Japan is grappling with a significant health crisis as cases of a deadly bacterial infection have reached unprecedented levels. Streptococcal toxic shock syndrome (STSS), commonly known as “flesh-eating bacteria,” has affected nearly 1,000 people in the country this year alone.
Health experts are sounding the alarm as the infection, which has a mortality rate of up to 30%, continues to spread rapidly.
Record-High Infections
As of June 2, 2024, Japan’s National Institute of Infectious Diseases has recorded 977 cases of STSS, surpassing last year’s total of 941 cases and setting a new record since statistics began in 1999.
According to the latest data, 77 people have died from the infection between January and March this year.
The current outbreak has hit Tokyo particularly hard, with 145 cases reported in the first half of 2024.
What is STSS?
STSS is a rare but severe bacterial infection caused by group A Streptococcus (GAS), the same bacteria that causes strep throat in children.
When these bacteria invade deep tissues and the bloodstream, they release toxins that can trigger an overwhelming immune response. This can lead to sudden shock, low blood pressure, and multiple organ failure.
Initial symptoms of STSS include fever, muscle pain, and vomiting. However, within 24 to 48 hours, symptoms can escalate dramatically to include swelling, dangerously low blood pressure, and organ failure. Despite treatment with high-dose intravenous antibiotics and supportive care, about three out of ten patients with STSS will die from the infection.
People with open wounds are at increased risk for STSS. This includes those who have recently had surgery or a viral infection that causes open sores, such as chickenpox and shingles.
The US Centers for Disease Control and Prevention (CDC) also notes that for nearly half of the people who get STSS, the entry point of the bacteria into the body remains unknown.
Why the Sudden Increase?
Experts are struggling to pinpoint the exact reasons behind the surge in STSS cases. Professor Ken Kikuchi of Tokyo Women’s Medical University NHK (Japan Broadcasting Corporation) that weakened immune systems following the COVID-19 pandemic might be a factor.
“We can boost immunity if we are constantly exposed to bacteria. But that mechanism was absent during the coronavirus pandemic,” Kikuchi said. “So, more people are now susceptible to infection, and that may be one reason for the sharp rise in cases.”
Global Concerns
There has been a marked rise in invasive group A Streptococcus infections (iGAS) around the world since the relaxation of COVID-19 restrictions. In late 2022, five European countries notified the World Health Organization about a rise in such infections, particularly affecting children under 10.
This is concerning because high levels of iGAS infections increase the risk and incidence of STSS.
Put simply, STSS is a specific manifestation of iGAS when the bacteria release toxins that lead to systemic symptoms and severe immune response. It is generally more severe with a higher mortality rate compared to other iGAS conditions. STSS can develop rapidly from an iGAS infection.
Prevention and Treatment
Health authorities emphasize the importance of good hygiene to prevent STSS. This includes thorough hand washing, treating any GAS infections promptly, and monitoring any wounds or skin infections closely. People with open wounds, those recovering from surgery, and individuals with underlying health conditions are at higher risk.
Even with treatment, STSS can be deadly. Early recognition and prompt medical intervention are crucial to improving outcomes for patients.
Moving Forward
The Japanese government and health officials are urging the public to remain vigilant and practice good hygiene. Researchers continue to investigate the factors contributing to the rise in STSS cases, aiming to develop better prevention and treatment strategies.
As Japan navigates this health crisis, the surge in STSS serves as a stark reminder of the importance of maintaining strong public health measures and the potential long-term impacts of the COVID-19 pandemic on global immunity and health.
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