Streptococcus A pandemic: After Covid-19, should Europe be concerned about the rise of “flesh-eating” bacterial infections in Japan?

Strep toxic shock syndrome (TSS) is usually caused by Streptococcus A, known as the “flesh-eating bacteria.” As of January 1, 2024, there have been 517 cases of the disease in Japan. A figure that worries health officials as SCTS is fatal in at least 30% of cases.

517 cases between 1^er January and March 17, 2024, according to The Japan Times. Japan is concerned about an explosion in cases of streptococcal toxic shock syndrome after 941 cases were reported throughout 2023, a record year. That same year, SCTS caused 30% of the deaths of infected individuals, an “extremely high mortality rate”, according to the Tokyo Metropolitan Government.

The result of the Kovid-19 pandemic?

Concerns are growing in Asia to such an extent that on Thursday March 21, 2024, Pyongyang announced that North Korea was protesting against Japan in the qualifying round for football’s 2026 World Cup.

This increase would be a result of the Covid-19 pandemic, during which infections associated with streptococcus bacteria have greatly decreased, due to strengthening of the barrier function.

“The population is less immune, it is the concept of immune debt, so there is a re-transmission and therefore the epidemic is recovered” deciphers for the bacteriologist, Marian Assama Tazi, who directs the National Reference Center for Streptococci.

The Streptococcus A in question

SCTS is often caused by angina and impetigo in 80% of cases; More rarely, it is responsible for invasive infections.

GAS in particular causes very serious and often fatal invasive infections:

• Fasciitis or necrotizing dermohypodermatitis: this is “total destruction of soft tissue, hence its nickname “flesh-eating bacteria”, recalls Public Health France;
• Streptococcal toxic shock syndrome (SSTS) causes multiple organ failure;
• Meningitis, inflammation of the membrane surrounding the brain.

We also see endocarditis and septicemia in invasive infections associated with GAS.

Aggressive infections that are often fatal

According to statistics from Public Health France, 50% of meningitis cases are caused by S. Invasive infection due to pyogenes, 40% of cases of SCTS, is fatal in 20 to 45% of cases of necrotizing dermohypoderma. “With high epidemic potential, S. pyogenes is transmitted through the air (droplets, editor’s note) or by direct contact among people around patients,” notes Public Health France. According to the Japan Times, transmission can also occur through injuries, especially to the hands. Diagnosis of invasive infection is based on detection of sterile bacteria.

Japanese authorities urge the population to seek medical advice quickly in case of pain, swelling of the extremities or fever. Treatment is based on taking antibiotics. However, for many families of Pasteur Institute antibiotics, S. Indicates increased resistance to pyogenes.

Cases rise in Europe

In 2021, the Pasteur Institute showed “a real increase in invasive streptococcal A infections in industrialized countries and especially in Europe. In France, these invasive infections have been increasing since 2000, with an incidence rate of 1.2 to 3.3 per 100,000 inhabitants.

In 2022, in particular, an increase in the number of cases of invasive group A streptococcal infection among children under 10 years of age was reported in many European countries, including France, Ireland, the Netherlands, the United Kingdom, and Sweden. “In France and the United Kingdom, the number of cases of invasive GAS infection in children is many times higher than the levels recorded before the pandemic for the same period,” the World Health Organization then noted.

Strep is not a vaccine

There is no vaccine against Streptococcus A and antibiotic treatment is sometimes not enough to fight the infection.