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Heal and Cooper in a recent letter  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. C...
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 . 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 . Sodium
polyacrylate has been reported by others to act as an osmotic disinfectant
in the presence of bacteria . 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
(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