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Dangerous streptococcal infections hit record high in Japan
March 18, 2024

Public health experts are concerned that they don't fully understand why the number of cases involving a rare, but potentially deadly type of bacterial infection known as streptococcal toxic shock syndrome (STSS) are on the rise in Japan. About 30% of STSS cases are fatal.
Japan's number of STSS cases in 2024 is expected to exceed last year’s record number of 941. In the first two months of 2024, 378 cases have already been recorded, with infections identified in all but two of Japan’s 47 prefectures.
STSS, most often caused by the bacteria group A streptococcus, was first reported in Japan in 1992. Since then, an average of 100 to 200 confirmed cases have been reported annually, but the number for 2023 exceeded the previous record of 894 cases in 2019, according to the National Institute of Infectious Diseases (NIID).
NIID states: “There are still many unknown factors regarding the mechanisms behind fulminant forms of streptococcus, and we are not at the stage where we can explain them.”
Although older individuals are at highest risk, Japanese public health experts say that the group A strain is leading to more deaths among patients under 50. NIID says that of the 65 people under 50 who were diagnosed with STSS between July and December in 2023, about a third, or 21, died.
Many people who get infected with strep A, including children, don't actually become ill. However, the highly contagious bacteria that cause the infection can, in some cases, cause serious illnesses, health complications including necrosis, and death, particularly in adults over 30.
Strep A infections are treated with antibiotics, but patients with the more severe invasive group A streptococcal disease are likely to need a combination of antibiotics and other drugs, along with intensive medical attention.
Some experts speculate that the rapid rise in cases last year were connected to the lifting of restrictions imposed during the coronavirus pandemic. In May 2023, the Japanese government downgraded COVID-19's status to be on par with the seasonal flu. In doing so, experts say that it led to more people skipping basic infection prevention hygiene, such as regular hand disinfection. It also hampered the ability of local authorities to order infected people to stay away from work or to recommend hospitalization.
Japanese health authorities are urging people to take basic preventative measures against strep A as was done for COVID-19, including proactive hand-washing and exercising cough etiquette.
Sources:
McCurry, Justin. (2024, March 14). The Guardian. Mystery in Japan as dangerous streptococcal infections soar to record levels. https://www.theguardian.com/world/2024/mar/15/japan-streptococcal-infections-rise-details
Otake, Tomoko. (2024, January 24). The Japan Times. Cases of tissue-damaging bacterial disease hit record high in Japan. https://www.japantimes.co.jp/news/2024/01/24/japan/science-health/rare-bacterial-diseases-rising-in-japan/
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