You may have heard recent reports about a “flesh-eating bacteria” spreading in Japan, associated with streptococcal toxic shock syndrome (STSS). Media reports indicate that Japan has seen over 1,000 cases of STSS in the first half of 2024, surpassing the total number of cases for all of 2023. However, these cases have not yet been published in peer-reviewed journals, so the accuracy of these reports is uncertain.

Understanding STSS

STSS is caused by the bacteria Streptococcus pyogenes, or Strep A. While Strep A is common and often harmless, certain strains can lead to severe illnesses, including invasive group A streptococcal disease. Since 2022, many countries, including Australia, the United States, and European nations, have reported an increase in severe invasive group A streptococcal disease, part of an overall rise in Strep A infections.

Who is at Risk?

Strep A can harmlessly colonize the throat or skin, but it can also cause sore throats and skin infections. Occasionally, it leads to invasive infections such as pneumonia, “flesh-eating” skin infections, and STSS, which are significant causes of sepsis. STSS, the most severe Strep A disease, is rare and primarily affects young children and the elderly, though it can occur at any age. Pregnant individuals may also be at higher risk, especially shortly after delivery.

Symptoms of STSS

In STSS, the bacteria produce a toxin triggering a severe immune response. The illness can become life-threatening within hours, with a high mortality rate of up to 40%. Early symptoms, like fever, rash, and nausea, are often vague, resembling common viral illnesses, especially in children. Signs of severe invasive group A streptococcal disease, including STSS, include lethargy, fast breathing, a rapidly changing rash, aching muscles, and confusion. STSS can co-occur with necrotizing fasciitis, where skin cells die due to bacterial toxins.

Parents should trust their instincts; if a child seems unusually sick with cold limbs, a red rash, or reduced responsiveness, seek immediate medical attention.

Why the Surge Now?

The surge in STSS cases may be due to more virulent strains of Strep A and increased human contact post-COVID-19. During the height of the pandemic, reduced exposure to Strep A left children without partial immunity. Increased contact since 2022 has led to higher transmission rates and more severe cases.

Treatment and Prevention

Strep A can be treated with penicillin, one of the oldest and most effective antibiotics. Early diagnosis and treatment with antibiotics usually prevent serious complications. Additional treatments, such as immunoglobulin, may be needed to control the immune response, and intensive care support is often required.

There is no vaccine for STSS or other Strep A infections. Researchers are working on developing a vaccine. Staying up to date with vaccines, including those for chickenpox and influenza, can reduce the risk of serious Strep A infections.

Hygiene and Travel Advice

Strep A spreads via respiratory droplets or direct contact. Practicing good hygiene, like regular hand washing and covering coughs, helps reduce its spread. Despite the reports, there’s no need to cancel your trip to Japan. STSS is rare, and your risk of contracting it is very low, similar to traveling anywhere else.

Ensure you are up to date with vaccinations, practice good hand hygiene, and be aware of the signs of severe bacterial infections that require urgent medical attention.