A dangerous bacterial infection called streptococcal toxic shock syndrome (STSS) is rising in Japan. Japan’s National Institute of Infectious Diseases warned about increasing STSS cases in March. This situation has convinced us to be concerned about our health. 

What causes STSS, and how are there ways to prevent it? Keep reading the article, and let’s find what you need to know.

What are the Current Statistics and Future Trends? 

By June 2, Japan’s Health Ministry reported 977 cases of streptococcal toxic shock syndrome (STSS), which has a death rate of up to 30%. Between January and March, 77 people died from this infection. Also, by June 19, its cases had reported an increase of 1,019 cases and no deaths were reported.

According to Public Health Ontario, between October 1, 2023, and May 31, 2024, 13 children in Ontario have died due to invasive group A streptococcus (iGAS) bacteria, which includes STSS. During this period, 1,510 reported cases, marking a 33% increase compared to the previous season.

The current STSS outbreak in Japan exceeded last year’s 941 cases, the highest since 1999. Last year, Japan’s National Institute of Infectious Diseases recorded 97 deaths from STSS, the second-highest number after six years. Also, Japan’s STSS cases are nearly two and a half times higher than in the United States this year. The U.S. has reported 395 cases this year, compared with 390 cases last year.

If the current infection rate continues, Japan could reach 2,500 STSS cases by the end of this year, said Ken Kikuchi, a professor of infectious diseases at Tokyo Women’s Medical University. He also mentioned that the death rate could be as high as 30%.

Understanding STSS

What is STSS?

STSS is a severe but uncommon infection caused by Streptococcus pyogenes or group A Streptococcus bacteria(GAS). These bacteria enter deep tissues and the bloodstream, releasing toxins that trigger a quick and dangerous reaction in the body. 

STSS is a “rare, but serious” bacterial infection that can “develop very quickly into a life-threatening emergency,” according to the Centers for Disease Control and Prevention.

Also, professor of infectious diseases at Tokyo Women’s Medical University Kikuchi said that most deaths happen within 48 hours.

As soon as a patient notices swelling in the foot in the morning, it can expand to the knee by noon, and they can die within 48 hours.” Said Kikuchi.

According to the CDC, early symptoms of STSS include fever, chills, muscle aches, nausea, and vomiting. Within 24 to 48 hours, low blood pressure usually occurs, leading to more severe problems like organ failure, increased heart rate, and rapid breathing. Further, the CDC said that even with treatment, STSS could be deadly. Also, they mentioned that out of 10 people with STSS, as many as three people will die from the infection.

How does STSS Spread?

Group A Streptococcus (GAS) causes STSS and can spread quite quickly. Typically, people spread the bacteria through respiratory droplets or direct contact. Sometimes, the bacteria can also spread through food. 

However, according to the CDC, it is rare for someone with STSS to spread it directly to others. Also, if untreated for less severe group A Streptococcus bacteria, it can develop into STSS.

According to the CDC, anyone could be infected with STSS, but certain factors can increase your risk. What are these factors? Let’s see.

  • It’s most common in adults aged 65 or older.
  • People who have Infections or injuries that break the skin.
  • People with Other health conditions such as diabetes and alcohol use disorder.

Infectious diseases expert and CBS News medical contributor Dr. Céline Gounder mentioned additional risk factors for severe Group A Streptococcus infections, that is,

  • Trauma
  • Surgery
  • Burns
  • Immunosuppression
  • Pregnancy
  • Injection drug use
  • Homelessness
  • Chickenpox or influenza infection

Impact of Recent events

Some experts think the sharp increase in cases last year was linked to easing restrictions imposed during the COVID-19 pandemic.

In May 2023, the government reclassified COVID-19 from class two (like tuberculosis and SARS) to class five, similar to seasonal flu. This change stopped local authorities from ordering infected people to stay home or recommending hospitalization. Also, the reduced enforcement of safety measures such as wearing masks and maintaining hand sanitizing has led to a noticeable increase in cases.

How to Prevent Bacterial Infection and Control?

Experts don’t yet know why these severe infections are becoming more common. However, there are ways to help prevent infection.

Dr. Céline Gounder suggested that “Because chickenpox and influenza are risk factors for severe GAS infection, vaccination against varicella zoster virus and influenza can reduce the risk of severe GAS infection.” Also he said that “People who have been in close contact with someone with severe GAS infections and who are immunocompromised, pregnant, or have open wounds should be given antibiotics to prevent infection.”

Health Canada advised the following to minimize the spread of infections:

  • Wash hands before and after handling food, coughing, sneezing, or using the bathroom.
  • Improve indoor ventilation.
  • Wear masks.
  • Stay home when sick.

Global Vision of GAS Spread

Since late 2022, according to the World Health Organization, several countries, including the United Kingdom, Ireland, France, the Netherlands, and Sweden, have experienced increases in cases of Group A Streptococcus (GAS). Dr. Céline Gounder emphasized the importance of continuous infectious disease monitoring and prevention worldwide, not just in the United States, in response to outbreaks like these.

Outbreaks like these speak to the need for ongoing infectious disease surveillance and control, not only in the United States, but around the world,” Gounder said.


In Japan, a deadly bacterial infection called streptococcal toxic shock syndrome (STSS) is rapidly increasing, with severe cases and high mortality rates. STSS, caused by group A Streptococcus bacteria, spreads through respiratory droplets and direct contact, posing significant health risks. To prevent this bacterial infection, follow health guidelines like handwashing, improving indoor ventilation, and staying home when sick. Stay informed and practice prevention to protect yourself and others from this life-threatening bacterial infection.

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