LANSING (WWJ/AP) – State health officials say they have identified a cluster of tampon-associated cases of toxic shock syndrome in Michigan.

The Michigan Department of Health and Human Services said Wednesday that five cases have been reported since December. None were fatal. The past 10 years averaged fewer than four reported cases annually.

READ MORE: Whitmer Recommends Mask Rules For School Districts As Delta Variant Spreads

The agency says toxic shock is a rare but serious syndrome caused by bacterial infection. Symptoms include sudden fever, vomiting, diarrhea, dizziness and shock with multi-organ dysfunction.

According to the agency, tampon-associated toxic shock has historically been attributed to improper use, such as leaving a tampon in too long. The agency says tampons shouldn’t be left in longer than six to eight hours, and to always use the lowest absorbency needed.

READ MORE: Automakers Reinstate Mask Mandate At All U.S. Facilities

“Although Toxic Shock Syndrome cases are rare, this recent cluster is an important reminder to always review product safety information,” Dr. Eden Wells, chief medical executive with the MDHHS, said in a statement.

The agency says the only commonalities found between the five cases involve product selection. Four out of five cases were using super absorbency tampons and four out of five were using the Playtex Sport brand. One case was using U by Kotex.

MORE NEWS: Historic Negro League Ballpark In Hamtramck To Undergo $2.6 Million Renovation

TM and © Copyright 2016 CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2016 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.