Japan Faces a Surge of Streptococcal Toxic Shock Syndrome 

Are you thinking about traveling to Japan this summer? Here is everything you need to know about STSS and keeping yourself safe during your visit.

Japan is currently grappling with an unprecedented surge in cases of streptococcal toxic shock syndrome (STSS), a rare but potentially fatal bacterial infection. With over 1,019 cases reported in the first half of 2024, the country has already surpassed last year’s total.¹

What is STSS?

Streptococcal toxic shock syndrome is caused by Group A Streptococcus (GAS) bacteria. This group of bacteria can be found in the nose, throat, and on the skin.^2,3 They can exist harmlessly and not cause any problems at all, or they can infect different parts of the body and cause mild-to-severe illnesses.³ If they manifest as an infection, they will typically be seen as strep throat or impetigo (a skin infection).³

When this group of bacteria invades the bloodstream and deep tissues, that’s when it can become life-threatening and present as STSS. 

STSS infection is most common in adults, aged 65 or older, and the current surge of STSS infection in Japan has mostly been seen in those over 50.¹ It can also affect people with open wounds, like from a recent surgery or open sores from a viral infection (for example varicella). Individuals with other factors such as diabetes or alcohol use are also at an increased risk for STSS.² 

What are the symptoms of STSS?

Early symptoms can appear one to three days after infection and include fever, chills, muscle aches, nausea, and vomiting, and they can rapidly progress to low blood pressure, a racing heart, and organ failure.³ Seeking immediate medical care upon presentation of symptoms is crucial, as the CDC estimates that three out of ten infections can lead to death.²

How to prevent STSS infection

The reason for the increase of STSS infections in Japan remains unclear, however, this trend isn’t unique to Japan; there has been a global rise in Group A Streptococcus infections post the COVID-19 pandemic. A potential theory is that people are likely to have developed lowered immunity from reduced exposure to other diseases during the lockdowns.⁴

How can you protect yourself?

1. Awareness and vigilance are crucial. Although STSS is rare, recognizing early symptoms and seeking immediate medical attention are vital for timely treatment with antibiotics and supportive care.^5,6
2. Practice proper hygiene. Wash your hands often, especially after coughing or sneezing, before and after caring for someone who’s sick, and always before preparing or eating food.^3,6
3. Wound care. If you have a wound, it’s crucial to keep it clean and monitor it closely for any signs of infection, such as redness, swelling, pain, or pus.^3,6 If your wound appears infected, or if you develop a fever, seek immediate medical attention.

While there is currently no vaccine for STSS, researchers are actively working on developing one, which could be available within the next decade. In the meantime, practicing good preventative measures can help mitigate the risk of infection.

References

1. Risk assessment for increase in streptococcal toxic shock syndrome (STSS) in Japan (no date) Risk Assessment for Increase in Streptococcal Toxic Shock Syndrome (STSS) in Japan. Available at: https://www.niid.go.jp/niid/en/2013-03-15-04-55-59/2655-disease-based/ka/tsls/cepr/12608-stss-2023-2024eng.html (Accessed: 29 July 2024). 
2. About streptococcal toxic shock syndrome (no date) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/group-a-strep/about/streptococcal-toxic-shock-syndrome.html (Accessed: 29 July 2024). 
3. Streptococcal Disease (group A) (2024) Epidemiology. Available at: https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/streptococcus-disease-group-a/ (Accessed: 29 July 2024). 
4. Ghanemi A, Yoshioka M, St-Amand J. Coronavirus Disease 2019 (COVID-19) Crisis: Losing Our Immunity When We Need It the Most. Biology (Basel). 2021;10(6):545. Published 2021 Jun 18. doi:10.3390/biology10060545
5. ​​Preventing group A strep infection (no date) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/group-a-strep/prevention/index.html (Accessed: 29 July 2024). 
6. Newberger R, Gupta V. Streptococcus Group A. [Updated 2023 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559240/