Streptococcus pyogenes showing beta-hemolysis on blood agar plate Streptococcus pyogenes showing beta-hemolysis on blood agar plate

Streptococcal infections on the rise in Japan


What it is and how to prevent it

Toxic shock syndrome (TSS) has been recognised since the 1970s and is caused by toxin-producing group A streptococci - mainly Streptococcus pyogenes [1, 2]. The earlystagesof TSS oftenpresentwithcold-like symptoms such assorethroat, which in rare casescanprogresstopneumoniaormeningitis, and in themostseverecasestoorganfailure and necrosis [1, 2]. TSS occurscontinuouslyworldwide in smallnumbersofcases. However, a regional clusterhasbeenobserved in Japan sincethebeginningofthisyear [2]

Where have infections been more common?

However, an increase in TSS or invasive group A streptococcus (iGAS) infections, such as the current one in Japan, is not unique. There were also 147 cases in children under the age of 15 in the UK at the end of 2022, half of whom died[3]. In Australia, a total of 280 caseswerereported in childrenbetween 2018 and 2022, with a mortality rate of just 1%. Most cases also occurred in the post-pandemicperiod in mid/late 2022 [4]. Similarresultswerereported in theNetherlands, wheremorechildrenfellillbetween mid-2021 and mid-2022 than in theyearsbeforethe COVID-19 pandemic [5]. The Robert Koch Institute (RKI) also reported an increase in iGASinfections in Germany, particularly in late 2022/early 2023, mainlyinvolving invasive isolates [6].

What is causing the increase in TSS and iGAS?

The reasons for theincreasedincidenceappeartobe multiple and probablyinclude environmental, population and microbialfactors [4]. These includecontactrestrictionsduringthe COVID-19 pandemic and theresultinglowerimmunitytoS. pyogenes, the post-pandemicdecline in handhygiene, increasedvirulenceofcertainbacterialstrains and increasedcirculationof viral respiratorypathogens, which may pavetheway for secondarybacterialinfections [4, 5]. Althoughtherearesimilarreportsfrom different countries in the northern and southern hemispheres, theclustersofiGASseemtobe limited totherespectiveregion. Nevertheless, highly virulent streptococcal strains can theoretically continue to spread across regions. While a permanent cluster of iGAS infections has been observed in resource-poor areas for some time, experts point out that the incidence is also increasing every year in developed countries, with the exception of the pandemic years 2020 and 2021 [4].

How can streptococcal transmission be reduced?

Streptococciaremainlytransmittedbydirectorindirectcontactwithcontaminatedpeopleorsurfaces, and lesscommonlybydropletinfectionorcontaminatedfoodorwater. To reduce the risk of infection, good hand and surface hygiene with bactericidal disinfectants is recommended. Suitable HARTMANN productscanbefoundhere. People at riskcan also wearmaskstoavoiddropletinfections. Althoughmoreworkisbeingdone, a vaccineagainstiGASis not yetavailable [7].


  1. Atchade E et al. (2024) Antibiotics (Basel) 13: 96.
  2. (accessed on 25.03.2024)
  3. Wrenn K et al. (2023) Lancet 402 Suppl 1: S93.
  4. Abo YN et al. (2023) Lancet Reg Health West Pac 41: 100873.
  5. van Kempen EB et al. (2023) PediatrInfect Dis J 42: e122-e124.
  6. Robert Koch-Institut (RKI). Epidemiologisches Bulletin 12/2024. (accessed on 25.03.2024)
  7. Ajay Castro S, Dorfmueller HC (2023) NPJ Vaccines8:135.

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