cdc japan travel level

US adds Japan to 'Do Not Travel' COVID-19 advisory list as Tokyo Olympics approach

"Travelers should avoid all travel to Japan," the CDC said.

The U.S. State Department on Monday issued the highest travel advisory for Japan due to “very high” levels of COVID-19 in the country.

“Travelers should avoid all travel to Japan," according to the latest guidelines from the Centers for Disease Control and Prevention (CDC). "Because of the current situation in Japan, even fully vaccinated travelers may be at risk for getting and spreading COVID-19 variants and should avoid all travel to Japan."

The Level 4 advisory announcement comes less than two months before the scheduled July 23 opening ceremony for the 2020 Tokyo Olympic Games.

The International Olympic Committee (IOC) has yet to comment on the latest U.S. travel advisory, but said Friday that the games would still open, even if some parts of Japan were under a state of emergency due to COVID-19.

MORE: Tokyo Olympics organizers unveil new playbooks, will decide on spectators in June

“It has become clearer than ever that these games will be safe for everyone participating and the Japanese people,” John Coates, the chair of the IOC’s Coordination Commission, said in a statement released May 21.

Last month, Japan declared its third state of emergency due to COVID-19. The extended state of emergency is set to expire on May 31, but the Associated Press reported that officials are warning that the situation is still not under control.

MORE: Pfizer, BioNTech to donate COVID-19 vaccines to Olympic athletes

“If the current situation continues, I hope the government will have the wisdom not to end the emergency at the end of May,” Haruo Ozaki, head of the Tokyo Medical Association, told the weekly magazine Aera.

According to Reuters’ global tracker , only 4.4% of Japan’s population has received at least one vaccine dose, making it the slowest vaccination rate among the world’s wealthiest countries.

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Travel Advisory January 8, 2024

Japan - level 1: exercise normal precautions.

Japan – Level 1: Exercise Normal Precautions

Reissued after periodic review without changes.

Exercise normal precautions in Japan.

Read the  country information page  for additional information on travel to Japan.

If you decide to travel to Japan: 

• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive Alerts and make it easier to locate you in an emergency.
• Follow the Department of State on  Facebook  and  Twitter .
• Follow Embassy Tokyo’s American Citizen Services section on  Facebook  and  Twitter .
• Review the  Country Security Report  for Japan.
• Visit the CDC page for the latest  Travel Health Information  related to your travel.
• Prepare a contingency plan for emergency situations. Review the  Traveler’s Checklist .

Embassy Messages

View Alerts and Messages Archive

Quick Facts

Duration of intended period of stay. Please note you cannot travel on a passport you have previously declared as lost or stolen even if you subsequently locate it

One page required for entry stamp

Amounts equivalent to ¥1,000,000 or above subject to declaration

Embassies and Consulates

U.S. Embassy Tokyo  1-10-5 Akasaka, Minato-ku, Tokyo 107-8420 Japan Telephone: 81-3-3224-5000 Emergency After-Hours Telephone: 81-3-3224-5000 Fax: 81-3-3224-5856 Our Navigator Assistant will guide you to the information you need.

U.S. Consulate General Osaka-Kobe 2-11-5, Nishitenma, Kita-ku, Osaka 530-8543, Japan Telephone: 81-6-6315-5900 Emergency After-Hours Telephone: 81-3-3224-5000 Fax: 81-6-6315-5914 Our  Navigator Assistant  will guide you to the information you need.

U.S. Consulate General Naha 2-1-1 Toyama, Urasoe City, Okinawa, Japan Telephone: 81-98-876-4211 Emergency Telephone: 81-3-3224-5000 Fax: 81-98-876-4243 Our  Navigator Assistant  will guide you to the information you need.

U.S. Consulate General Sapporo Kita 1-jo Nishi 28-chome, Chuo-ku, Sapporo 064-0821, Japan Telephone: 81-11-641-1115 Emergency After-Hours Telephone: 81-11-641-1115 Fax: 81-11-643-1283 Our Navigator Assistant will guide you to the information you need. All assistance at the Consulate General Sapporo is by appointment only.

U.S. Consulate Fukuoka 5-26 Ohori 2-chome, Chuo-ku, Fukuoka 810-0052, Japan Telephone: 81-92-751-9331 Emergency After-Hours Telephone: 81-3-3224-5000 Fax: 81-92-713-9222 [email protected] Our Navigator Assistant will guide you to the information you need. Routine services are provided by appointment only.

U.S. Consulate Nagoya Nagoya International Center Bldg. 6th floor, 1-47-1 Nagono, Nakamura-ku, Nagoya 450-0001, Japan Telephone: 81-52-581-4501 Emergency After-Hours Telephone: 81-3-3224-5000 Fax: 81-52-581-3190 Our Navigator Assistant will guide you to the information you need. Emergency services are provided by U.S. Consulate General Osaka-Kobe. 

Destination Description

See the Department of State’s Fact Sheet on Japan for information on U.S-Japan relations.

Entry, Exit and Visa Requirements

Visit the  Embassy of Japan  website for the most current visa information.

There are no COVID-related entry requirements for U.S. citizens.

Entry & Exit:

• You must have a valid passport and an onward/return ticket for tourist/business "visa free" stays of up to 90 days. Your passport must be valid for the entire time you are staying in Japan.
• You cannot work on a 90-day "visa free" entry.
• "Visa free" entry status may not be changed to another visa status without departing and then re-entering Japan with the appropriate visa, such as a spouse, work, or study visa.
• Visit the Embassy of Japan website for the most current information on all visa categories.
• Japanese immigration officers may deny you entry if you appear to have no visible means of support. 
• All foreign nationals are required to provide fingerprint scans and to be photographed at the port of entry. Exceptions to this requirement include diplomatic and official visa holders, minors, and individuals covered under SOFA Article IX.2. For further information about landing procedures, please visit the  Immigration Bureau of Japan’s website . 
• Make sure your passport is valid. Note you cannot travel on a passport you have previously declared as lost or stolen even if you subsequently locate it. Japanese authorities will likely deny you entry into Japan if you attempt to do so. If you have reported your passport lost or stolen, you must apply for a new passport before travel.

Transiting Japan: 

• Ensure that your passport and visa are valid and up-to-date before you leave the United States. Passport services are not available at the airport.
• Airlines in Japan may deny you boarding for transit if you do not have the required travel documents for an onward destination in another country or if your passport does not have six months of validity remaining. For the entry requirements of the country you are traveling to, visit the  State Department's Country Specific Information  website.

Military/SOFA Travelers:  While active-duty U.S. military personnel may enter Japan under the Status of Forces Agreement (SOFA) with proper Department of Defense (DoD) identification and travel orders, all SOFA family members, civilian employees, and contractors must have valid passports to enter Japan. Please consult the  DOD Foreign Clearance Guide  before leaving the United States.

See  the Immigration Bureau of Japan’s website  for various immigration procedures.

HIV/AIDS Restrictions:  The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Japan. 

Find information on  dual nationality ,  prevention of international child abduction  and  customs regulations  on our websites.

Safety and Security

For police services in Japan, dial 110. For fire or ambulance services, dial 119.

Crime:  Crime against U.S. citizens in Japan is generally low and usually involves personal disputes, theft, or vandalism. In addition:

• Robberies committed after a victim has been drugged from a spiked drink can occur, especially in nightlife districts.
• Sexual assaults are not often reported, but they do occur, and victims may be randomly targeted.  Victim's assistance resources or shelters are difficult for foreigners to access.
• Hate-related violent crimes rarely occur, although some U.S. citizens have reported being the target of discrimination because of their nationality or their race.
• Pick pocketing can occur in crowded shopping areas, on trains, and at airports.
• Police reports must be filed before leaving Japan, as Japanese police will not accept reports filed from overseas. 
• In instances involving credit card theft or fraud, Japanese police often provide a report number rather than a police report.  You can provide this report number to your credit card company to confirm the incident with the police.

Entertainment and Nightlife Districts in Tokyo: 

• Exercise caution in all entertainment and nightlife districts throughout Japan, especially Roppongi, Kabuki-cho, Shibuya, and Ikebukuro. 
• Incidents involving U.S. citizens in these areas include physical and sexual assaults, drug overdoses, theft of purses, wallets, cash and credit cards at bars or clubs, and drugs slipped into drinks. 
• Drink spiking at bars and entertainment venues, especially in areas such as Roppongi and Kabuki-cho, near Shinjuku, has led to robbery, physical and sexual assaults, and credit card fraud.  Some victims regain consciousness in the bar or club; other victims may awaken on the street or other unfamiliar locations.
• U.S. citizens have reported being threatened with gun or knife violence in such venues so that they will pay exorbitant bar tabs or withdraw money.  U.S. citizens have also reported being beaten when they have refused to pay or hand over money.
• There have been reports of U.S. citizens being forcibly taken to ATMs and robbed, or made to withdraw funds after being unable to pay exorbitant bar tabs.
• Please be aware that Roppongi, Kabuki-cho, and other entertainment and nightlife districts have also been the scenes of violence between criminal syndicates. 

See the  Department of State  and the  FBI  pages for information on scams. 

Police reports must be filed at the nearest police station prior to departure from Japan. The Japanese police cannot accept reports filed from overseas. Report crimes to the local police at 110 and contact the U.S. Embassy at 03-3224-5000 (011-81-3-3224-5000 from overseas).  Remember that local authorities are responsible for investigating and prosecuting the crime.

See our webpage on  help for U.S. victims of crime overseas .

• help you find appropriate medical care;
• assist you in reporting a crime to the police;
• contact relatives or friends with your written consent;
• explain the local criminal justice process in general terms;
• provide a list of local attorneys;
• provide information on  victim’s compensation programs in the U.S. ;
• provide an emergency loan for repatriation to the United States and/or limited medical support in cases of destitution
• help you find accommodation and arrange flights home; and/or
• replace a stolen or lost passport.

Contacting Police, Fire and Ambulance Services:  You can reach the police throughout Japan by dialing 110. Fire and ambulance services can be contacted by dialing 119.  Note that English-speaking dispatchers may not be available. Please review advice on  “Calling for Help” on our  website . If you need assistance, you should be able to describe your address/location in Japanese or find someone who can do so, since few police officers speak English.

Domestic Violence:  Victim's assistance resources or battered women's shelters exist in major urban areas, but are difficult for foreigners to access. These types of resources are also generally unavailable in rural areas. Investigations of sexual assault crimes are often conducted without female police officers present, and police typically ask about the victim's sexual history and previous relationships.

Tourism:  The Victim's assistance resources or battered women's shelters exist in major urban areas, but are difficult for foreigners to access. These types of resources are also generally unavailable in rural areas. Investigations of sexual assault crimes are often conducted without female police officers present, and police typically ask about the victim's sexual history and previous relationships.

See our webpage for more  information on insurance providers for overseas coverage.

Local Laws & Special Circumstances

Criminal Penalties:  You are subject to Japanese law while you are in Japan. If you violate Japanese laws, even unknowingly, you may be arrested, imprisoned, or deported. If you are arrested in Japan,  even for a minor offense , you may be held in detention without bail for several months or more during the investigation and legal proceedings.

Some offences are also prosecutable in the United States, regardless of Japanese law. For examples, see our website on  crimes against minors abroad  and the  Department of Justice  website.

The vast majority of arrests of U.S. citizens in Japan are for drug-related offenses. Japanese authorities aggressively pursue drug smugglers and users, including recreational users with sophisticated detection equipment, "sniffing" dogs, blood tests, “stop and frisk” tactics, and other methods. Penalties for possessing, using, or trafficking a drug that is illegal in Japan are severe, and convicted offenders can expect long jail sentences and fines. Please note that some drugs which may be legal in certain jurisdictions outside of Japan, including marijuana and synthetic drugs, remain illegal in Japan. This also applies to certain prescription drugs that doctors in the United States may prescribe.  Japanese law makes no distinction between medical and recreational marijuana; therefore, having a prescription for medical marijuana will not help you avoid arrest or prosecution. Even possession of a small amount of marijuana for personal medical or recreational use can result in a long jail sentence and fine. Japanese customs officials carefully screen incoming packages, and individuals who are mailed drugs can be arrested and prosecuted as drug traffickers.   

Confiscation of Prescription Drugs and Other Medication:  It is important to note that some medications that are routinely prescribed in the United States, including Adderall and marijuana, are strictly prohibited in Japan. The Japanese government decides which medications may be imported legally into Japan. The Embassy and Consulates of Japan in the United States have limited information available and do not have a comprehensive list of specific medications or ingredients. Please see more  information on importing medicines  into Japan.

You must carry your U.S. passport or Japanese Residence Card (Zairyu Kado) with you at all times. In Japan, you may be taken in for questioning if you do not have your passport or Japanese residence card to show your identity and status in Japan (e.g., as a visitor, student, worker, or permanent resident).

It is illegal to work in Japan while in tourist or visa-waiver status. Overstaying your visa or working illegally may lead to fines of several thousands of dollars, and in some cases, re-entry bans as long as 10 years, or indefinitely for drug offenders. For additional information, please see  Japan’s Immigration Control and Refugee Recognition Act  and contact the  Japanese Embassy  or nearest Japanese Consulate in the United States for more information.

Driving under the influence of alcohol could also land you immediately in jail. The blood-alcohol limit in Japan is 0.03%. Punishments can be up to 10,000 USD in fines and up to five years in prison.

Possession of a gun or ammunition is a crime in Japan. Carrying a knife with a locking blade, or a folding blade that is longer than 5.5 cm (a little more than two inches), is illegal in Japan. U.S. citizens and U.S. military personnel have been arrested and detained for more than 10 days for carrying pocket knives that are legal in the United States but illegal in Japan. The possession of lock-picking tools is illegal in Japan.

Establishing a Business : Individuals establishing a business or practicing a profession that requires additional permits or licensing should seek information from the competent local authorities, prior to practicing or operating a business.

A  list of English-speaking lawyers  located throughout Japan is available on our  website .

Arrest Notification : If you are arrested or detained, ask police or prison officials to notify the U.S. Embassy immediately. See the Department of State’s webpage  and the Embassy’s  website  for additional information.

Counterfeit and Pirated Goods: Although counterfeit and pirated goods are prevalent in many countries, they may still be illegal according to local laws. You may also pay fines or have to give them up if you bring them back to the United States. See the U.S. Department of Justice’s website for more information .

Faith-Based Travelers:  See our following webpages for details:

• Faith-Based Travel Information
• International Religious Freedom Report  – see country reports
• Human Rights Report  – see country reports
• Hajj Fact Sheet for Travelers
• Best Practices for Volunteering Abroad

LGBTQI+ Travelers:  There are no legal restrictions on same-sex sexual relations or the organization of LGBTI+ events in Japan.

Laws governing rape, sexual commerce, and other activity involving sexual relations do not apply to same-sex sexual activity. This leads to lower penalties for perpetrators of same-sex rape and sexual assault and greater legal ambiguity surrounding same-sex prostitution.

See our  LGBTQI+ Travel Information  page and section 6 of our  Human Rights report  for further details.

Travelers with Disabilities:  The law in Japan prohibits discrimination against persons with disabilities. Japanese disability laws require the public sector to provide reasonable accommodations and the private sector to make best efforts in employment, education, access to health care, or the provision of other services; however, there are no penalties for noncompliance. Social acceptance of persons with disabilities in public is not as prevalent as in the United States.

Although Japan’s accessibility laws mandate that new construction projects for public use include provisions for persons with disabilities, older buildings are not likely to have been retrofitted for accessibility. At major train stations, airports, and hotels, travelers with disabilities should encounter few accessibility problems. Note that many smaller stations are inaccessible to those who cannot climb stairs. Information on travel in Japan for travelers with disabilities is available at  Accessible Japan .

Travelers with disabilities can learn more about resources available in country from the Japan National Tourism Organization’s  traveling with a disability page .

Students:  See our  Students Abroad  page and  FBI travel tips .

Women Travelers:  See our travel tips for  Women Travelers .

Conditions at Prisons and Detention Facilities:  Japanese prisons and detention facilities maintain internal order through a regime of very strict discipline.  U.S. citizen prisoners often complain of stark, austere living conditions and psychological isolation.  Heating in winter can be inadequate in some facilities, food portions can be significantly smaller than what many may be accustomed to, and access to specialized medical care, particularly mental health care, at detention facilities and prisons is sometimes limited. Additional  information on arrests in Japan  is available on our embassy website.

Customs Regulations:  Please contact the Japanese Embassy or nearest Japanese consulate in the United States, or  visit the Japanese Customs website  for specific information regarding import restrictions and customs requirements.

Japanese customs authorities encourage the use of an Admission Temporaire/Temporary Admission (ATA) Carnet in order to temporarily import professional equipment, commercial samples, and/or goods for exhibitions and trade fairs into Japan.  For additional information, please call (212) 354-4480, or  email the U.S. CIB  for details.

Pets:  The Japanese  Animal Quarantine Service  (AQS) sets procedures for importing pets. At a minimum, the process will take seven to eight months, though the process can take up to a year before a pet may enter Japan. Advance planning is critical. You can find more information about  importing a pet into Japan  or information about  exporting a pet from Japan  on our  Embassy website.

Employment Issues:  U.S. citizens should not come to Japan to work without having the proper employment visa arranged ahead of time. Teaching English, even privately, and serving as hosts/hostesses are both considered "work" in Japan and are illegal without the proper visa.

Some U.S.-based employment agencies and Japanese employers do not fully or correctly represent the true nature of employment terms and conditions. A minimum requirement for effectively seeking the protection of Japanese labor law is a written and signed work contract. If there is no signed contract, Japanese authorities are not able to act on behalf of foreign workers. If you are coming to Japan to work, carefully review your contract and the history and reputation of your Japanese employer before traveling to Japan. Complaints against U.S.-based employment agencies or recruiters may be directed to the  Better Business Bureau  or the Office of the Attorney General in the relevant state(s).

Disaster Preparedness : Japan is prone to natural disasters, including earthquakes, typhoons, tsunamis, and landslides. See the  Embassy’s  webpage for recommendations and steps you can take to prepare for an emergency. The Japan Tourism Organization’s  Safety Tips app  and  NHK World app  provide Japanese government emergency “J-Alerts” to your cell phone in English through push notifications. “J-Alerts” can provide early warning emergency alerts on earthquakes predicted in a specific area, sometimes seconds before an earthquake hits. 

Radiation: Fukushima Daiichi Nuclear Power Plant : The Government of Japan continues to closely monitor the conditions at and around the Fukushima Daiichi Nuclear Power Plant. You should comply with all travel restrictions and cautions put into place by the Government of Japan for areas surrounding the plant. For more information, contact the  Japan Nuclear Regulation Authority .

For police service in Japan, dial 110. For fire or ambulance, dial 119.

Ambulance services are widely available but receiving hospitals may decline to accept inbound patients unless they can provide proof of funds to pay for services.

COVID-19 Testing:

• Travelers should contact Japanese local health providers to determine the location of testing facilities within Japan. A non-comprehensive list of some COVID-19 testing facilities can be found here on the Embassy website.

COVID-19 Vaccines:

• The COVID-19 vaccine is available for U.S. citizens to receive in Japan.
• Review the Government of Japan’s  English language website  on COVID-19 vaccinations in Japan.
• Visit the FDA's website to  learn more about FDA-approved vaccines  in the United States. 

The Department of State does not pay medical bills.  Be aware that U.S. Medicare/Medicaid does not apply overseas. Most hospitals and doctors overseas do not accept U.S. health insurance.

Medical Insurance:  Make sure your health insurance plan provides coverage overseas. Some care providers in Japan only accept cash payments. See our webpage for more information on insurance providers for overseas coverage. Visit the U.S. Centers for Disease Control and Prevention for more information on type of insurance you should consider before you travel overseas.

We strongly recommend  supplemental insurance  to cover medical evacuation.

If traveling with prescription medication, check with the government of  Japan’s Ministry of Health website to ensure the medication is legal in Japan; possession, use, or importation of a prescription drug that is illegal in Japan may result in arrest and criminal prosecution. Always carry your prescription medication in original packaging with your doctor’s prescription. U.S. prescriptions are not honored in Japan, so if you need ongoing prescription medicine, you should arrive with a sufficient supply for your stay in Japan or enough until you are able to see a local care provider.

Vaccinations:  Be up-to-date on all  vaccinations recommended  by the U.S. Centers for Disease Control and Prevention.

Further health information:

• World Health Organization
• U.S. Centers for Disease Control and Prevention  (CDC)

Japan has a national health insurance system which is available only to those foreigners with long-term visas for Japan. National health insurance does not pay for medical evacuation. Medical caregivers in Japan may require payment in full at the time of treatment or concrete proof of ability to pay before they will treat a foreigner who is not a member of the national health insurance plan.

U.S.-style and standard psychological and psychiatric care can be difficult to locate outside of major urban centers in Japan and generally is not available outside of Japan's major cities. Extended psychiatric care can be very difficult to obtain.

Air Quality: Visit AirNow Department of State for information on air quality at U.S. Embassies and Consulates.

Travel and Transportation

Road Conditions and Safety : Driving in Japan can be complicated and expensive. Traffic moves on the left side of the road. Those who cannot read the language will have trouble understanding road signs. Highway tolls can be very high, and city traffic is often very congested. A 20-mile trip in the Tokyo area may take two hours. There is virtually no legal roadside or curbside parking; however, traffic is commonly blocked or partially blocked by those illegally parked curbside. In mountainous areas, roads are often closed during the winter, and cars should be equipped with tire chains. Roads in Japan are much narrower than those in the United States.

Traffic Laws : Japanese law provides that all drivers in Japan are held liable in the event of an accident, and assesses fault in an accident on all parties. Japanese compulsory insurance (JCI) is mandatory for all automobile owners and drivers in Japan. Most short-term visitors choose not to drive in Japan. Turning right or left on red lights is not permitted in Japan, and all passengers are required to fasten their seat belts.

Japan has a national 0.03 percent blood-alcohol-level standard for driving, and drivers stopped for driving under the influence of intoxicants will have their licenses confiscated. If you are found guilty of driving under the influence, speeding, or blatantly careless driving resulting in injury, you are subject to up to 15 years in prison. 

See our  Road Safety page  for more information. The National Police Agency (NPA) oversees the administration and enforcement of traffic laws in Japan. You can find further information in English on the  NPA English website . Information about roadside assistance, rules of the road, and obtaining a Japanese driver's license is available in English from the  Japan Automobile Federation (JAF) web site . See  the Japan National Tourism Organization’s website for car rental and driving in Japan.

Emergency Assistance : For roadside assistance, please contact the Japan Automobile Federation (JAF) at 03-5730-0111 in Tokyo, 072-645-0111 in Osaka, 011-857-8139 in Sapporo, 092-841-5000 in Fukuoka, or 098-877-9163 in Okinawa.

International Driving Permits (IDPs):  An international driving permit (IDP) issued in the United States by the American Automobile Association (AAA) or the American Automobile Touring Alliance (AATA) is required of short-term visitors who drive in Japan. You must obtain an IDP issued in your country of residence prior to arriving in Japan. The U.S. Embassy andU.S. consulates do not issue IDPs. IDPs issued via the Internet and/or by other organizations are not valid in Japan. 

Foreign residents in Japan who use an IDP may be fined or arrested. In practice, the term “resident” involves more than simply visa status or length of stay in Japan and is determined by the police. In short, a driver license from country outside Japan is not a substitute for a valid Japanese license for foreign residents. See the U.S. Embassy’s  website  for more information on driving in Japan.

Aviation Safety Oversight : The U.S. Federal Aviation Administration (FAA) has assessed the government of Japan’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Japan’s air carrier operations. Further information may be found on the  FAA's safety assessment page .

Maritime Travel : Mariners planning travel to Japan should also check for U.S. maritime advisories and alerts  in the Alerts section of the Embassy’s messages. Information may also be posted to the  U.S. Coast Guard homeport website , and the  National Geospatial-Intelligence Agency (NGA) broadcast warnings website portal  select “broadcast warnings.”

For additional travel information

• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive security messages and make it easier to locate you in an emergency.
• Call us in Washington, D.C. at 1-888-407-4747 (toll-free in the United States and Canada) or 1-202-501-4444 (from all other countries) from 8:00 a.m. to 8:00 p.m., Eastern Standard Time, Monday through Friday (except U.S. federal holidays).
• See the  State Department’s travel website  for the  Worldwide Caution  and  Travel Advisories .
• Follow us on  Twitter  and  Facebook .
• See  traveling safely abroad  for useful travel tips.

Review information about International Parental Child Abduction in  Japan . For additional IPCA-related information, please see the  International Child Abduction Prevention and Return Act ( ICAPRA )  report.

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State Department, CDC warn against travel to Japan ahead of Summer Olympics

The State Department issued a travel advisory Monday warning against travel to Japan, where Covid-19 infection rates are rising about two months before Tokyo hosts the Summer Olympic Games.

The "Level 4: Do Not Travel" guidance does not specifically mention the Olympics, which were delayed last year and are set to begin July 23. Case numbers have been rising in Japan as the government has begun vaccinating health care workers and people ages 65 and up.

The country has had over 36,000 Covid-19 cases and 779 deaths in the last seven days and nearly 716,000 cases overall, according to an NBC News tally . Japan, where over 12,000 people have died overall, is also still under a state of emergency as it prepares to welcome 11,000 athletes from 200 nations and territories.

The State Department noted that travel for tourism and other short-term purposes is still not permitted in Japan. Visa-free travel is also suspended. The Centers for Disease Control and Prevention also updated a travel advisory Monday warning against traveling to Japan.

"Travelers should avoid all travel to Japan," the CDC said. "Because of the current situation in Japan even fully vaccinated travelers may be at risk for getting and spreading COVID-19 variants and should avoid all travel to Japan."

The agency added, "If you must travel to Japan, get fully vaccinated before travel."

NBC will broadcast the Tokyo Games, which were postponed last summer because of the pandemic.

John Coates, vice president of the International Olympic Committee, said Friday that the games will be safe.

"I can say it's now clearer than ever these games would be safe for everyone participating and safe for the people of Japan," Coates said in a virtual news conference, Reuters reported. "After eight years of hard work and planning, the finish line is within touching distance."

Dartunorro Clark covered national politics, including the Covid-19 recovery, for NBC News.

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U.S. CDC eases travel recommendations on some 110 countries, territories including Japan

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Protests at U.S. universities showed no sign of slowing over the weekend, with more arrests on campuses across the country and skirmishes between pro-Israeli and pro-Palestinian demonstrators at UCLA, where a tent encampment was set up last week.

CDC Opens New East Asia and Pacific Regional Office in Japan

For Immediate Release, Monday, February 5, 2024 Contact: Media Relations (404) 639-3286

TOKYO, February 5, 2024 – U.S. Centers for Disease Control and Prevention (CDC) Director Mandy Cohen celebrated the opening of the new CDC East Asia and Pacific (EAP) regional office in Tokyo, Japan, at a ceremony that included U.S. Ambassador to Japan Rahm Emanuel, Japan Minister of Health, Labour and Welfare Keizo Takemi, diplomatic and health leaders from countries in the region, international organizations, and academic institutions. CDC’s EAP regional office will further strengthen the United States Government’s global health impact by working with Japan, partner countries and regional organizations to prevent, detect and respond to health threats.

“America’s safety and security is dependent on the strong linkages between countries around the world,” said Mandy Cohen, M.D., M.P.H, Director of the Centers for Disease Control and Prevention. “CDC’s East Asia and Pacific regional office will address health security – globally and in the region – by focusing on cooperation in advanced threat detection, laboratory networks, response capacities, and other platforms and systems for rapid response to ongoing and emerging public health threats.”

Priorities for the new regional office include:

• Expanding CDC’s core global health security capacity by building stronger collaboration and partnerships in the East Asia and Pacific region,
• The ability to detect public health threats and respond quickly, and
• Knowledge and information exchange between CDC and the region.

“The COVID pandemic reminded us that viruses don’t stop at borders,” said Rahm Emanuel, U.S. Ambassador to Japan. “International collaboration, transparency, and science, especially among partner countries like Japan, are key.  The opening of CDC’s regional office in Tokyo brings together American, Japanese, and regional expertise to track, respond to and defeat diseases.”

Through this office, CDC will focus on identification, response, and mitigation of health threats in international settings to rapidly respond to outbreaks at their source and prevent spread to and within the U.S. Expanding government and nongovernment partnerships will help CDC build the trust and transparency needed for the rapid exchange of data, and it will also strengthen core global health security capacities. Partnering to train a global workforce to prevent, detect, and respond, and sharing scientific expertise will strengthen programs and people to prevent emerging threats.

Michelle McConnell, MD, has been named the new CDC EAP regional director, transitioning from her previous role as director for Asia and the Pacific in the Office of Global Affairs at the U.S. Department of Health and Human Services. In her new position, Dr. McConnell will formulate a global health security strategy for the region, oversee global health security activities, collaborate on the implementation of headquarters programs through partnership with CDC country offices, and engage with other relevant stakeholders.

In today’s interconnected world, a disease threat anywhere can become a health threat in the U.S.  Recognizing that disease knows no borders, CDC has setup regional offices worldwide to promote U.S. global health security objectives and establish a lasting global presence. In the past few years, CDC established regional offices in South America (Brazil), Eastern Europe/Central Asia (Georgia), the Middle East/North Africa (Oman), and Southeast Asia (Vietnam) and this year will add two new regional offices with the opening of the East Asia Pacific Office today and the opening of the Central America/Caribbean office in Panama later this year.

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CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.

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DRC is seeing its worst mpox outbreak — but has no vaccines or treatments yet. Why?

Gabrielle Emanuel

The Imvanex vaccine is one of two available vaccines that are used to protect against the mpox virus. Vaccines were widely used during the 2022 mpox outbreak. But currently no vaccines are available in the Democratic Republic of Congo, which has reported thousands of cases so far this year. Alain Jocard/POOL/AFP via Getty Images hide caption

The Imvanex vaccine is one of two available vaccines that are used to protect against the mpox virus. Vaccines were widely used during the 2022 mpox outbreak. But currently no vaccines are available in the Democratic Republic of Congo, which has reported thousands of cases so far this year.

In the Democratic Republic of Congo, the fight against mpox – previously known as monkeypox – is entering a new phase.

While many are anxious to contain the outbreak – the largest mpox outbreak ever recorded in the DRC with more than 4,500 cases so far this year – experts say that's not yet possible: There are no vaccines or treatments in the country right now, and even the testing capacity is severely limited. Instead, this new phase of the mpox fight involves simply getting a better understanding of what exactly is going on.

"We've been doing a lot of groundwork and building support and trying to strengthen things. And now, I hope, we're at a pivot point," says Dr. Jennifer McQuiston of the U.S. Centers for Disease Control and Prevention. "Over the next three weeks, we expect to learn a lot about what's happening on the ground."

The CDC has worked with the DRC for 15 years but has increased their efforts in response to the current mpox outbreak, as has the World Health Organization. They've helped the DRC expand its testing capacity by opening labs in some of the most affected, remote areas. The CDC has also helped fund local epidemiological teams that can provide a more granular understanding of mpox cases.

A changing virus

The DRC's mpox outbreak is noteworthy not only for its size but for the changing nature of the virus.

According to Africa CDC, 11 African countries have reported mpox cases but the DRC is the clear epicenter, with a caseload three times what it was this time last year. The virus, which usually jumps from a small animal to a human and then spreads between people, causes painful lesions and sometimes fever, malaise and even death.

The concern is heightened because the type of mpox circulating, called Clade I, is 10 times deadlier than the type of mpox that caused a worldwide outbreak in 2022. About 10% of Clade I cases are fatal; DRC has confirmed 311 mpox deaths this year. In addition, early evidence suggests there is a new strain of the mpox virus in the eastern part of the DRC that's circulating among sex workers and seems to be sexually transmitted. Clade I has never been known to transmit sexually.

Other countries and international organizations have been working to balance their desire for quick action against the DRC's right to address its own health plans and priorities. The nation is juggling a number of pressing health challenges, including measles, cholera and plague.

"We have work to do," says Dr. Mandy Cohen , the director of the CDC. "[We] have to work with a sovereign country. And they have a lot of health threats... And so helping them work through not just mpox but their overall response is really what we're trying to do."

Earlier this month, the Africa Centres for Disease Control and Prevention – the public health agency of the African Union – helped convene a high-level emergency meeting on mpox in Kinshasa, DRC. The meeting brought together hundreds of experts.

No vaccines in DRC yet

By the end of the meeting, the DRC had announced its intent to use vaccines against mpox – although it still needs to approve the vaccines and draw up a strategy for delivery. In addition, the DRC said it would work quickly to approve a treatment option.

Vaccines have been used to combat mpox outbreaks in other places, including the U.S., Europe and Japan. So far, they have not been approved for use in most African nations.

One challenge is that there is very limited data on how the vaccines work in children – who represent the majority of mpox cases in the DRC – and also minimal data on its use in populations that deal with other health issues, like malnutrition. In March, the WHO's vaccine advisory committee recommended the off-label use of the mpox vaccine in children but urged further study.

There are also major logistical challenges to rolling out an mpox vaccination effort, given that most of the cases are in remote areas and parts of the country face violent unrest. Now that the DRC has declared its intent to use two types of mpox vaccines, its National Regulatory Authority is meeting for a vaccine assessment. While mpox vaccines are likely months away, these steps are being heralded as progress – as is the country's acknowledgement of the scale of the concern.

Should an emergency be declared?

"This situation constitutes a public health emergency," said Samuel-Roger Kamba , the Minister of Health in the DRC, speaking in French at the Africa CDC meeting's closing ceremony. "The Democratic Republic of Congo remains very concerned by the scale and severity of the mpox epidemic which is raging in 23 of the country's 26 provinces."

Nicaise Ndembi , a virologist and senior adviser to the director-general of the Africa CDC, says that, so far, that speech has not been followed by an official declaration of a health emergency. "Meetings are meetings, right? Except if we really take action," he tells NPR.

Ndembi says there are a lot of considerations that come into play before an official declaration can be issued. Many countries vividly – and bitterly – remember how travelers from numerous African countries were banned after Botswana and South Africa shared news about the discovery of Omicron, which was then a new strain of COVID. These bans cost the countries economically and drew criticism since simultaneous cases in Europe did not receive the same response. "So, it's very sensitive," he says.

Nonetheless, Ndembi says his instinct is that the scientific evidence merits a health emergency, particularly because the DRC borders nine countries and the virus could spread through travelers as it did in 2022.

"I would say: Declare! Because, by declaring, you have access to the drugs, you have access to the vaccines. We don't need to go through all the approval processes. And that will open the door for international support to mobilize resources," he says.

But in the interim, there are steps that can be taken, including disease surveillance, emergency response communication, infection prevention control and improved clinical care, even without mpox treatments in the country, says Dr. Rosamund Lewis , the WHO's technical lead and emergency manager for mpox.

"Small children [with mpox] can become dehydrated very quickly. When you have enlarged lymph nodes in the neck and sores in the mouth, children can't eat or drink. So without access to rehydration methods, nasogastric tubes, intravenous [fluids] if needed – without basic medical care that you would take for granted anywhere else – the children have a very high risk of severe disease and death, which we're seeing in the data," explains Lewis.

"Our responsibility, as a global community, is to support and accompany the DRC in their actions," she says.

"I will remind everyone that in two and a half, three years of mpox response, there hasn't been a single penny of donor money invested at a global level for controlling mpox," adds Dr. Michael Ryan , executive director of the WHO's Health Emergencies Programme. "So while the concerns of the world are very well known, I don't see the concerns of the world reflected in the investment of resources needed to actually contain this virus."

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