Surge in Bacterial Infections in Japan

This year, bacterial infections in Japan are on the rise, with a surge in cases of a potentially deadly condition. This increase has health officials scrambling to understand the cause and urging the public to be aware of the symptoms. In the first six months of 2024, there have been 1,019 recorded cases, surpassing the total from the previous year. Streptococcal toxic shock syndrome, or STSS, is the culprit behind this worrying trend.

In March, Japan’s National Institute of Infectious Diseases issued a warning about the uptick in cases following the recording of 77 deaths attributed to the illness. The majority of these cases involved individuals over the age of 50.


For context, the United States reported 145 cases of STSS in 2021, based on the most recent data from the U.S. Centers for Disease Control and Prevention.

Surge in Bacterial Infections in Japan
Shibuya – Tokyo, Japan. Credit: PickPik

For further information, please visit Streptococcal Toxic Shock Syndrome by the CDC and the National Institute of Infectious Diseases.

What is Streptococcal Toxic Shock Syndrome (STSS)?

Streptococcal toxic shock syndrome (STSS) is a severe illness caused by Group A Streptococcus bacteria spreading into the blood and deep tissues, as explained by the Centers for Disease Control and Prevention (CDC).


Group A Streptococcus (GAS) is a common bacterium found in the throat and on the skin. According to the CDC, most GAS infections result in mild illnesses, such as strep throat. However, life-threatening conditions like STSS can occur when the bacteria invade areas where they are not typically found, such as the blood or muscle.

Bacterial Infections in Japan
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Céline Gounder, editor-at-large for public health at KFF Health News and an infectious disease specialist and epidemiologist at NYU and Bellevue Hospital, notes that GAS often causes sore throats and skin infections. More severe infections, such as those affecting the blood, lungs, or causing necrotizing fasciitis (a “flesh-eating” infection), are less common.

Factors that increase the risk of contracting STSS include open wounds or sores, diabetes, and alcohol use, according to the CDC. The agency estimates that three out of ten STSS patients are likely to die from the infection.

Additional risk factors include recent surgery or a recent varicella virus infection, such as chickenpox or shingles. STSS is more prevalent in individuals over the age of 65.

Andrew Steer, director of infection, immunity, and global health at the Murdoch Children’s Research Institute in Melbourne, Australia, highlights that STSS is highly associated with necrotizing fasciitis, a severe form of Group A Strep infection. Necrotizing fasciitis can destroy muscles, skin, and underlying tissues, as detailed by Penn Medicine, affiliated with the University of Pennsylvania.

What are the Symptoms of STSS?

According to the CDC, the symptoms of streptococcal toxic shock syndrome (STSS) begin with fever, chills, muscle aches, nausea, and vomiting.

Andrew Steer, director of infection, immunity, and global health at the Murdoch Children’s Research Institute, notes that often there are no prior warning signs. “You tend to be well, and then become acutely quite sick,” he explains, adding that a sunburn-like rash could also be an early indication of infection.

Within 24 to 48 hours, blood pressure drops, leading to organ failure, and a rapid heart rate and breathing, according to the CDC. It is critical to seek hospital care immediately.

Steer also mentions that while a sore throat is commonly associated with Strep A infections, STSS is a different manifestation caused by the same bacterial species. “It’s essentially one or the other,” he says.

Treatment for Streptococcal Toxic Shock Syndrome (STSS) requires an aggressive and multifaceted approach, given the severity and rapid progression of the condition. Here’s a detailed breakdown:

  1. Antibiotic Therapy: The cornerstone of STSS treatment is the administration of antibiotics. Immediate broad-spectrum antibiotics are given initially to cover a wide range of potential bacteria, followed by specific antibiotics once Group A Streptococcus is confirmed. This often includes penicillin or clindamycin, which are effective against the bacteria.
  2. Intravenous Fluids: Due to the risk of severe dehydration and shock, patients typically require substantial intravenous fluids. These fluids help maintain blood pressure and support organ function.
  3. Management of Organ Failure: STSS can lead to multi-organ failure, necessitating intensive care. This may involve the use of vasopressors to maintain blood pressure, mechanical ventilation for respiratory failure, and dialysis for kidney failure.
  4. Surgical Intervention: In cases where the infection has caused necrotizing fasciitis (flesh-eating disease) or other severe tissue damage, surgical removal of infected tissue is critical. This helps to control the spread of the infection and remove dead tissue that can harbor bacteria.
  5. Supportive Care: Comprehensive supportive care is essential, including pain management, wound care, and monitoring of vital signs and organ function. Patients often need prolonged hospital stays in intensive care units.
  6. No Vaccine Availability: Currently, there is no vaccine for Group A Streptococcus infections, which means prevention relies heavily on prompt treatment and control measures to avoid spreading the bacteria.
  7. Research and Future Prospects: Scientists, such as Andrew Steer and his team, are working on developing a vaccine for Group A Strep. Steer hopes that a vaccine could be available within the next “5 to 10 years,” offering hope for better prevention and control of these infections in the future.

Overall, the treatment of STSS is complex and requires a combination of immediate medical interventions and long-term supportive care to improve patient outcomes. The lack of a current vaccine emphasizes the importance of ongoing research in this field.

What is Causing the Outbreak in Japan?

The precise causes behind the recent rise in streptococcal toxic shock syndrome (STSS) cases in Japan remain unclear, according to the country’s Health Ministry. However, the relaxation of COVID-19 restrictions may be playing a role in the increase in streptococcal pharyngitis cases.

This trend is not unique to Japan. Despite the rise in cases, the ministry has stated that it remains safe to travel to the country. They advise maintaining good hand hygiene, practicing proper cough etiquette, and cleaning wounds promptly to prevent infections.

Andrew Steer, director of infection, immunity, and global health at the Murdoch Children’s Research Institute, suggests that the surge in STSS in Japan should be understood within the broader context of a global increase in Group A Strep infections following the pandemic. He explains that the extensive precautions people took to avoid contracting COVID-19, such as wearing masks and social distancing, also helped reduce the incidence of other infectious diseases. As these precautions are lifted, there may be a rebound effect with increased susceptibility and lower immunity to infections like STSS.

Bacterial infections in Japan have brought renewed attention to this rare condition.

Streptococcal toxic shock syndrome (STSS) is a rare but serious condition that has been recognized globally for a long time. Andrew Steer, director of infection, immunity, and global health at the Murdoch Children’s Research Institute, explains that “we’ve had streptococcal toxic shock syndrome and invasive Strep A infection in the U.S. for decades and decades, even hundreds of years.”

STSS, while uncommon, has seen a recent increase in cases, prompting a need for heightened vigilance among both the community and healthcare providers. Steer emphasizes the importance of being aware of the symptoms, which can include fever, chills, muscle aches, nausea, vomiting, diarrhea, and a red, flat rash. If these symptoms occur, it is crucial to seek prompt medical attention to ensure early diagnosis and treatment. Early intervention can significantly improve outcomes and reduce the risk of severe complications, making awareness and timely response vital in managing this infection.

Safety Tips for Travelers in Japan: Preventing and Responding to Streptococcal Infections

With the recent rise in streptococcal toxic shock syndrome (STSS) cases in Japan, it’s crucial for travelers to take preventive measures seriously and know how to respond if they fall ill. Here is a detailed guide to help you stay safe and healthy during your visit:

Preventive Measures

1. Rigorous Hand Hygiene

  • Wash your hands thoroughly with soap and water for at least 20 seconds, especially after using the restroom, before eating, and after coughing or sneezing.
  • Use an alcohol-based hand sanitizer containing at least 60% alcohol when soap and water are not available.

2. Proper Respiratory Etiquette

  • Cover your mouth and nose with a tissue or your elbow when you cough or sneeze.
  • Dispose of used tissues immediately in a trash bin.
  • Avoid touching your face, particularly your eyes, nose, and mouth, with unwashed hands.

3. Wound Care and Management

  • Clean all cuts, scrapes, and wounds immediately with soap and water.
  • Apply an antiseptic and cover the wound with a clean, sterile bandage.
  • Change bandages regularly and keep wounds dry.

4. Avoid Close Contact with Sick Individuals

  • Stay away from people who are visibly ill, especially those with symptoms of a respiratory infection or skin infection.
  • Maintain physical distance in crowded places and consider wearing a mask in high-risk areas.

5. Boost Your Immune System

  • Maintain a balanced diet rich in vitamins and minerals.
  • Stay hydrated and get adequate sleep.
  • Engage in regular physical activity to strengthen your immune response.

Recognizing Symptoms

Be aware of the signs and symptoms of STSS and streptococcal infections. These can include:

  • Sudden high fever
  • Chills
  • Muscle aches
  • Nausea and vomiting
  • Diarrhea
  • Severe pain in an infected area of the skin
  • Red, flat rash
  • Dizziness or confusion

Immediate Actions if Infected

1. Seek Medical Attention Promptly

  • If you experience any of the symptoms mentioned above, visit the nearest hospital or clinic immediately.
  • Inform the healthcare provider about your travel history and symptoms in detail.

2. Follow Medical Advice

  • Adhere strictly to the treatment plan prescribed by the healthcare provider, including the full course of antibiotics if given.
  • Rest and avoid strenuous activities until you have fully recovered.

3. Notify Your Travel Insurance

  • Contact your travel insurance provider to understand your coverage and get assistance with medical expenses and care coordination.

Advisory for Future Travelers

1. Stay Informed

  • Monitor travel advisories from reputable sources such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC).
  • Stay updated on the local health situation in Japan through reliable news outlets.

2. Prepare Adequately

  • Ensure you have comprehensive travel insurance that includes coverage for medical emergencies.
  • Pack a travel health kit including antiseptic wipes, hand sanitizer, bandages, and over-the-counter medications.

3. Consult Health Professionals

  • Before your trip, consult with your healthcare provider about any additional vaccines or preventive measures you might need.
  • Consider carrying a list of emergency contacts and local medical facilities in the areas you plan to visit.

By following these detailed guidelines, you can significantly reduce your risk of infection and ensure a safer, healthier travel experience in Japan.



You see, my love for Japan is not only based on personal experience; it's based on a deep admiration for Japanese culture, history, and traditions. Thank you, Japan, for being a constant source of inspiration, joy, and wonder in my life. I may never be able to express my love for Japan in person, but I hope that through my blog and my writing, I can share a small piece of my admiration and devotion with the world.

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