Vaccinations in Japan (予防接種 yobosesshu) are administered in a different manner than many of our home countries and therefore can be difficult to navigate. This article will attempt to give a an overview of childhood vaccinations in Japan; however, since they are administered by each municipality the information may differ where you live. Please check with your pediatrician or the Vaccination Department of your local health centre (保険予防課 hokenyoboka) for local information.

Vaccinations are regulated by Law No. 68 (June 30, 1948) which lists the vaccinations required to be provided for free by municipalities. There were fines for non-compliance with the vaccine law in the post-war years, but the fines were rescinded in 1976.

Vaccine records are expected to be held by each individual in the mother-child handbook (母子手帳 boshitecho) provided by each municipal health centre during pregnancy. If you have moved to Japan after the birth of your children, you can ask for one at your municipal health centre. The vaccination pages have room for the name of each vaccination as well as the lot number, date received, and the institution where it was received, making it easy to track and to be sure that vaccinations are not given during the rest interval.

An example of a vaccination page from the mother-child handbook.

Vaccinations are divided into two major categories: Routine (paid for by the government, required) which includes BCG, MR, Japanese Encephalitis, polio, and DPT-IV (including the followup DT), and Optional (sometimes paid for by parents, not required) which includes Hepatitis B, seasonal influenza, Hib, streptococcus pneumonia, HPV, chicken pox (varicella), mumps, and rotavirus. They are further divided into live and inactivated vaccines, indicated below. Live vaccines require a longer rest interval between doses, at least 27 days, in comparison with 6 days for inactivated vaccines.

In general, vaccinations are performed at pediatric clinics (or other clinics/hospitals which see children), based on forms provided by the municipal health centre. Most pediatricians will have a certain time on a day of the week when they only see children for vaccinations. This is so that healthy children don’t have to wait in a waiting room with sick children. However, those hours are likely to be 2:30 to 3:30 on a weekday so it may not be convenient for working parents. Ask your clinic if they will provide vaccinations outside these hours.

In general, you will get a form for the routine vaccination in the mail from your health centre (directly from the clinic for optional vaccines such as influenza). Fill it out and bring it to your pediatric or other trusted clinic, after calling ahead to see if appointments are necessary. Also bring your mother-child handbook and health insurance card. Reschedule if your child has a fever over 38C. Most clinics require children to stay in the clinic for 30 minutes after the vaccination to monitor for adverse reactions.

Routine Vaccinations
BCG (live): The Bacillus Calmette–Guérin vaccine is one of the world’s oldest, and protects against tuberculosis. It is administered by applying an ampoule of live vaccine to the upper arm of an infant using a 9-point stamp apparatus. There will initially be very little redness, but then it will eventually getter redder and scab over before healing. This is part of the process of checking for efficacy. Although scarring in older people was common, recently most children outgrow the scars. Administered once, between 3 months and 1 year old.

MR (live) 麻疹風疹 mashin fushin: The MR vaccine protects against measles and rubella. Administered twice as a shot, first at 1-2 years and second at between 5 and 7 years old.

Japanese Encephalitis (inactivated) 日本脳炎 nihon noen: Although technically classed as mandatory, it depends on where you live whether your doctor will recommend it for your child. Four shots are required in total; 2 between the ages of 3 and 5, 1 shot a year after the second shot, and 1 between 9 and 13 years old.

DPT-IPV (inactivated) 四種混合 yonshukongo: This is 4 vaccines in one, a tetravalent combination vaccine that provides protection against diphtheria, pertussis (whooping cough), tetanus, and acute poliomyelitis. Until early 2013, this was normally given as just DPT 三種混合 sanshukongo, and polio was not included, and this can still be ordered easily depending on the status of a child’s polio vaccination. There are four shots in total required; the first three are given between 3 months and 1 year, and the booster is given 6 months after the first shot. The followup DT (diphtheria and tetanus) is given at 11 years old.

Polio (inactivated at the present) ポリオ: Until September 2012 polio was administered twice as an oral live vaccine at municipal health checks. Now it is administered as the inactivated vaccine, but there are two main ways of doing it, as part of DPT-IPV, or as the standalone polio vaccine (4 shots, 3 between 3 months and 1 year, and a booster at least 6 months later). The first is as part of the DPT-IPV noted above, and the second is alone as an IPV shot only, depending on whether a child has received the DPT separately or not. If your child has had the DPT but no polio vaccine, ask for the separate inactivated polio shot. If your child has had neither DPT nor polio, ask for the DPT-IPV above. If your child has had DPT and 1 oral vaccine, your child will need 3 of the 4 normal polio shots. If your child has had DPT and 2 oral polio doses, s/he is finished the full course.

Optional Vaccinations
(normally not funded but it depends on the municipality prices depend on clinic so shop around!)

Hepatitis B (inactivated) B型肝炎 B gata kanen: This shot protects against hepatitis B, a liver disease, 4 shots in total. First given at 2 days after birth, then 2, 3, and 5 months later. This one is normally administered by an obstetrician. The price is between ¥5000 and ¥7000 per dose.

Seasonal Influenza (inactivated) : Administered yearly for those 6 months and older, sometime between October and December. This protects against influenza, the respiratory virus, not “stomach flu.” There is 1 dose for those 13 years and older and 2 doses for those 13 years and younger. Between ¥2000 and ¥4000 per dose. Most employer insurance plans partially fund influenza vaccines for dependents, so ask your HR about this.

HiB (inactivated) : This vaccination against hemophilus influenza (Hib) protects against meningitis. Many municipalities fund this and call this a routine vaccination, but it is not in the Vaccine Provision Law. There are 4 shots in total, administered from 2 months, 3 at first and then a booster 7-12 months. If not funded the price is about ¥40000 so quite different than the other vaccines.

Streptoccocus Pneumoniae (inactivated) 小児肺炎球菌　shonihaienkyukin (PCV): This prevents against pneumococcal disease, and is often funded for preemies and children with asthma. There are 4 shots in total, administered from 2 months, 3 at first and then a booster 7-12 months. Many municipalities cover this for children in the target range, or offer a coupon for half the amount (so it costs about ¥5000 per dose).

HPV (inactivated) 子宮頸がん shikyukeigan: This vaccine is against human papilloma virus, which causes most cervical cancers. Two vaccines, a quadrivalent vaccine (Gardasil) and bivalent vaccine (Cervarix) are available in Japan. They are available for 11 year olds to 15 year old girls, and most municipalities cover the cost for girls only. There are 3 doses, 1 month apart for Cervarix and 2 months apart for Gardasil. These are available from pediatricians and gynecologists.

Chicken Pox (Varicella) (live) みずぼうそう mizuboso: This is a 2-dose shot meant to be given after the MR vaccine is administered, from 1 year. Cost is approximately ¥7-9000 per dose.

Mumps (live) おたふく風邪　otafukukaze:  This is a 2-dose shot from 1 year, around the same time as MR and Chicken Pox vaccines are administered. The second shot is to be administered 2 4 years after the first. Cost is approximately ¥5-7000 per dose.

Rotavirus(live) ロタウイルス rotavirus: There are two vaccines available in Japan, Rotarix (2 doses) or Rotateq (3 doses) and both protect against rotavirus strains of gastroenteritis. The cost is between ¥9000 and ¥14000 but many municipalities have a ¥3-5000 subsidy.

If you are still having trouble deciding when to get the vaccines for your children, a Japanese NPO has a free vaccination scheduler app for Androids and iPhones.

Here is a simple PDF of the routine and optional vaccines available. Ask your local health centre and your employer for information on any subsidies available.Vaccines in Japan 2014.