Health Professionals

Clinical Updates

Updated 16 May 2011

Advice for travel to areas of Japan affected by the earthquake and tsunami of 11 March 2011

Regions affected

  • The northeast coast of Honshu island.
  • The worst affected areas are the east coast of Tohoku region and southern Hokkaido.  
  • Following explosions at the Fukushima nuclear facility 150km north of Tokyo, a 20km restricted area around the facility is in place. Anyone entering the restricted area is liable to a fine.
  • As an extra precaution, the Foreign and Commonwealth Office (FCO) advises British nationals to remain outside an 60km radius of the nuclear facility.

View a map of affected areas on the Reliefweb website

Safety

  • The FCO is currently advising against all but essential travel to areas north-east of Tokyo affected by the earthquake and tsunami.
  • The FCO advises that anyone within an 60km radius of the Fukushima nuclear facility should leave the area or remain indoors if unable to travel.
  • Areas within a 30km radius of the nuclear facility are subject to evacuation.
  • Travellers intending to visit Japan should regularly consult the FCO website for the latest information about safety and the advisability of travelling.
  • Travellers should check with their airline and tour operator to see if their intended travel is still going ahead.  
  • British nationals in Japan should follow local advice to ensure their safety in the event of further aftershocks and tsunamis.
  • British nationals in Japan should contact the FCO if they require assistance and to report that they are safe. The FCO helpline number is: +44 (0)20 7008 0000.
  • Consular staff at the British Embassy in Tokyo are available between 09:30-14:30 Monday to Friday to provide assistance to British nationals. If assistance is required outside of these hours, the British Embassy can be contacted on 03 5211 1100.
  • The FCO can also be contacted via email (japan.earthquake@fco.gov.uk) or skype (text not call) on "fcojapan" and updates are available via social media including twitter (@fcotravel) and Facebook.
  • All travellers to Japan should ensure they have appropriate health insurance, and that it is valid, particularly if visiting areas affected by the earthquake and tsunami.

Infectious disease risks

To date there have been no reports of specific disease outbreaks as a result of this natural disaster. However, lack of adequate clean drinking water and sanitation facilities, psychosocial trauma, and overcrowding in evacuation centres could contribute to the risk of disease outbreaks.  

Food and water advice

Flooding, stagnant water and contamination of the water supply are conducive to development of diseases such as salmonellosis, campylobacter infection, shigellosis, hepatitis A and E, and intestinal parasites including Giardia and Cryptosporidium.

Careful food and water hygiene precautions should be employed by travellers to affected areas.

Reliable sources of bottled water may not be available and it may be necessary to use water sterilisation methods. Bringing water to a boil is the most reliable method, but this may not always be practical. Using chlorine preparations to purify water is usually effective but protozoan parasites such as Cryptosporidium and Giardia are not always killed by these agents. In these cases combining chlorine treatment with filtration of water using a portable water filter that has a filter size of 0.2 µm to 1.0 µm should be performed.

Those with gastrointestinal symptoms should exercise strict personal hygiene to prevent spread of the disease to those in close contact.

Travellers are advised to carry a medical kit. Suggested items to include are: oral rehydration therapy, loperamide, and a treatment course of ciprofloxacin (500 mg twice daily for up to three days) for diarrhoea.

Radioactivity has been detected in certain foods following damage to the Fukushima nuclear power plant. Persons in the exclusion zone of northeast Japan are advised to follow the Japanese Government’s advice on food and water.

Further precautionary measures include:

  • Avoid fruit and vegetables that have been outdoors in affected areas, including those from market stores.
  • Avoid fish, shellfish and milk products.
  • Food stored inside the home since sheltering was advised, as well packaged foods such as tinned produce, are safe.

Further advice and precautionary measures are available from the Health Protection Agency, the FCO and the World Health Organization.

Vaccination advice for those travelling to affected areas

Information on specific disease risks in Japan can be found on the NaTHNaC Country Information Page.

All travellers should be up to date with routine immunisations for living in the UK, including measles, mumps and rubella (MMR) vaccine.

Tetanus/diphtheria/polio: Tetanus is transmitted via wound contamination with the bacterium Clostridium tetani; diphtheria can be transmitted by the respiratory route or following skin infection with Corynebacterium diphtheria. A booster is recommended if not received within the past 10 years. There is no risk of wild type polio in Japan.

Hepatitis A: transmitted by the faecal-oral route. The risk to most travellers to Japan is low. However, travellers to affected areas, long stay travellers and those visiting friends and relatives should consider vaccination.

Hepatitis B: transmitted by contact with blood or body fluids. Vaccine is recommended for those involved in health care, relief work, or who may be exposed to blood and body fluids. Sexual transmission is also a risk.

Influenza: transmitted via the respiratory route. Seasonal influenza cases in Japan have declined to baseline levels. Travellers in certain clinical risk groups should ensure they have received influenza vaccine. Cases of avian influenza have recently been reported in poultry in Chiba, 40km east of Tokyo. The risk to travellers is very low.

Rabies: There have been no indigenous cases of rabies reported in Japan since 1956. However, avoidance of animals is important, and medical assistance should be sought in the event of a bite or scratch.

Japanese encephalitis: The risk of Japanese encephalitis in Japan is very low. It is transmitted by mosquitoes and occurs between June to September in the affected areas. Travellers are advised to take insect bite avoidance measures.

Leptospirosis

Leptospirosis is a zoonosis which infects a variety of wild and domesticated animals and is excreted in their urine.

The disease is transmitted to humans if they are exposed to fresh or brackish water or moist soil contaminated by the urine of infected animals.

The organism usually enters the body through cut or abraded skin, mucous membranes, or conjunctivae. Ingestion of contaminated water can also lead to infection.

Risk of acquiring the disease is greatest for those exposed to fresh water. Travellers should be advised to avoid exposure to potentially contaminated water. Flooding as may increase the risk of leptospirosis.

Pre-exposure chemoprophylaxis of doxycycline 200 mg weekly, commencing 1 to 2 days prior to exposure, can be offered to those who are unavoidably exposed to potentially contaminated water.

Protective clothing should be worn by those who may be in direct contact with rodents, sewage or contaminated water. Cuts and grazes should be covered.

Radiation concerns

Due to the risk of radiation-related health problems following explosions at the Fukushima nuclear power plant, there is a 20km restricted zone in place. Persons living between 20 and 30km away from the power plant are subject to evacuation. General advice and information on radiation exposure is available from the Health Protection Agency and the World Health Organization.

Persons in the exclusion zone are recommended to take the precautionary measures for food and water as listed above.

Other health risks

Other possible infections that travellers may encounter directly after a flood are those transmitted through direct contact with polluted waters, such as wound and skin infections, eye infections such as conjunctivitis, and ear, nose and throat infections. Vibrio vulnificus infection is a risk if open wounds are exposed to salt or brackish water. 

Melioidosis is not endemic to Japan, all cases have been imported.

The infectious disease risk from handling dead bodies is low. Workers should be psychologically prepared to work in such difficult situations. Support from fellow workers and family may be helpful.

Returning travellers

Information for health professionals advising travellers returning from Japan is available from the Health Protection Agency.

Returning travellers who are unwell with fever, gastro-intestinal symptoms, or have wounds that are failing to heal should consult their GP promptly for treatment.

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