Japan: Stippy » Daddy-san (part 4): Immunising your child after arriving in Japan

Vaccinations in Japan are different than in the West - there are important points that you should know, because your Japanese doctor may not.

For most long-term parents of children in Japan, there is little to consider when it comes to vaccinations. The Japanese government immunises the population against the primary diseases in Japan and so long as you’re here in the long-run then you’re not going to give it a second thought. Unfortunately, things are not so simple for families who shift to Japan in the first six months after their child’s birth. When we came to Japan six weeks after my son was born in Hong Kong, we discovered pretty quickly that immunisation schedules don’t conform to any international standard and continuing vaccination programs that were begun overseas isn’t straight forward. Hopefully this article saves a bit of stress of other young families that have recently moved to Japan. It’ll probably also be of interest to any parents keen to immunise their children against some diseases that aren’t part of the standard program for Japanese children.

There are two very important things to know about new born vaccinations in Japan:

1. Japan doesn’t immunise for as many diseases as is standard in the West.
2. Japan has developed its own domestic vaccines for most diseases which means that they are not compatible with vaccinations taken for the same disease in other countries.

At the time of writing, the recommended injections for newborns in Japan (i.e. those that are provided free of charge to residents) are as follows:

The yobosesshu brand - Japanese babies will wear this mark with them until adulthood and beyond

BCG (結核予防法) → at birth
Diphtheria(ジフテリア) → 2, 4 and 6 months
Pertussis(百日咳) → 2, 4 and 6 months
Tetanus (破傷風) → 2, 4 and 6 months
Polio (ポリオ) → 2, 4 and 6 months

In addition to these diseases, Hong Kong, for example, also recommends (and provides free of charge) vaccinations for the following diseases:

Hepatitis B (Ｂ型肝炎) → 2, 4 and 6 months
HiB (ヘモフィラス・インフルエンザ菌タイプB) → 2, 4 and 6 months
Pneumococcal conjugate (PCV) (肺炎球菌結合ワクチン) → 2, 4 and 6 months
Rota Virus (ロタウィルス) → 2, 4 and sometimes also 6 months

According to our paediatrician who was educated in London and Australia, both Australia and most of Europe vaccinate for the same diseases as Hong Kong. I’m assuming that they are all copy cats of the UK standard. Furthermore, each of these countries uses the same brand of vaccinations so your child isn’t going to have any problems if you travel between those countries. On the other hand, when we found ourselves in Japan 4 months after my son’s birth we realised that we’d created two problems for ourselves: (1) we were half way through vaccinations for diseases that Japanese paediatricians hadn’t even heard about (e.g. rota virus) and (2) we couldn’t even complete the four diseases that Japan also immunises for, as Japanese hospitals use domestically developed brands that aren’t compatible with the first two rounds that we’d taken overseas. Don’t let a Japanese doctor fool you on this point. They are not compatible.

This is an interesting chart (source) that makes a comparison of the standard Japanese vaccination schedule with that of the United States. Could be a good one to take with you when you visit your Japanese GP, to spur discussion about how he/she needs to help you:
Comparison of Japanese and US Vaccination Schedule

It is actually possible to receive a hepatitis B vaccination in Japan if you pay for it yourself so I guess it is unfair to include it in the second list although it is not standard and most children don’t receive it. I’ve also heard that the HiB vaccine is very close to approval in Japan as well. Even if it is improved, it is unlikely that it will be included on the free list of vaccinations for several years so will probably be in the same basket as the hepatitis B vaccination.

It might seem like a lot of injections for your baby to receive but in actual fact almost all of these injections are administered at the same time. If you find a friendly paediatrician in Japan then you will probably get diphtheria, pertussis and tetanus together in one injection called a DPT (三種混合, sanshu kongo) which reduces some of the shock to the poor little kid. If you’re unlucky, your paediatrician might

Some clinics in Japan will give vaccinations the Western way - at 2 months the baby receives all of them at the same time with simultaneous jabs in both legs

try to convince you to visit on three separate occasions in order to reduce the psychological stress on your baby. Believe me, it is more stressful having three different jabs and you might like to recall that your doctor gets paid by the number of visits that you make to his surgery, not necessarily by the number of injections. In Hong Kong (and most of the west), they actually roll polio, hepatitis B and HiB into the DPT to make a 6-in-one injection called infanrix hexa. If Japan ever gets it, I suppose they will call it a 六種混合, rokushu kongo. Our doctor in Hong Kong took this even a step further by getting his nurse to jab the PCV injection into my sons other leg at the same time as he jabbed the “6-in-one”, so my son would only feel pain once. The rota virus is a live vaccine and it seems as though the world (except Japan) hasn’t decided on a global standard brand for the vaccination yet. The two main ones (brands) are Rotarix (only taken twice in months 2 and 4) and Rotateq (taken three times in months 2, 4 and 6). Don’t forget, these brands are not compatible and so you can’t mix them, either. Given the large number of infants that are hit with severe diarrhoea because of the rota virus, perhaps even people living in Japan long-time might want to consider this vaccination. (Apparently most children will catch the rota virus at least once before the age of five (source)).

It only took a few phone calls to leading hospitals in Osaka and Tokyo to realise that no public hospitals were able to administer any vaccinations other than those officially recommended by the Japanese government. They recommended me to try and find a small private hospital that might be importing the drugs on a proprietary basis. After smiling and dialling every international sounding private hospital I could think of in Osaka, Kobe and Tokyo, I was proudly offered various combinations of DPT and a bunch of branded vaccines that I’d never heard of. I thought I’d almost struck gold with a small practice in Hiro (広尾), until the senior doctor (院長先生, inchosensei) – who will remain unnamed – started trying to convince me that both brands of the rota virus vaccination were interchangeable. It scares me to think how many unsuspecting parents take their children to that guy and get the wrong vaccination!

Anyway to cut a long story short, I was only able to find one hospital that was able to administer each of the injections for us. Here are their details:

Tokyo Medical and Surgical Clinic
Address: 32 Shiba koen Building 2F,
3-4-30 Shiba-koen, Minato-ku, Tokyo 105-0011
Telephone: 03-3436-3028 (24 hours)
Fax: 03-3436-5024

Unfortunately for families coming from Australia, they only had Rotarix (and not Rotateq which is standard in Australia) for the rota virus at that time but that might change in the future. I highly recommend them for the other vaccinations and their professionalism. At the time of writing these vaccinations cost a hefty 80,000 yen for one round of all 8. For obvious reasons, it is nice to have an insurance policy that covers these payments – but it will have to be private as the clinic is not recognised by the Japanese health insurance system. While my focus has been on newborns, parents of children who are either 12 months or 4 years old will probably want to know what the story is with chicken pox, mumps, measles and rubella. All of these injections are available in Japan, but only measles and rubella are provided free to residents. Whereas the west generally administers measles, mumps and rubella together in a 3-in-one injection called MMR, for some reason Japan doesn’t include mumps and just gives an “MR”. It’s worth confirming the brand that you used for the first round at 12 months if you are giving the 4 year booster to your child for the same reason as mentioned above.

Lets us know about your yobosesshu experiences in Japan, or for that matter, anywhere else. It’s a fascinating topic, but sometimes a scary one, especially when it involves your own little one.