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Japan

Health & safety

Before you go

Further reading

For those spending an extended period of time in Japan the best book is the Japan Health Handbook by Meredith Maruyama, Louise Picon Shimizu and Nancy Smith Tsurumaki. It gives an excellent overview of the Japanese medical system for expats. Lonely Planet’s Healthy Travel Asia & India is a useful pocket-sized guide to travel health. Travel with Children from Lonely Planet is useful if you are taking children with you. Other recommended general travel-health references are Traveller’s Health by Dr Richard Dawood and Travelling Well by Dr Deborah Mills – check out the website www.travellingwell.com.au for other trips.

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Travel insurance

A travel insurance policy to cover theft, loss and medical problems is a good idea. Some policies will specifically exclude ‘dangerous activities’, which can include scuba diving, motorcycling and even trekking; if you plan to engage in such activities, you’ll want a policy that covers them.

You may prefer a policy that pays doctors or hospitals directly rather than have you pay on the spot and claim later. If you have to claim later, make sure you keep all documentation. Some policies ask you to call (reverse-charge) a centre in your home country where an immediate assessment of your problem is made. Check that the policy covers ambulances or an emergency flight home.

Some insurance policies offer lower and higher medical-expense options; choose the high-cost option for Japan. Be sure to bring your insurance card or other certificate of insurance to Japan; Japanese hospitals have been known to refuse treatment to foreign patients with no proof of medical insurance.

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Health insurance

Even if you are fit and healthy, don’t travel without specific travel health insurance – accidents can happen. If your health insurance does not cover you for medical expenses while abroad, get supplemental insurance. Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. Take a higher medical expense option as health costs in Japan are high. If you are seeing a doctor as an outpatient in Japan you will usually be expected to pay up front. If you’re admitted to hospital, your insurance company may be able to pay the hospital directly; however, this is much easier if the company actually has an office in Japan.

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Internet resources

There is a wealth of travel health advice on the internet. For further information, the Lonely Planet website, at www.lonelyplanet.com, is a good place to start. WHO publishes a superb book called International Travel and Health, which is revised annually and is available free online at www.who.int/ith/. Other websites of general interest are MD Travel Health at www.mdtravelhealth.com, which provides complete travel-health recommendations for every country; the Centers for Disease Control and Prevention has a good site at www.cdc.gov; and Fit for Travel at www.fitfortravel.scot.nhs.uk has up-to-date information about outbreaks and is very user-friendly.

It’s also a good idea to consult your government’s travel-health website before departure, if one is available.

Australia (www.dfat.gov.au/travel/)

Canada (www.travelhealth.gc.ca)

New Zealand (www.moh.govt.nz)

UK (www.dh.gov.uk)

USA (www.cdc.gov/travel/)

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Prevention is the key to staying healthy while abroad. A little planning before departure, particularly for pre-existing illnesses, will save trouble later. See your dentist before a long trip, carry a spare pair of contact lenses and glasses, and take your optical prescription with you. Bring medications in their original, clearly labelled containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity. If you have a heart condition bring a copy of a recent electrocardiogram (ECG/EKG). If you take any regular medication carry extra supplies in case of loss or theft – it may be difficult to get exactly the same medications in Japan. In particular it can be difficult to get oral contraceptives.

Although medical care in most of Japan is quite reasonable, it is still wise to carry a basic medical kit suitable for treating minor ailments. Recommended items include simple painkillers, antiseptic and dressings for minor wounds, insect repellent, sunscreen, antihistamine tablets and adequate supplies of your personal medications.

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Recommended vaccinations

No vaccinations are required for Japan. However, you should be aware that Japan scrupulously checks visitors who arrive from countries where there is a risk of yellow fever and other similar diseases.

The World Health Organization (WHO) recommends that all travellers be covered for diphtheria, tetanus, measles, mumps and rubella, regardless of their destination. Since most vaccines don’t produce immunity until at least two weeks after they’re given, visit a physician at least six weeks before departure. Specialised travel medicine clinics are your best source of information as they will be able to give you personalised information for you and your trip. The doctors will take into account factors like your medical history, past vaccination history, the length of your trip, time of year you are travelling, and any activities you may be undertaking, as any of these factors can alter general recommendations. Ensure you receive an International Certificate of Vaccination (the yellow booklet), which lists the vaccines you have received.

Adult diphtheria/tetanus (ADT) A booster is recommended if it is more than 10 years since your last shot. Side effects include a sore arm and a fever.

Measles/Mumps/Rubella (MMR) Two doses of MMR are recommended unless you have had the diseases. Many adults under the age of 35 require a booster. Occasionally a rash and flu-like illness can occur about a week after vaccination.

Varicella (Chickenpox) If you have not had chickenpox you should discuss this vaccine with your doctor. Chickenpox can be a serious disease in adults with complications such as pneumonia and encephalitis. As an adult you require two shots, six weeks apart (usually given after a blood test to prove you have no immunity).

Under certain circumstances, or for those at special risk, the following vaccinations are recommended. These should be discussed with a doctor specialised in travel medicine.

Hepatitis A The risk in Japan is low but travellers spending extensive amounts of time in rural areas may consider vaccination. One injection gives almost 100% protection for six to 12 months; after a booster at least 20 years’ protection is provided. This vaccine is commonly combined with the hepatitis B vaccine in the form of ‘Twinrix’.

Hepatitis B For those staying long term or who may be exposed to body fluids by sexual contact, acupuncture, dental work etc, or for health-care workers. Three shots are required, given over six months (a rapid schedule is also available).

Influenza If you are over 50 years of age or have a chronic medical condition such as diabetes, lung disease or heart disease, you should have a flu shot annually. Side effects include a mild fever and a sore arm.

Japanese B encephalitis There is no risk in Tokyo, but there is risk in rural areas of all islands. The risk is highest in the western part of the country from July to October. Three shots are given over the course of a month, with a booster after two years. Rarely, allergic reactions can occur, so the course is best completed 10 days prior to travel.

Pneumonia (pneumococcal) This vaccine is recommended to travellers over the age of 65 or with chronic lung or heart disease.

Tick-borne encephalitis This is present only in the wooded areas of Hokkaido and is transmitted from April to October. This vaccine is readily available in Europe but can be difficult or impossible to find elsewhere.

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Dangers & annoyances

Earthquakes

Japan is an earthquake-prone country, although most quakes can only be detected by sensitive instruments. If you experience a strong earthquake, head for a doorway or supporting pillar. Small rooms, like a bathroom or cupboard, are often stronger than large rooms but even a table or desk can provide some protection from falling debris. If you’re in an urban area, do not run outside as this could expose you to falling debris.

All Japanese hotels have maps indicating emergency exits, and local wards have emergency evacuation areas (fires frequently follow major earthquakes). In the event of a major earthquake, try to stay calm and follow the locals, who should be heading for a designated safe area.

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Theft

The low incidence of theft and crime in general in Japan is frequently commented on. Of course, theft does exist and its rarity is no reason for carelessness. It’s sensible to take the normal precautions in airports and on the crowded Tokyo rail network, but there’s definitely no need for paranoia.

Lost-and-found services do seem to work; if you leave something behind on a train or other mode of transport, it’s always worth inquiring if it has been turned in. The Japan­ese word for a lost item is wasure-mono, and lost-and-found offices usually go by the same name. In train stations, you can also inquire at the station master’s (eki-chō) office.

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In transit

Deep vein thrombosis (DVT)

Blood clots may form in the legs during plane flights, chiefly because of prolonged immobility. The longer the flight, the greater the risk. The chief symptom of DVT is swelling or pain of the foot, ankle or calf, usually but not always on just one side. If a blood clot travels to the lungs it may cause chest pain and breathing difficulties. Travellers with any of these symptoms should immediately seek medical attention.

To prevent the development of DVT on long flights you should walk about the cabin, contract the leg muscles while sitting, drink plenty of fluids and avoid alcohol. If you have previously had DVT speak with your doctor about preventive medications (usually given in the form of an injection just prior to travel).

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Jet lag & motion sickness

To avoid jet lag (common when crossing more than five time zones) try drinking plenty of nonalcoholic fluids and eating light meals. Upon arrival, get exposure to natural sunlight and readjust your schedule (for meals, sleep and so on) as soon as possible.

Antihistamines such as dimenhydrinate (Dramamine), prochlorperazine (Phenergan) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. The main side effect of these medications is drowsiness. A herbal alternative is ginger.

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While you're there

Air pollution

Air pollution can be a problem in major centres such as Tokyo if you have an underlying lung condition. If you have a pre-existing lung condition speak with your doctor to ensure you have adequate medications to treat an exacerbation.

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Altitude sickness

Altitude sickness could develop in some people when climbing Mt Fuji or some of the higher Japanese alps. Altitude sickness is best avoided by slowly acclimatising to higher altitudes. If this is impossible, the medication Diamox can be a helpful preventative if taken on a doctor’s recommendation. The symptoms of altitude sickness include headache, nausea and exhaustion and the best treatment is descending to a lower altitude. We recommend that you familiarise yourself with the condition and how to prevent it before setting out on any climb over 2000m. Rick Curtis’s Outdoor Action Guide to High Altitude: Acclimatization and Illness (www.princeton.edu/~oa/safety/altitude.html) provides a comprehensive overview.

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Hypothermia

Hypothermia is possible if walking or climbing in the alps. It is surprisingly easy to progress from very cold to dangerously cold due to a combination of wind, wet clothing, fatigue and hunger, even if the air temperature is above freezing. It is best to dress in layers; silk, wool and some of the new artificial fibres are all good insulating materials. A hat is important, as a lot of heat is lost through the head. A strong, waterproof outer layer (and a space blanket for emergencies) is essential. Carry basic supplies, including food containing simple sugars to generate heat quickly and fluid to drink. Symptoms of hypothermia are exhaustion, numb skin (particularly the toes and fingers), shivering, slurred speech, irrational or violent behaviour, lethargy, stumbling, dizzy spells, muscle cramps and violent bursts of energy. Irrationality may take the form of sufferers claiming they are warm and trying to take off their clothes. To treat mild hypothermia, first get the person out of the wind and/or rain, remove their clothing if it’s wet and replace it with dry, warm clothing. Give them hot liquids – not alcohol – and some high-calorie, easily digestible food. The early recognition and treatment of mild hypothermia is the only way to prevent severe hypothermia, which is a critical condition.

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Insect bites & stings

Insect bites and stings are not a common problem in Japan. You should, however, follow general insect avoidance measures if you are hiking in the woods or are in rural areas during the summer months. These include using an insect repellant containing 20% to 30% DEET (diethyl-M-toluamide), covering up with light-coloured clothing and checking yourself for ticks after being in the forest. When removing ticks ensure you also remove their heads. Some people have an allergic reaction to ticks so it is a good idea to carry an antihistamine with you.

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Water

The water is generally safe to drink in Japan.

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AIDS & STDs

AIDS and STDs can be avoided completely only by abstaining from sexual contact with new partners. Condom use in Japanese society is low. HIV is still relatively uncommon in Japan, but the incidence is slowly increasing. In the year 2000, 78% of new cases were contracted via sexual contact. Condoms can help prevent some sexually transmitted infections, but not all. If you have had sexual contact with a new partner while travelling, or have any symptoms such as a rash, pain or discharge, see a doctor for a full STD check-up.

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Hepatitis B

Hepatitis B is a virus spread via body fluids, eg through sexual contact, unclean medical facilities or shared needles. People who carry the virus are often unaware they are carriers. In the short term hepatitis B can cause the typical symptoms of hepatitis – jaundice, tiredness and nausea – but in the long term it can lead to cancer of the liver and cirrhosis. Vaccination against hepatitis B is now part of most countries’ routine childhood vaccination schedule and should be considered by anyone travelling for a long period of time or who may have contact with body fluids.

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Hepatitis E

Hepatitis E is avirus spreadvia contaminated food and water. There have been a number of cases reported from Japan, linked to eating boar and deer meat, and most recently undercooked pork liver.The disease causes jaundice (yellow skin and eyes), tiredness and nausea. There is no specific treatment and those infected usually recover after four to six weeks. However, it can be a disaster in pregnant women, with a death rate of both mother and baby of up to 30% in the third trimester. Pregnant women should be particularly careful to avoid eating any undercooked foods. There is no vaccine yet available to prevent hepatitis E.

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Influenza

Influenza is generally transmitted between November and April. Symptoms include high fever, muscle aches, runny nose, cough and sore throat. It can be a very severe illness in those aged over 65 or with underlying medical conditions such as heart disease or diabetes. Vaccination is recommended for these high-risk travellers or for anyone who wishes to reduce their risk of catching the illness. There is no specific treatment for ‘the flu’, just rest and paracetamol.

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Japanese B Encephalitis

Japanese B encephalitis is a viral disease transmitted by mosquitoes. It is a rare disease in travellers and the vaccine is part of the routine childhood vaccination schedule in Japan. Risk exists in rural areas of all islands, but is highest in the western part of the country. In western Japan the risk season is from July to October. On Ryuku Island (Okinawa) the risk season runs from April to December. Vaccination is recommended for travellers spending more than a month in rural areas during the transmission season. Other precautions include general insect avoidance measures such as using repellents and sleeping under nets if not in screened rooms. Although this is a rare disease, it is very serious - there is no specific treatment and a third of people infected will die and a third will suffer permanent brain damage.

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Lyme disease

Lyme disease is spread via ticks and is present in the summer months in wooded areas. Symptoms include an early rash and general viral symptoms, followed weeks to months later by joint, heart or neurological problems. The disease is treated with the antibiotic doxycycline. Prevent Lyme disease by using general insect avoidance measures and checking yourself for ticks after walking in forested areas.

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Tick-borne encephalitis

Tick-borne encephalitis occurs on the northern island of Hokkaidō only, and, as its name suggests, is a virus transmitted by ticks. The illness starts with general flu-like symptoms, which last a few days and then subside. After a period of remission (about one week) the second phase of the illness occurs with symptoms such as headache, fever and stiff neck (meningitis), or drowsiness, confusion and other neurological signs such as paralysis (encephalitis). There is no specific treatment, and about 10% to 20% of those who progress to the second phase of illness will have permanent neurological problems. You can prevent this disease by using insect avoidance measures and checking yourself for ticks after walking in forested areas. A vaccine is available in Europe but is very difficult if not impossible to find elsewhere. Two doses are given four to 12 weeks apart with a third shot after nine to 12 months. Boosters are required every three years to maintain immunity.

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Children

Japan is a great place to travel with kids: it’s safe and clean and there’s never a shortage of places to keep them amused. Look out for Japan for Kids by Diane Wiltshire Kanagawa and Jeanne Huey Erickson, an excellent introduction to Japan’s highlights from a child’s perspective. In addition, Lonely Planet publishes Travel with Children, which gives the lowdown on getting out and about with your children.

Parents will find that Japan is similar to Western countries in terms of facilities and allowances made for children, with a few notable exceptions. Cots are available in most hotels and these can be booked in advance. High chairs are available in many restaurants (although this isn’t an issue in the many restaurants where everyone sits on the floor). There are nappy-changing facilities in some public places, like department stores and some larger train stations; formula and nappies are widely available, even in convenience stores. Breast feeding in public is generally not done. The one major problem concerns child seats for cars and taxis: these are generally not available. Finally, child-care agencies are available in most larger cities. The only problem is the language barrier: outside Tokyo, there are few, if any, agencies with English-speaking staff.

Tokyo has the most child-friendly attractions in Japan, including Tokyo Disneyland; for more information, see Tokyo for Children. In Kansai, popular attractions for the young ’uns include Osaka’s Universal Studios Japan, Osaka Aquarium and Nara-kōen in Nara, with its resident deer population.

Children who enjoy the beach and activities like snorkelling will adore the islands of Okinawa and the Izu-shotō.

Tokyo has some remarkable toy shops. Elsewhere, look out for some of the traditional wooden toys produced as regional specialities – they make good souvenirs for adults and children alike.

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Availability & cost of health care

Medical care in Japan is significantly better in the major cities compared to rural areas. Outside urban areas it may be difficult to access English-speaking doctors, so try to take a Japanese speaker with you to any medical facility. Japan has a national health insurance system, but this is only available to foreigners if they have long-term visas in Japan. Be aware that medical facilities will require full payment at the time of treatment or proof that your travel insurance will pay for any treatment that you receive. Insurance companies in the West are comfortable with the facilities in Japan’s major urban centres, but have found variable standards of care in the country areas.

Tourist offices operated by Japan National Tourist Organization (JNTO) have lists of English-speaking doctors and dentists, and hospitals where English is spoken. You can contact your insurance company or embassy to locate the nearest English-speaking facility.

Dental services are widespread and of good standard; however, they are very expensive so make sure you have a check-up before you leave home.

Drugs that require a prescription in the West also generally require one in Japan. Ensure you bring adequate supplies of your own medications from home.

There are certain medications that are illegal to bring into Japan, including some commonly used cough and cold medications such as pseudoephedrine (found in Actifed, Sudafed etc) and codeine. Some prescription medications not allowed into Japan include narcotics, psychotropic drugs, stimulants and codeine. If you need to take more than a one-month supply of any other prescription drug, you should check with your local Japanese embassy as you may need permission. Ensure you have a letter from your doctor outlining your medical condition and the need for any prescription medication.

Pregnant women should receive specialised advice before travelling. Some vaccines are definitely not recommended, others are only prescribed after an individual risk/benefit analysis. The ideal time to travel is during the second trimester (between 15 and 28 weeks), when the risk of pregnancy-related problems are at their lowest and pregnant women generally feel at their best. During the first trimester there is a risk of miscarriage and in the third trimester problems such as premature labour and high blood pressure are possible. Always travel with a companion, have a list of quality medical facilities available at your destination and ensure you continue your standard ante­natal care while you travel. Avoid travel to rural areas with poor transport and medical facilities. Most importantly, ensure your travel insurance covers you for pregnancy-related problems, including premature labour. There have recently been reports of hepatitis E in Japan, contracted from undercooked pork liver, boar and deer meat.

Supplies of sanitary products are readily available in Japan. It can be very difficult to get the oral contraceptive pill so ensure you bring adequate supplies of your own pill from home.

Japan is a safe country to travel with children. Ensure they are up to date with their basic vaccinations prior to travel.

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Traditional medicine

The two most well-known forms of traditional Japanese medicine are shiatsu and reiki.

Shiatsu is a type of massage that emerged in Japan out of traditional Chinese medicine. It is a form of manual therapy incorporating gentle manipulations and stretches derived from physiotherapy and chiropractic, combined with pressure techniques exerted through the fingers or thumbs. The philosophy underlying shiatsu is similar to many traditional Asian medical systems and involves the body’s ki (vital energy) flowing through the body in a series of channels known as meridians. If the ki is blocked from flowing freely, illness can occur. The technique is used to improve the flow of ki. Shiatsu was officially recognised by the Japanese government as a therapy in its own right in the mid-1900s.

Reiki claims to heal by charging this same life force with positive energy, thus allowing the ki to flow in a natural, healthy manner. In a standard treatment, reiki energy flows from the practitioner’s hands into the client. The practitioner places their hands on or near the clients’ body in a series of positions that are held for three to 10 minutes. People become practitioners after receiving an ‘attunement’ from a reiki master.

If you do decide to have any traditional medical treatments make sure you tell your practitioner if you are taking any Western medicines.

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Traveller’s diarrhoea

There is a low risk of traveller’s diarrhoea in Japan, only 10% to 20% of travellers will experience some stomach upset. If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution (eg Dioralyte). A few loose stools don’t require treatment, but if you start having more than four or five stools a day you should start taking an antibiotic (such as norfloxacin, ciprofloxacin or azithromycin) and an anti­diarrhoeal agent (such as loperamide). If diarrhoea is bloody, persists for more than 72 hours, is accompanied by fever, shaking, chills or severe abdominal pain, or doesn’t respond quickly to your antibiotic, you should seek medical attention.

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Women travellers

Japan is a relatively safe country for women travellers, though perhaps not quite as safe as some might think. Women travellers are occasionally subjected to some form of verbal harassment or prying questions. Physical attacks are very rare, but have occurred. Long-term foreign women residents of Japan have been victims of stalking, harassment and worse, and have often found the local police to be unwilling to help them prosecute offenders.

The best advice is to avoid being lulled into a false sense of security by Japan’s image as one of the world’s safest countries and to take the some precautions you would in your home country. If a neighbourhood or establishment looks unsafe, then treat it that way. Never give your address or the name of your accommodation out to an unfamiliar man and never invite an unfamiliar man to your place or go to his. As long as you use your common sense, you will most likely find that Japan is a pleasant and rewarding place to travel.

Several train companies in Japan have recently introduced women-only cars to protect female passengers from chikan (men who feel up women and girls on packed trains). These cars are usually available during rush-hour periods on weekdays on busy urban lines. There are signs (usually pink in colour) on the platform indicating where to board these cars, and the cars themselves are usually labelled in both Japanese and English (again, these are often marked in pink).

If you have a problem and find the local police unhelpful, you can call the Japan Helpline (0570-000-911), an emergency number that operates 24 hours a day, seven days a week.

Finally, an excellent resource available for any woman setting up in Japan is Caroline Pover’s book Being A Broad in Japan, which can be found in bookstores and can also be ordered from her website at www.being-a-broad.com.

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