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February 08, 2016 04:30 PM

Any woman that’s used a tampon has likely heard about toxic shock syndrome – but what exactly causes it? And are you at risk?

The life-threatening disease recently made headlines when 15-year-old Rylie Whitten of Greenville, Michigan, almost lost her life to a severe case, and it is now being reported that three other women in the East Michigan area have also suffered from TSS. All of the women were using super-absorbency tampons.

While the effects of toxic shock syndrome are alarming – TSS can cause organ damage, shock and even death in 50 percent of cases – it is extremely rare. It occurs in only 1 out of every 100,000 people, and only 254 cases were reported in the U.S. in 2015, according to the CDC.

In order to get TSS, four factors must be in place, explains Dr. JoAnn Pinkerton, executive director of The North American Menopause Society.

“The first is vaginal colonization with a strain of S. aureus, which can make the toxin; the second is production by the S. aureus of the toxin; the third is penetration across the vaginal epithelium of enough toxin to cause disease; and the fourth is a lack of adequate titers of the neutralizing antibody to the toxin,” Pinkerton tells PEOPLE.

According to Pinkerton, it is very rare that all four factors will occur: vaginal colonization with toxigenic S. aureus has been reported in only one to four percent of the population, and it has been shown that the presence of serum antibody increases with age – almost 87 to 100 percent of the adult population has developed serum antibody to the toxin that causes TSS.

Pinkteron believes the multiple cases concentrated in East Michigan could be actually related to the women’s location.

“It more often occurs in Mountain and North Central states,” she says. “The cluster might be related to the presence of the toxigenic S. aureus or lack of antibody production.”

Age could also be a factor.

RELATED VIDEO: I Wanted to Kill Myself’: Heartbroken Model Loses Leg to Toxic Shock Syndrome after Using a Tampon

“Younger women are more likely to get TSS, possibly because of more exposure through tampons or barrier contraceptive use,” she says. “It may also be because they haven’t developed the antibodies yet.”

While there is a link between the use of super-absorbency tampons and TSS, Pinkerton explains that it is not caused by the tampons themselves.

“When you use super-absorbent tampons, if the vagina becomes dry, it could irritate the vaginal mucosa, so that could make it easier for the toxin to [enter the body],” she explains. “We believe it’s the abrasion caused by larger products in the vagina that could cause a problem.”

To prevent TSS, Pinkerton recommends changing tampons every two to three hours, and avoid leaving them in overnight.

“All tampons in the market today, which are FDA-regulated as medical devices and held to strict manufacturing guidelines, are associated with a low risk of TSS,” Laura Dressman, Tampax communications manager, tells PEOPLE. “The best way to manage TSS, no matter whether you use a tampon or another feminine care product that is inserted into the vagina, is to be aware of the signs. If you experience symptoms [which include sudden high fever, low blood pressure, vomiting, diarrhea, rash, confusion, muscle aches, redness of the eyes, mouth and throat, seizures and headaches], remove the product right away and contact your health care provider.”

“The safety of girls and women who use our products is the foundation of everything we do,” adds Dressman. “We are deeply sorry to hear about the young woman in Michigan, and our hearts go out to her and her family.”

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