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of all islands, but is highest in the western part of the country. In western Japan the risk season is from July to October. In the Nansei-shotō (the islands of Kagoshima-ken and Okinawa-ken) the risk season runs from April to December. Vaccination is recommended for travellers spending more than a month in rural areas during the transmission season. Other precautions include general insect avoidance measures such as using repellents and sleeping under nets (if not in screened rooms). Although this is a rare disease, it is very serious – there is no specific treatment and a third of people infected will die and a third will suffer permanent brain damage.

Lyme Disease

Lyme disease is spread via ticks and is present in the summer months in wooded areas. Symptoms include an early rash and general viral symptoms, followed weeks to months later by joint, heart or neurological problems. The disease is treated with the antibiotic doxycycline. Prevent Lyme disease by using general insect avoidance measures and checking yourself for ticks after walking in forested areas.

Tick-Borne Encephalitis

Tick-borne encephalitis occurs on the northern island of Hokkaidō only, and, as its name suggests, is a virus transmitted by ticks. The illness starts with general flu-like symptoms, which last a few days and then subside. After a period of remission (about one week) the second phase of the illness occurs with symptoms such as headache, fever and stiff neck (meningitis), or drowsiness, confusion and other neurological signs such as paralysis (encephalitis). There is no specific treatment, and about 10% to 20% of those who progress to the second phase of illness will have permanent neurological problems.

You can prevent this disease by using insect avoidance measures and checking yourself for ticks after walking in forested areas. A vaccine is available in Europe but is very difficult, if not impossible, to find elsewhere. Two doses are given four to 12 weeks apart with a third shot after nine to 12 months. Boosters are required every three years to maintain immunity.

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TRAVELLER’S DIARRHOEA

There is a low risk of traveller’s diarrhoea in Japan: only 10% to 20% of travellers will experience some stomach upset. If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution (eg Dioralyte). A few loose stools don’t require treatment, but if you start having more than four or five stools a day you should start taking an antibiotic (such as norfloxacin, ciprofloxacin or azithromycin) and an antidiarrhoeal agent (such as loperamide). If diarrhoea is bloody, persists for more than 72 hours, is accompanied by fever, shaking, chills or severe abdominal pain, or doesn’t respond quickly to your antibiotic, you should seek medical attention.

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ENVIRONMENTAL HAZARDS

Air Pollution

If you have an underlying lung condition, air pollution can be a problem in major centres such as Tokyo. If you do have a pre-existing lung condition, speak with your doctor to ensure you have adequate medications to treat an exacerbation.

Altitude Sickness

Altitude sickness could develop in some people when climbing Mt Fuji (for more information, Click here) or on some of the higher mountains in the Japan Alps. Altitude sickness is best avoided by slowly acclimatising to higher altitudes. If this is impossible, the medication Diamox can be a helpful preventative, but it should only be taken on a doctor’s recommendation. The symptoms of altitude sickness include headache, nausea and exhaustion, and the best treatment is descending to a lower altitude. We recommend that you familiarise yourself with the condition and how to prevent it before setting out on any climb over 2000m. Rick Curtis’s Outdoor Action Guide to High Altitude: Acclimatization and Illness (www.princeton.edu/~oa/safety/altitude.html) provides a comprehensive overview.

Hypothermia

Hypothermia is possible when hiking in the Japan Alps, swimming in cold water or simply being outside in winter (December