9th April 2024 – (Tokyo) A rare but potentially fatal bacterial infection known as streptococcal toxic shock syndrome (STSS) or “flesh-eating disease” has been rapidly spreading across Japan, causing widespread concern among health authorities and the public. The surge in cases, which has been reported in 45 of Japan’s 47 prefectures, is a grim reminder of the persistent threat posed by infectious diseases in the post-pandemic era.

According to data from Japan’s National Institute of Infectious Diseases (NIID), a staggering 474 STSS cases were recorded in the first two and a half months of 2024, compared to 941 cases throughout the entire previous year. The alarming spike has prompted experts to sound the alarm, warning that the outbreak may be linked to a more virulent strain of the bacteria and a general lapse in hygiene practices following the easing of COVID-19 restrictions.

The death of a 47-year-old Hong Kong man during a recent trip to Osaka has further heightened concerns, highlighting the potential risks for travellers to Japan. The man, who was visiting with his wife, was hospitalised on 27th March and tragically passed away the following day, his body later repatriated to Hong Kong on April 3. While details surrounding the circumstances of his infection remain unclear, the rapid progression of the disease underscores the urgency of seeking prompt medical attention for any symptoms.

STSS, caused by the group A streptococcus bacteria, is a rare but severe condition characterised by fever, muscle aches, nausea, and low blood pressure. If left untreated, the infection can progress rapidly, leading to organ failure and, in some cases, the necrotizing of soft tissues, earning it the moniker “flesh-eating disease.” The mortality rate for STSS is alarmingly high, ranging from 30% to 70%, depending on factors such as age and underlying health conditions.

Dr. Kazuhiro Tateda, president of the Japan Association of Infectious Diseases and a member of the government’s COVID-19 advisory panel, acknowledged the gravity of the situation, stating, “It is becoming a serious problem, but there are still many things that we do not know.” Tateda expressed uncertainty regarding the origins of the outbreak and the specific strain responsible, noting that it appears to be a variant of the highly transmissible M1UK strain that was prevalent in the United Kingdom in the 2010s.

Health experts attribute the surge in cases to a combination of factors, including the relaxation of COVID-19 precautions and a potential decrease in immunity levels among the population. Dr. Tsang Kay Yan Joseph, co-chairman of the Hong Kong Medical Association’s Advisory Committee on Communicable Disease, suggested that the outbreak might be linked to a general decline in preventive measures, such as hand-washing and mask-wearing, following the abatement of the pandemic.

The rapid spread of the infection has raised concerns among international health organizations and neighbouring countries. North Korea, for instance, cited the “contagious disease spreading in Japan” as the reason for cancelling plans for the Japanese national football team to travel to Pyongyang for a World Cup qualifying match last month.

While Japanese health authorities have attempted to downplay the severity of the outbreak, urging travellers to maintain good hygiene practices and seek prompt medical attention for any symptoms, experts warn that the situation should not be taken lightly. Dr. Leung Chi-chiu, a respiratory medicine specialist in Hong Kong, cautioned that the outbreak could persist for several months, based on the patterns observed in Europe and the United States following similar surges.

Japan’s apparent downplaying of streptococcal toxic shock syndrome carries grave consequences that extend beyond its borders. By failing to accurately assess and address the true scope of the problem, the country risks exacerbating the spread and impact of this deadly disease, both domestically and internationally. Within Japan, the underreporting of cases and lack of public awareness create an environment ripe for undetected outbreaks and delayed treatment. This, in turn, can lead to higher mortality rates and increased suffering for those afflicted with STSS.

Moreover, the limited research and funding dedicated to the disease hinder the development of improved diagnostic tools, preventive measures, and potentially life-saving treatments. This not only impacts Japan but also impedes global efforts to combat STSS, as advancements in understanding and managing the condition could benefit populations worldwide.