United States: The contagious tissue damaging disease, which has become a threat for hundreds in Japan, can become a threat for Americans. Reportedly, the concerns have been raised after the cases of the infection have witnessed sudden upsurge.
As per several reports, a historic surge in cases was recorded the previous year, and a mortality rate of 30 percent was documented. The identification of a novel, potentially more potent strain of bacteria accountable for the disease.
Reports of an uncommon yet severe bacterial infection dubbed Streptococcal Toxic Shock Syndrome (STSS) in Japan are circulating extensively, domestically and internationally, stirring significant apprehension among certain individuals. Queries from travelers abroad have reached the health ministry, inquiring whether a visit to the nation is advisable presently, as per the reports by The Japan Times.
North Korea’s withdrawal from a soccer match against Japan last month, citing the presence of a “malignant, infectious ailment,” appears to have intensified the spotlight on the disease, further stoking public anxiety, which is primarily caused by bacteria commonly referred to as strep A.
Does the situation in Japan warrant such concern to prompt reconsideration of travel arrangements?
According to specialists, while there is an increase in cases, they remain substantially lower compared to other contagious ailments. Additionally, STSS is unlikely to spread extensively among the populace, given that it is not an airborne illness like measles, tuberculosis, and COVID-19.
“We do not anticipate pandemic-scale outbreaks,” stated Hitoshi Honda, a professor and expert in infectious diseases at Fujita Health University’s School of Medicine in Aichi Prefecture. “It is not the type of contagion that necessitates travel constraints in any way.”
What is STSS?
STSS, short for Streptococcal Toxic Shock Syndrome, emanates from bacteria known as group A streptococcus (group A strep), akin to those responsible for strep throat infections, primarily affecting children. However, a strep throat infection is distinct from STSS.
While strep A throat infections, characterized by throat pain and fever, are relatively common, this year has seen a surge in cases, reaching the highest in the past five years, with over 11,500 reported instances in the week ending March 24 across 3,000 pediatric hospitals. Experts attribute this rise in part to the easing of pandemic restrictions, as per The Japan Times.
The same bacteria can also induce redness on the skin surface, with symptoms dissipating within approximately five days upon administration of antibacterial drugs, according to Honda.
Nevertheless, in rare occurrences involving certain high-risk individuals, it may progress to “invasive” infections deep within the skin, potentially leading to STSS.
STSS typically initiates with fever, chills, muscle aches, nausea, and vomiting, as outlined by the US Centers for Disease Control and Prevention.
Precisely speaking, STSS can be triggered not only by strep A but also other bacterial groups such as strep B, C, and G. Nonetheless, strep A remains the predominant type.
Who is susceptible to severe symptoms?
The elderly, immune-compromised, and those with underlying conditions like liver cirrhosis and diabetes are Chief among the vulnerable groups that are facing high chances of exhibiting severe symptoms.
The bacteria can disseminate into deeper layers of skin and muscles that are selectively being destroyed with associated formation of tissue infiltrations, therefore the very name “flesh-eating bacteria.”
This phenomenon, which is similar to a gangrene, is referred to as a “necrotizing soft-tissue infection,” the Japan Times reported.
Also, should bacteria spread into the bloodstream, consequently, the toxins could affect the whole body, resulting in irreversible events like sudden cardiac arrest or renal failure.
Approximately 30 percent of individuals developing this condition – STSS – may succumb, according to Honda.
How does the disease propagate?
Honda asserts that droplets and contact are the primary transmission modes, implying that transmission occurs only when an infected individual comes into close contact with another individual without wearing a mask.
Unlike COVID-19, tuberculosis, and measles, the disease does not disseminate through the air.
Consequently, Honda believes a rapid escalation in infections is improbable.
This year, Japan has reported 556 STSS cases up to March 24, surpassing half of the total (941) for 2023. The figures for this year range from 25 to 50 weekly infections, exceeding those of previous years.
Nonetheless, these figures warrant contextualization. In contrast, at the peak of the pandemic, the daily number of new COVID-19 cases exceeded 250,000.
“Twenty-five cases (weekly) nationwide are noteworthy medically but not from a public health standpoint,” remarked Honda, as reported by the Japan Times.
He further noted a surge in cases in countries like the United States and Britain.
Why is there a surge in STSS cases in Japan?
The cause for the escalating cases in the country remains undetermined.
Honda suggests that hygiene standards may have deteriorated in Japanese society following the relaxation of stringent infection control measures enacted during the COVID-19 pandemic in May 2023.
Additionally, he posits that Japanese doctors tend to underreport infectious diseases despite being mandated to do so by health authorities, partly due to a lack of awareness that the diseases they diagnose are reportable.
Both strep A throat infections and STSS are classified as Level 5 under the Infectious Disease Control Law, akin to COVID-19 and influenza.
However, Honda contends that the surge in STSS infections is not due to increased reporting by doctors but rather an actual rise in infections.
The bacteria themselves may be evolving, becoming more pathogenic and increasing the likelihood of severe conditions, necessitating further research to elucidate the pathogen’s behavior, as the Japan Times reported.
Recent cases attributed to a subvariant of M1 strains of strep A bacteria, referred to as M1UK, have been documented in Japan and elsewhere.
According to the National Institute of Infectious Diseases, M1UK is purported to produce nine times more toxins than other M1 strains and is more transmissible. Nonetheless, there is no consensus among experts regarding whether the surge in invasive strep A infection correlates with the spread of the M1UK strain.
How can an individual mitigate risks?
Honda advocates for good hygiene practices such as regular handwashing and observing proper cough etiquette as optimal precautions, dismissing the need for public masking or travel restrictions.
Effective wound care and hand hygiene before handling food or after using restrooms, with soap and water or alcohol-based disinfectants, are crucial.
“For generally healthy and active individuals, fretting over a strep infection and confining oneself at home is unnecessary,” he concluded.