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Summary of recommendations:
No special immunizations or medications are necessary for most trips to Japan.
Recommended for all travelers from November through April
Recommended for long-term (>1 month) travelers to rural areas if visiting between June and September (risk extends from April to October on the Ryuku Islands)
Measles, mumps, rubella (MMR)
Two doses recommended for all travelers born after 1956, if not previously given
Revaccination recommended every 10 years
All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics, prior to international travel. The following are the recommended vaccinations for Japan:
Japanese encephalitis vaccine is recommended for long-term (greater than 1 month) travelers to rural areas or travelers who may engage in extensive unprotected outdoor activities in rural areas, especially in the evening, during shorter trips. Rare human cases of Japanese encephalitis are reported on all islands except Hokkaido, though animal cases occur there. Transmission is from June to September except on the Ryuku Islands (Okinawa), where transmission is from April to October.
The vaccine (JE-VAX; Aventis Pasteur Inc.) (PDF) is given as a series of three injections on days 0, 7 and 30. If time is short, the third dose may be given on day 14. Mild side effects including fever, headache, muscle aches, malaise and soreness at the injection site occur in about 20% of those vaccinated. Serious allergic reactions including urticaria, angioedema, respiratory distress and anaphylaxis occur in approximately 0.6% of vaccinees and may occur as long as one week after vaccination. Any person who receives the vaccine should be observed in the doctor's office for at least 30 minutes following the injection and should complete the full series at least 10 days before departure.
Insect protections measures are strongly advised for all travelers at risk for Japanese encephalitis.
Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.
Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.
Influenza vaccine is recommended for all travelers during flu season, which runs from November through April. Influenza vaccine may cause soreness at the injection site, low-grade fevers, malaise, and muscle aches. Severe reactions are rare. Influenza vaccine should not be given to pregnant women during the first trimester or those allergic to eggs.
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A rubella outbreak was reported from Japan in April 2013, causing more than 5000 cases by May (see ProMED mail). All travelers born after 1956 should make sure they have had either two documented MMR immunizations or a blood test showing rubella immunity. This does not apply to people born before 1957, who are presumed to be immune.
An outbreak of H5N1 avian influenza ("bird flu") was reported in December 2010 from a layer farm at Yasugi city in Shimane prefecture, in the southwest of Honshu, followed by poultry outbreaks in Miyazaki, Kagoshima, Aichi, Oita, and Mie prefectures over the following two months, and then a poultry outbreak from Chiba city in March 2011. In January-February 2007, outbreaks were reported from three poultry farms in Miyazaki Prefecture in the southwestern part of Japan and one poultry farm in the western prefecture of Okayama. Before that, in January 2004, an avian influenza outbreak was reported from a farm in Yamaguchi Prefecture. One human case was identified retrospectively.
Most travelers are at extremely low risk for avian influenza, since almost all human cases in other countries have occurred in those who have had direct contact with live, infected poultry, or sustained, intimate contact with family members suffering from the disease. The Centers for Disease Control and the World Health Organization do not advise against travel to countries affected by avian influenza, but recommend that travelers should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked. A vaccine for avian influenza was recently approved by the U.S. Food and Drug Administration (FDA), but produces adequate antibody levels in fewer than half of recipients and is not commercially available. The vaccines for human influenza do not protect against avian influenza. For further information, go to the World Health Organization, Health Canada, the Centers for Disease Control, and ProMED-mail.
A measles outbreak was reported from Japan in April 2007, causing an estimated 18,000 cases by the end of the year. The outbreak began in the southern Kanto area, including Tokyo, Kanagawa, Saitama, and Chiba Prefectures, and eventually spread throughout the country. Two cases were reported among visitors from Taiwan. An additional 9600 cases were reported in the first six months of 2008, chiefly in Tokyo and Hokkaido (see MMWR, the Infectious Disease Surveillance Center and ProMED mail, April 24, May 22 and 23, and June 14, 2007). All travelers born after 1956 should make sure they have had either two documented measles immunizations or a blood test showing measles immunity. This does not apply to people born before 1957, who are presumed to be immune to measles. Although measles immunization is usually begun at age 12 months, children between the ages of 6 and 11 months should be given an initial dose of MMR vaccine before traveling to Japan.
A nationwide outbreak of norovirus infections was reported from Japan in late 2006, resulting in tens of thousands of cases. Norovirus infections cause nausea, vomiting, diarrhea, and crampy abdominal pain. Most cases resolve uneventfully, but the illness may be complicated by severe dehydration, especially in the very young and very old. Travelers to Japan should be sure to avoid eating raw shellfish (bivalves), which are thought to be a source of infection. For further information, go to ProMED-mail (December 23, 2006).
An outbreak of pharyngoconjunctival fever, known popularly as "swimming pool fever", was reported from across Japan in July 2006. Symptoms included low-grade fever, headaches, fatigue, pink-eye, and sore throat. Most outbreaks of pharyngoconjunctival fever are caused by adenovirus and are spread by inadequately chlorinated swimming pools. For further information, go to ProMED-mail (July 16, 2006).
A small number of cases of bovine spongiform encephalopathy ("mad cow disease") have been identified, but transmission to humans has not been reported to date. The Centers for Disease Control does not advise against eating Japanese beef. For recent updates, go to ProMED-mail.
An outbreak of food poisoning caused by Staphylococcus aureus was reported in July 2000. More than 13,000 people were affected. The source was found to be contaminated milk from a processing plant in Osaka. See World Health Organization for details.
The number of infections caused by Vibrio parahaemolyticus, which causes a diarrheal illness, has been increasing in recent years. Most outbreaks occur in the summer, with few infections in the winter. Most cases are related to uncooked or undercooked seafood. Boiled crabs were responsible for an especially large outbreak.
Hemorrhagic E. coli caused several large-scale outbreaks of food poisoning in 1996, including an outbreak involving more than 6000 schoolchildren in Sakai City. Fewer cases have been reported in recent years.
Echovirus: epidemics of aseptic meningitis due to echovirus were reported from Japan in 1983, 1989-1991, and 1997-1998. Most cases occurred in children.
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- Severe fever with thrombocytopenia virus (life-threatening viral infection transmitted by ticks; causes fever, low platelets, low white blood cell count, and elevated liver enzymes; eight cases reported from western Japan in January-March 2013; see ProMED-mail, February 20, 2013)
- Leptospirosis (animal reservoir includes rats, mice, pigs, dogs, and goats)
- Hepatitis E (sporadic cases related to consumption of undercooked boar or deer meat)
- Lung fluke (paragonimiasis) (acquired by eating raw or partially cooked crabs, crayfish or shrimp)
- Oriental liver fluke (clonorchiasis) (acquired by eating raw fish)
- Fish tapeworm (diphyllobothriasis) (contracted by eating undercooked fish or fish roe or liver)
- Gnathostomiasis (acquired by eating undercooked freshwater fish; see Emerging Infectious Diseases)
- Giant intestinal fluke (fasciolopsiasis)
- Hemorrhagic fever with renal syndrome (rare; transmitted by rodents)
- Scrub typhus (occurs in certain valleys; transmitted by chigger bites)
- Japanese spotted fever (transmitted by ticks; southwestern and central Japan)
HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.
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Insect and tick protection
Wear long sleeves, long pants, hats and shoes (rather than sandals) when traveling to rural or forested areas. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accomodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night.
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Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.
Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.
Pack a personal medical kit, customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag, discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.
Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.
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For an ambulance in Japan, call 119.
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Physicians and hospitals
For a guide to English-speaking physicians, hospitals, and pharmacies in Japan, go to the U.S. Embassy website.
For an overview of health care in Japan, go to the World Health Organization - Western Pacific Region.
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Medical facilities (reproduced from the U.S. State Dept. Consular Information Sheet)
While medical care in Japan is good, English-speaking physicians and medical facilities that cater to Americans' expectations are expensive and not very widespread. Japan has a national health insurance system, which is only available to foreigners with long-term visas for Japan. National health insurance does not pay for medical evacuation or medical care outside of Japan. Medical caregivers in Japan require payment in full at the time of treatment or concrete proof of ability to pay before treating a foreigner who is not a member of the national health insurance plan.
U.S.-style and standard psychiatric care can be difficult to locate in major urban centers in Japan, and generally is not available outside of Japan's major cities. Extended psychiatric care for foreigners in Japan is difficult to obtain at any price; see http://japan.usembassy.gov/e/acs/tacs-psychadmissions.html for more information.
U.S. prescriptions are not honored in Japan, so travelers with ongoing prescription medicine needs should arrive with a sufficient supply to see them through their stay in Japan, or enough until they are able to see a local care provider. Certain medications, including some commonly prescribed for depression and Attention Deficient Disorder (ADD), are not widely available. Please see the section below entitled, Confiscation of Prescription Drugs and Other Medication, regarding the importation of medicine into Japan. More information on importing medicines into Japan is also available at http://japan.usembassy.gov/e/acs/tacs-medimport.html. A list of English-speaking medical facilities throughout Japan is available on our web site at http://japan.usembassy.gov/e/acs/tacs-7119.html.
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Prescription drugs (reproduced from the U.S. State Dept. Consular Information Sheet)
Decisions on what medications may be imported legally into Japan are made by the Japanese Government, and unfortunately the limited information we have available at the American Embassy and our Consulates does not include comprehensive lists of specific medications or ingredients.
It is illegal to bring into Japan some over-the-counter medicines commonly used in the United States, including inhalers and some allergy and sinus medications. Specifically, products that contain stimulants (medicines that contain Pseudoephedrine, such as Actifed, Sudafed, and Vicks inhalers), or Codeine are prohibited. Up to a two-months' supply of allowable over-the-counter medication and up to a four-months' supply of allowable vitamins can be brought into Japan duty-free.
Some U.S. prescription medications cannot be imported into Japan, even when accompanied by a customs declaration and a copy of the prescription. Japanese customs officials have detained travelers carrying prohibited items, sometimes for several weeks. Japanese customs officials do not make on-the-spot humanitarian exceptions for medicines that are prohibited in Japan.
Generally, up to one month's supply of allowable prescription medicine can be brought into Japan. Travelers must bring a copy of their doctor's prescription as well as a letter stating the purpose of the drug. Travelers who must carry more than one month's supply, or are carrying syringes, may be required to fill out a customs declaration form before entering Japan. To obtain the customs declaration form before you leave, or for more information on taking medication into Japan, contact the Embassy of Japan's Economic Section 202-238-6700 or at http://www.us.emb-japan.go.jp/jicc/consulat.htm. The American Embassy and our Consulates in Japan do not stock these forms.
Japanese physicians can often prescribe similar, but not identical, substitutes to medicines available in the U.S. A Japanese doctor, consulted by phone in advance, is also a good source of information on medications available and/or permitted in Japan. A list of English-speaking medical facilities throughout Japan is available on our web site at http://japan.usembassy.gov/e/acs/tacs-7119.html.
Some popular medications legal in the U.S., such as Prozac and Viagra, are sold illegally in Japan on the black market. You are subject to arrest and imprisonment if you purchase such drugs illegally while in Japan.
Persons traveling to Japan carrying prescription and non-prescription medications should consult the Japanese Embassy, or a Japanese Consulate, in the United States before leaving the U.S. to confirm whether they will be allowed to bring the particular medication into Japan. A full listing of phone numbers and email addresses is available at http://www.us.emb-japan.go.jp/jicc/consulat.htm.
Other Government of Japan sources of information are included on the web site of the Ministry of Health, Labor and Welfare at http://www.mhlw.go.jp/english/topics/import/index.html.
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Traveling with children
Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed.
All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).
Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, and appropriate antibiotics for common childhood infections, such as middle ear infections.
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Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.
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Registration/Embassy location (reproduced from the U.S. State Dept. Consular Information Sheet)
U.S. citizens resident in or visiting Japan are encouraged to register at the Consular Section of the U.S. Embassy in Tokyo or one of the five U.S. Consulates in Japan, where they may also obtain updated information on travel and security within Japan. Registration forms are available via the home pages of, or by fax from, the U.S. Embassy or one of the U.S. Consulates at http://japan.usembassy.gov/e/acs/tacs-7130a.html. Online registration is available for the areas served by the Embassy and our Consulate in Naha, Okinawa through their respective web sites. Travelers and residents can also sign up for an e-mail Community Security Update newsletter at http://www.tokyoacs.com/. Alien registration formalities required under Japanese immigration law are separate from U.S. citizen registration, which is voluntary and allows U.S. consular officials to better assist American citizens in distress. Registration information is protected by the Privacy Act.
The U.S. Embassy in Tokyo is located at 1-10-5 Akasaka, Minato-ku, Tokyo 107-8420 Japan; telephone 81-3-3224-5000; fax 81-3-3224-5856. Recorded visa information for non-U.S. citizens is available at the following 24-hour toll phone number: 03-5354-4033. The U.S. Embassy in Tokyo's web site is http://www.tokyoacs.com/. Please see also the U.S. Commercial Service in Japan's web site at http://www.csjapan.doc.gov/.
The U.S. Consulate General in Osaka-Kobe is located at 2-11-5 Nishitenma, Kita-ku, Osaka 530-8543; telephone 81-6-6315-5900; fax 81-6-6315-5914. Recorded information for U.S. citizens concerning U.S. passports, notarials and other American citizens services is available 24 hours at 81-6-6315-5900. Recorded visa information for non-U.S. citizens is available at the following 24-hour toll phone number: 0990-526-160. Its web site is http://www.senri-i.or.jp/amcon/.
The U.S. Consulate General in Naha is located at 2564 Nishihara, Urasoe, Okinawa 901-2101; telephone 81-98-876-4211; fax 81-98-876-4243. Its web site is http://naha.usconsulate.gov.
The U.S. Consulate General in Sapporo is located at Kita 1-Jo Nishi 28-chome, Chuo-ku, Sapporo 064-0821; telephone 81-11-641-1115, fax 81-11-643-1283. Its web site is http://sapporo.usconsulate.gov.
The U.S. Consulate in Fukuoka is located at 2-5-26 Ohori, Chuo-ku, Fukuoka 810-0052; telephone 81-92-751-9331; fax 81-92-713-9222. Its web site is http://fukuoka.usconsulate.gov.
The U.S. Consulate in Nagoya is located at the Nishiki SIS Building, 6th Floor, 3-10-33 Nishiki, Naka-ku, Nagoya 460-0003; telephone 81-52-203-4011; fax 81-52-201-4612. The U.S. Consulate in Nagoya offers only limited emergency consular services for U.S. citizens. The U.S. Consulate General in Osaka-Kobe handles all routine matters. A consular officer from the U.S. Consulate General in Osaka-Kobe visits the U.S. Consulate in Nagoya on the second Wednesday of every month. During those visits, the consular officer provides consular services to U.S. citizens by appointment. To make an appointment for consular services in Nagoya, please contact the U.S. Consulate in Nagoya at the number listed above. The U.S. Consulate in Nagoya's web site is http://nagoya.usconsulate.gov.
Maps to all our offices in Japan, along with directions on using public transportation to reach us, are available at http://japan.usembassy.gov/e/acs/tacs-7123.html.
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For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada, and the Australian Department of Foreign Affairs and Trade.
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