in Emily's distraught parents trying to find any possible clue to what had made her so sick the parents really indicated that she had been exposed to anything there was nobody else in the family sick she had some siblings and they were perfectly well and the parents were perfectly well nobody was sick at home nobody was sick at school examining Emily's chest x-rays dr. Chesney tried to understand what had happened her silhouette is not that fall it's narrow like we would see with shock and I she certainly didn't have congestive heart failure anything there no curly beads what he saw was perplexing it didn't make any sense the thing that was confusing to us in looking at her chest it was clear she didn't have pneumonia and she also didn't have a collapse of her lungs or anything like that what she actually had was she had a hemorrhage from the lung Emily's lungs were bleeding it was hard for her to breathe dr. Chesney recognized this was a dangerous and potentially deadly complication but Chesney had no idea what the cause was the more he learned about her case the more baffled he became her symptoms seemed random disconnected it was the nightmare of any parent that mourning their daughter had left the house a healthy teenager now she was hooked up to IVs and monitors [Music] luckily IV fluids and dialysis eventually began to help Emily's blood pressure started to rise to a safer level and it stayed there for an hour too and I felt comfortable in going home and trying to find out more about this with the patient finally stable Chesney could concentrate on the diagnosis he sought a second opinion from his wife dr. Joan Chesney is the head of the infectious disease division at the University of Wisconsin School of Medicine the patient's high fever diarrhea and dehydration were all classic symptoms of an infection but she has a lot of other extra features that just don't make sense well one of the things she has is a rash that is spreading like crazy total body rash I really can't figure what's going on - dr. Joan Chesney the symptoms sounded familiar red rash and red eyes it reminded Joan of a Journal article she had recently seen by a doctor in Colorado the article outlined a new syndrome called toxic shock characterized by shocks a rash and multi organ disease the illness was linked to a toxin produced by the bacterial Staphylococcus aureus the disease was named toxic shock syndrome in extreme cases it could be fatal the next morning Joan Chesney came in to examine Emily Marie in her 11 year studying infectious diseases she had never seen anything like it blood vessels became inflamed when the bacteria released its toxins causing a rash that covered Emily's entire body even her palms in the journal article the staph aureus bacteria was described as infecting the patient's bodies through an open wound but Emily did not have any cuts or wounds for the bacteria to infect so where had it come from my biggest question was is this toxic shock syndrome as he described it but I was very skeptical about the staph aureus particularly because she didn't have any infections site Emily did have many of the same symptoms she even developed small hemorrhages in her eyes Chesley was determined to unravel this medical mystery further bacterial infections that can cause shock and multi-system disease but they don't generally cause the rash or the red eyes so it was one of those things that you just had a sixth sense that there was something not right about this Emily fit the description of toxic shock syndrome but not completely Joan Chesney wondered if they were seeing the birth of a new and terrifying disease you have to make yourself keep an open mind to the fact that it might be a new virus it might be a new bacteria we were wondering if it could have been some kind of chemical reaction that she may be absorbed a chemical through her skin or taking a drug that nobody knew about then just hours later a second case appeared 19 year-old Kaylee Wilson was rushed to the University of Wisconsin Medical Center like Emily she arrived in the ER with a raging fever extremely low blood pressure and a bizarre red rash the ER staff pumped her with fluids desperately trying to raise her blood pressure Kaylee's mother was frantic the girl was fighting for her life Joan Chesney was immediately notified we see patients all the time who had very unusual presentations of some disease but there's only one of them and we don't we often don't figure out what it is no matter how hard we try but here we had to write less than 24 hours apart both of whom were very sick the similarity between the two cases was uncanny Joan's experience with infectious diseases told her this couldn't be a coincidence she recommended supportive treatment massive amounts of IV fluid and a broad spectrum of antibiotics soon after Kaylee was admitted Joan learned that a third case of the mysterious illness was being treated at a hospital just across town this was no random event this was the beginning of something widespread something far-reaching this was the start of an epidemic to say my heart rate doubled would be an understatement it was scary Joan knew it was time to bring in the director of the Wisconsin Department of Health dr. Jeff Davis the fact that three cases were occurring in one community simultaneously certainly was a impact we felt it was certainly unusual needed to be investigated right away as chief epidemiologist for the state of Wisconsin it was dr. Davis's job to make sense of this outbreak to figure out how these three cases were related had the young women all been exposed to something in common what was the source of the illness dr. Davis interviewed the three patients asking about pets allergies dietary habits anything that might provide a link a clue to the origin of this mysterious infection we asked about a lot of activities these were fairly far-reaching you know where people shop you know where they went whether you thought if ities were Davis then compared the interviews looking for overlapping data the one key point where the patient's lives intersected what he found was absolutely nothing except for the fact that they were women and they were from basically the greater Madison area they didn't have anything in common the mystery was growing and unless doctors and public health officials could identify the source of the toxic infection more young women could be in danger a strange outbreak a mysterious infection and in Madison Wisconsin young women were being rushed to the hospital in each case the symptoms were the same high fever dangerously low blood pressure signs of shock and a bizarre sunburn like rash [Music] as dr. struggled to keep the women alive health officials worked round the clock to find the cause Wisconsin state epidemiologist dr. Jeff Davis combed through the woman's medical records searching for clues what did these patients have in common the only thing they shared was that they were all young and they were all women it seemed like nothing in fact it was the beginning of an answer so that's when I thought what differentiates women from men and given their age I thought that menstruation may be a factor unfortunately the medical files had no record of menstrual cycles doctor Davis would have to revisit the patient's Emily Murray the first was in the best shape of the three her kidneys were failing and she had been put on dialysis but she was at least lucid enough to talk regular since that time normal monthly periods over the next day the other patients told him the same thing they had both been menstruating when they got sick at last Davis had found something all the patients had in common but what did it mean was it even significant he shared his findings with infectious disease expert dr. Joan Chesney she was skeptical my reaction was jennife if you take any group of young women at one point in time you know a significant number gonna be having their period and he said well I know but I just can't find anything else but Davis's interviews uncovered another clue supporting his suspicions one of the women had suffered similar but less severe symptoms a month before the implications were frightening [Music] had the young women taken a pain reliever that was contaminated a tainted batch of oral contraceptives Davis and Chesney wondered if other doctors in the area were seeing the same strange illness it was time to get the word out to get as many brains working on the mystery as possible we found a real sense of urgency to let other people know as quickly as possible and to see if people had seen it not recognized it to be sure we picked up any additional cases dr. Chesney presented her cases at a hospital conference on infectious disease to tell you about three patients that we've seen in the last two days and we wanted to bring it to your attention so that if any of you saw a patient with this in the next few months or if you've seen a patient with us over the last six months please let us know I'm sure it's not just going on here in Madison but it's probably when she asked if anyone had seen patients with similar symptoms a medical resident spoke up he had treated a young woman in her teens a few months earlier dr. Chesney asked to look at the patient's records thank you again for letting us come today as she reviewed the file dr. Chesney saw all the tell-tale signs look she was in shock at the time and she had a rash just like I told you earlier anybody recorded that she was having her period my knowledge is started you find it here it is they did document that she was having her period at the time of her symptoms this was yet another documented case of the mysterious illness Wisconsin was firmly in the grip of an outbreak soon another teenager was being admitted to the Wisconsin Medical Center like the other women when she arrived at the ER she was disoriented and covered with a bright red rash [Music] have you heard there's another teenager the emergency room with a few scratches shocked and they'd like you to come now please my name's dr. Chesney this new patient was also menstruating dr. Chesney had been developing a theory about the source of infection since the patients were all menstruating at the onset of illness Chesney ordered a vaginal culture to test for bacteria in the lab the culture was incubated on a growth medium 24 hours later it was placed in a reagent solution and identified as Staphylococcus aureus the bacteria associated with toxic shock syndrome Joan Chesney's initial diagnosis had proven correct and sure enough it was a what we call a pure culture that was the only bacteria that grew and it was a heavy growth so that was our first clue hard clue that maybe our thoughts were going in the right direction for dr. Jeff Davis the epidemiologist it was time to place the entire state on alert [Music] he notified over 3500 physicians that Wisconsin was facing an outbreak of the deadly toxic shock syndrome he requested information and sample cultures from any patients who displayed symptoms it was important to get this letter out because they needed to learn about the illness using always occurring we made recommendations for laboratory tests to obtain them so that expanded their ability to get the appropriate tests in a time before email Davis's letter on toxic shock was distributed the old-fashioned way by US Mail but all across the state physicians got the message watch out for unusual cases it was really that very very unique combination of symptoms and signs that we tried to let people know about and you know don't give them some penicillin I send them home because they won't be better in the morning you need to get them to the hospital right away the response was overwhelming hospital statewide reported cases of the deadly illness not just one or two but hundreds of them young women all over Wisconsin were infected with toxic shock syndrome and health officials had no idea why in 1980 dozens of young Wisconsin women were coming down with the disease no one had ever heard of before menstral toxic shock syndrome the local doctors were baffled more cases were appearing across the state [Music] then several weeks into the outbreak the Wisconsin Department of Health learned that three women in Minnesota had also been hospitalized with unusual symptoms epidemiologist Jeff Davis was baffled toxic shock syndrome is not contagious how would it spread to another state we discussed the importance of reporting this to CDC because clearly this was going on in a couple of states at the Centers for Disease Control in Atlanta dr. Bruce Dan was part of the investigation to suddenly hear that women in Wisconsin Minnesota were having the same symptoms and not just the same symptoms very strange collection of symptoms you don't have to be a really trained epidemiologist to realize you had a real epidemic on your hands and something very strange was going on in all his experience with the CDC's epidemiologic Intelligence Service dan had never encountered toxic shock syndrome he tried to learn all he could it was important for us to talk to a lot of experienced investigators that infectious disease experts who had seen years and years of disease especially in medical centers and universities where they get referred lots of very unusual cases and they said you know we have never ever seen anything like this before you guys are handling something totally new totally unrecognized as far as we're concerned the CDC's investigative team rolled into action to learn the scope of danger health departments across America were contacted by CDC lead investigator Catherine Schanz we needed to figure out whether this was a regional outbreak or a national outbreak and so we began to put out the word and ask people had they seen this illness in other locations than Wisconsin and Minnesota only two things were certain toxic shock syndrome was dangerous and it was spreading on Sunday February 8th 1980 Ronald and Jeanette Dilek were on their way to church jerilyn their 16-year old daughter was running late [Music] [Music] and st. Mary's Hospital in Milwaukee an emergency team sprang into action as jerilyn flickered in and out of consciousness the ER staff charted her vital signs the teenager was suffering from multiple high-risk symptoms her heart was inflamed and her temperature soared to 106 degrees doctor struggled to make a diagnosis until the attending physician received Jeff Davis's letter she recognized his patient symptoms as a textbook case of the brand-new epidemic meeting with geralyn's family the doctor asked if she had been menstruating when she became sick she had their answer confirmed his diagnosis toxic shock syndrome he would need to contact the Wisconsin Department of Health to get the latest information on treatment with her life hanging in the balance Geralyn was given fluids to rehydrate her and help raise her blood pressure she was also given an antibiotic to combat the staph infection if Geralyn stood any chance of survival treatment would have to take effect quickly news of the 16 year olds desperate condition reached Neil Rosenberg a Milwaukee based health reporter he was intrigued by the mysterious illness when I first heard about Geralyn Dulac it came not with a name but fear and the voice of an anonymous caller I was sitting at my desk looking for a story as I usually do when the phone rang and there was a person who said a young woman was seriously ill critically ill he said on the south side of Milwaukee from a killer virus tracking the story Rosenberg contacted dr. Jeff Davis at the Wisconsin Department of Health he learned the mysterious illness had a surprising connection he gave me a graphic description of the symptoms and at one point in it I said is there any common leak he said they were all menstruating and that really threw me for a loop and I said well what do you think that means and he says we really don't know Neil that's what we're looking into Rosenberg story made front-page news for Jeff Davis in the Department of Health it also opened a floodgate that article had a lot of information about toxic shock syndrome and I started getting a lot of phone calls a huge number phone calls and so that article had an extraordinary impact hundreds of calls began pouring in physicians call to report suspected cases women call to share their stories of surviving about with the deadly syndrome astonished by the response Davis launched a case study to analyze the data [Music] health officials work non-stop gathering information they had to find the link between toxic shock syndrome and menstruation through scores of interviews the team compared 35 confirmed cases of toxic shock to a larger control group of healthy women all the women healthy or infected lived in the same area they were all about the same age and shared similar lifestyles [Music] the Health Department also conducted field interviews with the participants some of the women described feeling unusually sick every time they got their periods [Music] but their symptoms had not escalated unlike Geralyn julik at st. Mary's Hospital the teenager was getting worse her condition had been steadily deteriorating finally after 20 days in the hospital she slipped into an irreversible coma and on February 28th jerilyn du Lac died from catastrophic organ failure Wisconsin had lost its first victim to toxic shock syndrome she would not be the last until 1980 the American public had never heard of toxic shock syndrome but now the rare bacterial infection was erupting in the Midwest one teenager had already died in Wisconsin now the disease showed up in Iowa on May 16 30 six-year-old Chris Leacock was rushed to the hospital her liver and kidneys were failing the emergency room team worked hard to stabilize their patient fire bombs enormous presents they called in the hospitals infectious disease expert dr. Charles Helms so they get a call from dr. Ling Ling who was the resident on-call in the intensive care unit the medical intensive care unit about a case that was really had him worried and concerned and wanted an infectious-disease consult dr. Helms had never seen anything like it It was as if the patient's entire body was shutting down one organ after another it's unusual to see a young healthy person as she was come in so desperately ill particularly with so many systems of her body involved as her condition got worse Chris was moved to the intensive care unit where she could be monitored in addition to her liver and kidneys her lungs were failing and perhaps of most concern to us here her respiratory status her ability to breathe and oxygenate her blood was in dire straits doctors rushed to intubate the patient they put her on a respirator her blood pressure was crashing her organs weren't functioning they were losing her their only hope of keeping Chris alive was to raise her blood pressure to get blood to her vital organs despite the CDC's efforts not all doctors were aware that a strange infection was on the move if it was a bacterial infection that she was on a sufficiently broad range of antibiotics to protect her while we figured out what was going on with her Chris Leacock was placed on life support in the ICU her family sat by her side as she slipped into a coma but Chris was not alone toxic shock was now a national problem at the CDC the calls were streaming in hundreds of girls were sick and some were dying epidemiologist Bruce Dan tracked the outbreak was happening nationally in a dozen states all over the country suddenly young previously healthy women who were going about their life going to high school going to college going to work raising kids suddenly get Hill as if they had the flu and some of them would be dead in the next 12 or 24 hours from a totally unknown cause that's frightening the CDC task force kept running totals of confirmed toxic shock cases reports were coming in from all over the country nationwide the death toll had risen to seven as the numbers kept going in we got more and more calls saying we've seen another case in another case in another case it was a lot of pressure to say we had to solve this very quickly find the answer to stop this epidemic and save a lot of lives the CDC put together an MMWR a mortality and morbidity weekly report on toxic shock syndrome it was an alert to physicians and hospitals all across the country the MMWR would help doctors make an early diagnosis of toxic shock patients it's basically the CDC's mechanism for getting information out to doctors nurses health officials across the country it's also mechanism for getting information back in the CDC's report arrived at the Iowa Hospital just in time dr. Helms recognize Chris Leacock symptoms immediately [Music] it was textbook toxic shock syndrome dr. Helms followed the CDC's recommendations massive amounts of fluids and antibiotics to fight infection for now her terrified family could only watch and wait back at the CDC the numbers continue to rise 107 cases had now surfaced in 33 separate states clearly this was the beginning of a nationwide epidemic but what was causing it your first hunch if you want to play hunches is probably maybe these are women who got a bad batch of some medication that women commonly take their minstrel period for for aches and pains and so forth but you can't play your hunches when you're dealing with something like this you have to do a real study and so the CDC launched a nationwide hunt to discover the cause of toxic shock you've got the names of 50 women from their medical records in hospitals across in the United States how do you find them how do you call them where are they now for each patient they needed to interview three control subjects they asked each of the patients for the names of three friends so it's not just a matter of making 200 phone calls but maybe 400 800 thousand phone calls to get hold all these people and took a huge amount of work we had a very short time to do it with the days passing and more women falling ill health officials race to get to the bottom of the mystery so we devised a questionnaire about 120 550 questions asking everything we could think about about their current health status medications they may be taking certainly everything we could think of about their menstrual period do you wear pads or tampons do you exercise during your period do you job do you take showers do you take baths what do you do unusual or not do unusual during your period to get an idea of what would make the case is different than the controls why did the one group of young women get toxic shock syndrome you get violently ill in other women were totally healthy and it was clear to us that if you asked enough questions you would we find out why women would talk to choc syndrome were different than other women turns out the answer surprises after weeks of medical detective work the CDC investigators had found the common link there was one thing that set the women with toxic shock apart 100 percent of them used tampons what could it be about tampons that would cause this severe disease and cause women to die they've been in use for 50 years 50 million women a month used in the United States there are all kind of brands out there they were commonplace and it didn't make a lot of scientific sense from a biological point of view of what what could it be about a tampon that could kill you the solution to one mystery was the beginning of the next CDC investigators presented their startling findings to every tampon manufacturer in the country we invited the tampon manufacturers to come down to Atlanta to CDC to discuss with us first of all to tell them what the results of our study worth so they would be aware and secondly to find out from them tell us about tampons how are they made where they made what are they made of the executives agreed to provide the CDC with the information but on one point they were unequivocal they had no intention of taking their products off the market they believed the scientific proof was lacking still CDC investigator Katherine Schanz felt the evidence linking tampons to toxic shock was clear enough the disease needed two things to occur one was the presence of staph aureus and actually an infection with staph aureus the other was the use of tampons and so the CDC went public with their findings they needed to warn women about the potential threat but the mystery was far from solved dozens of questions still lingered investigators needed to conduct a second study to determine why tampons were making women sick what caused the infection had specific brands become contaminated so we collected tampons to test him in the laboratory to see if any particular tampon any brand any style from any kind of manufacturing location might be contaminated and though we looked at hundreds and thousands of tampons you know hundreds and thousands of hours of laboratory time to look for that we couldn't find any particular tampon that were contaminated with anything that would cause a disease this story of the outbreak made national headlines and all over America women were confused and terrified this was also under sort of a national spotlight and suddenly not only do you have the spotlight on you from just your local colleagues but the director of CDC the Surgeon General the Department of Health and Human Services Secretary and even the presidential office is looking very quickly at you to say hey is the real problem are you guys going to solve it throughout the summer involved the epidemic raged on and it began to set in as more and more women found themselves in a battle with a mysterious disease fighting for their lives all across America women were dying and health officials didn't know why as scientists race to find answers more patients were being rushed to the hospital patients like 25-year old Pat Kemp the mother of two small children she had early flu-like symptoms now she was in the ER and her husband Mike was worried every 15 or 20 minutes I was allowed to enter into the emergency room that could hold her hand she was having such a difficult time breathing she wasn't able to communicate very well with me but I could squeeze her hand and she could squeeze it back as Pat's condition deteriorated Mike grew more concerned to think that just a few days prior she was the young healthy mother of my children and we were enjoying life and making plans for our future to see her in a hospital setting looking totally unlike her normal self and fighting to take every breath the medical community was now on high alert for patients who showed signs of toxic shock syndrome and Pat Kemp was a classic case admitted to the ICU pat was treated with antibiotics to fight the infection but her situation was grave and Mike could see she had taken a turn for the worse and so alarmed at how her coloring had changed and later I understood that that was because her blood vessels were bursting under her skin to do the toxins and the poison in her body and I said well doctor what's the worst thing I can expect and he said Mike that's a good question to ask you know my fear was what she have lung damage or brain damage or some other organ that could be damaged by all this and he said you know that that's a fair question but our fight right now is just to try to keep her alive and at that point it dawned on me just how critical she was even as Pat can lay on that hospital bed the CDC was working around the clock to pinpoint the source of her infection was it a style of tampon one specific brand that's when investigators had a breakthrough in this particular study one particular brand with tampon the Kadett for about two-thirds of all the cases and it was a brand of tampons and only about a fifth of women united states were using so something was highly risky about this tampon the brand was a relatively new product that had been aggressively marketed as a super absorbent tampon the manufacturer had spent millions of dollars promoting it to women nationwide they told us that they had made changes in the composition of tampons over the last several years prior to 1975 all tampons had been made of cotton and rayon and they had begun introducing high absorbency chemical materials into tampons to obviously to increase the absorbency the FDA acted swiftly and pulled the brand from the shelves when they did that the number of cases of Topsy shock syndrome dropped off too dramatically and not surprisingly if tampon is responsible for two-thirds of the cases removing that tampon from the market as quickly as you can reduce the number of cases the CDC got the word out tampons were directly linked to toxic shock syndrome but for Pat Kemp it was already too late despite the doctor's rapid diagnosis she lay in a coma unable to breathe on her own and I would spend the evening with her at the hospital she squeezed my hand and tears are flowing down her cheeks and those tears were ripped because of the blood vessels burst in enterprise [Music] on September 6 1980 Pat cam lost her battle with toxic shock syndrome another victim of this terrible plague but the story wasn't over although one brand of tampons had been pulled from the shelves more cases of the infection turned up at hospitals around the country women were getting sick while using other brands and no one knew exactly why absorbency levels seemed to be a factor as well as how long they remained inside the body to alert the public the FDA required tampon manufacturers to include information in their packaging about toxic shock syndrome and how to avoid it in Iowa Chris Leacock spent weeks lying near death finally the aggressive antibiotic therapy kicked in her body fought off the staph aureus bacteria chris is dr. Richard Helms credits the research of the CDC for saving her life Chris was fortunate that she came in to a hospital in this country at that particular point in the evolution of American medicine where we had a syndrome where we had an approach to that syndrome and that syndrome included treatment of Staphylococcus aureus nearly a month after she was admitted Chris Leacock was released from the hospital today she's still thankful for dr. Helms quit thinking [Music] they saved my life there's no doubt about it they saved my life they were on top of it they had to try a lot of different things you have to realize that my kidneys failed my I went into congestive heart failure I was being kept alive by a life support and they kept me live and I'm very very very grateful to them in the span of the more unfortunate year hundreds of young women were infected with toxic shock syndrome 37 of them died dozens more suffered lingering pain in trauma but women like Chris Leacock like Emily Marie and Kaylee Wilson all survived in the end in the following years researchers got a much clearer idea of what had caused the outbreak the tampons were the culprit the new synthetic materials simply work too well they became tiny incubators for disease the perfect growth medium for the staph aureus bacteria [Music] manufacturers went back to old-fashioned cotton and rayon and health officials got out the warning the need to change tampons regularly and watch for flu-like symptoms the outbreak Todd larger lessons as well I think one of the lessons of toxic shock syndrome is that just as much as we've learned about bioterrorism anthrax lately is that you need to have a group of highly trained professionals who at a moment's notice can look into solve and fix an epidemic one of the things about epidemics is you never know where they're gonna happen or whether they're gonna come from the key is early detection and swift reaction mike kam and his wife sister carol have become advocates for women's health myself and my daughters and our family our goal today is for the next generation of young women who are using feminine hygiene products today to please read the warning labels that are on the boxes of these products or inside on pamphlets and have an awareness that if you have any flu-like symptoms you could be endangering your life and to remove the product and seek medical attention immediately that simple warning came 30 or 45 days too late to save my wife's life today nearly 20 years after the first outbreak the numbers of syndrome cases caused by tampons have declined sharply but they have not disappeared hundreds of incidents are still reported each year thanks to new diagnostic tools and early detection many of those lives can now be saved [Music] [Music]