Japan - Streptococcal infections soar to record levels

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Mystery in Japan as dangerous streptococcal infections soar to record levels

Health officials racing to identify cause of rise in streptococcal toxic shock syndrome, which has a 30% fatality rate

Justin McCurry in Tokyo
Thu 14 Mar 2024 21.05 EDT
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The number of cases in 2024 is expected to exceed last year’s record numbers, while concern is growing that the harshest and potentially deadly form of group A streptococcal disease – streptococcal toxic shock syndrome (STSS) – will continue to spread, after the presence of highly virulent and infectious strains were confirmed in Japan.

The National Institute of Infectious Diseases (NIID) said: “There are still many unknown factors regarding the mechanisms behind fulminant (severe and sudden) forms of streptococcus, and we are not at the stage where we can explain them.”

Provisional figures released by the NIID recorded 941 cases of STSS were reported last year. In the first two months of 2024, 378 cases have already been recorded, with infections identified in all but two of Japan’s 47 prefectures.

While older people are considered at greater risk, the group A strain is leading to more deaths among patients under 50, according to NIID. Of the 65 people under 50 who were diagnosed with STSS between July and December in 2023, about a third, or 21, died, the Asahi Shimbun newspaper reported..
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Ken Kikuchi, a professor of infectious diseases at Tokyo Women’s Medical University, says he is “very concerned” about the dramatic rise this year in the number of patients with severe invasive streptococcal infections.

He believes the reclassification of Covid-19 was the most important factor behind the increase in streptococcus pyogenes infections. This, he added, had led more people to abandon basic measures to prevent infections, such as regular hand disinfection.

“In my opinion, over 50% Japanese people have been infected by Sars-CoV-2 [the virus that causes Covid-19],” Kikuchi tells the Guardian. “People’s immunological status after recovering from Covid-19 might alter their susceptibility to some microorganisms. We need to clarify the infection cycle of severe invasive streptococcal pyogenes diseases and get them under control immediately.”
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https://www.theguardian.com/world/2024/mar/15/japan-streptococcal-infections-rise-details

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'30% deaths' due to fulminant hemolytic streptococcus infection, the highest rate ever in Tokyo, nicknamed 'flesh-eating bacteria'

March 22, 2024 20:29
　
This year in Tokyo, the number of patients with fulminant hemolytic streptococcal disease (STSS), which has an extremely high mortality rate, is increasing at a rate that far exceeds last year's record high. The Tokyo metropolitan government is urging people to promptly seek medical attention if they have symptoms such as pain in their limbs or fever.

◆As of the 17th, 88 people have been reported infected, three times the pace of last year

A report was made at the Tokyo Metropolitan Infectious Disease Control Liaison Conference on the 22nd. As of the 17th, there are 88 patients in 2024. Infections are being confirmed at a rate three times higher than in 2023, when there were 141 people. In 2023, 42 people, about 30%, died.
　
The pathogens include group A streptococcus, which is prevalent mainly among children, as well as groups B and C. Symptoms begin with pain in the limbs and fever, and progress rapidly. Multiple organ failure develops within tens of hours. It is also called "flesh-eating bacteria" because it can cause necrosis of limbs. The mechanism of onset has not been elucidated.
　
According to the Tokyo metropolitan government, many of the patients were in their 40s, and it is possible that they were infected by streptococcal infections, which were prevalent among children in 2023. The replacement by the highly contagious M1UK strain, which has been increasing in the UK since the 2010s, is also believed to be a factor in the spread of infection. The Tokyo metropolitan government is analyzing infection trends and revising response guidelines for medical institutions. (Mayuko Watanabe)

https://www.tokyo-np.co.jp/article/316716

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Epidemic status of fulminant hemolytic streptococcal infections (Tokyo 2024)

Update date: March 22, 2024

1 Trends in the number of reports of fulminant hemolytic streptococcal infections

Trends in the number of reports received by week (2024)

Trends in the number of reports by year (past 10 years)

Trends in the number of reports received by week (past 5 years)

• For detailed information such as the number of reported cases, please see the WEB Infectious Disease Trend Survey .
• Reporting week correspondence table (National Institute of Infectious Diseases)

2 Number of reports by age group and gender

https://idsc.tmiph.metro.tokyo.lg.jp/diseases/s-group-a/s-group-a/

[Mary Wilson]

Tokyo issues warning as rare but deadly STSS Bacterial infections rise

Mar 24, 2024
BY KATHLEEN BENOZA

The Tokyo Metropolitan Government has issued a warning as cases of a rare-yet-severe type of bacterial infection have exceeded more than half of last year’s count — 88 in the capital — along with 517 infections nationwide. ...

At a city meeting on infectious disease controls Friday, it was revealed that Tokyo had 88 patients as of March 17. In 2023, the capital reported a total of 141 cases and 42 deaths linked to the infections. ...

A variant called the M1UK strain, which is considered highly transmissible among the group A streptococcus bacteria, is believed to be linked to the recent rise of STSS cases as it has been increasingly detected in patients from mid-November of last year. ...

https://www.japantimes.co.jp/news/2024/03/24/japan/science-health/tokyo-issues-warning-for-bacterial-infection-disease/

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STSS infections growing at record pace in Japan

May 27, 2024

The number of patients with streptococcal toxic shock syndrome (STSS), a lethal infection caused by the bacteria behind strep throat, is rising at a record pace in Japan.
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According to a preliminary report by the National Institute of Infectious Diseases, there were 941 STSS patients in Japan last year, the highest since current records began in 1999. The patient tally this year had reached 851 as of May 12, with the figure being 2.8 times higher than a year before.
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The M1UK strain, which spread in Britain in the 2010s, is a highly toxic strain of the group A bacteria and has been detected more often in areas including the Kanto region since the second half of last year.

The health ministry is strengthening its monitoring efforts, but the connection between the strain and the rise in STSS cases is unclear.

"Elderly individuals age 65 and above constitute the majority of STSS patients," said professor Ken Kikuchi of Tokyo Women's Medical University Hospital. "Bacteria often enter through minor foot injuries such as shoe sores and rashes caused by athlete's foot."

Kikuchi called on people involved in elderly nursing to check daily whether elderly people's feet have been kept clean.
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https://www.japantimes.co.jp/news/2024/05/27/japan/science-health/lethal-bacterial-infection/

[Shiloh]

Source: https://english.kyodonews.net/news/2...-in-japan.html

"Flesh-eating" bacterium cases hit record high in Japan
KYODO NEWS KYODO NEWS - 17 hours ago - 14:13 | All, Japan

Streptococcal toxic shock syndrome, a potentially deadly disease caused by a "flesh-eating" bacterium, is spreading rapidly in Japan, with cases in the first half of this year already surpassing last year's record, a national infectious disease institute said Tuesday.

There have been 977 cases of the disease caused by the bacterium called streptococcus pyogenes which is often associated with strep throat but occasionally leads to limb necrosis and multiple organ failure.

The number of people infected has already topped last year's 941, the highest annual number of cases tallied since mandatory reporting began in 1999, according to the institute...

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Translation Google

Severe streptococcal hemolytic syndrome (STSS)

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About the outbreak


As of June 2nd, the number of reported cases of severe hemolytic streptococcal infections in Japan in 2024 has already exceeded the number reported in 2023, which was the highest number since statistics began being collected in 1999. The latest reported number of cases of severe hemolytic streptococcal infections is regularly published in the National Institute of Infectious Diseases' IDWR Flash Data.
National Institute of Infectious Diseases' IDWR Flash Data

Recent reports of severe hemolytic streptococcal infections in Japan




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Notice (Published on March 29, 2024, partially updated on June 11)

Japanese

Hemolytic streptococci (commonly known as Streptococcus) are bacteria that commonly cause acute pharyngitis, but in rare cases they can cause a severe illness known as severe streptococcal syndrome (STSS).

Regarding streptococcal pharyngitis, the largest epidemic in the past 10 years has been occurring since October 2023, and the number of reported cases of STSS nationwide last year was 941 (preliminary figure), exceeding the highest number in 2019 since statistics began to be collected in 1999. Furthermore, this year, the number of reported cases as of June 2nd is 977 (preliminary figure), already exceeding the number of reported cases last year.

The reason for the increase in the number of STSS patients is not entirely clear; however, in addition to the long-term increasing trend, it is possible that one of the causes is the increase in the number of patients with streptococcal pharyngitis amid an increase in various respiratory infections since the relaxation of COVID-19 countermeasures.

Regarding strep throat and STSS, an increase has been confirmed in many regions since COVID-19 countermeasures were relaxed worldwide in 2022, with some regions experiencing epidemics last season and others experiencing epidemics this season. This increasing trend is not limited to Japan.

Those planning to travel to Japan do not need to cancel their trip due to the outbreak of this disease. When traveling, please take basic infection control measures such as hand hygiene, cough etiquette, and cleaning wounds.
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https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000137555_00003.html

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Translation Google
Severe streptococcal hemolytic syndrome (STSS)
...
About the outbreak

As of June 2nd, the number of reported cases of severe hemolytic streptococcal infections in Japan in 2024 has already exceeded the number reported in 2023, which was the highest number since statistics began being collected in 1999. The latest reported number of cases of severe hemolytic streptococcal infections is regularly published in the National Institute of Infectious Diseases' IDWR Flash Data.
National Institute of Infectious Diseases' IDWR Flash Data

Recent reports of severe hemolytic streptococcal infections in Japan
Year 2019 2020 2021 2022 2023 2024(～6/16)
報告数 894 718 622 708 941※ 1060※

*Preliminary figures
...

https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000137555_00003.html

[Shiloh]

Source: https://japannews.yomiuri.co.jp/soci...240713-198481/

Fatal Strep Infections on the Rise in Japan, with Pregnant Women in Particular Danger
The streptococcus bacteria
The Yomiuri Shimbun
14:21 JST, July 13, 2024

Five pregnant women died from a fatal condition caused by the streptococcus bacteria from July 2023 to March 2024, according to a study by the Japan Association of Obstetricians and Gynecologists. The aggressive infection, called streptococcal toxic shock syndrome (STSS), often occurs through the nose or throat, and the association has called for mask-wearing to prevent its spread.

Fatalities of pregnant women compiled by the association were examined by Prof. Junichi Hasegawa of the St. Marianna University School of Medicine and his team. While 19 deaths were recorded from STSS from 2010 to 2019, there were no cases reported from January 2020 to June 2023, a period coinciding with the COVID-19 pandemic...

...By June 30, the number of patients in Japan with the STSS had reached 1,144 for the year, topping last year’s record of 941 cases, according to the National Institute of Infectious Diseases.

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ISSN: 1080-6059
Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released. Volume 31, Number 4—April 2025

Research Letter

Emerging Trends in Streptococcal Toxic Shock Syndrome, Japan

Mugen Ujiie
Author affiliation: National Center for Global Health and Medicine, Tokyo, Japan

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Abstract


Japan experienced substantial increases in streptococcal toxic shock syndrome and group A Streptococcus pharyngitis after relaxing COVID-19 restrictions in May 2023. Increased detection of the M1_UK lineage of Streptococcus pyogenes, especially in the vicinity of Tokyo, emphasizes the need to raise awareness of disease characteristics and epidemiologic trends.


Figure 1. Number of reported STSS (all-cause, including GAS and other streptococcal groups) and GAS pharyngitis reported in Japan during 1999–2024. GAS pharyngitis is reported weekly from ≈3,000 pediatric sentinel medical institutions...

A genetic variant of Streptococcus pyogenes, the M1_UK lineage, is characterized by high transmissibility and increased production of streptococcal pyrogenic exotoxin A. This variant might have been associated with increased scarlet fever cases in England since ≈2014 (1). Similar trends have been observed in other regions, including Europe and North America (2,3). In New Zealand, M1_UK strains have been detected among school children with pharyngitis, suggesting that community transmission might be a source of invasive infections (4). We document a similar trend in Japan since ≈2014 (5–7) and demonstrate increased prevalence of streptococcal toxic shock syndrome (STSS) and group A Streptococcus (GAS) pharyngitis (Figure 1). The trend in Japan was temporarily disrupted by nonpharmaceutical interventions during the COVID-19 pandemic but resurged in 2023 after relaxation of COVID-19 restrictions, similar to the case for other infectious diseases. This report might inform effective infection control strategies and raise awareness for STSS. Ethics approval was not required for this registered study, which used routine surveillance data.

Under the Infectious Diseases Control Law in Japan, physicians must report STSS cases that meet criteria for shock symptoms and >2 of the following conditions: hepatic failure, renal failure, acute respiratory distress syndrome, disseminated intravascular coagulation, soft tissue inflammation, generalized erythematous rash, central nervous system symptoms, or detection of β-hemolytic streptococci from typically sterile sites (e.g., blood). The Japan National Institute of Infectious Diseases reported a marked increase in STSS cases in 2024 (8). By week 50 (December 15) of 2024, a total of 1,834 cases had been reported, which is the highest annual number of reported cases (Figure 1). By week 24 (June 16) of 2024, a total of 1,060 STSS cases had been reported; 656 cases were caused by GAS, 222 by group G Streptococcus, 114 by group B Streptococcus, 10 by group C Streptococcus, and 58 by other or unknown groups (8). The percentage of STSS cases caused by GAS rose from 30%–50% during 2018–2023 to 62% in 2024.

Figure 2. Prevalence of Streptococcus pyogenes M1 strains in study of emerging trends in streptococcal toxic shock syndrome, Japan. M1_UK lineage within emm1genotype strains detected in...

By June 19, 2024, the National Institute of Infectious Diseases had received 532 isolates from patients with STSS in 42 prefectures (8). GAS accounted for 377 (70.9%) of those cases; 221 (58.6%) were M1 strains, of which 194 (87.8%) belonged to the M1_UK lineage (Figure 2). The highest prevalence of M1_UK lineage strains was seen in the Kanto region and surrounding areas. The highest number of M1_UK isolates were reported in Tokyo (n = 47), followed by Kanagawa (n = 20), Chiba (n = 15), Nagano (n = 9), and Saitama (n = 8). Analysis of 760 GAS isolates from patients with STSS during 2018–2023 identified 215 (28.3%) as M1 strains; 50 (23.3%) of those belonged to the M1_UK lineage (Figure 2) (8,9). Those data indicate a substantial rise in M1_UK lineage strains since 2023, especially in Japan’s Kanto region.

Among the 656 patients with STSS caused by GAS, 377 (57%) were male and 279 (43%) female (8). The age distribution was skewed toward the elderly. Age ranges were <20 (n = 23), 20–29 (n = 11), 30–39 (n = 55), 40–49 (n = 87), 50–59 (n = 98), 60–69 (n = 132), 70–79 (n = 140), and >80 (n = 110) years.

Although reporting clinical outcomes is not mandatory, among the 656 STSS cases caused by GAS, 149 deaths (87 male and 62 female patients) occurred at diagnosis (8). No deaths occurred in patients <20 years of age; deaths occurred in patients 20–29 (n = 2), 30–39 (n = 12), 40–49 (n = 16), 50–59 (n = 16), 60–69 (n = 34), 70–79 (n = 36), and >80 (n = 33) years of age. Deaths occurred in 30.9% (21/68) of persons <50 years of age during July–December 2023, a marked increase from previous years (19.7% in 2018, 24.1% in 2019, 12.8% in 2020, 9.1% in 2021, 12.1% in 2022, and 15.4% during January–June 2023) (9).

The increase in detection and prevalence of M1_UK lineage strains in Japan, especially in the Kanto region around Tokyo, and the correlation between the rise in GAS-caused STSS cases and the increase M1_UK bacteria isolation rates is concerning. The rising incidence of STSS, characterized by a high mortality rate and requiring prompt treatment for invasive GAS infections, raises critical public health concerns.

In conclusion, the resurgence of STSS and GAS pharyngitis in Japan after relaxation of COVID-19 restrictions highlights the need for continuous surveillance and public health preparedness. The increasing detection of the S. pyogenes M1_UK lineage emphasizes the importance of genetic monitoring and targeted interventions to prevent its spread. Effective infection control strategies, heightened awareness among healthcare professionals, and public health education are essential to address severe infections in the postpandemic era (10).

Dr. Ujiie is the director of the Immunization Support Centre at the National Center for Global Health and Medicine. His research interests focus on immunization, tropical infectious diseases, and travel medicine.

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https://wwwnc.cdc.gov/eid/article/31/4/24-1076_article