Diseases to Watch Out For at Your Destination
This page provides brief notes on diseases to be aware of at your travel destination, along with explanations of transmission routes, symptoms, treatment methods, etc.
The recommended recipients and schedules for each vaccine follow the Ministry of Health, Labour and Welfare Quarantine Station (FORTH) and various guidelines.
We can administer or prescribe all of the medications we carry on the same day.
Travel Medicine is entirely self-pay (outside insurance coverage).
For details on malaria prevention medication and vaccination schedules, please see below.
You can look up the types of vaccines and schedules for each destination below.
Please select the disease you would like to view.
Hepatitis A
– Endemic in many developing countries (especially South Asia and Africa)
– Difficult to prevent because it is transmitted through food
– Vaccination provides reliable, long-term protection
Infection occurs through direct person-to-person contact (fecal-oral transmission), or through consumption of contaminated food or water.
It can also be transmitted through sexual intercourse.
After infection with the virus and an incubation period of 2-7 weeks, sudden fever, general fatigue, loss of appetite, nausea and vomiting appear, and several days later jaundice (yellowing of the skin and the whites of the eyes) develops.
Adults are more likely than children to show symptoms, and severity and mortality are higher in the elderly.
There is no specific treatment; care is given to relieve symptoms.
Those staying in endemic areas, and travelers to countries or regions with poor sanitation
For hepatitis A, we carry Aimmugen (domestic), Havisure (imported) and Twinrix (imported).
Accelerated Vaccination is available for Twinrix. Please consult with a doctor for more details.
Antibodies persist for approximately 10 to 20 years.
Cost: 16,500 yen per dose (tax included)
Number of doses: 3 doses
Vaccination schedule: First dose, 2 to 4 weeks later, 6 to 12 months later
Cost: 13,000 yen per dose (tax included)
Number of doses: 2 doses
Vaccination schedule: First dose, 6 to 12 months later
This is a combination vaccine for hepatitis A and hepatitis B.
Cost: 13,000 yen per dose (tax included)
Number of doses: 3 doses (4 doses in the case of Accelerated Vaccination)
Vaccination schedule (standard): First dose, 4 weeks later, 6 months later
Vaccination schedule (accelerated): First dose, 1 week later, 4 weeks later, 1 year later
For more about hepatitis A and the hepatitis A vaccine, please also see the blog below.
Hepatitis B
– Persistent infection causes chronic infection, cirrhosis, liver cancer, etc.
– Transmitted through contact with the body fluids of an infected person, etc.
– Approximately 90 percent acquire antibodies with 3 doses
Infection occurs through sexual activity with an infected person, or through the use of medical instruments contaminated with the virus.
Newborns born to an infected person may already be infected at the time of birth.
After an asymptomatic period of 90-150 days following infection, fatigue, loss of appetite, nausea, vomiting, abdominal pain and jaundice (yellowing of the skin and the whites of the eyes) occur.
Skin rash and joint pain may occur. The mortality rate in adults is approximately 1%.
In some people the infection becomes chronic, and it may progress to cirrhosis or become cancerous.
For acute hepatitis B, treatment is given to relieve symptoms.
If it becomes chronic, treatment with antiviral agents is given.
Long-term visitors to endemic areas, and those at risk of contact with blood or body fluids
For hepatitis B, we carry Bimmugen (domestic) and Twinrix (imported).
Accelerated Vaccination is available for Twinrix. Please consult with a doctor for more details.
Antibodies persist for approximately 10 to 20 years.
Cost: 7,000 yen per dose (tax included)
Number of doses: 3 doses
Vaccination schedule: First dose, 2 to 4 weeks later, 6 to 12 months later
This is a combination vaccine for hepatitis A and hepatitis B.
Cost: 13,000 yen per dose (tax included)
Number of doses: 3 doses (4 doses in the case of Accelerated Vaccination)
Vaccination schedule (standard): First dose, 4 weeks later, 6 months later
Vaccination schedule (accelerated): First dose, 1 week later, 4 weeks later, 1 year later
For more about hepatitis B and the hepatitis B vaccine, please also see the blog below.
Measles
– Common in Asia and Africa, but there is a high likelihood of contracting it during overseas travel
– Highly contagious and likely to become severe in adults
– Infection during pregnancy carries a risk of premature birth and miscarriage
The infection spreads through direct contact with a person infected with the virus, and through droplets containing the measles virus being dispersed into the air by an infected person’s coughing or sneezing.
After an asymptomatic period of 10 to 12 days following infection, high fever, cough and runny nose persist for several days, and small white spots form inside the mouth.
The fever subsides once, but rises again after about half a day, after which a red rash forms over the whole body.
There is no specific treatment; care is given to relieve symptoms.
Those aged 1 year or older with no history of infection who have not completed 2 doses, and those with insufficient antibody titers
For measles, we carry Priorix (imported).
As a rule, no booster dose is necessary after 2 doses of Priorix (the same applies to other MMR vaccines).
This is a combination vaccine for measles, rubella and mumps (MMR vaccine).
Cost: 10,000 yen per dose (tax included)
Number of doses: 2 doses
Vaccination schedule: First dose, 4 weeks later
For more about measles, rubella, mumps and Priorix, please also see the blog below.
Rubella
– Commonly present in many regions of the world
– Infection during pregnancy carries a risk of miscarriage and congenital abnormalities
It is transmitted by touching a person infected with the virus directly, or by directly inhaling virus dispersed by an infected person’s coughing or sneezing.
Symptoms include fever and a rash accompanied by swollen lymph nodes, but approximately 25 percent to 50 percent of infected people have no symptoms.
If rubella is contracted in early pregnancy, there is a risk of stillbirth, and babies may be born with congenital rubella syndrome (cataracts, heart abnormalities, hearing impairment, etc.).
There is no specific treatment; care is given to relieve symptoms.
Those aged 1 year or older with no history of infection who have not completed 2 doses, and those with insufficient antibody titers
For rubella, we carry Priorix (imported).
As a rule, no booster dose is necessary after 2 doses of Priorix (the same applies to other MMR vaccines).
This is a combination vaccine for measles, rubella and mumps (MMR vaccine).
Cost: 10,000 yen per dose (tax included)
Number of doses: 2 doses
Vaccination schedule: First dose, 4 weeks later
For more about measles, rubella, mumps and Priorix, please also see the blog below.
Mumps
– There is no specific drug, so care is symptomatic
– Adults are likely to develop severe illness
It is transmitted through droplets from coughing and sneezing. It is also transmitted by touching mucous membranes with hands that have touched doors or handrails carrying the mumps virus.
This is an infection characterized by swelling of the parotid glands. After an incubation period of 2 to 3 weeks, fever, headache and swelling and pain in both parotid glands appear.
Adults are more likely than children to develop severe illness, with a risk of complications such as encephalitis, oophoritis, orchitis and hearing loss.
There is no specific treatment; care is given to relieve symptoms.
Those aged 1 year or older with no history of infection who have not completed 2 doses, and those with insufficient antibody titers
For mumps, we carry Priorix (imported).
As a rule, no booster dose is necessary after 2 doses of Priorix (the same applies to other MMR vaccines).
This is a combination vaccine for measles, rubella and mumps (MMR vaccine).
Cost: 10,000 yen per dose (tax included)
Number of doses: 2 doses
Vaccination schedule: First dose, 4 weeks later
For more about measles, rubella, mumps and Priorix, please also see the blog below.
Tetanus
– A severe infection that requires intensive care once it develops
– Tetanus bacteria are present in soil throughout the world
– Approximately 500,000 people die of tetanus every year
When you are injured, tetanus bacteria enter the body through the wound. Soil contaminated with animal feces is particularly dangerous.
After an asymptomatic period of 3 days to 3 weeks following infection, symptoms such as difficulty opening the mouth, tightness in the neck and body aches appear.
After that, numbness and pain spread throughout the body, and death follows the appearance of a posture in which the whole body arches backward and of difficulty breathing.
Patients who develop the disease are given serum and antibacterial agents for treatment, but the fatality rate is high at 10 to 20 percent, making it an extremely dangerous disease.
Those staying in developing countries, and travelers who often take part in outdoor activities (such as mountain climbing) and are prone to injury
For tetanus, we carry tetanus toxoid (domestic), Boostrix (imported) and Tetrabik (domestic).
Antibodies are thought to persist for approximately 10 years or longer.
Cost: 4,000 yen per dose (tax included)
Number of doses: 1 dose or 3 doses*
Vaccination schedule: First dose only, or first dose, 3 to 8 weeks and 4 to 6 months later
This is a combination vaccine for tetanus, diphtheria and pertussis.
Cost: 9,000 yen per dose (tax included)
Number of doses: 1 dose or 3 doses*
Vaccination schedule: First dose only, or first dose, 3 to 8 weeks and 4 to 6 months later
This is a combination vaccine for tetanus, diphtheria, pertussis and polio.
Cost: 12,000 yen per dose (tax included)
Number of doses: 1 dose or 3 doses*
Vaccination schedule: First dose only, or first dose, 3 to 8 weeks and 4 to 6 months later
*If the primary series was completed in childhood, 1 dose is given; if it was not completed, 3 doses are given.
Diphtheria
– Outbreaks since 2010 in Nigeria, India, Indonesia, Haiti, Venezuela, Yemen, Bangladesh, etc.
It is transmitted when saliva contained in coughs or sneezes enters the mouth. It is also transmitted through close physical contact.
Rarely, it is transmitted by touching objects to which saliva or the like has adhered.
After an asymptomatic period of 1 to 10 days, fever, sore throat and fatigue occur.
A membrane-like coating forms on the mucous membranes of the throat and nose, and forcibly peeling it off causes bleeding. In severe cases, this membrane can block the throat and cause suffocation.
Treatment is carried out by administering antibiotics.
Those who have not completed the primary series in childhood; those traveling to endemic areas (Africa, Central and South America, Asia, the Middle East and Eastern Europe)
For diphtheria, we carry Boostrix (imported) and Tetrabik (domestic).
Antibodies are thought to persist for approximately 10 years or longer.
This is a combination vaccine for tetanus, diphtheria and pertussis.
Cost: 9,000 yen per dose (tax included)
Number of doses: 1 dose or 3 doses*
Vaccination schedule: First dose only, or first dose, 3 to 8 weeks and 4 to 6 months later
This is a combination vaccine for tetanus, diphtheria, pertussis and polio.
Cost: 12,000 yen per dose (tax included)
Number of doses: 1 dose or 3 doses*
Vaccination schedule: First dose only, or first dose, 3 to 8 weeks and 4 to 6 months later
*If the primary series was completed in childhood, 1 dose is given; if it was not completed, 3 doses are given.
Pertussis
– Cases are seen in Japan as well among people who have not been vaccinated and people whose immunity has waned over the years since vaccination, and many outbreaks still occur in countries around the world
– Adults often have mild illness, but children are likely to develop severe illness
It is transmitted through droplets from coughing and sneezing and through contact.
It presents as an acute respiratory tract infection characterized by distinctive spasmodic coughing fits (paroxysmal coughing attacks).
Treatment is carried out by administering antibiotics.
Those who have not completed the primary series in childhood; those traveling to endemic areas
For pertussis, we carry Boostrix (imported) and Tetrabik (domestic).
Antibodies are thought to persist for approximately 10 years or longer.
This is a combination vaccine for tetanus, diphtheria and pertussis.
Cost: 9,000 yen per dose (tax included)
Number of doses: 1 dose or 3 doses*
Vaccination schedule: First dose only, or first dose, 3 to 8 weeks and 4 to 6 months later
This is a combination vaccine for tetanus, diphtheria, pertussis and polio.
Cost: 12,000 yen per dose (tax included)
Number of doses: 1 dose or 3 doses*
Vaccination schedule: First dose only, or first dose, 3 to 8 weeks and 4 to 6 months later
*If the primary series was completed in childhood, 1 dose is given; if it was not completed, 3 doses are given.
Polio
– Those staying 4 weeks or longer in countries with ongoing outbreaks (Afghanistan and Pakistan) may be asked for a vaccination certificate when entering or leaving the country, so it is necessary to check the latest outbreak situation and entry/exit requirements
– There was an outbreak in the Philippines in 2019
– Those born between Showa 50 and Showa 52 tend to have low acquired immunity
Infection occurs when poliovirus enters a person’s mouth and multiplies in the intestines.
The poliovirus that has multiplied is excreted again in the stool, and spreads to other people through this stool.
Even when infected, 90% to 95% of people show no symptoms and develop immunity without knowing it.
However, 3 days to 35 days after infection, cold-like symptoms such as fever, headache, sore throat, nausea and vomiting may appear.
Furthermore, the virus that has entered the intestinal tract may enter part of the spinal cord, causing flaccid paralysis (limp paralysis) mainly in the arms and legs, and this paralysis may remain for life, or death may occur from difficulty breathing.
There is no definitive treatment such as a specific drug.
Those who have not completed the primary series in childhood; those staying in countries where polio occurs
For pertussis, we carry Tetrabik (domestic).
Antibodies are thought to persist for approximately 10 years or longer.
This is a combination vaccine for tetanus, diphtheria, pertussis and polio.
Cost: 12,000 yen per dose (tax included)
Number of doses: 1 dose or 3 doses*
Vaccination schedule: First dose only, or first dose, 3 to 8 weeks and 4 to 6 months later
Cost: 9,000 yen per dose (tax included)
Number of doses: 1 dose or 3 doses*
Vaccination schedule: First dose only, or first dose, 3 to 8 weeks and 6 to 12 months later
*If the primary series was completed in childhood, 1 dose is given; if it was not completed, 3 doses are given.
Japanese encephalitis
– Approximately 20 percent of those who develop the disease die, and approximately 40 percent of survivors are left with lasting complications
– Transmitted by the bite of mosquitoes that have fed on the blood of pigs or wild birds
– In Japan, vaccination has been recommended since 1954
The virus is transmitted from pig to pig by mosquitoes (a pig → mosquito → pig cycle).
The mosquito that carries the virus is mainly Culex tritaeniorhynchus (the small house mosquito), which lives in Japan and many other Asian countries.
It is said that the disease develops in 1 out of every 100 to 1,000 infected people.
After a usual incubation period of 6 to 16 days, high fever, headache, nausea and vomiting are seen.
Following that, impaired consciousness, convulsions, abnormal behavior and muscle rigidity appear.
It is said that 50 percent of severe cases die, and that 30-50 percent of survivors are left with lasting complications such as mental impairment or motor impairment.
There is no specific treatment; care is given to relieve symptoms.
Those staying in suburban and rural areas of Southeast Asia
For Japanese encephalitis, we carry ENCEVAC (domestic).
Antibodies are thought to persist for approximately 3 to 4 years or longer.
Cost: 7,500 yen per dose (tax included)
Number of doses: 1 dose or 3 doses*
Vaccination schedule: First dose, 1 to 4 weeks and 6 months to 1 year later
*If the primary series was completed in childhood, 1 dose is given; if it was not completed, 3 doses are given.
Rabies
– Many countries carry a risk of infection
– The fatality rate after onset is nearly 100 percent
– With vaccination beforehand, immunoglobulin therapy after being bitten by an animal is unnecessary
The virus is contained in the saliva of infected animals. It infects cells of the nervous system when you are bitten by a mammal, or when a wound or the mucous membranes of the eyes or mouth are licked.
Because animals lick their front paws, infection is also possible from being scratched by claws carrying the virus.
When the virus directly attacks the central nervous system, fever, headache, general fatigue, vomiting and the like occur from around the 10th day.
On the other hand, when peripheral nerve fibers are infected, the virus travels toward the brain very slowly, so it generally takes about 1 to 3 months for the disease to develop.
Very rarely, it can take several years for the disease to develop.
After onset, swallowing becomes difficult, and because the muscles spasm when trying to drink liquids, the person comes to fear water, eventually falls into a coma and dies as breathing becomes paralyzed.
If you are bitten by a mammal, please seek medical care at a hospital as soon as possible.
At the same time, if you are bitten by an animal that may have rabies, wash the wound thoroughly with soap and water (running water if possible) and disinfect it with an antiseptic solution.
Because infection can occur through the mucous membranes, never try to suck anything out of the wound with your mouth.
Those staying in endemic areas (most countries), and travelers to countries or regions with poor sanitation
For rabies, we carry ChiroRab (imported).
With the rabies vaccine, a booster dose is generally considered unnecessary once the entire schedule has been completed.
Cost: 13,000 yen per dose (tax included)
Number of doses: 3 doses
Vaccination schedule: First dose, 1 week later, 3 to 4 weeks later
Typhoid
– Difficult to prevent because it is transmitted through food
– Most common in South Asia, so caution is needed
– 60-70 percent of typhoid can be prevented, but paratyphoid cannot be prevented
Consumption of uncooked raw vegetables, water and ice, and seafood
There are no symptoms for 1 to 3 weeks after infection, after which symptoms appear such as high fever, headache, general fatigue, a pale pink rash on the chest, back and abdomen that appears for several hours when the fever is high, and constipation.
A characteristic feature is a slow pulse relative to the high fever. As serious symptoms, bleeding from the intestines or a perforation of the intestines can occur.
Antibiotics are taken over a long period.
Long-term stays in endemic areas (Asia, the Middle East, Eastern Europe and Africa), and travelers to countries or regions with poor sanitation
For typhoid, we carry Typer TCV (imported).
Antibodies are thought to persist for approximately 2 to 3 years.
Cost: 10,000 yen per dose (tax included)
Number of doses: 1 dose
Vaccination schedule: First dose only
Meningococcal disease
– Frequent in central Africa, with the area known as the meningitis belt being especially dangerous
– Outbreaks are seen in the dry season (December to June)
– Outbreaks often occur among students living in dormitories
Droplets produced by an infected person’s coughing or sneezing enter the airways, reach the meninges from the bloodstream and cause inflammation.
After an incubation period of 1 to 14 days, headache, fever and stiffness that makes it difficult to move the neck occur.
Because the bacterial infection extends not only to the meninges but throughout the body, symptoms can worsen rapidly and mental status can change.
Without treatment, it leads to death without exception.
If meningitis is suspected, antibiotics and antiviral agents are administered as soon as possible.
Those traveling to the meningitis belt region (central Africa), those going on the Hajj (the Islamic pilgrimage) and those living in dormitories
For meningococcal disease, we carry Nimenrix (imported, ACWY type) and Bexsero (imported, type B).
Antibodies are thought to persist for approximately 2 to 3 years.
Cost: 17,000 yen per dose (tax included)
Number of doses: 1 dose
Vaccination schedule: First dose only
Cost: 25,000 yen per dose (tax included)
Number of doses: 2 doses
Vaccination schedule: First dose, 4 weeks later
Tick-borne encephalitis
– Endemic mainly in Central Europe, Russia, the Baltic states, etc.
– The risk of infection is high in areas where ticks live, such as forests and mountainous areas
– Neurological symptoms and lasting complications may remain after infection, and severe cases can be fatal
– In Hokkaido within Japan as well, 7 patients have been reported as of July 2024
Infection occurs through being bitten by ticks that carry the virus.
Infection can also occur through oral consumption of unpasteurized milk or dairy products produced from animals infected with this virus.
After an asymptomatic period of 4 to 28 days, headache, muscle pain, fatigue and fever occur.
If it worsens, damage to the brain develops and breathing can become impossible.
In severe forms, death can occur. Also, even after recovery, neurological complications (memory impairment, motor impairment, etc.) can remain.
Treatment is given to relieve symptoms. Because there is no curative treatment, prevention is extremely effective.
Travelers to endemic areas
For tick-borne encephalitis, we carry FSME-IMMUN (imported).
Antibodies initially persist for 3 years, and after a booster dose, vaccination is required every 5 years.
Cost: 12,000 yen per dose (tax included)
Number of doses: 3 doses
Vaccination schedule (standard): First dose, 1-3 months later, 5-12 months after the 2nd dose
Vaccination schedule (accelerated): First dose, 2 weeks later, 5-12 months after the 2nd dose
Influenza
– Vaccination is recommended for travel during the epidemic season (November-February)
– Vaccination can prevent severe illness
It is transmitted by directly inhaling droplets dispersed by an infected person’s coughing or sneezing, or by eating food or rubbing your eyes with hands that have touched objects contaminated with an infected person’s droplets.
After an incubation period of 1 to 4 days, fever, muscle pain, headache, fatigue, cough, sneezing, rhinitis, etc. occur.
Treatment is given to relieve symptoms. For people at risk of severe illness, early treatment with antiviral agents is given.
Travel during the epidemic season
For influenza, we carry the influenza HA vaccine (domestic).
The vaccine must be given every year.
Vaccine (domestic)
Cost: 4,000 yen per dose (tax included)
Number of doses: 1 dose
Vaccination schedule: First dose only
Shingles
– Highly contagious, and likely to become severe in the elderly and those who are immunocompromised
– The pain is severe, and it is not uncommon for daily life to become difficult
– Even with a history of infection, shingles can be prevented by vaccination in people aged 50 years or older
Transmission is mainly by contact with the blister fluid of a person with shingles, but droplet transmission from saliva can also occur.
It is characterized by a rash accompanied by pain and itching. Symptoms of shingles improve after treatment, but a complication called postherpetic neuralgia (PHN) may develop, with pain that continues over a long period.
Treatment is carried out with antiviral drugs (drugs that suppress the multiplication of the virus) and, in some cases, analgesics (painkillers).
Recommended for those aged 50 years or older who have not received 2 doses (vaccination is also possible for those aged 49 years or younger)
Those in an immunocompromised state
For shingles, we carry Shingrix (domestic).
The effect in preventing onset is said to last for 9 years or longer.
Cost: 22,000 yen per dose (tax included)
Number of doses: 2 doses
Vaccination schedule: First dose, 8 weeks later
For more about shingles and Shingrix, please also see the blog below.
COVID
– A vaccination certificate is very rarely required for overseas travel, but vaccination can prevent severe illness
– Vaccination is recommended in the case of travel to endemic areas
It is transmitted by inhaling airborne aerosols containing the virus, by directly inhaling droplets dispersed by an infected person’s coughing or sneezing, or by eating food or rubbing your eyes with hands that have touched objects contaminated with an infected person’s droplets.
The incubation period is 1 day at the shortest and 14 days at the longest, but symptoms often appear from 3 days to 5 days after infection.
The main symptoms are fever, respiratory symptoms (cough, sore throat), headache, fatigue, etc. Diarrhea, vomiting and impairment of smell and taste can also occur.
Treatment is given to relieve symptoms. COVID treatment drugs approved by the Ministry of Health, Labour and Welfare include “anti-inflammatory drugs”, “antiviral drugs” and “neutralizing antibody drugs”.
Those at risk of severe illness from infection; those traveling to endemic areas
For COVID, we carry Comirnaty (domestically approved drug).
The type of COVID vaccine (the strains contained in the vaccine) is to be reviewed every year for the time being. For this reason, when routine vaccination is carried out, annual vaccination is considered desirable.
Cost: 16,000 yen per dose (tax included)
Number of doses: 1 dose (vaccination is possible once at least 3 months have passed since the previous COVID vaccination. For those with no history of vaccination, 2 doses at an interval of approximately 4 weeks are necessary.)
Vaccination schedule: First dose only (for those with no history of vaccination, first dose and 4 weeks later)
＜Dr. Satoshi Kutsuna＞Specialist in infectious disease internal medicine, PhD in medicine. For about 10 years he was engaged in travel medicine and imported infectious disease care at the National Center for Global Health and Medicine Hospital (Shinjuku-ku, Tokyo), home to Japan's largest travel clinic, and he continues to be involved in activities including clinical practice and research today. His other areas of specialty are emerging and re-emerging infectious diseases and COVID infection, and he works to raise awareness of infectious diseases through a variety of outlets including the media and the internet. He also sees patients at our clinic as a part-time physician and supervises our Travel Medicine.
