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Re: Toxic shock syndrome and nappies

Dear Editor,

Heal and Cooper in a recent letter [1] raised several serious issues relating to disposable nappies without consideration of the evidence available. In one of these they imply that sodium polyacrylate in disposable nappies increases the risk of toxic shock syndrome (TSS) to those that wear them. This proposal may be challenged.

Firstly there are no reported cases of such an eventuality. Careful documentation of UK cases of staphylococcal or streptococcal TSS for which data are available has been carried out for over 10 years by clinicians and PHLS staff. There is no evidence that this clinical scenario has ever been reported or considered despite the high rate of staphylococcal carriage in some infants [2,3]. There are no reported cases in the international literature. As a consequence the risk of contracting TSS from a nappy is too small to be estimated, a point supported by the extensive safety literature of these products [4]. Reporting of any cases by the authors, or perhaps an independent study, would be welcomed.

Secondly sodium polyacrylate is used in clinical and cosmetic products without complication and is included in some topical preparations as an emollient. At a microbiological level there are no observations that sodium polyacrylate supports the growth of toxin-secreting bacteria, encourages expression of toxin genes or enhances toxin activity [5]. Sodium polyacrylate has been reported by others to act as an osmotic disinfectant in the presence of bacteria [6]. There are no data to indicate that sodium polyacrylate was or is implicated in tampon-related TSS, unless the authors have new observations to present.

Hypotheses such as those in this letter which lack a thorough approach to existing publications and report no new data or hypotheses do little to support either the academic position or training of paediatricians in the eyes of families we care for. They will generate understandable anxiety and cannot support constructive efforts to reach the holy grail of improved infant safety.

COLIN A. MICHIE, NATHAN HASSON
Department of Paediatrics, Ealing Hospital NHS Trust LONDON UB1 3HW

References

(1) Heal C, Cooper C. Other implications of disposable nappies. Arch Dis Child 2001; 85: 269.
(2) Lindberg E, Nowrouzian F, Adlerbert I, Wold A.E. Long-time persistence of superantigen-producing Staphylococcus aureus strains in the intestinal microflora of healthy infants. Pediatric Research 2000; 48: 741-747.
(3) Michie C.A., Hasson N, Cheema S. A prospective cohort of toxic shock syndrome patients: Outcomes and Management. Ped Res 2001; 49: 249A.
(4) Campbell RL, Seymour JL, Stone LC, Milligan MC. Clinical studies with disposable diapers containing absorbent gelling materials: evaluation of effects on infant skin condition. J Am Acad Dermatol 1987; 17: 978-987.
(5) Keswick BH. Evaluation of the growth of microorganisms on diaper absorbent materials. J. Indust Microbiol 1988; 3: 21-28.
(6) Lintner, K, Genet V. A physical method for preservation of cosmetic products. International Journal of Cosmetic Science 1998; 20: 103 -115.