What vaccinations are recommended for travel to Japan?

Recommended Vaccinations for Travel to Japan

For most travelers to Japan, routine vaccinations are sufficient, with Japanese encephalitis (JE) vaccine only recommended for specific high-risk situations such as long-term stays in rural areas or during transmission season. 1

Routine Vaccinations

All travelers to Japan should ensure they are up-to-date with routine vaccinations including:

• MMR (measles, mumps, rubella)
• Tdap (tetanus, diphtheria, pertussis)
• Influenza (seasonal)
• COVID-19
• Hepatitis A and B
• Pneumococcal (for those eligible)
• Varicella (chickenpox)

Japanese Encephalitis Risk Assessment

Japanese encephalitis vaccine should be considered based on specific risk factors:

Risk Factors Requiring Assessment:

1. Duration of travel

   • Highest risk: Stays ≥1 month
   • Lower risk: Short-term travel (<1 month)

2. Season of travel

   • JE virus transmission occurs seasonally in temperate areas (summer and fall)
   • Year-round transmission possible in subtropical/tropical regions

3. Location within Japan

   • Highest risk: Rural or agricultural areas, especially rice fields
   • Lower risk: Urban areas only

4. Activities planned

   • Higher risk: Extensive outdoor activities, especially during evening/night
   • Lower risk: Indoor or daytime urban activities only

5. Accommodation type

   • Higher risk: Accommodations without air conditioning, screens, or bed nets
   • Lower risk: Modern hotels with air conditioning

Japanese Encephalitis Vaccine Recommendations

JE vaccine is recommended for:

• Travelers planning to spend ≥1 month in endemic areas during transmission season
• Those moving to Japan to take up residence in rural areas
• Frequent travelers to endemic areas in Japan

JE vaccine should be considered for:

• Short-term travelers (<1 month) who plan to visit rural areas with substantial outdoor exposure
• Travelers with uncertain itineraries who might visit rural areas
• Those planning extensive outdoor activities in rural areas, especially during evening/night

JE vaccine is NOT recommended for:

• Short-term travelers whose visit will be restricted to urban areas
• Travel outside of JE virus transmission season

Japanese Encephalitis Vaccine Administration

If indicated, the JE vaccine (IXIARO) should be administered as follows 1, 2:

• Ages 2-35 months: 2 doses (0.25 mL each) IM on days 0 and 28
• Ages 3-17 years: 2 doses (0.5 mL each) IM on days 0 and 28
• Ages 18-65 years: 2 doses (0.5 mL each) IM on days 0 and 7-28 (accelerated schedule option)
• Ages >65 years: 2 doses (0.5 mL each) IM on days 0 and 28

The series should be completed at least 1 week before potential exposure to JE virus.

Important Considerations

• Japan has different vaccination practices compared to other industrialized nations, including routine childhood BCG vaccination and immunization against Japanese encephalitis 3, 4
• All travelers should take precautions to avoid mosquito bites regardless of vaccination status
• Mosquito bite prevention includes using insect repellent, permethrin-treated clothing, and staying in accommodations with screens or air conditioning 1
• The risk of JE for most short-term travelers to Japan who stay in urban areas is extremely low

Common Pitfalls to Avoid

1. Overestimating risk: Most short-term tourists visiting only urban areas in Japan do not need JE vaccination
2. Inadequate timing: Failing to complete the vaccination series at least 1 week before travel
3. Ignoring mosquito precautions: Relying solely on vaccination without implementing mosquito bite prevention measures
4. Underestimating rural exposure risk: Some coastal resorts may be located near rice-growing areas with JE risk

For most typical tourists visiting major cities in Japan for short periods, JE vaccination is unnecessary, but a careful risk assessment based on specific itinerary and activities should guide the decision.