In recent months, Japan has faced a concerning uptick in cases of Streptococcal Toxic Shock Syndrome (STSS), attributed to a rare “flesh-eating bacteria.” This bacterial infection, known for its rapid and severe progression, has over 1,000 reported cases this year alone, surpassing previous records.

Most STSS cases are caused by group A streptococcus (GAS), which typically causes fever and throat infections known as “strep throat,” in children. Rarely, strep A can become invasive, producing toxins in deep tissues and the bloodstream, leading to toxic shock. It can also cause “flesh-eating” necrotizing fasciitis, which can lead to loss of limbs.

With a mortality rate of 30% and the ability to turn deadly within 48 hours, the rise of flesh-eating bacterial infections in Japan has understandably caused public concern. To understand public perception of this deadly ‘flesh-eating bacteria’ outbreak, Real Research, an online survey app, conducted a survey to gauge public awareness and concerns.

Key Findings:

  • Almost everyone surveyed (73%) is worried about STSS because the infection can turn deadly within 48 hours.
  • While the health ministry advises against them, the majority (70%) wanted restrictions to prevent the spread of STSS.
  • Experts say STSS is unlikely to become a pandemic – over 60% agree it wouldn’t be widespread like COVID.

How aware are people of the outbreak?

The survey revealed that nearly two-thirds of respondents were aware of the rise in flesh-eating bacterial infections in Japan. This awareness is further emphasized by the fact that over 80% (60.14% very familiar + 24.74% somewhat familiar) reported some level of familiarity with STSS itself.

Figure 1: Respondents’ level of familiarity with STSS.

How worried are people about this illness?

STSS is alarming due to its rapid progression. Many die within 48 hours of infection, leaving little time for treatment. “Out of 10 people with STSS, as many as three people will die from the infection,” the US Centers for Disease Control and Prevention says. This rapid progression and high mortality rate of STSS are alarming to a vast majority (73.08%).

Should there be travel restrictions in Japan?

Interestingly, despite the outbreak being centered in Japan, there’s a prevailing concern about international spread through travel. While the Japanese health ministry advises against travel restrictions (which 29.06% agreed with), a large majority (70.94%) believed such measures were necessary to curb the spread of flesh-eating bacterial infections in Japan.

Can STSS become a pandemic like COVID-19?

Nonetheless, STSS is not a respiratory illness like pneumonia or COVID-19, so it is unlikely to lead to a pandemic, said Dr Hitoshi Honda, an infectious disease professor at Fujita Health University. The disease is primarily transmitted through nasal or throat mucosa droplets and via contact with wounds.

Figure 2: Respondents agree with Dr Honda‘s assessment that STSS is unlikely to lead to a pandemic.

This was reflected in the survey results, with 62.26% agreeing that STSS wouldn’t become a widespread outbreak like COVID-19.

What caused the outbreak in Japan?

The survey also explored potential reasons for the STSS outbreak in Japan.  A plurality (42.82%) believed increased stress and mental health issues were the primary culprit, followed by those attributing it to weakened immune systems post-COVID (39.18%). 5.72% pointed to lifestyle and dietary changes during the pandemic.

Figure 3: The cause of the STSS outbreak in Japan.

Finally, the survey on the rise of flesh-eating bacterial infections in Japan addressed public confidence in the Japanese government’s handling of the outbreak. Disappointingly, over half (53.72%) of respondents felt the government wasn’t adequately addressing the STSS outbreak.


Survey TitleSurvey on the Rise of Flesh-eating Bacterial (STSS) Infections in Japan
DurationJune 23, 2024 – July 4, 2024
Number of Participants5,000
DemographicsMales and females, aged 21 to 99
Participating Countries Afghanistan, Algeria, Angola, Argentina, Armenia, Australia, Azerbaijan, Bahrain, Bangladesh, Belarus, Benin, Bolivia, Brazil, Brunei, Bulgaria, Burkina Faso, Cambodia, Cameroon, Canada, Chile, China, China (Hong Kong) China (Macao), China (Taiwan), Colombia, Costa Rica, Croatia, Czech Republic, Ecuador, Egypt, El Salvador, Ethiopia, Finland, France, Gambia, Georgia, Germany, Ghana, Greece, Greanada, Guatemala, Honduras, Hungary, India, Indonesia, Iraq, Ireland, Israel, Italy, Ivory Coast, Japan, Jordan, Kenya, Kuwait, Kyrgyzstan, Latvia, Lebanon, Libya, Lithuania, Malaysia, Maldives, Maluritania, Mexico, Moldova, Mongolia, Morocco, Mozambique, Myanmar [Burma], Namibia, Nepal, Nicaragua, Nigeria, Oman, Pakistan, Palestine, Panama, Peru, Philippines, Poland, Portugal, Qatar, Romania, Russia, Saudi Arabia, Serbia, Sierra Leone, Singapore, Slovakia, South Africa, South Korea, Spain, Sri Lanka, Tanzania, Thailand, Togo, Tunisia, Turkey, Turkmenistan, Uganda, Ukraine, United Arab Emirates, United Kingdom, United States, Uruguay, Uzbekistan, Venezuela, Vietnam, Yemen, Zimbabwe.