A staggering 40 million visitors are expected to descend on Japan this summer for the Tokyo Olympics. Amidst the outbreak of the coronavirus in neighboring China, Japan is preparing to be on high alert.
Japan's National Institute of Infectious Diseases has flagged Invasive Meningococcal Disease (IMD) as one of the diseases that could pose a potential risk of outbreak at the Olympics.
Despite this, and the history of meningitis outbreaks at international events in Japan, IMD or meningitis is currently not mentioned in the Japanese government’s disease prevention plan for the Olympics and there is no information on the official Tokyo 2020 website about preventative measures for infectious diseases.
CoMO member Hajime Takeuchi from the Japan Child Meningitis Org (JaCMO) has been working to bring the danger of IMD to the attention of the Japanese government.
Is meningitis common in Japan?
Between 2013 and 2017, there was an average of 32 cases a year from IMD in Japan. This is relatively low when compared to countries like the UK, who reported more than 700 cases a year from IMD during the same period.[1]
However, in recent years, there have been cases of foreign visitors contracting meningitis after large events in Japan. In 2015, for example, after an international Scout meeting in Yamaguchi, 100km southwest of Tokyo, there was an outbreak of IMD. Six cases were reported by Swedish and Scottish nationals.
Why could infectious diseases spread at the Olympics?
The risk of a disease outbreak at the Olympics is heightened as athletes, workers and tourists travel from countries all over the world, arriving in their millions and bringing together a vast array of germs.[2] One of Tokyo’s Olympic stadiums has a capacity of 68,000 spectators. In such big crowds, the risk of infection increases and there is a fear that people will become ill and transmit diseases upon returning to their home countries.
Disease prevention at the Olympic Games
In the past, Olympic committees have provided public information and advice when there is a high risk of disease outbreak. At the 2016 Olympic games in Brazil, for example, the official Olympic website gave advice on vaccines for those visiting the Olympics.[3] At the time of writing, no such advice is readily available on the 2020 Olympics website. When compared to past Olympic games, the lack of information about IMD from the Japanese government and Olympic committee is worrying, especially as it has been identified as a serious cause for concern.
What is being done to combat infectious diseases?
In August 2019, the Japanese government launched an infectious disease prevention plan.[4] The programme requires employees working at the games to get a combined vaccine for measles and rubella. It also recommends the vaccine to airport workers, who come into contact with many tourists, as well as staff working at the Olympic event venues.
Authorities are also set to use thermography to monitor visitors' body temperatures at airport immigration control points, and ask people who have a fever to undergo a health check. The technology will screen visitors coming from countries in which tuberculosis is a major health issue, based on information from international institutions including the World Health Organization.
What isn’t being done?
The official disease prevention programme for the 2020 Olympics is, at the time of writing, very limited and it doesn’t mention IMD or meningococcal at all.
Patient advocacy groups in Japan have been campaigning for a more comprehensive and inclusive vaccine program. In November 2019, JaCMO sent a questionnaire to the The Ministry of Health, Labor and Welfare, requesting the details of the strategies against IMD for the Olympics and Paralympic Games in 2020. In their response, the ministry says that it has robust systems in place to monitor cases of disease and formulate necessary responses.
Their vague response is perhaps unsurprising for patient and vaccine advocates as the national immunization program in Japan is also limited:
The mumps vaccine has not been accepted onto the national immunisation programme.
The meningococcal vaccine (MenactraTM) has been accepted as a voluntary vaccine, but it's costly.
The meningococcal B vaccine has not been introduced.
The Japanese government’s current prevention plan against infectious diseases at the Olympics this year is worryingly insufficient given the risk of IMD infection and the history of cases in Japan at large-scale international events. JaCMO are calling on government and Olympics officials to re-asses the risk of an IMD outbreak, taking into account the report from Japan’s National Institute of Infectious Diseases. CoMO wish to thank JaCMO for bringing this important issue to our attention. JaCMO website. JaCMO Facebook.
References:
[1]Public Health England, Invasive meningococcal disease in England Annual report for 2018 to 2019 supplementary data tables, [accessed 17/02/2020]. [2] Collins CJ, O’Connell B, Infectious disease outbreaks in competitive sports, 2005-2010, 2012;47(5):516–518. [3] Silvio Tafuri, Vaccinations among athletes: evidence and recommendations, Taylor & Francis (2017), 16.9, pp. 867-869. [4] https://mainichi.jp/english/articles/20190802/p2a/00m/0na/006000c