As Japan battles ‘flesh eating’ infection outbreak, health authorities attempt to soothe visitors’ jitters

Health authorities in Japan are attempting to play down reports in foreign media of a sharp uptick in the number of “flesh eating” streptococcal toxic-shock syndrome (STSS) cases, although a leading doctor of infectious diseases has admitted that it was unclear how widespread the illness is or why it seems to be spreading so swiftly.

Global media coverage of the outbreak has highlighted a spike in the number of cases of the rare but frequently deadly bacterial infection, highlighting an apparent fatality rate of 30 per cent.

A health ministry official stressed that travellers concerned about contracting STSS need not cancel their plans to visit Japan, telling the Asahi newspaper that the frequent washing of hands, use of a face mask and keeping any open wounds clean should be sufficient to prevent infection.

People walk across a road in Tokyo on Monday. Cases of “flesh eating” STSS have been reported in 45 of Japan’s 47 prefectures. Photo: EPA-EFE
Media coverage of the outbreak intensified when North Korea cancelled plans for the Japanese national football team to travel to Pyongyang last month for a qualifying match for the 2026 World Cup, with North Korean football authorities citing concern that the foreign players would bring “the contagious disease spreading in Japan” into the country.
Japan’s health ministry pointed out that the World Health Organization had not moved to limit travel to Europe in 2022 during a similar rise in STSS cases in the region.

From the start of the year to March 10, Japan’s National Institute of Infectious Diseases (NIID) recorded 474 STSS cases, compared with 941 in the whole of last year. The infection has also spread across the nation, with cases reported in 45 of Japan’s 47 prefectures, 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,” the institute said.

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A risk assessment issued by the NIID on March 29 identified STSS’ symptoms as including liver failure, renal failure, acute respiratory distress syndrome, soft-tissue inflammation, rashes and effects on the central nervous system.

It added that an examination of the virus showed it was a variant of the M1UK strain, which was prevalent in Britain in the 2010s and is “considered to be highly pathogenic and transmissible”.

“It is becoming a serious problem, but there are still many things that we do not know,” said Kazuhiro Tateda, president of the Japan Association of Infectious Diseases and a member of the panel that advised the government during the Covid-19 pandemic.

“We know that it is a variant of the strain that was spreading in the UK, but we do not know how or when it came to Japan,” he told This Week in Asia.

Health experts understand STSS typically spreads in the same way as other bacteria, primarily through skin contact, but treatment is proving challenging, Tateda admitted.

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Typically, older people or those with underlying health complaints are considered to be at greater risk of STSS, although this variant is causing more fatalities among people under the age of 50.

“The infection progresses so rapidly that it is sometimes difficult to respond quickly enough to save a patient’s life,” he said. “We need to be able to detect the bacteria early and for people to take better precautions.”

Health experts are recommending that anyone with symptoms, which often start with painful skin lesions or tonsillitis, seek medical advice immediately.

“It is not possible to say whether the outbreak is going to get worse, but we do need to be careful and try to monitor the number and spread of the cases,” Tateda said.

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