Date: Mon, 7 Jan 2019 04:13:43 +0100

Tokyo, Jan 7, 2019 (AFP) - Japan on Monday started levying a 1,000 yen ($9.22) departure tax on each person leaving the country, a measure aimed at raising funds to further boost tourism.   The International Tourist Tax will cover everyone regardless of nationality -- from business people to holidaymakers older than two years of age -- and will be tacked on to the price of a airline ticket.

The government wants to use an estimated 50 billion yen ($460 million) it will generate in additional tax revenue to improve tourism infrastructure, such as making airport immigration processes faster and encouraging visitors to explore areas beyond traditionally popular destinations such as Tokyo and Kyoto.   Japan has been aggressively courting international tourists as a new pillar of economic growth.

More than 30 million foreigners are estimated to have visited Japan in 2018, a new record, thanks to a steady flow of tourists from Asia -- particularly China, South Korea and Taiwan.   The nation aims to boost visitor figures to 40 million by 2020, when Tokyo hosts the Olympic Games.
Date: Mon 10 Dec 2018
Source: Animal Pharm [edited]
<https://animalpharm.agribusinessintelligence.informa.com/AP015007/Zoonotic-SFTS-cases-persist-in-Japan>

A veterinarian at an animal hospital in Japan's Miyazaki prefecture was tired with fever in August 2018 and went into hospital after she treated a cat with poor health. The cat was diagnosed with severe fever with thrombocytopenia syndrome [SFTS] by the veterinary school at Miyazaki University. The referral hospital identified SFTS virus in the vet's blood sample. The vet recovered from the disease and left the hospital.

Additionally, a veterinary nurse from the same animal hospital was also tired with fever and visited a medical clinic after treating the same cat. Her blood sample was also positive for the SFTS virus. She recovered from her symptoms after several days.

Japan has suffered from cat and human cases of SFTS for some while. Last year [2017], the country reported the world's 1st case of SFTS caused by a dog. The disease is potentially fatal for humans.
=====================
[SFTS is a serious disease and of significant public health concern. Although SFTS virus infections may be serious, there is evidence for subclinical or mild infections as well. There is also some evidence for person-to-person direct transmission of the virus, but that appears to be a rare event. The virus is doubtless endemic in several countries in Asia, and cases have occurred previously in Japan. Apparently, the 2 affected individuals acquired their infections directly from the SFTS virus-infected cat. No mention was made of tick transmission in this instance. The possible route of transmission from the cat to the veterinarian and veterinary nurse via exposure to blood or other bodily fluids is not mentioned.

SFTS virus is a tick-transmitted phlebovirus in the Bunyavirus family. Images of a _Haemaphysalis longicornis_ tick, the SFTS vector, can be seen at
<http://www.lowchensaustralia.com/pests/paralysis-tick/haemaphysalis-longicornis-description.htm>. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Miyazaki Prefecture, Japan: <http://healthmap.org/promed/p/11482>]
Date: Sat 1 Dec 2018
Source: Sputnik News [edited]
<https://sputniknews.com/society/201812011070298400-Rise-Japan-Syphilis-Officials-Scratching-Heads/>

The [annual] number of syphilis cases in Japan hit 6000 for the first time in 50 years this month [November 2018], and officials are rushing to nip the epidemic in the bud ahead of the 2020 Olympics in Tokyo. The problem is they have no idea what's causing it.

According to the National Institute of Infectious Diseases, as of 19 Nov [2018], there have been 6096 cases of the sexually transmitted disease in the country [in 2018], the 1st time that number broke 6000 since 1970.

The highest number of syphilis patients were found in the capital metropolis of Tokyo, which had 1548; it was followed by 1043 in Osaka, 399 in Aichi, 314 in Kanagawa, and 272 in Fukuoka. The rest were scattered among the remainder of Japan's 47 prefectures, the Japan Times noted.

Authorities have tried a variety of methods to stem the tide of syphilis, which was believed to primarily affect the LGBTQ community until a recent set of studies proved the sharpest rise was among men who have sex with women and women who have sex with men. Methods have included mass distribution of contraceptives like condoms and a leaflet campaign in which anime character Sailor Moon pleads with people: "If you don't get tested, I will punish you!"

The South China Morning Post notes that authorities have been unable to identify the causes behind the spike in cases, although the publication noted that one Osaka doctor had floated the idea that male tourists utilizing the commercial sex industry had driven the increase. With Tokyo due to see millions of new visitors when it hosts the Summer Olympics in 2020, metropolitan officials aren't wasting time trying to get a handle on the outbreak.

Beginning next year [2019], Japan's Health Ministry will institute a mandatory reporting system for doctors, including the source of the infection. They will also be stepping up their contraception campaign, the Japan Times notes.

Syphilis is a sexually transmitted disease spread by contact and caused by the _Treponema_ bacteria. It goes through distinct phases that begin with minor sores and ulcers around the genitals but, if left untreated, can progress to damage the patient's internal organs, including their heart and brain. The illness can be cured with a simple antibacterial medication if caught early but is difficult to treat in later stages.
Date: Wed 7 Nov 2018
Source: FNN.JP [online trans., summ., edited]
<https://www.fnn.jp/posts/00404934CX>

The number of people infected with "acute relaxation" [disease] in which paralysis appears in the limbs of children is rapidly increasing. [The disease] is one of infectious diseases in which the hands and feet of children suddenly [become paralyzed].

According to the National Institute of Infectious Diseases, 86 ["acute relaxation"] infections have been reported since May [2018], of which 28 have been onset since October [2018], and the number of reports has increased rapidly in the past few weeks. The [disease starts] with symptoms similar to a cold, such as a fever, then [appears in] the limbs. One of the causes is infection with a virus called "enterovirus D68."

It is important to thoroughly wash hands every day as a precautionary measure [against the disease]. The Ministry of Health, Labor and Welfare has continued warning and monitoring, as infections are rapidly increasing.
*************************************
Date: Tue 6 Nov 2018
Source: Asahi.com [online trans., summ., edited]
<https://www.asahi.com/articles/ASLC63HSDLC6UBQU001.html>

The number of reports of "acute relaxation" [disease], in which paralysis suddenly enters the limbs of children, has increased since around October [2018]. Reports of paralysis have been reported successively for 3 years, since the epidemic of enterovirus D68 infection. In May [2018], the Ministry of Health, Labor and Welfare asked for reports from medical institutions nationwide as well as strengthened monitoring. Connections are pointed out this time as well. Experts are calling for thorough washing and early consultation with medical institutions.

According to the National Institute of Infectious Diseases, 9 cases were reported nationwide in the latest week [22-28 Oct 2018] [compared to a few cases per week]. Ten cases were reported the previous week. Kakoko Tashiya, head of the Center for Infectious Diseases Epidemiology, points out that "there are 10 cases in a week" and 86 cumulative since May [2018]. Infection with enterovirus D68 has been pointed out as a cause. It is related to a virus that causes polio and hand, foot & mouth disease, also called childhood paralysis. It is contagious with a [wet] cough and is most prevalent from summer to autumn.

There is only symptomatic treatment, and there is no vaccine to prevent infection. Since it takes time to examine pathogens, it is detected only from a [sample] of patients with paralysis at the present time. However, from medical institutions in various places this year, 26 cases of virus detection including respiratory illness were reported this month [November 2018]. Ryutaro Kira, chief of Paediatric Neurology at Fukuoka City Children's Hospital, who participates in the research group, said, "This illness is not fully known yet; if [the infection appears in] a limb after a symptom like a cold, consult a medical institution. Washing and gargling are indispensable for prevention."
=====================
[Like poliovirus and hand, foot & mouth disease (HFMD), only a small fraction of EV-D68 infection cases manifest neurological symptoms [Global emergence of enterovirus D68: a systematic review. Lancet Infect Dis 2016; 16: e64-75]. An earlier study by Chong et al. reported strong temporal correlation with EV-D68 detection from pathogen surveillance  [<https://www.researchgate.net/publication/320264264_Clinical_Features_of_Acute_Flaccid_Myelitis_Temporally_Associated_With_an_Enterovirus_D68_Outbreak_Results_of_a_Nationwide_Survey_of_Acute_Flaccid_Paralysis_in_Japan_August-December_2015/download>].

Early general clinical management of children with AFM should be intensive nursing for children with severe neurological disease, and physical and occupational therapy should be initiated as soon as the child is physically stable to optimize functional outcomes. Treatment with intravenous immunoglobulin (IVIG) and/or pulse steroid therapy have been reported to have little impact on the final prognosis. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map:
Japan: <http://healthmap.org/promed/p/156>]
Date: Tue 23 Oct 2018
Source: NHK World-Japan [edited]
<https://www3.nhk.or.jp/nhkworld/en/news/20181023_38/>

US health officials have warned that pregnant women who are not protected against rubella, or German measles, through either vaccination or previous infection, should not travel to Japan during the current outbreak in the country.

The number of patients with the viral infection is increasing, mostly in Tokyo and neighboring prefectures.

The US Centers for Disease Control and Prevention on [Mon 22 Oct 2018] raised its advisory level for the rubella outbreak in Japan to "alert," the 2nd highest of 3 levels.

The health officials say that travelers to the country should make sure they are vaccinated against the infection before travel.

Babies born to women who contract the disease during pregnancy are at risk of having birth defects, such as eye, ear, or heart disorders.

The World Health Organization announced in 2015 that the Americas are the world's 1st region to eliminate rubella and congenital rubella syndrome.

Japan's health ministry says that at the moment, the US is the only country to call for pregnant women not to travel to Japan.
****************************************
US CDC: travel alert
Date: Mon 22 Oct 2018
Source: Travelers' Health CDC [edited]
<https://wwwnc.cdc.gov/travel/notices/alert/rubella-japan>

Rubella in Japan, alert - level 2, practice enhanced precautions
----------------------------------------------------------------
Key points
- There is an outbreak of rubella in Japan.
- Travelers to Japan should make sure they are vaccinated against rubella with the MMR (measles, mumps, and rubella) vaccine before travel.
- Rubella is very dangerous for a pregnant woman and her developing baby. Pregnant women who are not protected against rubella through either vaccination or previous rubella infection should not travel to Japan during this outbreak.

What is the current situation?
Health officials in Japan have reported an outbreak of rubella. Most cases continue to be reported in the Kanto region (Tokyo, Kanagawa, Chiba, and Saitama).

What can travelers do to protect themselves?
- Make sure you are fully vaccinated or otherwise protected against rubella.*
- People who cannot show that they were vaccinated or are otherwise protected against rubella should get vaccinated before leaving the United States:
- Infants (6-11 months of age) should have 1 dose of MMR (measles, mumps, and rubella) vaccine. Children in the United States routinely receive MMR vaccination at age 12-15 months.
- Adults and children 1 year of age or older should have 2 doses of MMR vaccine separated by at least 28 days.
- Avoid contact with people who are sick.
*Those who are otherwise protected include people who were born before 1957 and those who have been tested and have confirmed immunity. Talk to a doctor to see if you are protected against rubella.

Special advice for pregnant women
When rubella infection occurs during early pregnancy, serious consequences -- such as miscarriages, stillbirths, and severe birth defects in infants, congenital rubella syndrome, CRS [<https://www.cdc.gov/rubella/pregnancy.html>] -- can result.

See more about pregnancy and rubella at
<https://www.cdc.gov/rubella/pregnancy.html>.

Pregnant women should
- talk with their healthcare providers before traveling to Japan to check whether they are protected against rubella and whether it is advisable to travel;
- avoid traveling to Japan during this outbreak if not protected against rubella, through either vaccination or previous rubella infection. This is especially important during the 1st 20 weeks of pregnancy;
- get MMR vaccine after they have given birth, if they are not already protected against rubella.

Learn more about preventing rubella and what to do if you think you have it on the rubella page for travelers
[<https://wwwnc.cdc.gov/travel/diseases/rubella>.

What can clinicians do?
- Check that your patients 6 months of age or older who will be traveling internationally are protected against rubella.
- Think Travel: keep rubella in mind when treating patients with fever and rash, especially if the patient has recently travelled internationally.

Traveler information
- Rubella webpage for travelers:
<https://wwwnc.cdc.gov/travel/diseases/rubella>
- CDC rubella homepage: <https://www.cdc.gov/rubella/index.html>
- MMR (measles, mumps, rubella) vaccine information statement:
<https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html>
- MMRV (measles, mumps, rubella, varicella) vaccine information statement:
<https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmrv.html>

Clinician information
- Rubella in CDC's Yellow Book (Health Information for International Travel):
<https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/rubella>
- Advisory Committee on Immunization Practices (ACIP) Recommendations for MMR vaccine
(<http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/mmr.html>)
and MMRV vaccine
(<http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/mmrv.html>)
- Rubella information for healthcare professionals
- Think Travel homepage <https://www.cdc.gov/thinktravel/>

What is rubella?
Rubella, also called German measles, is a disease spread by the coughs and sneezes of infected people. Symptoms include rash and fever for 2-3 days. Rubella is very dangerous for a pregnant woman and her developing baby. If a pregnant woman gets rubella virus, her baby could have birth defects such as deafness, cataracts (blurred vision), heart defects, mental disabilities, and organ damage.
=======================
[Maps of Japan:
<http://mapsof.net/uploads/static-maps/cities_of_japan_map.png> and
<http://healthmap.org/promed/p/156>]
More ...