About COVID-19
To stay up to date on COVID-19 and COVID-19 vaccines,
visit the following pages on the Ministry of Health, Labourand Welfare website for the latest information.

◆ More information on COVID-19:
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000164708_00001.html◆ More information on COVID-19 vaccines:
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/vaccine_00184.html◆ Frequently asked questions about COVID-19:
https://www.cov19-vaccine.mhlw.go.jp/q1

1. Infectious Diseases
Infectious Diseases

2. Special Considerations
Special Considerations

It is up to us to take care to protect our own health. There

It is important to closely monitor your child’s health before

are a variety of infectious diseases in the world, and many

and after being vaccinated. If you have any concerns, you

people, regions, societies, and countries that suffer fromshould consult your family doctor, nurses or the person

infections and symptoms. Japan's good sanitary conditions,

responsible in your local municipality.

well-functioning medical system, and extensive immunization
coverage make it a relatively safe country in terms of

Before Vaccinations

infectious disease. Still, no matter how sanitary Japan may① Read vaccination notices or announcements from yourbe, it is impossible to defend against all viral and bacterial

local municipality, vaccination consent forms, and otherinfections. The risk of infection also increases when travelinginformation carefully before undergoing vaccinations. Be

abroad or in time of disaster. Particularly due to the relative

sure to ask any questions you may have in advance.

lack of effective antiviral medications, viral epidemics, once

② Bathe and wash your child the day before vaccination.

underway, can have terrible consequences and lead to③ Keep in mind to dress your child in clean clothes.

many sicknesses and fatalities. To live without fear of such

④ Don’t forget to bring your vaccination consent form,

infections, we must remember to get vaccinated againstmaternity passbook, official notices and any otherdiseases that can be prevented through vaccination and torequired documents as instructed by your local

follow a well-planned immunization program from infancy togovernment office.

adulthood.

⑤ On the day of vaccination carefully monitor your child’s
condition and complete all necessary information on thevaccination consent form. Follow the instructions of yourdoctor, nurse, or the person responsible in your local
municipality when receiving the vaccination.

23

1. Infectious Diseases
Infectious Diseases

2. Special Considerations
Special Considerations

It is up to us to take care to protect our own health. There

It is important to closely monitor your child’s health before

are a variety of infectious diseases in the world, and many

and after being vaccinated. If you have any concerns, you

people, regions, societies, and countries that suffer fromshould consult your family doctor, nurses or the person

infections and symptoms. Japan's good sanitary conditions,

responsible in your local municipality.

well-functioning medical system, and extensive immunization
coverage make it a relatively safe country in terms of

Before Vaccinations

infectious disease. Still, no matter how sanitary Japan may① Read vaccination notices or announcements from yourbe, it is impossible to defend against all viral and bacterial

local municipality, vaccination consent forms, and otherinfections. The risk of infection also increases when travelinginformation carefully before undergoing vaccinations. Be

abroad or in time of disaster. Particularly due to the relative

sure to ask any questions you may have in advance.

lack of effective antiviral medications, viral epidemics, once

② Bathe and wash your child the day before vaccination.

underway, can have terrible consequences and lead to③ Keep in mind to dress your child in clean clothes.

many sicknesses and fatalities. To live without fear of such

④ Don’t forget to bring your vaccination consent form,

infections, we must remember to get vaccinated againstmaternity passbook, official notices and any otherdiseases that can be prevented through vaccination and torequired documents as instructed by your local

follow a well-planned immunization program from infancy togovernment office.

adulthood.

⑤ On the day of vaccination carefully monitor your child’s
condition and complete all necessary information on thevaccination consent form. Follow the instructions of yourdoctor, nurse, or the person responsible in your local
municipality when receiving the vaccination.

23

3. Vaccination Intervals
Interval between diﬀerent vaccines

After Vaccinations① As sudden side effects may develop, remain at thevaccination facility for approximately 30 minutes after

Previous inoculation

Injected Live Vaccines

At least 27 days

Next inoculation

Injected Live Vaccines

vaccination and closely monitor your child’s condition. If

Injected
Live
Vaccines

be sure you have a means of contacting your doctor.
② Monitor your child’s condition, paying close attention tohis or her arm and the area where the vaccination was
administered, over the course of four weeks in the case

Oral
Live
Vaccinesof live vaccines and one week in the case of inactivatedvaccines. If you have any concerns, consult yourdoctor, nurse, or the person responsible in your local
municipality.
③ Do not let your child take part in strenuous activities
on the day of vaccination, whether before or after theInactivatedVaccines

Oral LiveVaccines

No rules concerning interval

you must leave the site immediately after the vaccination,

Inactivated Vaccines
Injected Live Vaccines
Oral LiveVaccines
Inactivated Vaccines
Injected Live Vaccines
Oral LiveVaccines
Inactivated Vaccines

vaccination.
④ Your child may take a bath or shower on the day of
vaccination, but do not rub the region where the vaccine
was administered.

Protect your child’s healthby learning the facts and getting vaccinated.
4

Notes

• Symptoms such as fever or swelling at the site of vaccination may
appear for a few days after an inoculation. Even when the rules permit a
subsequent inoculation, be sure to confirm that there is no fever, swellingat the point of vaccination, or other problem before receiving one.
• Simultaneous inoculation is possible with the specific approval of aphysician.
• Please follow the interval rules in the appended document when
receiving multiple administrations of the same vaccine.
Refer to the Ministry of Health, Labour and Welfare website (listed on p.1)
for more information on vaccination intervals for vaccinations other than
COVID-19 vaccines.

53. Vaccination Intervals
Interval between diﬀerent vaccines

After Vaccinations① As sudden side effects may develop, remain at thevaccination facility for approximately 30 minutes after

Previous inoculation

Injected Live Vaccines

At least 27 days

Next inoculation

Injected Live Vaccines

vaccination and closely monitor your child’s condition. If

Injected
Live
Vaccines

be sure you have a means of contacting your doctor.
② Monitor your child’s condition, paying close attention tohis or her arm and the area where the vaccination was
administered, over the course of four weeks in the case

Oral
Live
Vaccinesof live vaccines and one week in the case of inactivatedvaccines. If you have any concerns, consult yourdoctor, nurse, or the person responsible in your local
municipality.
③ Do not let your child take part in strenuous activities
on the day of vaccination, whether before or after theInactivatedVaccines

Oral LiveVaccines

No rules concerning interval

you must leave the site immediately after the vaccination,

Inactivated Vaccines
Injected Live Vaccines
Oral LiveVaccines
Inactivated Vaccines
Injected Live Vaccines
Oral LiveVaccines
Inactivated Vaccines

vaccination.
④ Your child may take a bath or shower on the day of
vaccination, but do not rub the region where the vaccine
was administered.

Protect your child’s healthby learning the facts and getting vaccinated.
4

Notes

• Symptoms such as fever or swelling at the site of vaccination may
appear for a few days after an inoculation. Even when the rules permit a
subsequent inoculation, be sure to confirm that there is no fever, swellingat the point of vaccination, or other problem before receiving one.
• Simultaneous inoculation is possible with the specific approval of aphysician.
• Please follow the interval rules in the appended document when
receiving multiple administrations of the same vaccine.
Refer to the Ministry of Health, Labour and Welfare website (listed on p.1)
for more information on vaccination intervals for vaccinations other than
COVID-19 vaccines.

54. Haemophilus Influenzae Type b (Hib)
Haemophilus Influenzae Type b (Hib)
Haemophilus Influenzae Type b (Hib) spreads from person
to person by droplet transmission. Infection with Hib can leadto otitis media (middle ear infection) and pneumonia, andin rare cases to inflammation of the membranes covering
the brain and the spinal cord (meningitis). It is believedthat before the introduction of the Hib vaccine, roughly 400
people contracted meningitis from Hib in Japan each year,of whom 25% suffered permanent damage and 5% died.
Introduction of the Hib vaccine, however, is reported to havegreatly reduced the incidence of Hib meningitis comparedto the three-year period prior to the introduction of a public
subsidy. Although very difficult to diagnose and treat, thisdisease can be prevented through vaccination.
Note that the microorganism that causes this disease
is different than the one that causes influenza as discussed
in section 20.

Who is eligible for this vaccine?
Infants can receive the vaccine from two months of age aspart of their routine vaccinations. The standard schedulecalls for three initial vaccinations followed by one subsequentvaccination for a total of four, so be careful not to miss any
administrations.
6

5. Pediatric Pneumococcal Infections
Pediatric Pneumococcal Infections

Pneumococcus can cause a variety of infectious diseases
including bacterial meningitis, bacteremia, pneumonia and otherserious systemic infections, otitis media (middle ear infection), andrespiratory infections such as sinusitis. Pneumococcal bacterial
meningitis in children, in particular, is difficult to identify because its
early symptoms are similar to those of the common cold. It is also
known to be prone to leave permanent damage and often result indeath. More than half of children who contract bacterial meningitis
are under 1 year of age, with the risk of infection increasing after
age six months and continuing through around age 5 years. In
recent years, more and more pneumococci have become resistantto antibiotics such as penicillin, which makes treatment difficult andis all the more reason to receive the vaccine.

Who is eligible for this vaccine?

The 13-valent pneumococcal conjugate vaccine is used for routine
vaccinations, which can be received beginning at age 2 months.
The standard schedule calls for three initial vaccinations followed
by one subsequent vaccination for a total of four, so be careful
not to miss any administrations. The subsequent vaccination, inparticular, should be administered shortly after turning 1 year old.
In addition, there are three types of optional vaccines the23-valent polysaccharide type and 13- or 15-valent conjugate type.
The 23-valent polysaccharide type is available to children
aged 2 and over who have an elevated risk of pneumococcal
infection, including those with respiratory conditions, cardiac
disease, or diabetes, or who have undergone a splenectomy as aresult of illness or injury. Note that Japan’s national health insurance
covers vaccination for those who have undergone a splenectomy.
The 13- or 15-valent conjugate type available as an optional
vaccine for people of any age who may have an elevated risk ofcontracting diseases caused by pneumococcal bacteria, including
those with respiratory conditions, cardiac disease, or diabetes, or
who have undergone a splenectomy as a result of illness or injury.

74. Haemophilus Influenzae Type b (Hib)
Haemophilus Influenzae Type b (Hib)
Haemophilus Influenzae Type b (Hib) spreads from person
to person by droplet transmission. Infection with Hib can leadto otitis media (middle ear infection) and pneumonia, andin rare cases to inflammation of the membranes covering
the brain and the spinal cord (meningitis). It is believedthat before the introduction of the Hib vaccine, roughly 400
people contracted meningitis from Hib in Japan each year,of whom 25% suffered permanent damage and 5% died.
Introduction of the Hib vaccine, however, is reported to havegreatly reduced the incidence of Hib meningitis comparedto the three-year period prior to the introduction of a public
subsidy. Although very difficult to diagnose and treat, thisdisease can be prevented through vaccination.
Note that the microorganism that causes this disease
is different than the one that causes influenza as discussed
in section 20.

Who is eligible for this vaccine?
Infants can receive the vaccine from two months of age aspart of their routine vaccinations. The standard schedulecalls for three initial vaccinations followed by one subsequentvaccination for a total of four, so be careful not to miss any
administrations.
6

5. Pediatric Pneumococcal Infections
Pediatric Pneumococcal Infections

Pneumococcus can cause a variety of infectious diseases
including bacterial meningitis, bacteremia, pneumonia and otherserious systemic infections, otitis media (middle ear infection), andrespiratory infections such as sinusitis. Pneumococcal bacterial
meningitis in children, in particular, is difficult to identify because its
early symptoms are similar to those of the common cold. It is also
known to be prone to leave permanent damage and often result indeath. More than half of children who contract bacterial meningitis
are under 1 year of age, with the risk of infection increasing after
age six months and continuing through around age 5 years. In
recent years, more and more pneumococci have become resistantto antibiotics such as penicillin, which makes treatment difficult andis all the more reason to receive the vaccine.

Who is eligible for this vaccine?

The 13-valent pneumococcal conjugate vaccine is used for routine
vaccinations, which can be received beginning at age 2 months.
The standard schedule calls for three initial vaccinations followed
by one subsequent vaccination for a total of four, so be careful
not to miss any administrations. The subsequent vaccination, inparticular, should be administered shortly after turning 1 year old.
In addition, there are three types of optional vaccines the23-valent polysaccharide type and 13- or 15-valent conjugate type.
The 23-valent polysaccharide type is available to children
aged 2 and over who have an elevated risk of pneumococcal
infection, including those with respiratory conditions, cardiac
disease, or diabetes, or who have undergone a splenectomy as aresult of illness or injury. Note that Japan’s national health insurance
covers vaccination for those who have undergone a splenectomy.
The 13- or 15-valent conjugate type available as an optional
vaccine for people of any age who may have an elevated risk ofcontracting diseases caused by pneumococcal bacteria, including
those with respiratory conditions, cardiac disease, or diabetes, or
who have undergone a splenectomy as a result of illness or injury.

76. Hepatitis B

7. Rotavirus Gastroenteritis

Hepatitis B

Rotavirus Gastroenteritis

Hepatitis B is a liver disease caused by infection of thehepatitis B virus. It is not contracted in everyday life but inrare cases, such as when there is an open wound, may
be transmitted through blood or bodily fluid that has been
contaminated with the virus. Although often resulting intransient acute hepatitis with symptoms such as fatigue andjaundice when contracted by adults, persistent infections
do also occur. Those with persistent infections, known as“carriers,” have a high risk of developing chronic hepatitis,
cirrhosis and liver cancer. Infected infants and children under
the age of 5 are known to have a high chance of becoming
carriers. Vaccination is an important measure to prevent
infection.

Rotavirus gastroenteritis is an infectious inflammation of thestomach and intestine often contracted by infants and causedby the rotavirus (RV). In Japan, rotavirus gastroenteritis
is usually contracted in winter and spring by infants age
3−24 months, with most cases occurring at age 7−15
months. When a child aged three months or older contracts
the disease for the first time, the symptoms are prone tobecoming serious. In most cases, rotavirus gastroenteritis
presents symptoms of sudden vomiting followed by watery,diarrhea. Fever is sometimes present, and recovery takes
about one week. People with rotavirus gastroenteritis
usually recover by simply taking water and electrolytes orally
without any special treatment, but complications such as
dehydration, renal failure and encephalitis/meningitis may
occur. Hospitalization may be required if symptoms areserious and patients are extremely dehydrated.

Who is eligible for this vaccine?
Babies born to mothers who are carriers (HBsAg positive)
can be vaccinated under Japan’s national health insurance
policy together with HBIG (human immunoglobulin) toprevent mother-child transmission. In addition, given therisk of horizontal transmission from others in the community,routine vaccination for those 0 years old was begun in
October 2016. Many countries overseas conduct universal
vaccination of all newborns. Optional vaccination is strongly
recommended for those who may come into contact withcontaminated blood or bodily fluids, such as medical
personnel, family members of carriers, staff members at
facilities for the elderly, staff at nursery schools, police
officers, and firefighters.
8

Who is eligible for this vaccine?
There are two types of rotavirus vaccine, which is part of theroutine vaccination program: a 1-valent type and a 5-valent
type. Both are administered orally. The 1-valent type isadministered two times to infants at age 6−24 weeks, at aninterval of at least 27 days. The 5-valent type is administered
three times to infants at age 6−32 weeks, at intervals of atleast 27 days. For either type, it is recommended that theinitial vaccination be administered before the age of 14
weeks and 6 days.

9

6. Hepatitis B

7. Rotavirus Gastroenteritis

Hepatitis B

Rotavirus Gastroenteritis

Hepatitis B is a liver disease caused by infection of thehepatitis B virus. It is not contracted in everyday life but inrare cases, such as when there is an open wound, may
be transmitted through blood or bodily fluid that has been
contaminated with the virus. Although often resulting intransient acute hepatitis with symptoms such as fatigue andjaundice when contracted by adults, persistent infections
do also occur. Those with persistent infections, known as“carriers,” have a high risk of developing chronic hepatitis,
cirrhosis and liver cancer. Infected infants and children under
the age of 5 are known to have a high chance of becoming
carriers. Vaccination is an important measure to prevent
infection.

Rotavirus gastroenteritis is an infectious inflammation of thestomach and intestine often contracted by infants and causedby the rotavirus (RV). In Japan, rotavirus gastroenteritis
is usually contracted in winter and spring by infants age
3−24 months, with most cases occurring at age 7−15
months. When a child aged three months or older contracts
the disease for the first time, the symptoms are prone tobecoming serious. In most cases, rotavirus gastroenteritis
presents symptoms of sudden vomiting followed by watery,diarrhea. Fever is sometimes present, and recovery takes
about one week. People with rotavirus gastroenteritis
usually recover by simply taking water and electrolytes orally
without any special treatment, but complications such as
dehydration, renal failure and encephalitis/meningitis may
occur. Hospitalization may be required if symptoms areserious and patients are extremely dehydrated.

Who is eligible for this vaccine?
Babies born to mothers who are carriers (HBsAg positive)
can be vaccinated under Japan’s national health insurance
policy together with HBIG (human immunoglobulin) toprevent mother-child transmission. In addition, given therisk of horizontal transmission from others in the community,routine vaccination for those 0 years old was begun in
October 2016. Many countries overseas conduct universal
vaccination of all newborns. Optional vaccination is strongly
recommended for those who may come into contact withcontaminated blood or bodily fluids, such as medical
personnel, family members of carriers, staff members at
facilities for the elderly, staff at nursery schools, police
officers, and firefighters.
8

Who is eligible for this vaccine?
There are two types of rotavirus vaccine, which is part of theroutine vaccination program: a 1-valent type and a 5-valent
type. Both are administered orally. The 1-valent type isadministered two times to infants at age 6−24 weeks, at aninterval of at least 27 days. The 5-valent type is administered
three times to infants at age 6−32 weeks, at intervals of atleast 27 days. For either type, it is recommended that theinitial vaccination be administered before the age of 14
weeks and 6 days.

98. Pertussis (Whooping Cough)

9. Diphtheria

Pertussis (Whooping Cough)Diphtheria

Pertussis is caused by the spread of the Bordetella pertussis

There have been no reported cases of diphtheria in Japan

bacteria by droplet transmission. Initial symptoms are similar

since 1999, but this does not mean that diphtheria itself has

to those of the common cold but the coughing then becomes

been eliminated. Indeed, in some countries the temporary

more severe and, in the typical pediatric case, develops

suspension of vaccinations has resulted in epidemics.

into sustained fits that cause patients to turn red in theSymptoms are severe, including difficulty in breathing, andface. The fever is mild, but coughing may cause breathingcan even lead to death. If the disease spreads to the heart ordifficulties in infants and small children and lead to seizures.

nerves, it can lead to myocarditis (damage to the heart) andComplications can include pneumonia and encephalopathy,

paralysis. Diphtheria is a very dangerous disease, but canand even death. In adults the symptoms are no more severe

be prevented through vaccination.

than a persistent cough, but this can result in transmission to
infants and small children so caution is needed.

Who is eligible for this vaccine?
Pertussis can be prevented with the DPT-IPV* quadruple
vaccine (or, in some cases, with the DPT** triple vaccine)
beginning at age 2 months as part of the routine vaccination
schedule. Numerous administrations (four) are required;parents are advised not to miss any vaccinations.

* DPT-IPV : Adsorbed purified pertussis-diphtheria-tetanusinactivated polio combined vaccine.
**DPT : Adsorbed purified pertussis-diphtheria-tetanus
combined vaccine.
10

Who is eligible for this vaccine?
Can be prevented in infants with
the DPT-IPV* quadruple vaccine
beginning at age 2 months as part of
the routine vaccination schedule. In
addition, a DT*** booster dose is also
administered between the age of 11
and 12 years.

*** DT : Adsorbed diphtheria-tetanus combined toxoid.
11

8. Pertussis (Whooping Cough)

9. Diphtheria

Pertussis (Whooping Cough)Diphtheria

Pertussis is caused by the spread of the Bordetella pertussis

There have been no reported cases of diphtheria in Japan

bacteria by droplet transmission. Initial symptoms are similar

since 1999, but this does not mean that diphtheria itself has

to those of the common cold but the coughing then becomes

been eliminated. Indeed, in some countries the temporary

more severe and, in the typical pediatric case, develops

suspension of vaccinations has resulted in epidemics.

into sustained fits that cause patients to turn red in theSymptoms are severe, including difficulty in breathing, andface. The fever is mild, but coughing may cause breathingcan even lead to death. If the disease spreads to the heart ordifficulties in infants and small children and lead to seizures.

nerves, it can lead to myocarditis (damage to the heart) andComplications can include pneumonia and encephalopathy,

paralysis. Diphtheria is a very dangerous disease, but canand even death. In adults the symptoms are no more severe

be prevented through vaccination.

than a persistent cough, but this can result in transmission to
infants and small children so caution is needed.

Who is eligible for this vaccine?
Pertussis can be prevented with the DPT-IPV* quadruple
vaccine (or, in some cases, with the DPT** triple vaccine)
beginning at age 2 months as part of the routine vaccination
schedule. Numerous administrations (four) are required;parents are advised not to miss any vaccinations.

* DPT-IPV : Adsorbed purified pertussis-diphtheria-tetanusinactivated polio combined vaccine.
**DPT : Adsorbed purified pertussis-diphtheria-tetanus
combined vaccine.
10

Who is eligible for this vaccine?
Can be prevented in infants with
the DPT-IPV* quadruple vaccine
beginning at age 2 months as part of
the routine vaccination schedule. In
addition, a DT*** booster dose is also
administered between the age of 11
and 12 years.

*** DT : Adsorbed diphtheria-tetanus combined toxoid.
1110. Tetanus

11. Polio

Tetanus

Polio

Tetanus is contracted when the Clostridium tetani bacterium

Polio is a disease caused by poliovirus that can lead toparalysis of the limbs. Frequently occurring among children it
was once known as “infantile paralysis,” but in fact adults arealso susceptible.
Due to Japan’s high immunization rate, there are
no known cases of polio occurring through natural infectionin the country. Polio epidemics are still reported in somecountries, however. Recently, cases of polio and evidenceof the polio virus in environmental water have even beenreported in major cities in the developed world. There is thus
no way of knowing when the virus might enter Japan. People
travelling abroad to such countries are at risk of contracting
the disease unless they have sufficient antibodies so it is still
essential to be vaccinated.

enters the body through a wound. There is a risk of infection
even for small wounds. Some victims of the Great East
Japan Earthquake are known to have contracted tetanus.
Toxins produced by Clostridium tetani cause symptoms suchas paralysis, severe muscle spasms, and difficulty breathing.
Tetanus has a high mortality rate, which is why it is importantfor people to build immunity to the disease throughvaccination.

Who is eligible for this vaccine?
Can be prevented in infants with the DPT-IPV* quadruple
vaccine beginning at age 2 months as part of the routine
vaccination schedule. In addition, the DT*** booster dose

Who is eligible for this vaccine?

* DPT-IPV : Adsorbed purified pertussis-diphtheria-tetanusinactivated polio combined vaccine.
*** DT : Adsorbed diphtheria-tetanus combined toxoid.

Polio can be prevented in infants with the DPT-IPV quadruple
vaccine (or in some cases the inactive polio vaccine on
its own) beginning at age 2 months as part of the routine
vaccination schedule. Numerous administrations (four) are
required; parents are advised not to miss any vaccinations.
Note that because the properties of the inactive polio vaccine
lead to a decline in its effectiveness at preventing infection
over time, an additional administration of the inactive
polio vaccine on its own is recommended as an optional
vaccination prior to enrollment in school.

1213

is also administered between the age of 11 and 12 years.
An adsorbed tetanus toxoid vaccine is recommended as an
optional vaccination for those who are injured and have notbeen vaccinated, or for whom 10 years or more have passed
since vaccination.

10. Tetanus

11. Polio

Tetanus

Polio

Tetanus is contracted when the Clostridium tetani bacterium

Polio is a disease caused by poliovirus that can lead toparalysis of the limbs. Frequently occurring among children it
was once known as “infantile paralysis,” but in fact adults arealso susceptible.
Due to Japan’s high immunization rate, there are
no known cases of polio occurring through natural infectionin the country. Polio epidemics are still reported in somecountries, however. Recently, cases of polio and evidenceof the polio virus in environmental water have even beenreported in major cities in the developed world. There is thus
no way of knowing when the virus might enter Japan. People
travelling abroad to such countries are at risk of contracting
the disease unless they have sufficient antibodies so it is still
essential to be vaccinated.

enters the body through a wound. There is a risk of infection
even for small wounds. Some victims of the Great East
Japan Earthquake are known to have contracted tetanus.
Toxins produced by Clostridium tetani cause symptoms suchas paralysis, severe muscle spasms, and difficulty breathing.
Tetanus has a high mortality rate, which is why it is importantfor people to build immunity to the disease throughvaccination.

Who is eligible for this vaccine?
Can be prevented in infants with the DPT-IPV* quadruple
vaccine beginning at age 2 months as part of the routine
vaccination schedule. In addition, the DT*** booster dose

Who is eligible for this vaccine?

* DPT-IPV : Adsorbed purified pertussis-diphtheria-tetanusinactivated polio combined vaccine.
*** DT : Adsorbed diphtheria-tetanus combined toxoid.

Polio can be prevented in infants with the DPT-IPV quadruple
vaccine (or in some cases the inactive polio vaccine on
its own) beginning at age 2 months as part of the routine
vaccination schedule. Numerous administrations (four) are
required; parents are advised not to miss any vaccinations.
Note that because the properties of the inactive polio vaccine
lead to a decline in its effectiveness at preventing infection
over time, an additional administration of the inactive
polio vaccine on its own is recommended as an optional
vaccination prior to enrollment in school.

1213

is also administered between the age of 11 and 12 years.
An adsorbed tetanus toxoid vaccine is recommended as an
optional vaccination for those who are injured and have notbeen vaccinated, or for whom 10 years or more have passed
since vaccination.

12. Tuberculosis (TB)

13. Measles

Tuberculosis (TB)

Measles

Tuberculosis tends to be thought of as a disease of the

Measles is caused by airborne transmission of the measles
virus. Many people may contract this highly contagious
disease unless properly vaccinated. Symptoms include highfever (39−40°C) and rash, and may lead to complications
such as pneumonia, otitis media (middle ear infection),
bronchitis, or encephalitis. Even in developed countries, it issaid that one in every few thousand people who contracts
measles will die. Vaccination is the most important means ofprevention. As a result of two-dose vaccinations since 2006,
Japan eliminated measles in 2015. Major epidemics are nolonger seen domestically, but caution is required as minor
epidemics continue to occur in Japan centered on cases
imported from overseas and among unvaccinated groups or
those who received single-dose vaccinations.

past, but Japan still has a relatively high number of patientscompared to other advanced countries; in 2021 there
were approximately 12,000 cases, primarily among theelderly, and roughly 2,000 deaths. However, the number ofpediatric tuberculosis cases in Japan is around 50 per year,
a figure lower than the low case count in the United States(where only some individuals receive the BCG vaccine).
This relative scarcity is believed to be a result of BCG
vaccination. Pediatric tuberculosis is frequently contracted
from family member or other nearby adults. Symptoms areminimal, so they may go unnoticed. Furthermore, infants
and small children have low resistance to tuberculosis, so
special caution is required as it may become aggravated anddevelop into more serious tuberculous meningitis or miliary
tuberculosis. To prevent onset by unexpected infection, earlyadministration of the BCG vaccine is recommended.

Who is eligible for this vaccine?
The Bacillus Calmette-Guérin (BCG)
vaccine for tuberculosis is available
as a routine vaccination for children
before they reach one year of age,with the standard age of administration
between 5 and 8 months.
14

Who is eligible for this vaccine?
For routine vaccinations, either the combined measles/
rubella (MR) vaccine or the measles vaccine alone isadministered in the following phases: Phase I: 1-year olds;
Phase II: children in the academic year (1 April–31 March)prior to the year they begin elementary school. In general,the combined MR vaccination is administered. Measles
remains endemic in many countries around the world; it cansometimes spread in Japan, mainly as the result of the virus
being brought in from overseas. It is important to continue
to maintain a high immunization rate in order to prevent
epidemics.
15

12. Tuberculosis (TB)

13. Measles

Tuberculosis (TB)

Measles

Tuberculosis tends to be thought of as a disease of the

Measles is caused by airborne transmission of the measles
virus. Many people may contract this highly contagious
disease unless properly vaccinated. Symptoms include highfever (39−40°C) and rash, and may lead to complications
such as pneumonia, otitis media (middle ear infection),
bronchitis, or encephalitis. Even in developed countries, it issaid that one in every few thousand people who contracts
measles will die. Vaccination is the most important means ofprevention. As a result of two-dose vaccinations since 2006,
Japan eliminated measles in 2015. Major epidemics are nolonger seen domestically, but caution is required as minor
epidemics continue to occur in Japan centered on cases
imported from overseas and among unvaccinated groups or
those who received single-dose vaccinations.

past, but Japan still has a relatively high number of patientscompared to other advanced countries; in 2021 there
were approximately 12,000 cases, primarily among theelderly, and roughly 2,000 deaths. However, the number ofpediatric tuberculosis cases in Japan is around 50 per year,
a figure lower than the low case count in the United States(where only some individuals receive the BCG vaccine).
This relative scarcity is believed to be a result of BCG
vaccination. Pediatric tuberculosis is frequently contracted
from family member or other nearby adults. Symptoms areminimal, so they may go unnoticed. Furthermore, infants
and small children have low resistance to tuberculosis, so
special caution is required as it may become aggravated anddevelop into more serious tuberculous meningitis or miliary
tuberculosis. To prevent onset by unexpected infection, earlyadministration of the BCG vaccine is recommended.

Who is eligible for this vaccine?
The Bacillus Calmette-Guérin (BCG)
vaccine for tuberculosis is available
as a routine vaccination for children
before they reach one year of age,with the standard age of administration
between 5 and 8 months.
14

Who is eligible for this vaccine?
For routine vaccinations, either the combined measles/
rubella (MR) vaccine or the measles vaccine alone isadministered in the following phases: Phase I: 1-year olds;
Phase II: children in the academic year (1 April–31 March)prior to the year they begin elementary school. In general,the combined MR vaccination is administered. Measles
remains endemic in many countries around the world; it cansometimes spread in Japan, mainly as the result of the virus
being brought in from overseas. It is important to continue
to maintain a high immunization rate in order to prevent
epidemics.
15

14. Rubella

15. Varicella (Chicken Pox)

RubellaRubella is a disease spread through droplet transmission of
the rubella virus. Primary symptoms include rashes, feverand swelling in the lymph nodes in the neck and behind theears. If contracted, complications may include arthralgia(joint pain), thrombocytopenic purpura, and encephalitis.
If pregnant women who are not immune to the disease
contract rubella in their first trimester, their infants may beborn with congenital rubella syndrome (CRS), manifested in
cataracts, heart disease, hearing loss and other symptoms.
There are no means of prevention other than vaccination.

Who is eligible for this vaccine?

Varicella (Chicken Pox)
Varicella, commonly called “chicken pox,” is caused by thehighly infectious varicella-zoster virus. Primary symptoms
include fever and a rash accompanied by blisters, butsevere cases can lead to hospitalization. Varicella can beparticularly serious for children with weakened immune
systems including those with leukemia and those who
are taking steroid medications due to conditions such as
nephrotic syndrome. The fetuses of women who contract

For routine vaccinations, either the combined measles/
rubella (MR) vaccine or the rubella vaccine alone isadministered in the following stages: Stage 1: 1-year olds;
Stage 2: children in the academic year (1 April−31 March)prior to the year they begin elementary school. In general,the combined MR vaccination is administered. In fiscal year
2019, routine vaccinations (Stage 5 vaccinations) wereintroduced for adult males who have low antibody levels.
Males born between 2 April 1962 and 1 April 1979 should
undergo rubella antibody testing at a designated medical
facility immediately after receiving the coupon from theirmunicipality of residence, and those with a low antibody levelshould undergo vaccination. It is also important for those
who are around adult males in the target group to remindthem to do this. In addition, because live vaccines cannot
be administered during pregnancy, it is recommended thatpeople seeking to become pregnant and family membersof pregnant women confirm their rubella antibody level andvaccination history in advance.

varicella during early pregnancy may be impaired, and the1617

newborns of women who contract the disease just prior todelivery may contract varicella at an early stage, leading toserious illness.

Who is eligible for this vaccine?
Routine vaccinations are administered to those aged
between 12 and 36 months who have not yet contracted
varicella. The standard schedule involves an initialadministration between the age of 12 and 15 months. A
second administration takes place at least 3 months after the
first (typically after an interval of between 6 and 12 months).

14. Rubella

15. Varicella (Chicken Pox)

RubellaRubella is a disease spread through droplet transmission of
the rubella virus. Primary symptoms include rashes, feverand swelling in the lymph nodes in the neck and behind theears. If contracted, complications may include arthralgia(joint pain), thrombocytopenic purpura, and encephalitis.
If pregnant women who are not immune to the disease
contract rubella in their first trimester, their infants may beborn with congenital rubella syndrome (CRS), manifested in
cataracts, heart disease, hearing loss and other symptoms.
There are no means of prevention other than vaccination.

Who is eligible for this vaccine?

Varicella (Chicken Pox)
Varicella, commonly called “chicken pox,” is caused by thehighly infectious varicella-zoster virus. Primary symptoms
include fever and a rash accompanied by blisters, butsevere cases can lead to hospitalization. Varicella can beparticularly serious for children with weakened immune
systems including those with leukemia and those who
are taking steroid medications due to conditions such as
nephrotic syndrome. The fetuses of women who contract

For routine vaccinations, either the combined measles/
rubella (MR) vaccine or the rubella vaccine alone isadministered in the following stages: Stage 1: 1-year olds;
Stage 2: children in the academic year (1 April−31 March)prior to the year they begin elementary school. In general,the combined MR vaccination is administered. In fiscal year
2019, routine vaccinations (Stage 5 vaccinations) wereintroduced for adult males who have low antibody levels.
Males born between 2 April 1962 and 1 April 1979 should
undergo rubella antibody testing at a designated medical
facility immediately after receiving the coupon from theirmunicipality of residence, and those with a low antibody levelshould undergo vaccination. It is also important for those
who are around adult males in the target group to remindthem to do this. In addition, because live vaccines cannot
be administered during pregnancy, it is recommended thatpeople seeking to become pregnant and family membersof pregnant women confirm their rubella antibody level andvaccination history in advance.

varicella during early pregnancy may be impaired, and the1617

newborns of women who contract the disease just prior todelivery may contract varicella at an early stage, leading toserious illness.

Who is eligible for this vaccine?
Routine vaccinations are administered to those aged
between 12 and 36 months who have not yet contracted
varicella. The standard schedule involves an initialadministration between the age of 12 and 15 months. A
second administration takes place at least 3 months after the
first (typically after an interval of between 6 and 12 months).

16. Mumps

17. Japanese Encephalitis

Mumps

Japanese Encephalitis

Mumps (epidemic parotitis) is a disease caused by catching

Japanese encephalitis is caused by a virus transmitted

the highly contagious mumps virus, either through droplet

by mosquitoes (primarily Culex tritaeniorhynchus) during

infection by inhalation or through contact infection by contact

summer and autumn. When contracted, the disease

between hands with the virus and the nose or mouth, anddevelops into acute encephalitis with symptoms including

characterized by fever and swelling of the parotid gland.

high fever, headache, vomiting, impaired consciousness, andMumps infects internal organs and nervous tissue throughout

seizures. Even after symptoms subside, many people suffer

the body, and can lead to complications including aseptic
meningitis, encephalitis, hearing loss, and orchitis (testicularinflammation) or ovaritis in post-pubescent individuals.
Hearing loss, in particular,

aftereffects such as sensory and motor disabilities, while
20–40% of those infected die. Building immunity throughvaccination is the most effective preventive measure against
this dangerous disease.

is a frequent complicationthat is serious and difficult

Who is eligible for this vaccine?

to treat effectively so

For routine vaccinations, basic immunizations should be

prevention through theadministered at 6−90 months of age, generally in two doses

mumps vaccine is important.

at an interval of 6−28 days at age 3, followed by a single

Who is eligible for this vaccine?

additional vaccination after an interval of about 1 year.

The mumps vaccine is optional, but administtation is

Typically, one additional vaccination is administered at age 9.

recommended around the time when the combined MR

The Ministry of Health, Labor and Welfare stopped

vaccine and varicella vaccine are administered−at the age

actively advocating Japanese encephalitis vaccinations onof 1 year or as soon as possible thereafter−because mumps

30 May 2005, but resumed advocating them from 2010. For

is often contracted by children aged 3– 6. Consult with yourmore information, contact your local government office.

primary care physician about getting the vaccine.
18

19

16. Mumps

17. Japanese Encephalitis

Mumps

Japanese Encephalitis

Mumps (epidemic parotitis) is a disease caused by catching

Japanese encephalitis is caused by a virus transmitted

the highly contagious mumps virus, either through droplet

by mosquitoes (primarily Culex tritaeniorhynchus) during

infection by inhalation or through contact infection by contact

summer and autumn. When contracted, the disease

between hands with the virus and the nose or mouth, anddevelops into acute encephalitis with symptoms including

characterized by fever and swelling of the parotid gland.

high fever, headache, vomiting, impaired consciousness, andMumps infects internal organs and nervous tissue throughout

seizures. Even after symptoms subside, many people suffer

the body, and can lead to complications including aseptic
meningitis, encephalitis, hearing loss, and orchitis (testicularinflammation) or ovaritis in post-pubescent individuals.
Hearing loss, in particular,

aftereffects such as sensory and motor disabilities, while
20–40% of those infected die. Building immunity throughvaccination is the most effective preventive measure against
this dangerous disease.

is a frequent complicationthat is serious and difficult

Who is eligible for this vaccine?

to treat effectively so

For routine vaccinations, basic immunizations should be

prevention through theadministered at 6−90 months of age, generally in two doses

mumps vaccine is important.

at an interval of 6−28 days at age 3, followed by a single

Who is eligible for this vaccine?

additional vaccination after an interval of about 1 year.

The mumps vaccine is optional, but administtation is

Typically, one additional vaccination is administered at age 9.

recommended around the time when the combined MR

The Ministry of Health, Labor and Welfare stopped

vaccine and varicella vaccine are administered−at the age

actively advocating Japanese encephalitis vaccinations onof 1 year or as soon as possible thereafter−because mumps

30 May 2005, but resumed advocating them from 2010. For

is often contracted by children aged 3– 6. Consult with yourmore information, contact your local government office.

primary care physician about getting the vaccine.
181918. Meningococcal Infection
Meningococcal Infection

Invasive meningococcal infection occurs via the invasionof meningococcal bacteria into parts of the body that arenormally bacteria-free, such as bone marrow or blood.
Meningococcal bacteria are spread from person to person
through coughing and sneezing. Symptoms include fever,headache, photophobia (discomfort or pain under bright
light), sore muscles, and fatigue, but symptoms worsen
rapidly and can lead to death within 24–28 hours. Even when
patients recover, they sometimes suffer after-effects suchas hearing loss, neurological disorders, or the amputationof limbs. Invasive meningococcal infection is difficult todiagnose because its early symptoms are similar to those of
the common cold. Early diagnosis and treatment is critical,
however, tends to lead to severe symptoms because theinfection proceeds rapidly and treatment is critical.

Who is eligible for this vaccine?

Vaccination is recommended for those who live indormitories, take part in extracurricular activities, or otherwise
engage in communal living whether in Japan or overseas,
those of any age who travel to areas where meningococcal
infections are endemic, and those who study abroad incountries where the meningococcal vaccination is routinely
administered. Vaccination is recommended even for highrisk patients (those with complement deficiency, asplenia, or
splenetic dysfunction; HIV infection; or undergoing treatment
with Eculizumab or Ravulizmab) .
Note: The meningococcal vaccines currently approved
and available in Japan protect against serotypes A,
C, Y, and W.
20

19. HPV Infection
HPV Infection
Human papillomavirus (HPV), a virus that can infect anyone,
is most commonly transmitted via sexual contact. Whilethe infection is expelled from the body naturally in thevast majority of cases, an HPV infection can cause cervial
cancer in more than 5 to 10 years if it persists. In addition tocervical cancer, HPV can also lead to cancer of the vulva,
cancer of the vagina, condyloma acuminatum (crest-shaped
warts around the genitals and/or anus), and other diseases.
Cervical cancer can be detected and treated early throughtesting, but certain treatments may result in fertility problems
or prevent patients from becoming pregnant. Given the risks,vaccination against HPV infection is vital. HPV vaccinationis considered most effective when administered at an age
before the start of sexual activity.

Who is eligible for this vaccine?
The 2-valent vaccine can be administered to girls aged
10 and older and the 4- and the 9-valent vaccine to girls
aged 9 and older. Vaccination is most often recommended
for girls aged 10−14 and next often for those aged 15−26.
Vaccination is also recommended for women aged 27−45
who wish to be vaccinated.
The 2- and 4-valent vaccines became routine
vaccinations as of April 1, 2013, and the 9-valent vaccine
entered the routine vaccination program as of April 1, 2023.
An HPV vaccination can be administered between the firstday of the fiscal year in which a girl turns 12 and the last day21

18. Meningococcal Infection
Meningococcal Infection

Invasive meningococcal infection occurs via the invasionof meningococcal bacteria into parts of the body that arenormally bacteria-free, such as bone marrow or blood.
Meningococcal bacteria are spread from person to person
through coughing and sneezing. Symptoms include fever,headache, photophobia (discomfort or pain under bright
light), sore muscles, and fatigue, but symptoms worsen
rapidly and can lead to death within 24–28 hours. Even when
patients recover, they sometimes suffer after-effects suchas hearing loss, neurological disorders, or the amputationof limbs. Invasive meningococcal infection is difficult todiagnose because its early symptoms are similar to those of
the common cold. Early diagnosis and treatment is critical,
however, tends to lead to severe symptoms because theinfection proceeds rapidly and treatment is critical.

Who is eligible for this vaccine?

Vaccination is recommended for those who live indormitories, take part in extracurricular activities, or otherwise
engage in communal living whether in Japan or overseas,
those of any age who travel to areas where meningococcal
infections are endemic, and those who study abroad incountries where the meningococcal vaccination is routinely
administered. Vaccination is recommended even for highrisk patients (those with complement deficiency, asplenia, or
splenetic dysfunction; HIV infection; or undergoing treatment
with Eculizumab or Ravulizmab) .
Note: The meningococcal vaccines currently approved
and available in Japan protect against serotypes A,
C, Y, and W.
20

19. HPV Infection
HPV Infection
Human papillomavirus (HPV), a virus that can infect anyone,
is most commonly transmitted via sexual contact. Whilethe infection is expelled from the body naturally in thevast majority of cases, an HPV infection can cause cervial
cancer in more than 5 to 10 years if it persists. In addition tocervical cancer, HPV can also lead to cancer of the vulva,
cancer of the vagina, condyloma acuminatum (crest-shaped
warts around the genitals and/or anus), and other diseases.
Cervical cancer can be detected and treated early throughtesting, but certain treatments may result in fertility problems
or prevent patients from becoming pregnant. Given the risks,vaccination against HPV infection is vital. HPV vaccinationis considered most effective when administered at an age
before the start of sexual activity.

Who is eligible for this vaccine?
The 2-valent vaccine can be administered to girls aged
10 and older and the 4- and the 9-valent vaccine to girls
aged 9 and older. Vaccination is most often recommended
for girls aged 10−14 and next often for those aged 15−26.
Vaccination is also recommended for women aged 27−45
who wish to be vaccinated.
The 2- and 4-valent vaccines became routine
vaccinations as of April 1, 2013, and the 9-valent vaccine
entered the routine vaccination program as of April 1, 2023.
An HPV vaccination can be administered between the firstday of the fiscal year in which a girl turns 12 and the last day
21

of the fiscal year in which she turns 16, with the standard
period of administration being between the first and last daysof the fiscal year in which a girl turns 13.

20. Influenza (Flu)
Influenza (Flu)

Note that experts are conducting an analysis andevaluation of the diverse symptoms (functional somatic
syndrome) that have been confirmed in some recipients
following administration of the HPV vaccine. Until the resultsof this analysis and evaluation were known, administrationo f th e v a c c i n e w a s te m p o r a r i l y n o t b e i n g a c t i v e l yrecommended. Through their evaluations and discussions,the experts concluded that there were no particular concerns
about the safety of the vaccine and determined that its
effectiveness clearly outweighed the risks of side effects.
The temporary suspension of recommendations for thevaccine thus came to an end on November 26, 2021, andlocal governments began sending pre-examination forms
to vaccine-eligible individuals in April 2022 to encourage
vaccination.
Those who missed their routine vaccinations while
the recommendations were suspended (those born between
1997 and 2005) will be eligible for catch-up vaccinations fora three-year period beginning April 1, 2022.
Note: For general information on the HPV vaccine, visit
the Ministry of Health, Labour and Welfare's"Human Papillomavirus (HPV Vaccine)" website:
https://www.mhlw.go.jp/bunya/kenkou/ kekkakukansenshou28/index.html (Japanese only).

Unlike the common cold, influenza (commonly referred toas “the flu”) is a contagious disease with severe respiratory
symptoms. It has the potential to spread on a global scale,and can lead to serious complications such as pneumonia,
acute otitis media (middle ear infection) and encephalopathy.
Vaccinations are said to be effective in preventing postinfection symptoms and safeguarding against severe
outcomes. For these reasons we recommend that infants,
young children, the elderly, and those with chronic diseases
receive the influenza vaccine.
Because the viruses that cause epidemics change
every year, we recommend annual vaccination.

Who is eligible for this vaccine?
We recommend the vaccine be administered twice forchildren aged 12 or under, and either once or twice (with a
4-week interval between administrations) for children aged
13 or older prior to the beginning of the flu season. Routine
vaccinations are recommended for people 65 or older, andfor those between the ages of 60 and 64 who suffer fromserious heart, kidney and/or respiratory conditions.

2223

of the fiscal year in which she turns 16, with the standard
period of administration being between the first and last daysof the fiscal year in which a girl turns 13.

20. Influenza (Flu)
Influenza (Flu)

Note that experts are conducting an analysis andevaluation of the diverse symptoms (functional somatic
syndrome) that have been confirmed in some recipients
following administration of the HPV vaccine. Until the resultsof this analysis and evaluation were known, administrationo f th e v a c c i n e w a s te m p o r a r i l y n o t b e i n g a c t i v e l yrecommended. Through their evaluations and discussions,the experts concluded that there were no particular concerns
about the safety of the vaccine and determined that its
effectiveness clearly outweighed the risks of side effects.
The temporary suspension of recommendations for thevaccine thus came to an end on November 26, 2021, andlocal governments began sending pre-examination forms
to vaccine-eligible individuals in April 2022 to encourage
vaccination.
Those who missed their routine vaccinations while
the recommendations were suspended (those born between
1997 and 2005) will be eligible for catch-up vaccinations fora three-year period beginning April 1, 2022.
Note: For general information on the HPV vaccine, visit
the Ministry of Health, Labour and Welfare's"Human Papillomavirus (HPV Vaccine)" website:
https://www.mhlw.go.jp/bunya/kenkou/ kekkakukansenshou28/index.html (Japanese only).

Unlike the common cold, influenza (commonly referred toas “the flu”) is a contagious disease with severe respiratory
symptoms. It has the potential to spread on a global scale,and can lead to serious complications such as pneumonia,
acute otitis media (middle ear infection) and encephalopathy.
Vaccinations are said to be effective in preventing postinfection symptoms and safeguarding against severe
outcomes. For these reasons we recommend that infants,
young children, the elderly, and those with chronic diseases
receive the influenza vaccine.
Because the viruses that cause epidemics change
every year, we recommend annual vaccination.

Who is eligible for this vaccine?
We recommend the vaccine be administered twice forchildren aged 12 or under, and either once or twice (with a
4-week interval between administrations) for children aged
13 or older prior to the beginning of the flu season. Routine
vaccinations are recommended for people 65 or older, andfor those between the ages of 60 and 64 who suffer fromserious heart, kidney and/or respiratory conditions.

2223

21. Adult Pneumococcal Infections
Adult Pneumococcal Infections

Pneumococcus can cause a variety of infectious diseases including
pneumonia, meningitis, bacteremia, bronchitis, and otitis media(middle ear infection). Pneumococcus is a frequent bacterialcause of pneumonia, which the elderly and those with underlying
conditions are known to be particularly susceptible to contracting
and developing severe symptoms of. Some pneumococcidemonstrate resistance to penicillin and other antibiotics,
underscoring the need for vaccination.

Who is eligible for this vaccine?

22. Herpes Zoster (Shingles)
Herpes Zoster (Shingles)
Herpes zoster (shingles) is a disease caused by the same
virus that causes varicella (chicken pox): the varicellazoster virus. People often contract varicella in childhood,
but this virus remains dormant in the body even after they
have recovered. Herpes zoster (shingles) is a condition

Routine vaccinations using the 23-valent polysaccharide vaccine
and covered by public funding in accordance with the law areavailable to people aged 65 (and, through fiscal year 2023, to those
aged 70 and over at an interval of 5 years) and to people aged 60
to 64 who have serious heart, kidney, or respiratory conditions.
Please contact your local municipal office for details.
In addition, there are three type of optional vaccines(not regulated by law) that an individual can receive at their own
expense: a 23-valent polysaccharide vaccine, 13-valent conjugate
vaccine, and 15-valent conjugate vaccine.
All three types of the pneumococcus vaccine (the 23valent polysaccharide vaccine, 13-valent conjugate vaccine,and 15-valent conjugate vaccine) are available to the elderly,
individuals with respiratory, heart, liver, or kidney conditions,individuals with diabetes, and individuals who have an elevated riskof pneumococcal infection, such as those who have undergone a
splenectomy as the result of illness or injury.
The 23-valent polysaccharide vaccine is available toindividuals aged 65 (and, through fiscal year 2023, to those aged
70 and over at an interval of 5 years) and individuals aged 60–64
who have serious heart, kidney, or respiratory conditions as aroutine vaccination covered by public funding in accordance withthe law. For more information, contact your doctor or local municipal
office. Japan’s national health insurance also covers vaccinations
for those who have undergone a splenectomy. Others wishing toreceive the vaccine may do so at their own expense.
The 13-valent conjugate vaccine and 15-valent conjugate vaccine
are also available as optional vaccines that individuals can choose
to receive at their own expense.

that occurs when this dormant virus later−due to lowered

24

25

immunity resulting from overwork, aging, or illness−again
becomes active and presents as a band of rash on the skinaccompanied by pain and blisters.

Who is eligible for this vaccine?
The vaccine sold in Japan to prevent herpes zoster (shingles)
comes in two types: a live type and an inactivated type. The
live vaccine, which is the same one used to prevent varicella,is administered in a single dose in individuals aged 50 andover. The inactivated vaccine is administered in two doses
in individuals aged 50 and over as well as individuals 18 andover who are thought to be at elevated risk of contracting
herpes zoster. The inactivated vaccine is administered in two
doses. The live vaccine for preventing herpes zoster cannot
be administered to ill people with abnormal immune function
or people undergoing immunosuppressant treatment.

21. Adult Pneumococcal Infections
Adult Pneumococcal Infections

Pneumococcus can cause a variety of infectious diseases including
pneumonia, meningitis, bacteremia, bronchitis, and otitis media(middle ear infection). Pneumococcus is a frequent bacterialcause of pneumonia, which the elderly and those with underlying
conditions are known to be particularly susceptible to contracting
and developing severe symptoms of. Some pneumococcidemonstrate resistance to penicillin and other antibiotics,
underscoring the need for vaccination.

Who is eligible for this vaccine?

22. Herpes Zoster (Shingles)
Herpes Zoster (Shingles)
Herpes zoster (shingles) is a disease caused by the same
virus that causes varicella (chicken pox): the varicellazoster virus. People often contract varicella in childhood,
but this virus remains dormant in the body even after they
have recovered. Herpes zoster (shingles) is a condition

Routine vaccinations using the 23-valent polysaccharide vaccine
and covered by public funding in accordance with the law areavailable to people aged 65 (and, through fiscal year 2023, to those
aged 70 and over at an interval of 5 years) and to people aged 60
to 64 who have serious heart, kidney, or respiratory conditions.
Please contact your local municipal office for details.
In addition, there are three type of optional vaccines(not regulated by law) that an individual can receive at their own
expense: a 23-valent polysaccharide vaccine, 13-valent conjugate
vaccine, and 15-valent conjugate vaccine.
All three types of the pneumococcus vaccine (the 23valent polysaccharide vaccine, 13-valent conjugate vaccine,and 15-valent conjugate vaccine) are available to the elderly,
individuals with respiratory, heart, liver, or kidney conditions,individuals with diabetes, and individuals who have an elevated riskof pneumococcal infection, such as those who have undergone a
splenectomy as the result of illness or injury.
The 23-valent polysaccharide vaccine is available toindividuals aged 65 (and, through fiscal year 2023, to those aged
70 and over at an interval of 5 years) and individuals aged 60–64
who have serious heart, kidney, or respiratory conditions as aroutine vaccination covered by public funding in accordance withthe law. For more information, contact your doctor or local municipal
office. Japan’s national health insurance also covers vaccinations
for those who have undergone a splenectomy. Others wishing toreceive the vaccine may do so at their own expense.
The 13-valent conjugate vaccine and 15-valent conjugate vaccine
are also available as optional vaccines that individuals can choose
to receive at their own expense.

that occurs when this dormant virus later−due to lowered

24

25

immunity resulting from overwork, aging, or illness−again
becomes active and presents as a band of rash on the skinaccompanied by pain and blisters.

Who is eligible for this vaccine?
The vaccine sold in Japan to prevent herpes zoster (shingles)
comes in two types: a live type and an inactivated type. The
live vaccine, which is the same one used to prevent varicella,is administered in a single dose in individuals aged 50 andover. The inactivated vaccine is administered in two doses
in individuals aged 50 and over as well as individuals 18 andover who are thought to be at elevated risk of contracting
herpes zoster. The inactivated vaccine is administered in two
doses. The live vaccine for preventing herpes zoster cannot
be administered to ill people with abnormal immune function
or people undergoing immunosuppressant treatment.

24. Vaccinations Required
for Overseas Travel

23. Hepatitis A
Hepatitis A
This contagious disease causes acute hepatitis as a resultof oral transmission through food or water contaminated withthe hepatitis A virus or sexual contact with infected persons.
Although infants infected with the virus often don’t show
symptoms, most adults do. Symptoms include fever of 38°C
or higher, general malaise, diarrhea and jaundice that take
2–3 months to recover from. On rare occasions the diseasedevelops into fulminant hepatitis.

Who is eligible for this vaccine?

Vaccinations Required for Overseas Travel
There are numerous infectious diseases in the world. It isnecessary first to be properly vaccinated in Japan before
travelling abroad. Particularly for children planning to study
abroad or families anticipating extended stays overseas, werecommend you create and follow a vaccination scheduletailored to conditions at your destination and receive
vaccinations in Japan in advance. For some destinations,
it is also necessary to take precautions against mosquito-

The vaccine is recommended for individuals such as those
traveling to any country where hepatitis A is endemic (forbusiness, pleasure, work, or study, etc.), those involved in
the production or preparation of marine products, medical
and nursing professionals who have frequent contact with
hepatitis A patients, those working at facilities such as
nursery schools and kindergartens, those with chronic liverdisease who are negative for the hepatitis A antibody, andthose in the vicinity of a mass or familial outbreak of hepatitis
A. Two administrations are performed at an interval of 2 to
4 weeks followed by a third administration 24 weeks after
the initial one. For those in a hurry to develop immunity, thetwo administrations at a 2-week interval will provide somemeasure of immunity, but the third administration provides
longer-term immunity. Vaccination is recommended for those
traveling to countries where hepatitis A is epidemic, but
caution is advised because foodborne infection occurs evenin Japan.

・Information about staying healthy when overseas, provided
by the Ministry of Health, Labor and Welfare Quarantine
Station (FORTH):▶ http://www.forth.go.jp/

26

27borne diseases such as malaria and dengue fever. Moreinformation is available at destination country embassies,
local quarantine stations throughout Japan, and the websites
listed below.

・Ministry of Foreign Affairs Overseas Safety Precautions:
World Medical Information:▶ http://www.mofa.go.jp/mofaj/toko/medi/index.html
・Information on safety overseas, provided by the Ministry ofForeign Affairs:▶ http://www.anzen.mofa.go.jp/

24. Vaccinations Required
for Overseas Travel

23. Hepatitis A
Hepatitis A
This contagious disease causes acute hepatitis as a resultof oral transmission through food or water contaminated withthe hepatitis A virus or sexual contact with infected persons.
Although infants infected with the virus often don’t show
symptoms, most adults do. Symptoms include fever of 38°C
or higher, general malaise, diarrhea and jaundice that take
2–3 months to recover from. On rare occasions the diseasedevelops into fulminant hepatitis.

Who is eligible for this vaccine?

Vaccinations Required for Overseas Travel
There are numerous infectious diseases in the world. It isnecessary first to be properly vaccinated in Japan before
travelling abroad. Particularly for children planning to study
abroad or families anticipating extended stays overseas, werecommend you create and follow a vaccination scheduletailored to conditions at your destination and receive
vaccinations in Japan in advance. For some destinations,
it is also necessary to take precautions against mosquito-

The vaccine is recommended for individuals such as those
traveling to any country where hepatitis A is endemic (forbusiness, pleasure, work, or study, etc.), those involved in
the production or preparation of marine products, medical
and nursing professionals who have frequent contact with
hepatitis A patients, those working at facilities such as
nursery schools and kindergartens, those with chronic liverdisease who are negative for the hepatitis A antibody, andthose in the vicinity of a mass or familial outbreak of hepatitis
A. Two administrations are performed at an interval of 2 to
4 weeks followed by a third administration 24 weeks after
the initial one. For those in a hurry to develop immunity, thetwo administrations at a 2-week interval will provide somemeasure of immunity, but the third administration provides
longer-term immunity. Vaccination is recommended for those
traveling to countries where hepatitis A is epidemic, but
caution is advised because foodborne infection occurs evenin Japan.

・Information about staying healthy when overseas, provided
by the Ministry of Health, Labor and Welfare Quarantine
Station (FORTH):▶ http://www.forth.go.jp/

26

27borne diseases such as malaria and dengue fever. Moreinformation is available at destination country embassies,
local quarantine stations throughout Japan, and the websites
listed below.

・Ministry of Foreign Affairs Overseas Safety Precautions:
World Medical Information:▶ http://www.mofa.go.jp/mofaj/toko/medi/index.html
・Information on safety overseas, provided by the Ministry ofForeign Affairs:▶ http://www.anzen.mofa.go.jp/

Vaccines Approved in Japan

beginning ten days after the vaccination, but beginning inYellow Fever

July 2016 they are now valid for life. Even older certificates

Yellow fever is a disease endemic to parts of Africa andwith set validity periods are now permanently valid; they will

South America within a range of about 15 degrees latitude

never expire. Make sure to keep your certificate in a safe

centered on the equator. It is caused by the yellow feverplace.

virus, which is spread through the bite of a yellow fever

Rabiesvirus infected mosquito (Aedes aegypti). After an incubation

Rabies is transmitted when an animal infected with theperiod of 3−6 days, yellow fever typically presents symptoms

rabies virus bites someone or licks an open wound, andincluding headaches, dizziness, fever, sore muscles, andleads to death in nearly 100% of full-blown cases. There

nausea, followed by jaundice, vomiting blood, bloody bowel

have been no cases in Japan since 1957 but in 2020 there

discharge, and albumin in the urine. Serious cases of yellow

were imported infections in people returning to Japan after

fever can lead to coma or death. The fatality rate for severe

being bitten by animals overseas. The vaccine may be usedcases is generally said to be 20% or higher.

preventively prior to being bitten by animals (pre-exposure)or to prevent onset after being bitten (post-exposure). After

Who is eligible for this vaccine?

being bitten by an animal, even those who have received

Vaccinations are available at quarantine stations and medicala pre-exposure rabies vaccination must receive anotherfacilities designated by the Ministry of Health, Labour andvaccination to prevent post-exposure onset.

Welfare. See FORTH for more information. The vaccinations
are administered as a single 0.5ml subcutaneous injection.

Who is eligible for this vaccine?

Infants younger than 9 months cannot receive the vaccine.

The number of doses administered and the intervals between

Some countries require an international certificate ofadministrations differ depending on whether the vaccine

vaccination in order to enter the country. Certificates ofis for pre-exposure immunity or post-exposure immunity.

vaccination were previously valid for a period of ten years

Please consult with your physician when getting vaccinated.

28

29

Vaccines Approved in Japan

beginning ten days after the vaccination, but beginning inYellow Fever

July 2016 they are now valid for life. Even older certificates

Yellow fever is a disease endemic to parts of Africa andwith set validity periods are now permanently valid; they will

South America within a range of about 15 degrees latitude

never expire. Make sure to keep your certificate in a safe

centered on the equator. It is caused by the yellow feverplace.

virus, which is spread through the bite of a yellow fever

Rabiesvirus infected mosquito (Aedes aegypti). After an incubation

Rabies is transmitted when an animal infected with theperiod of 3−6 days, yellow fever typically presents symptoms

rabies virus bites someone or licks an open wound, andincluding headaches, dizziness, fever, sore muscles, andleads to death in nearly 100% of full-blown cases. There

nausea, followed by jaundice, vomiting blood, bloody bowel

have been no cases in Japan since 1957 but in 2020 there

discharge, and albumin in the urine. Serious cases of yellow

were imported infections in people returning to Japan after

fever can lead to coma or death. The fatality rate for severe

being bitten by animals overseas. The vaccine may be usedcases is generally said to be 20% or higher.

preventively prior to being bitten by animals (pre-exposure)or to prevent onset after being bitten (post-exposure). After

Who is eligible for this vaccine?

being bitten by an animal, even those who have received

Vaccinations are available at quarantine stations and medicala pre-exposure rabies vaccination must receive anotherfacilities designated by the Ministry of Health, Labour andvaccination to prevent post-exposure onset.

Welfare. See FORTH for more information. The vaccinations
are administered as a single 0.5ml subcutaneous injection.

Who is eligible for this vaccine?

Infants younger than 9 months cannot receive the vaccine.

The number of doses administered and the intervals between

Some countries require an international certificate ofadministrations differ depending on whether the vaccine

vaccination in order to enter the country. Certificates ofis for pre-exposure immunity or post-exposure immunity.

vaccination were previously valid for a period of ten years

Please consult with your physician when getting vaccinated.

28

29

*1

*2

*3

*4

Vaccination started in Japan on December 19, 2008. Although those aged 2 months or older but younger than
5 years are targeted, the standard period for the first dose is from at least 2 months to younger than 7 months
old. Vaccination is done by three subcutaneous inoculations. Normally, 3 doses are given subcutaneously
at intervals of 27 or more days before 12 months of age (possibly at 20-day intervals if the physician deems
it necessary). If the first dose is given after 7 months or older but younger than 12 months, usually 2 doses
are given subcutaneously at interval of at least 27 days (possibly at a 20-day interval if the physician deems
it necessary). After the first dose, the following dose is given by subcutaneous inoculation after an interval ofmore than 7 months. If the first dose is given when a child is 1 year or older but younger than 5 years old, it isnormally one dose by subcutaneous inoculation.
This has been introduced as a routine vaccination replacing 7-valent conjugate vaccines since November 1,
2013. The first dose is given at 2 months or older but younger than 7 months, followed by two more doses
given at intervals of at least 27 days. Normally a booster shot is given between 12 to 15 months of age, fora total of 4 inoculations. Those who missed their vaccination may be vaccinated according to the following
schedule:
If the child is 1 year old when vaccination begins, two doses are administered at an interval of 60 days.
If the child is 2 to 4 years old when vaccination begins, a single dose is administered.
Since June 2014, vaccination has been available to elderly people aged 65 and over.
Since 29 May 2020, vaccination has been available to people ages 6 to 64 “thought to be at elevated risk ofcontracting diseases caused by pneumococcal bacteria.”
Note that people “thought to be at elevated risk of contracting diseases caused by pneumococcal bacteria”
include those:• who have chronic cardiac, respiratory, liver, or kidney conditions;• who have diabetes;• who are or may be immunodeficient due to underlying conditions or treatment;• who have congenital or acquired asplenia (those with asplenia syndrome or who have undergone a
splenectomy);• who have sickle cell anemia or other hemoglobinopathy;• who have reduced biological defense functions due to the use of a cochlear implant or to anatomicalfactors such as chronic cerebrospinal fluid leakage; or• who have been determined by a physician to require vaccination for some other reason.
Note: Administration methods differ by age: subcutaneous injection for people aged between 2 months and 5
years and intramuscular injection for people aged 6 years and over.
Vaccination started in Japan on April 10, 2023. Vaccination has been available to children since June 26,
2023. The vaccine is administered to elderly people and those aged 18 and over who are thought to be atelevated risk of contracting diseases caused by pneumococcal bacteria via a single intramuscular injection.
For those younger than 18 who are thought to be at elevated risk of contracting diseases caused bypneumococcal bacteria, the vaccine is administered via a single subcutaneous or intramuscular injection. For
the prevention of invasive infections caused by pneumococcal bacteria in children, 3 doses are administeredsubcutaneously or intramuscularly at an interval of at least 27 days. A booster shot is administered via asingle subcutaneous or intramuscular injection at least 60 days after the third dose. Those who missed theirvaccination may be vaccinated subcutaneously or intramuscularly according to the following schedule:Ifthe child is aged 7 months or older but younger than 12 months when vaccination begins, after 2 doses
are administered at an interval of at least 27 days, a single booster shot is administered when the child isaged at least 1 year and at least 60 days have passed after the second dose. If the child is 1 year old when
vaccination begins, 2 doses are administered at an interval of at least 60 days. If the child is aged 2 years orover but younger than 18 when vaccination begins, a single dose is administered. For examples of people“thought to be at elevated risk of contracting diseases caused by pneumococcal bacteria,” see *2.
Introduced as a routine vaccination on October 1, 2016 for those born on or after April 1, 2016. Vaccinations
to prevent mother-to-child transmission must be received together with HB immunoglobulin under healthinsurance coverage rather than as a routine vaccination
Indications Covered Under Health Insurance:① Prevention of mother-to-child Hepatitis B virus transmission[HB vaccine (together with anti-HBs human immunoglobulin)] Typically, a single 0.25mL dose isadministered subcutaneously within 12 hours of birth. (May be administered more than 12 hours
after birth depending on the condition of the infant, but as soon as possible after birth in any case.)
Two subcutaneous booster shots of 0.25mL each administered one and six months after the initial
vaccination. However, booster shots are administered when there is an absence of active anti-HBs.
[HBIG (in principle, together with HB vaccine)] Initial intramuscular injection of 0.5 to 1.0mL within
5 days of birth (preferably within 12 hours of birth). A booster shot of 0.16 to 0.24 mL is also
administered.

30

The age of vaccination was changed beginning October 18, 2013.
② When used to prevent Hepatitis B in hemophilia patients.
③ Non-occupational use to prevent Hepatitis B in the wake of contamination with HBs antigen-positive
and HBe antigen-positive blood (together with anti-HBs human immunoglobulin).
Covered Under Workers’ Compensation Insurance:① Occupational use in the event of contamination with HBs antigen-positive and HBe antigen-positive
blood (together with anti-HBs human immunoglobulin).
② Occupational use in the event of contamination through contact of an existing wound with HBs antigenpositive and HBe antigen-positive blood (together with anti-HBs human immunoglobulin).
*5 Age from birth is calculated using the date of birth as the reference date (day 0). The first dose should be
administered by the age of 14 weeks and 6 days. Children may be given either two doses of the 1-valent typeor three doses of the 5-valent type. On October 1, 2020, the vaccine was introduced as a routine vaccination
for all children born August 1, 2020, or later.
*6 DPT-IPV is an acronym for diphtheria (D), pertussis (whooping cough) (P), tetanus (lockjaw) (T), andinactivated poliovirus (IPV). IPV was introduced as a routine vaccination on September 1, 2012, and the DPTIPV combination vaccine entered the routine vaccination program on November 1, 2012. The administration
protocol generally comprises four doses. If the child has already received one dose of OPV (oral [live] polio
vaccine), however, he or she should receive three doses of IPV. Since September 1, 2012, OPV has not been
available as part of the routine vaccination program. The DPT-IPV vaccine is a DPT-sIPV vaccine mixed with
IPV made from an inactivated Sabin strain, a live polio vaccine strain.
*7 Once again available beginning January 29, 2018.
*8 Those who have received two doses of live polio vaccine (OPV), except before traveling to countries where
polio is endemic, do not require IPV vaccination. Those who have received one dose of OPV receive threedoses of IPV. Those who have received no doses of OPV receive four doses of IPV.
*9 May be administered as an emergency measure.
*10 In general, the combined MR vaccine is administered. Those who have received either the measles-only or
rubella-only vaccines during a given stage, and those who specifically request single-antigen vaccines, may
opt for a single-antigen vaccine.
*11 See https://www.niid.go.jp/niid/images/idsc/disease/rubella/Rubella-HItiter8_Ver3.pdf (Japanese only) for
details.
*12 Introduced as a routine vaccination on October 1, 2014, with two doses administered at an interval of at least
3 month (typically 6 to 12 months).
*13 Those who were born between April 2, 2007 and October 1, 2009 may receive Stage 1 vaccination as aroutine vaccination during the periods from 6 to 89 months of age and from 9 to 12 years of age.
*14 For those who were born between April 2, 1995 and April 1, 2007, have not received all four doses, andare under 20 years of age.
*15 In general, the same vaccine is to be administered intramuscularly in the prescribed number ofadministrations. The administration interval and number of administrations differ according to the vaccine.
The scope of people eligible for the 4-valent vaccine expanded to include males aged 9 years and over in
December 2020, but the scope of the routine vaccination program comprises only females in grade 6 ofelementary school to year 1 of high school. Females who were born in the years 1997–2005 and have notreceived a total of three doses of the HPV vaccine will have opportunities to receive vaccinations in the period
from April 2022 to March 2025.
*16 Vaccinations are administered to females aged 9 and older via a total of three single 0.5mL intramuscular
injections. The second and third administrations take place 2 months and 6 months after the first, respectively.
In cases where the individual is unable to receive the second and/or third administrations at the prescribedintervals, the second administration is to be performed at least 1 month after the first administration, and thethird administration is to be performed at least 3 months after the second administration. Females aged 9–14
may receive their vaccinations via a total of two administrations, with the second administration between 6
and 12 months after the first administration.
*17 Routine vaccinations are administered once every year. Influenza vaccines from KM Biologics, Biken, andDenka are to be administered no less than 6 months after birth, while the influenza vaccine from Daiichi
Sankyo is to be administered at no less than 1 year of age.
*18 Introduced as a routine vaccination on October 1, 2014. A single-dose routine vaccination is available to those
who turned 65, 70, 75, 80, 85, 90, 95, or 100 or over in FY2019 (the age stipulation in place in FY2019) or willturn 65, 70, 75, 80, 85, 90, 95, or 100 in the corresponding fiscal year (the age stipulation in place since April
1, 2020) and have not yet been vaccinated. Japan’s national health insurance covers the vaccination only incases where the vaccine is administered to “prevent infection caused by pneumococci in individuals aged 2
or over who have undergone a splenectomy.”

31

*1

*2

*3

*4

Vaccination started in Japan on December 19, 2008. Although those aged 2 months or older but younger than
5 years are targeted, the standard period for the first dose is from at least 2 months to younger than 7 months
old. Vaccination is done by three subcutaneous inoculations. Normally, 3 doses are given subcutaneously
at intervals of 27 or more days before 12 months of age (possibly at 20-day intervals if the physician deems
it necessary). If the first dose is given after 7 months or older but younger than 12 months, usually 2 doses
are given subcutaneously at interval of at least 27 days (possibly at a 20-day interval if the physician deems
it necessary). After the first dose, the following dose is given by subcutaneous inoculation after an interval ofmore than 7 months. If the first dose is given when a child is 1 year or older but younger than 5 years old, it isnormally one dose by subcutaneous inoculation.
This has been introduced as a routine vaccination replacing 7-valent conjugate vaccines since November 1,
2013. The first dose is given at 2 months or older but younger than 7 months, followed by two more doses
given at intervals of at least 27 days. Normally a booster shot is given between 12 to 15 months of age, fora total of 4 inoculations. Those who missed their vaccination may be vaccinated according to the following
schedule:
If the child is 1 year old when vaccination begins, two doses are administered at an interval of 60 days.
If the child is 2 to 4 years old when vaccination begins, a single dose is administered.
Since June 2014, vaccination has been available to elderly people aged 65 and over.
Since 29 May 2020, vaccination has been available to people ages 6 to 64 “thought to be at elevated risk ofcontracting diseases caused by pneumococcal bacteria.”
Note that people “thought to be at elevated risk of contracting diseases caused by pneumococcal bacteria”
include those:• who have chronic cardiac, respiratory, liver, or kidney conditions;• who have diabetes;• who are or may be immunodeficient due to underlying conditions or treatment;• who have congenital or acquired asplenia (those with asplenia syndrome or who have undergone a
splenectomy);• who have sickle cell anemia or other hemoglobinopathy;• who have reduced biological defense functions due to the use of a cochlear implant or to anatomicalfactors such as chronic cerebrospinal fluid leakage; or• who have been determined by a physician to require vaccination for some other reason.
Note: Administration methods differ by age: subcutaneous injection for people aged between 2 months and 5
years and intramuscular injection for people aged 6 years and over.
Vaccination started in Japan on April 10, 2023. Vaccination has been available to children since June 26,
2023. The vaccine is administered to elderly people and those aged 18 and over who are thought to be atelevated risk of contracting diseases caused by pneumococcal bacteria via a single intramuscular injection.
For those younger than 18 who are thought to be at elevated risk of contracting diseases caused bypneumococcal bacteria, the vaccine is administered via a single subcutaneous or intramuscular injection. For
the prevention of invasive infections caused by pneumococcal bacteria in children, 3 doses are administeredsubcutaneously or intramuscularly at an interval of at least 27 days. A booster shot is administered via asingle subcutaneous or intramuscular injection at least 60 days after the third dose. Those who missed theirvaccination may be vaccinated subcutaneously or intramuscularly according to the following schedule:Ifthe child is aged 7 months or older but younger than 12 months when vaccination begins, after 2 doses
are administered at an interval of at least 27 days, a single booster shot is administered when the child isaged at least 1 year and at least 60 days have passed after the second dose. If the child is 1 year old when
vaccination begins, 2 doses are administered at an interval of at least 60 days. If the child is aged 2 years orover but younger than 18 when vaccination begins, a single dose is administered. For examples of people“thought to be at elevated risk of contracting diseases caused by pneumococcal bacteria,” see *2.
Introduced as a routine vaccination on October 1, 2016 for those born on or after April 1, 2016. Vaccinations
to prevent mother-to-child transmission must be received together with HB immunoglobulin under healthinsurance coverage rather than as a routine vaccination
Indications Covered Under Health Insurance:① Prevention of mother-to-child Hepatitis B virus transmission[HB vaccine (together with anti-HBs human immunoglobulin)] Typically, a single 0.25mL dose isadministered subcutaneously within 12 hours of birth. (May be administered more than 12 hours
after birth depending on the condition of the infant, but as soon as possible after birth in any case.)
Two subcutaneous booster shots of 0.25mL each administered one and six months after the initial
vaccination. However, booster shots are administered when there is an absence of active anti-HBs.
[HBIG (in principle, together with HB vaccine)] Initial intramuscular injection of 0.5 to 1.0mL within
5 days of birth (preferably within 12 hours of birth). A booster shot of 0.16 to 0.24 mL is also
administered.

30

The age of vaccination was changed beginning October 18, 2013.
② When used to prevent Hepatitis B in hemophilia patients.
③ Non-occupational use to prevent Hepatitis B in the wake of contamination with HBs antigen-positive
and HBe antigen-positive blood (together with anti-HBs human immunoglobulin).
Covered Under Workers’ Compensation Insurance:① Occupational use in the event of contamination with HBs antigen-positive and HBe antigen-positive
blood (together with anti-HBs human immunoglobulin).
② Occupational use in the event of contamination through contact of an existing wound with HBs antigenpositive and HBe antigen-positive blood (together with anti-HBs human immunoglobulin).
*5 Age from birth is calculated using the date of birth as the reference date (day 0). The first dose should be
administered by the age of 14 weeks and 6 days. Children may be given either two doses of the 1-valent typeor three doses of the 5-valent type. On October 1, 2020, the vaccine was introduced as a routine vaccination
for all children born August 1, 2020, or later.
*6 DPT-IPV is an acronym for diphtheria (D), pertussis (whooping cough) (P), tetanus (lockjaw) (T), andinactivated poliovirus (IPV). IPV was introduced as a routine vaccination on September 1, 2012, and the DPTIPV combination vaccine entered the routine vaccination program on November 1, 2012. The administration
protocol generally comprises four doses. If the child has already received one dose of OPV (oral [live] polio
vaccine), however, he or she should receive three doses of IPV. Since September 1, 2012, OPV has not been
available as part of the routine vaccination program. The DPT-IPV vaccine is a DPT-sIPV vaccine mixed with
IPV made from an inactivated Sabin strain, a live polio vaccine strain.
*7 Once again available beginning January 29, 2018.
*8 Those who have received two doses of live polio vaccine (OPV), except before traveling to countries where
polio is endemic, do not require IPV vaccination. Those who have received one dose of OPV receive threedoses of IPV. Those who have received no doses of OPV receive four doses of IPV.
*9 May be administered as an emergency measure.
*10 In general, the combined MR vaccine is administered. Those who have received either the measles-only or
rubella-only vaccines during a given stage, and those who specifically request single-antigen vaccines, may
opt for a single-antigen vaccine.
*11 See https://www.niid.go.jp/niid/images/idsc/disease/rubella/Rubella-HItiter8_Ver3.pdf (Japanese only) for
details.
*12 Introduced as a routine vaccination on October 1, 2014, with two doses administered at an interval of at least
3 month (typically 6 to 12 months).
*13 Those who were born between April 2, 2007 and October 1, 2009 may receive Stage 1 vaccination as aroutine vaccination during the periods from 6 to 89 months of age and from 9 to 12 years of age.
*14 For those who were born between April 2, 1995 and April 1, 2007, have not received all four doses, andare under 20 years of age.
*15 In general, the same vaccine is to be administered intramuscularly in the prescribed number ofadministrations. The administration interval and number of administrations differ according to the vaccine.
The scope of people eligible for the 4-valent vaccine expanded to include males aged 9 years and over in
December 2020, but the scope of the routine vaccination program comprises only females in grade 6 ofelementary school to year 1 of high school. Females who were born in the years 1997–2005 and have notreceived a total of three doses of the HPV vaccine will have opportunities to receive vaccinations in the period
from April 2022 to March 2025.
*16 Vaccinations are administered to females aged 9 and older via a total of three single 0.5mL intramuscular
injections. The second and third administrations take place 2 months and 6 months after the first, respectively.
In cases where the individual is unable to receive the second and/or third administrations at the prescribedintervals, the second administration is to be performed at least 1 month after the first administration, and thethird administration is to be performed at least 3 months after the second administration. Females aged 9–14
may receive their vaccinations via a total of two administrations, with the second administration between 6
and 12 months after the first administration.
*17 Routine vaccinations are administered once every year. Influenza vaccines from KM Biologics, Biken, andDenka are to be administered no less than 6 months after birth, while the influenza vaccine from Daiichi
Sankyo is to be administered at no less than 1 year of age.
*18 Introduced as a routine vaccination on October 1, 2014. A single-dose routine vaccination is available to those
who turned 65, 70, 75, 80, 85, 90, 95, or 100 or over in FY2019 (the age stipulation in place in FY2019) or willturn 65, 70, 75, 80, 85, 90, 95, or 100 in the corresponding fiscal year (the age stipulation in place since April
1, 2020) and have not yet been vaccinated. Japan’s national health insurance covers the vaccination only incases where the vaccine is administered to “prevent infection caused by pneumococci in individuals aged 2
or over who have undergone a splenectomy.”31

*19 As of February 10, 2023, the two available vaccines are a diphtheria toxoid conjugate vaccine (product name:
Menactra) and a tetanus toxoid conjugate vaccine (product name: MenQuadfi). These vaccines prevent
invasive meningococcal disease caused by serogroups A, C, Y, and W.
Health insurance coverage applies when Eculizumab (product name: Soralis intravenous drip) is administered
to control hemolysis in patients with paroxysmal nocturnal hemoglobinuria, control thrombotic microangiopathy
in patients with atypical hemolytic uremic syndrome, relapse in whole-body myasthenia gravis, or relapse inneuromyelitis optica spectrum disorder (including neuromytelitis optica); when Ravulizumab (product name:
Ultomiris for intravenous infusion) is administered for paroxysmal nocturnal hemoglobinuria, atypical hemolytic
uremic syndrome, or whole-body myasthenia gravis; and when Sutimlimab (product name: Enjaymo) is
administered for cold agglutinin disease. In some cases involving the use of complement inhibitors, theadministration of a meningococcal vaccine is necessary even in individuals under the age of 2.
*20 Administered only at quarantine stations, not at general healthcare facilities.
*21 There are two vaccines: one from KM Biologics that is administered subcutaneously and one from GSK thatis administered intramuscularly. For the number of administrations and the intervals between them, please
consult the package insert for each vaccine.As of October 2022, shipments of the KM Biologics vaccine aresuspended indefinitely.
*22 For those aged 50 and over, the vaccine is administered via two intramuscular doses (0.5mL each), usually 2months apart. For those aged 18 and over who are thought to be at elevated risk of contracting herpes zoster,
the vaccine is administered via two intramuscular doses (0.5mL each), usually 1 to 2 months apart. Individuals
thought to be at elevated risk of contracting herpes zoster include those:・who are immunodeficient due to underlying conditions or treatment or those whose immune
system is weakened or may be weakened; or・who have been determined by a physician to require vaccination for some other reason.
*23 Granted approval on February 14, 2021 (Comirnaty intramuscular injection: Pfizer) and available starting
February 17, 2021. The vaccine is diluted with 1.8mL of physiological saline (Japanese Pharmacopoeia
grade), and two doses (0.3mL each) are administered intramuscularly, usually 3 weeks apart.On June 1,
2021, the minimum age of administration was changed from 16 to 12. Individuals may receive their third doseat least 3 months after their second dose and their fourth dose at least 3 months after their third dose.
*24 Granted special approval on January 21, 2022. The vaccine is diluted with 1.3mL of physiological saline(Japanese Pharmacopoeia grade), and two doses (0.2mL each) are administered intramuscularly, usually 3
weeks apart. Individuals may receive their third dose at least 3 months after their second dose.
*25 Granted approval on February 27, 2023 (Comirnaty intramuscular injection for ages 5–11 (2-valent:
Original/Omicron BA.4-5): Pfizer) and available starting March 8, 2023. The vaccine is diluted with
1.3mL of physiological saline (Japanese Pharmacopoeia grade). A booster shot of 0.2mL is administeredintramuscularly in a single dose. The booster shot may be administered at least 3 months after the mostrecent administration of a SARS-CoV-2 vaccine.
*26 Granted approval on October 5, 2022 (Comirnaty intramuscular injection for ages 6 months–4: Pfizer) andavailable starting October 24, 2022. The vaccine is diluted with 2.2mL of physiological saline, and two doses(0.2mL each) are administered intramuscularly, usually 3 weeks apart. The third dose is administered at least
8 weeks after the second dose.
*27 Granted approval on April 19, 2022 (Nuvaxovid intramuscular injection: Takeda/Novavax) and available
starting May 25, 2022. The vaccine, available to individuals aged 12 and over, is undiluted, and two doses(0.5mL each) are administered intramuscularly, usually 3 weeks apart.
Individuals aged 12 and over may receive a booster shot at least 6 months after their most recent dose of a
SARS-CoV-2 vaccine.
*28 The Comirnaty RTU intramuscular injection (2-valent: Original/Omicron BA.1) was granted approval on
September 12, 2022, and made available starting September 20, 2022. The Comirnaty RTU intramuscular
injection (2-valent: Original/Omicron BA.4-5) was granted approval on October 5, 2022, and made available
starting October 13, 2022.
A booster shot of 0.3mL is administered intramuscularly in a single dose. Individuals aged 12 and over who
have already received an initial dose or booster shot of a SARS-CoV-2 vaccine are eligible for the booster
shot. The booster shot may be administered at least 3 months after the most recent administration of a
SARS-CoV-2 vaccine.
*29 The Spikevax intramuscular injection (2-valent: Original/Omicron BA.1) was granted approval on September
12, 2022, and made available starting September 20, 2022. The Spikevax intramuscular injection (2-valent:
Original/Omicron BA.4-5) was granted approval on November 1, 2022, and made available on November
28, 2022. A booster shot of 0.5mL is administered intramuscularly. Individuals aged 12 and over who havealready received an initial dose or booster shot of a SARS-CoV-2 vaccine are eligible for the booster shot.
The booster shot may be administered at least 3 months after the most recent administration of a SARSCoV-2 vaccine.

3233