Time Zone: +9 hours. No daylight savings time in 2008.
Tel. Country Code: 81
USADirect Tel.: 0
Electrical Standards: Electrical current is 100/60 (volts/hz). North American Style Adaptor Plug. Grounding Adaptor Plug A.
Travel Advisory - Japan
Malaria, Japanese encephalitis, and dengue fever occur throughout SE Asia and the Indian sub-Continent. Insect-bite protection is essential. Hepatitis E, spread by contaminated water, is also a threat. There is no vaccine. Pregnant women are at special risk. Take measures, as needed, to purify your water outside of first-class hotels.
Dr. Rose Recommends for Travel to Japan
• U.S. Embassy
Tel:  (3) 3224-5000
Website: usembassy.state.gov/tokyo, www.csjapan.doc.gov
• Consulates: 2-11-5 Nishitenma, Kita-ku, Osaka, Osaka-Kobe; Tel: 81-6-6315-5900; 2564 Nishihara, Urasoe, Naha, Okinawa; Tel: 81-98-876-4211; Kita 1-Jo Nishi 28-chome, Chuo-ku; Tel: 81-11-641-1115; 2-5-26 Ohori, Chuo-ku, Fukuoka 810-0052; Tel: 81-92-751-9331; Nishiki SIS Building 6th Floor, Naka-ku, Nagoya; Tel: 81-52-203-4011.
• Canadian Embassy
3-38 Akasaka 7-chome
Tel:  (3) 5412-6200
• British Embassy
No 1 Ichiban-cho
Tel:  (3) 5211-1100
HIV Test: Not required.
Required Vaccinations: None required.
Passport/Visa: Japan is a stable, highly developed parliamentary democracy with a modern economy. Tourist facilities are widely available. Find information quickly and easily on consular services for all of Japan, including registration, passport renewal, legal matters and safety and security, using convenient, alphabetized links at http://japan.usembassy.gov/acs.
ENTRY/EXIT REQUIREMENTS: A valid passport and, for tourist/business "visa free" stays up to 90 days, an onward/return ticket are required. Passports must be valid for the intended period of stay in Japan. A visa is not required for tourist/business stays up to 90 days. Americans cannot work on a 90-day "visa free" entry. As a general rule, "visa free" entry status may not be changed to another visa status without departing and then re-entering Japan with the appropriate visa such as a spouse, work or study visa.
As of November 20, 2007, all foreign nationals entering Japan, with the exemption of certain categories listed below, are required to provide fingerprints and a facial photograph at the port of entry. This requirement does not replace any existing visa or passport requirements. Foreign nationals exempt from this new requirement include special permanent residents, persons under 16 years of age, holders of diplomatic or official visas, and persons invited by the head of a national administrative organization. SOFA personnel are exempt from the new biometrics entry requirements under SOFA Article 9 (2).
U.S. citizens entering or transiting Japan should ensure that their passports and visas are up to date before leaving the United States. Airlines have mistakenly boarded U.S. citizens coming to Japan, even though their passports had already expired. The U.S. Embassy or our consulates cannot "vouch for" a U.S. citizen without a valid passport, and passport services are not available at the airport. In some instances, travelers have been returned immediately to the U.S., while in other cases, they have been issued 24-hour "shore passes" and were required to return the next day to Japanese Immigration for lengthy processing.
Airlines in Japan will deny boarding to Americans who seek to transit Japan without the required travel documents for their final destinations in Asia. Many Asian countries require that travelers hold passports valid for a minimum of six months. It is not usually possible to obtain a new U.S. passport and foreign visa during a brief stopover while transiting Japan, as tourist passport processing in Japan can take approximately two weeks.
Airlines in Japan will deny boarding to Americans for onward flights to China if the U.S. passport holder does not have a Chinese visa. Transit visas in China are required for any stop (even if the traveler does not exit the plane or train). Without preplanning the entire trip, the traveler is faced with having to obtain a Chinese visa in Japan, which can be a lengthy and complex process. The Chinese Embassy requires at least one full, blank page to be available in the passport. The U.S. Embassy and Consulates cannot assist in obtaining Chinese visas.
Vaccinations: Recommended and Routine
Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A who wish added protection.
Hepatitis B: Recommended for all non-immune travelers at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from acupuncture, tattooing or body piercing; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and any traveler requesting protection against hepatitis B infection.
Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
Japanese Encephalitis: Recommended for travelers planning to visit rural farming areas for >4 weeks and under special circumstances, such as a known outbreak of Japanese encephalitis.
Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• In addition to tetanus, all travelers, including adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tdap vaccine) should be given to those who have not received a dose within the previous 10 years.
Note: ADACEL is a new tetanus-diphtheria-pertussis (Tdap) vaccine that not only boosts immunity against diphtheria and tetanus, but has the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccine can be administered in place of the Td vaccine when a booster is indicated.
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.
Note: Measles, mumps, rubella (MMR) immunity is especially important for any female of childbearing age who may become pregnant.
Who should receive the MMR vaccine?
• All infants 12 months of age or older
• Susceptible adults who do not have documented evidence of measles immunity, such as a physician-diagnosed case of measles, a blood test showing the presence of measles antibody, or proof of receiving measles vaccine.
• People born before 1957 who are not in one of these high-risk categories are generally considered immune to measles through environmental exposure.
Hospitals / Doctors
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 available only to foreigners with long-term visas for Japan.
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers• diarrhea or other infections. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain equivalent prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage. Policies should cover: ground and air ambulance transport, including evacuation to home country; payment of hospital bills; 24-hour telephone assistance.
A listing of medical facilities and physician in the Tokyo area is maintained by the U.S. Embassy at:
• St. Luke�s International Hospital
Tel.  (3) 3541-5151
A primary facility for tourists and expatriates.
• Tokyo Medical & Surgical Clinic
Mori Building 32
3-4-3 Shiba Koen
Tel:  (3) 3436 3028
The Tokyo Medical and Surgical Clinic was established in 1951 in cooperation with some embassies as a private general and surgical practice for the International Community in Tokyo.
• National Medical Clinic
#202, 5-16-11 Minami-Azabu
Tel:  (3) 3473-2057
• Expat Nisieifuku Dental Clinic
Uniion Trois Building 2F
4-19-10 Eifuku, Suginami-ku
Tel:  (3) 5378-2228
Dr. Naoko Freeman (Tsurumi Univ. School of Dentistry, U.S. Army Tri-Service Dental Society 1999 presenter; ITI Hollow Cylinder Implantology Certificate 1996; FDA approved Emdogain Certificate 2001.)
• EXPAT Irako Clinic
5-3-29 Kyodo, Setagaya-ku
Tel:  (3) 3426-0220
Dr. Taiga Rako; cardiology, endocrinology, diabetes mellitus, allergic diseases; (Dana-Farber Cancer Institute of Harvard University; Jikei University School of Medicine.)
• Hiroo International Clinic
International Medicine & General Practice
BARBIZON34 BLDG 7F
4-14-6 Minamiazabu Minato-ku
Tel:  (3) 5789-8861
Dr. Isao Tsutsumi is a Board-Certified internist who is American-trained. The Hiroo International Clinic is oriented towards treating English-speaking travelers and expatriates.
Destination Health Info for Travelers
AIDS/HIV: The estimated percentage of adults (ages 15-49) living with HIV/AIDS in Japan by the end of 2006 is less than 0.1%. Data released by the Japanese government in 2007 showed that annual numbers of new HIV infections and AIDS cases rose to an all time high in 2007. The most prominent rise occurred among men having sex with men (MSM), who account for at least 60% of annually reported HIV infections in Japan.
• The development of AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with another person's body fluids or blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.
Anisakiasis: Raw fish, often consumed as sushi or sashimi, is a potential source of parasitic disease. One such disease, anisakiasis, is transmitted by raw or undercooked saltwater fish, squid, or octopus. Humans are usually infected by eating herring, salmon, cod, mackerel or Pacific red snapper in which infectious larvae are present. Although the sushi bars in Japan are strictly regulated, consumption of raw fish is not without some risk. Each traveler must decide to what extent they wish to be exposed to this potential risk.
Avian Influenza A (Bird Flu): Numerous outbreaks of H5N1 avian influenza were reported in 2007 from poultry farms. One human case, but no deaths, occurred.
• Avian influenza A (H5N1) is predominantly a disease of birds. The virus does not pass easily from birds to people and does not to pass from person to person (except in very rare cases of close contact with an infected blood relative).
• The risk to humans from avian influenza is believed to be very low and no travel restrictions are advised, except travelers should avoid visiting animal markets, poultry farms and other places where they may come into close contact with live or dead poultry, or domestic, caged or wild birds and their excretions. In addition, travelers are advised to:
1. Cook poultry and egg dishes thoroughly. (Well-cooked poultry is safe to eat.)
2. Wash hands frequently with soap and water if around poultry.
• The World Health Organization (WHO) does not recommend travel restrictions to countries experiencing outbreaks of influenza A (H5N1) in birds, including those countries which have reported associated cases of human infection. To date, no cases of avian influenza A (H5N1) illness have been identified among short-term travelers visiting countries affected by outbreaks among poultry or wild birds.
The usual vaccines against influenza are not protective against “bird flu.” Oseltamivir (Tamiflu) is somewhat effective in the treatment of avian influenza A (H5N1). It seems to be effective in some cases, but may fail in others. Recently, resistant strains have been reported. In addition, the dosage and duration of treatment appear to be different in severe cases.
Cholera: The first case of cholera since 2002 was reported by ProMED in April 2008. Ten patients developed symptoms after eating sashimi and other food at a Japanese-style restaurant in Saitama Prefecture. Although this disease has been reported active in this country, travelers are at very low risk. Cholera vaccine is recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
• The main symptom of more severe cholera is copious watery diarrhea.
• Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.
• A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)
Helminthic Infections (flukes and worms): Paragonimiasis (lung fluke disease; from eating raw crab or crayfish or the juice of raw crabs or crayfish).
• Clonorchiasis (an infection of the bile ducts by the liver fluke). transmitted by raw fish and pickled fish in vinegar (sunomono). Prevented by thoroughly cooking or freezing all freshwater fish prior to consumption.
• Diphyllobothriasis (fish tapeworm disease). avoided by not eating raw salmon.
• Gnathostomiasis (a fish roundworm disease). Prevented by avoiding raw freshwater fish, as well as raw chicken, eels, and frogs.
Hepatitis: There is a generally low risk of hepatitis A in Japan, which affects less than 1% of people under 25 years of age. All travelers, however, not previously immunized against hepatitis A should consider vaccination, as a general precaution. Hepatitis A is transmitted through contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E virus (HEV) is endemic, with a seroprevalence of 1.9% to 14.1% in healthy individuals. Sporadic cases of indigenous hepatitis E are reported (http://jcm.asm.org/cgi/content/abstract/40/9/3209), but the source is not clear. (Farm animals, such as pigs, are a a possible source of the virus.) In lesser-developed countries, transmission of HEV occurs primarily through contaminated drinking water and prevention relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at 3.4%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic with a prevalence of 2.3% in the general population. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.
Influenza: Influenza is transmitted from November through March. Flu vaccine is recommended for travelers over age 6 months.
Japanese Encephalitis (JE): Unvaccinated foreigners are at potential risk of illness in rural rice and pig farming areas where the infective mosquitoes are most active. Mosquito activity is most intense during the warmer, rainier months (April to November in Okinawa and July to September on the other islands). Highest risk of infection occurs in southeastern Japan where 80% of cases occur on Kyushu, Shikoku, and Chubu; there is negligible risk in northern Hokkaido.
• The Centers for Disease Control and Prevention (CDC) recommends JE vaccination for travelers spending more than 30 days in an endemic environment, or less than 30 days in areas with epidemic transmission. However, the use of an arbitrary cutoff cannot protect all travelers. Advance knowledge of trip details, accommodation and purpose as well as local geography, is warranted to give adequate advice. Is travel occurring during the peak transmission season. In general, travelers to rural areas (especially where there is pig rearing and rice farming) should be vaccinated if the duration of their trip exceeds 3 to 4 weeks. They may consider vaccination for trips of shorter duration if more intense exposure is anticipated, especially during unprotected outdoor activities in the evening.
• All travelers should take measures to prevent mosquito bites, especially at twilight and in the evening. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet.
Journal of Travel Medicine May/June 2009. JE vaccination before departure is recommended for:
• All expatriates.
• Repeat travelers (eg, property owners, seasonal workers, visitors of friends and relatives) who return frequently to the region or who, cumulatively, have a prolonged duration of exposure.
• Any individual with a prolonged duration of stay, independent of itinerary.
• Any individual with a travel itinerary including rural areas.
• Travelers wishing maximum protection.
Geographic Distribution of Japanese Encephalitis:
Lyme Disease: Sporadic cases have been reported from Hokkaido, Honshu, Shikoku, and Kyushu Islands. Hikers and forest workers are at most risk. The prevalence of Lyme disease bacteria in ticks is estimated as high as 24% in some areas.
• All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease if taken within 72 hours of being bitten by an infected tick. (Reference: http://content.nejm.org/cgi/content/abstract/345/2/79).
Malaria: There is no risk of malaria in Japan.
Measles: A measles outbreak was reported from Japan in April 2007, particularly affecting the southern Kanto area, including Tokyo, Kanagawa, Saitama, and Chiba Prefectures.
All travelers should be fully immunized.
Other Diseases/Outbreaks: Angiostrongyliasis (occurs mostly in the southwestern islands, including Kyushu Ryukyu. May present as transient meningitis or a more severe disease involving the brain, spinal cord and nerve roots, with a characteristic eosinophilia of the peripheral blood and CSF; human infections are usually acquired by purposeful or accidental ingestion of infective larvae in terrestrial mollusks, planaria (non-parasitic flatworms) and fresh-water crustacea. There is no effective specific treatment)
• Alveolar echinococcosis (reported in Hokkaido)
• Ehrlichiosis (may occur in western Japan)
• Enterohemorrhagic E. coli infection (associated with radish sprouts in school lunches; no recent outbreaks reported)
• Chikungunya fever (a case of imported chikungnya occurred in 2007)
• Clonorchiasis (liver fluke disease, caused by Clonorchis sinensis. Infection is acquired through the consumption of raw or undercooked freshwater fish. Light infections are usually asymptomatic; heavier infections may cause fever, chills, upper abdominal pain, tender hepatomegaly, diarrhea, and mild jaundice. Treatment is with praziquantel or albendazole)
• Fasciolopsiasis (giant intestinal fluke disease; prevent by avoiding or thoroughly cooking all aquatic plants and vegetables)
• Gnathostomiasis (acquired by eating undercooked freshwater fish)
• Japanese spotted fever (transmitted by ticks; southwestern and central Japan)
• Norovirus gastroenteritis (reported from Japan in 2006, resulting in tens of thousands of cases. Norovirus causes nausea, vomiting, diarrhea, and crampy abdominal pain; also a cause of cruise ship diarrhea; travelers should avoid raw shellfish)
• Paragonimiasis(Oriental lung fluke disease; transmitted when humans ingest raw or undercooked, infected crustaceans, such as crayfish and crabs; infection has also occurred following ingestion of raw pork from wild pigs that contained the juvenile stages of Paragonimus species)
• Scrub typhus (rural areas; transmitted by chiggers)
• Vibrio parahaemolyticus (a cause of travelers diarrhea; most cases are related to uncooked or undercooked seafood),
• Air pollution is a major problem in Osaka, Tokyo, and Yokohama.
Schistosomiasis: Officially eradicated in 1996; no new cases reported since the late 1970s.
Scrub Typhus: Mite-borne; risk is present in grassy rural areas countrywide; incidence is highest in Kanagawa, Chiba, Miyazaki, Kagoshima Prefectures and in Akita and Niigata regions; greatest risk occurs during May and November.
Tick-Borne Encephalitis (TBE): There is a possible risk of TBE in southern Hokkaido. The transmission season varies, however, ticks are most active during early spring to late autumn (March to November).
Travelers, especially those engaging in outdoor activities in rural areas, such as campers and hikers, are advised to take measures to prevent tick bites during the peak transmission season. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
Travelers' Diarrhea: Low risk. Nearly all areas of Japan are supplied with potable water. Many water treatment facilities, however, are in need of modernization. Outside of hotels and resorts, we recommend that you filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized dairy products. Do not eat raw or undercooked food. Peel all fruits.
• Good hand hygiene reduces the incidence of travelers• diarrhea by 30%.
• A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.
Tuberculosis (TB): Tuberculosis has been controlled acceptably in Japan, but the situation is now deteriorating because of the spread of HIV infection, which renders its victims susceptible to tuberculosis. Japan is tied with Mexico at 64 cases per 100,000 people. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact with an infected individual. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.