Toxic Shock Expert On O.B. Tampon Shortage

A photo from 2008, when o.b.s were still plentiful

I checked back in with Johnson & Johnson spokeswoman Bonnie Jacobs this week to ask if she had any news on the o.b. tampon shortage. No, she messaged: “I don’t have any updates to the information I provided.” (See her previous statement here; she cites a “supply interruption” and says that the decision to discontinue the Ultra size was not based on any adverse events.)

All well and good, but frustrated reports of empty o.b. shelves continue to roll in to CommonHealth from as far away as Iceland, and to be honest, I’m now just ragingly curious. Why can Johnson & Johnson not just tell their clamoring would-be customers exactly what went wrong with o.b. production? And why not disclose their reasons for doing away with the Ultra, which has long been a mainstay for women with heavy periods?

One theory bandied about in our comments is that perhaps the Ultras, or o.b.s in general, have been linked to recent cases of toxic shock, a rare but potentially deadly syndrome that can be triggered by tampon use. To check on that, I spoke today with the microbiologist known for helping to crack the mystery of toxic shock syndrome back in the 1980s.

Dr. Philip M. Tierno Jr. is director of clinical microbiology and immunology at New York University Langone Medical Center, and author of the “The Secret Life of Germs.” He has been involved in work on toxic shock syndrome for thirty years, and speaking with him for just a few minutes is enough to convert any tampon-user to the all-cotton products sold in health food stores. Or pads. Or cups. The point is, toxic shock, though rare, still happens. Young women still die, or need limbs amputated, he said.

But first, the o.b. question. I laid out the picture of the shortage, including J&J’s report of supply interruptions, and asked what light he could shed.

“I have no idea what their production problem is,” Dr. Tierno said. “Certainly there is some sort of production problem, that’s clear. I know that tampons are made primarily of viscose rayon; sometimes they may have mixes of cotton. And what I know is that the Chinese and other producers of cotton have had difficulty with crops. So this may play some role, if they’re mixing with a specific amount. And the only other thing I can tell you is that all of the extant tampons on the [mainstream] market are made with the synthetic ingredient viscose rayon, in mixes with or without cotton, and all of these extant tampons are able to produce TSST1 toxin [which has been implicated in toxic shock syndrome]. In my studies I have clearly shown that, albeit viscose rayon is the best of the bad four ingredients in tampons and the other three have been removed, this still remains, and toxic shock still occurs in this country, and deaths also occur in this country.”

[See this story on a 20-year-old Indiana woman who died of toxic shock syndrome this summer.]

How many people are dying? I asked. A handful a year?

Reporting toxic shock deaths to the CDC is not required, he said, so the numbers are not very accurate. But tampon box warnings say that between 1 and 17 of every 100,000 girls and women using tampons get toxic shock syndrome. [My thought: Rare, yes, but there are tens of millions of menstruating women in this country.]

And are tampons meant for heavier flow, like the Ultra, likelier to cause it?

In the past, he said, absorbency and size did matter, “but it’s more the composition that matters. Even the regular size can cause toxic shock. And we’ve had slender regulars cause toxic shock when they’re made of viscose rayon. I know of no case, none, of people who use 100% cotton who had toxic shock syndrome.”
It’s expensive, he said, and cotton is a crop subject to the vagaries of nature, but companies do make 100% cotton tampons.

Does he recommend 100% cotton tampons, then?

“Without question,” he said. “Shift to all cotton. And if you’re too young, don’t use tampons. [Young women are more susceptible to toxic shock because they're less likely to have the antibodies to fight it.] And if you use tampons, never use them at night.” [Additional advice from health authorities: Never leave a tampon in for more than eight hours. Some Web MD basics on prevention are here.]

“People are dying,” he said. And “it’s not only the dead, it’s those young kids who have amputations of various limbs, and toes and hands and legs. It’s not just death.”

So might the o.b. Ultra, or o.b.s in general, have been implicated in cases of toxic shock lately?

If they had been, Dr. Tierno said, he would not expect the manufacturers to admit it. That would be “admitting guilt.”

Not to end on so sinister a note, one recent CommonHealth commenter had this to say:

“The reason they have discontinued the OB Ultra’s is simply MONEY! If we cannot get our Ultra’s, we’ll have to use the next size down. As those will last an hour or less, we’ll consume more and they will profit more.”

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  • RFinNJ

    I had to smile while reading some of these posts… I’m right there with you in the frustration department. How can they just pull them off the shelves and not have anything concrete to say about it? I was told a month and a half ago that there was some problem with distribution and that they should get them soon and would even notify me as to when they were in my area. BULL! Like SWIMMER GIRL, I too, thought to go to Kotex U… a little weird at first with the applicator (been so many years with O.B.), but they were pretty good (a little longer than the O.B.s I think). I think JANE was saying about the mess after insertion – I get what you’re saying. I had the same idea about removing them from the applicator. I liked the idea of the compact applicator and they’re so colorful… it’s like a party in every box! LOL I tell myself that Kotex is fine by me from now on because I’m so mad at J & J, but I know I’ll go back to O.B. whenever they finally get back on the shelf! For now, I’m stuck with Kotex and the one O.B I have in my purse for emergencies.

  • Ultra Mad

    Please sign this petition ( ) to encourage Johnson & Johnson to bring back the largest size OB tampons, the Ultra.

  • O.B. now shipping!

    I just saw this online and just called the company and spoke to a rep — she verified that they are being shipped AND that they may be bringing back the Ultras at some point. Super Plus will be the next size down…. but at least there will be something on the shelves soon!

  • guest from ME

    Yet more GREAT reasons to use a Diva Cup or Lady Cup! safer for your health, easier to use (buy 1 per year), cheaper, and greener (no landfilling tampons every month).

    • TooUnfazed

      Use the CUP–it’s better for your body and better for the environment. Cups are very soft and easy to use. They are smaller than tampons and can be used for longer periods of time (no pun intended). They come in various sizes as you go through the cycle of life.

  • Rebecca44678

    On o.b. tampons facebook page:
    a post went up about 9 AM EST on 11 January that o.b. tampons are shipping again. No mention that the Ultras will come back as well. The commenters were lambasting J&J for not providing a reason for the interruption in production.

  • Steve

    I just talked with a gal who works at an over-flow call center for J&J. This call center has been involved in all of the recent J&J recalls. They are hiring and training hundreds of new people at the direction of J&J.

    I have NO information if this involves OB or not. Just passing along the info…
    Will comment more whn/if I get more information…

  • AShap

    Hi, I just called the info line (877-454-7843) to ask if they had an update and the woman said, just today they got word that they have begun shipping to stores across the country. It may take a few days or weeks for them to reach our area stores, depending on where we live. The rep said she thought that message would appear on their site soon.

  • swimmer girl

    going to try the kotex U, saw a picture and they expanded a lot like the OB, sadly the LIletts tampons sold in Britain the web site says they can’t ship to canada or the US. any more.

  • tralala

    7th generation makes organic all cotton tampons and they work.

    • Guest

      I have tried the applicator free version of the 7th Generation tampons, they absorb in the same pleated cylindrical shape as OBs (not like the “bloom to fit” really wide tulip shape that I thinks was an awkward Playtex style) but they are stiff and feel like you”re inserting corrugated cardboard into your body. Is this just an issue with the 7th Generation brand or are all organic cotton tampons this stiff?

  • JEinNJ

    I have been to a dozen stores and this is getting annoying! I have been using OB for years and I use OB because I don’t like the other brands – the ones the stores have hundreds of! Every website that says they sell them are out of stock! I’m about to go back onto birth control just so I won’t need tampons anymore!

    • Jane

      I am feeling the exact same way!

  • Jane

    I have just returned from a 3 store mission to find the super-plus since the ultra have been missing for some time. I had no luck and had to resort to buying a different brand. I haven’t used anything but o.b. in 20 plus years. The company really owes us an explanation. When I contacted them last month about the missing ultras they said to use the super plus and that it was a manufacturing change and that the ultras would be back. Now the super plus are gone too. I am not so sure. Is the entire line going away?

    • Guest

      After using applicator free OBs for 15 years, I tried my first applicator tampons. After thoroughly reading and following the instructions, I was entirely disappointed with the results. Who wants to shove a plastic tube inside your body only to pull it out all covered in blood? After a few “Maybe I’m doing this wrong?” attempts (tampon wouldn’t come out of the applicator, etc.) I finally had lackluster success. Because of this, I decided to put my results through one more personal test. After I finished inserting the applicator tampon and cleaning up I tore off a few sheets of toilet paper and gently wiped the insertion area to check if there was any blood on the outside of the tampon and surrounding areas (aka leakage or mess from insertion). I have always done this with OBs (and other applicator free tampons) to test for proper insertion and possible future leakage and I’ve always come up with reassuringly clean results. To my shock, I wiped off unwanted external blood not just after my first successful applicator tampon insertion but after every so-called successful applicator tampon insertion (I tried several brands over the course of 2 months). Try it. You might be shocked too. I think this is a partially a result of inserting an object of one size into your body and leaving behind a slightly smaller object, thus not creating a proper seal/barrier and partially due to the flawed design of any applicator. By design a nonabsorbent applicator touches every surface twice (instead of one like an applicator free tampon), thus covering every surface with unwanted blood upon removal. Even though you have to be a bit more self aware to use an applicator free tampon, they are by far more sanitary and leak free. Since OB has vanished from store shelves I have not found great applicator free alternative (7th Generation makes organic ones but they are very stiff and take a bit of getting used to). Therefore, I have resorted to removing the applicators from the tampons I buy and inserting them as I would with traditional applicator free tampons. It is a decent solution until you end up needing to use one at the house of a first date and don’t want them to know it’s that time of the month yet. Bright pink wrappers and plastic applicators are not so incognito in the trash. Besides, it’s wasteful to manufacture something that you’ll just end up quickly throwing away, and it my case never even use.

  • Carey Goldberg

    Thanks so much, Rebecca, for pointing this out!! I’m going to post on it soon and if you’d like, I’ll give you credit by name — just hit the Get In Touch button at the bottom of the blog and let me know how you’d like to be identified…I wonder if we’ll ever know the real reasons….