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

Vaccinations in Japan are different than in the West
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
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
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.

17 thoughts on “Daddy-san (part 4): Immunising your child after arriving in Japan”

  1. great article, very helpful, you always here about medical issues in Japan (and China) because they stick to local drugs which doesn’t help expat families

  2. Did you try the British Clinic in Ebisu?

    They did the UK immunisations for our daughter, although it costs an arm and a leg without international health insurance.

  3. i’ve only recently found this blog (blog?) and finding it very interesting.
    i’m in the same boat (well will be soon) as my wife is about to give birth in hong kong and we will then be moving back to japan when our little one is 7 months old.
    such immunization issues never crossed my mind until today so i will be sure to jot down that tokyo medical clinic address!

  4. Our doctor only provided the HepB vaccination at 3 months for our daughter. I’ve printed the U.S. Centers for Disease Control vaccination schedule (http://www.cdc.gov/vaccines/recs/schedules/default.htm), and according to our pediatrician here in Hiroo (a very popular place, right on Gaien Nishi Dori near the Lambo dealership), they didn’t have any information on 2 of them/did not offer them (PCV & Rota Virus).

    Our daughter DID NOT receive any type of vaccinations at birth.

    I just received the Shibuya Ward immunization coupon/schedule (trying to deciper it with my poor Japanese- will need the wife to look at this tomorrow) and from what I gather, National Health Care offers (free or cheap):

    DPT (Diphteria, Pertussis, Tetanus)
    DT (Diphteria & Tetanus?)
    MR (Measles / Rubella… No Mumps).

    Our doctor here suggested we do the remaining vaccinations once we get to the U.S. (we’re moving back in a few months) since it’s much cheaper there.

    I would assume the risks of contracting any of these diseases is much less in Japan versus the rest of the world, hence, non-conforming vaccinations here. However, given that we are an international family, I will surely follow the U.S. CDC schedule, and maybe integrate some of the Japanese-specific vaccinations as well (i.e: Japanese Incephalitus)…

  5. Very nice and helpful article.
    As a Pediatrician in Orange County, California I have a number of Japanese families who start the US series of vaccines and want to continue getting the vaccines when they go back to Japan. The information on the Tokyo clinic will be most helpful.

    Just one point on immunization compatability and intercheangability. Although it is ideal to start and end with one manufacturer’s vaccine, even in the US we have to switch back and forth at times so we do mix brands often. As long as you follow the guidelines from the CDC on timing of the vaccines this is OK.

    I also have many internationally adopted patients and deal with foreign manufactured vaccines all the time. On this matter the CDC states, “Although some vaccines with inadequate potency have been produced in other countries, most vaccines used worldwide are produced with adequate quality control standards and are reliable.” So even if you had to get Japanese vaccines most Pediatricians in the US will accept them. The only thing to be careful of is that the timing of the vaccines is compatible with the schedule used in the US. The problem I have found with the Japanese schedule (besides not including many of the US vaccines) is that the ones used are given too close together. In those cases I just ignore the ones given too soon and count the others given at the correct intervals. This usually means the child needs a dose or two extra to become fully vaccinated by US standards. This is better than ignoring all the vaccines and starting over from scratch.

  6. Does the Japanese health care system vaccinate for free for travel in other parts of Asia or is this all out of pocket? We are moving to Japan in December with our 3 and 4 year olds, I am wondering if I should ask their doctor here to vaccinate them as if they were traveling to China, Viet Nam, the Phillipeans, which are some of the places we might visit.

  7. Kathleen,
    You can get the vaccinations here but you have to pay for them.  It is a bit old information but I found this data from 2002 with a Japanese language google search:

    Hepatitis A 8830 yen
    Tetanus 4330 yen
    Yellow Fever 4900 yen
    Rabies 7230 yen
    Japanese Encephalitis 5130 yen
    Cholera 1500 yen

    (http://www48.tok2.com/home/sawakon/3oyakudachi/3-03vassiation.htm)

    Pretty cheap I think? How much would it cost you back home?

    I think you actually need a yellow card (proof of a yellow fever vaccination) to go to some strange countries but I think the three you mentioned should be fine.

  8. Interesting article

    Just wanted to say that in the Western world, many parents are sceptical of immunization, especially in connection to any possible side effects, like for autism and such, and actually some say that it’s better for the kid to recieve immunisations separately as to not overwhelm their system…
    You may want to read up on it…

    Not sure if any of the Japanese immunization is mercury-based or not? Or containing any other possibly iffy chemicals?

  9. Good news (for all but Layla perhaps?)
    The Japanese immunization scene has changed dramatically over the last 12 months. You can now get Hib, Prevnar, HPV, etc.
    see here:

    http://idsc.nih.go.jp/vaccine/dschedule.html

    the interesting thing is that these changes are opening up the eyes of Japanese to realize that they are trailing the world in this field.

  10. David Shinmei, M.D.
    (or anyone else who might be able to help out)

    My son began his vaccinations in Hong Kong and I just realised that we forgot to get his fourth and final HiB vaccination (I guess it is a booster – the one at 18 months). He is now 3 yo. His first three were included in Infranhexa. Is it worth while/safe/advised getting a booster from a Japanese MD with the Japanese vaccine (ActHIB)?

  11. I love this article so much, it helps and give me an idea about the difference of the vaccination in japan and other country because me and my baby are going to migrate in japan.A little bit scared after reading this,all I want is the best for my baby. so maybe I”m gonna finish first his vaccination here in PH before we gonna transfer there.

  12. nice article..thanks for the info..me too is worried about my 1 year old daughter to get the oral polio vaccine here in japan cause i heard that some child who got this OPV got the disease..it took me a year of thinking and im still undecided weather we should go for that vaccine this coming october because japanese government only gives the vaccine on spring and autumn.can someone tell me what to do..is it really safe to go for OPV here in japan?me too all I want is the best for my baby…can someone help me here..thanks a lot.
    http://www.healing-arts.org/children/vaccines/vaccines-information.htm

  13. Great informative article! My son is due for his 12 mth vaccincations and his 2,4,6 were all done in australia while we avoided the dangers of radiation etc… Now were back in tokyo and have a dilemma about what to do with his 12 mth vacc in january. Id love to go back to australia to get the vaccs and hang out with my family, but finances are a bit tight… I personally dont really trust the vaccs here in japan as there have been so many scary stories, polio… And the the prevenar one that was cancelled march 2010 cuz several cases of children died within weeks of it…. Apparently that batch of imported prevenar had problems (???).

    Anyway, im glad to know that we can get import stuff and that there are hospitals that support the vaccs needs of foreigners with kids in japan.

    Ps: rhea i wish i had an answer for you… Sorry i cant help, but just from my gut feeling and opinion, i would rather wait to go back to home country or wait until they can do the shot. Ive seen the news about oral polio on tv these days and its just so sad for the unlucky ones that got polio from the oral vaccine…

  14. Hi everyone,
    Thanks to the Dad who posted the original post herein as it has helped me quite a lot, in conjunction with the following posts. We are from NZ and did all of the required shots there we also asked for shots that would assist and be suitable for the Asian countries as we travel quite a bit.
    Anyway, after reading all of your posts, I would like to think that our son has sufficient protection, however further research for any parent is strongly encouraged in the effort to protect and give the best to our wee ones. There is that Japanese E shot (can’t remember the entire name)…I would like to know a bit more on this shot, as well as the polio one, and others that we didn’t take in NZ ! How about the malaria shot ? Does anyone have any information on that ? The doctor that we saw last here in Japan told us that the malaria substance is injected into the baby — so I didn’t have our son take that one. It’s always best to get the most information on anything to do with our little ones.
    What is the prenavar one that was mentioned earlier by Happiesusie? Glad to know that you did go with your gut feeling. I think that that is what we will do in this case too !
    Take care

  15. Omg how frustrating!! Its the 2nd time my typing disappeared when the stupid page refreshed randomly…

    Hi worriedmum,

    I had written a really long msg to u re: the vaccs n stuff in jpn, but now ill just have to summarise cuz i spent the whole day typing it whenever i was free. N now its time to cook… :(

     Heres my reply minus the previous ramblings :)

    1. Prevenar was stopped in march 2011 for investivation after 4 mystery deaths in japan. Now it been resumed again, apparently not related to the deaths “they say”…

    http://online.wsj.com/article/SB10001424052748704041504576185611566311144.html

    http://online.wsj.com/article/SB10001424052748704604704576221623126167378.html

    2. Polio (inactive kind) is (if i remember correctly) available at that medical clinic (next to tokyo tower) mentioned in this post. Not sure exactly though cuz we didnt need that shot. They have all the available vaccs on their website and if u need more info give them a buzz, they speak english (most of them ;)

    3. My son’s 12 mths vaccs were all done at that clinic. MMR and MENCCV were imported and HIB was local stuff. From my (not so good) memory, i think it costed us 50,000-60,000yen.

    4. As for all the japanese ones not listed on the aust vaccs program, we skipped because i was unsure abt them (and also dont really trust the jpn vaccs program). Even our jpn ped said that the jpn vacs program was way behind the rest of the world.

    Last month we moved to singapore (due to the concerns of food safety/health in jpn for the lil one). After unpacking our boxes n setting up the new home, ill have to research on vaccs for living in se-asia… There we go again…!

    Good luck to u mum n bub!!! 

  16. Hello Happiesusie,

    Thanks ever so much for helping me along here. Our dr visits were most frustrating in the past because we had to start from bitter scratch by going online searching English speaking clinics/hospitals/doctors and then racing down roads for taxis who would take us all the way half across Tokyo! Taxi fares of course weren’t cheap, neither were the medical fees even though we are residents (we found out recently that our baby is eligible for a voucher which entitles him to free medical care along with free vaccinations, when we registered him at the Shinjuku Medical Centre/or that Immigration office…can’t remember, they didn’t send us the voucher as they were supposed to). Oh and just for those planning to migrate here or are here and in need of help—go to your Embassy , ours has a list of recommended English speaking doctors/dentists/etc. Also, even ask them yourself for help when necessary. The doctors that we have seen so far and they were THREE DIFFERENT doctors…EBISU and the ST MARK INTERNATONAL HOSPITAL…they doctors were quite indifferent. Not only were they lacking in english skills, they lacked general good medical advice and gave us …what seemed like 2mins consultation … I left feeling so angry and frustrated having had travelled so far , spent so much to only get a HURRIED consulation…and when i even tried to show the dr baby’s medication that he had been taking previously…she brushed it aside. Sorry for the drab, but this is to warn others to take the time to look for doctors.
    Coming back to vaccinations: I’m postponing it for 2 weeks whilst I get more info as Ido have time to reserach thoroughly. I am so grateful Happiesusie for all of your information and hope you have a better experience in Singapore of which I am confident that you will as they speak English there ! What a relief !! We have had babys MMR and MENCCV, I’m not sure what the HIB is. there are so many aren’t there? Baby has had to drink milk formulae and so we brought a lot of them from NZ, now that he’s run out, do you know of any reliable good ones. We are moving again , this time to Cambodia. So, like you said, the challenges remian, however, I believe that you are heading to a very organised and highly regarded city! Enjoy it and hope to hear from you soon. Take care to happiesusie and little bub

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