Flu Vaccination in Japan: Routine Vaccination Is for Age 65 and Over, and Children Under 13 Get Two Doses

In Japan, of the flu vaccinations, the “routine vaccination” (定期接種), which municipalities carry out under the law, covers only people aged 65 or older and some people aged 60 to 64 who have a serious disability. Vaccination of children is an “optional vaccination” (任意接種) that people receive if they wish, and for children under 13 two doses is the standard. Health insurance does not apply to either.

The following is based on the Immunization Act and its Cabinet order and ministerial ordinance (e-Gov Japanese Law Search), the Ministry of Health, Labour and Welfare’s pages and Q&A, the Implementation Guidelines for Routine Vaccination, influenza trend reports from the Japan Institute for Health Security (JIHS), the Japan Pediatric Society’s schedule, and the vaccines’ package inserts, as confirmed in October 2026. This article does not judge whether you should be vaccinated or which vaccine to choose. Please consult a doctor and your municipality’s counter.

Routine Vaccination Covers Those Aged 65 and Over and Some People Aged 60 to 64

The Immunization Act divides the diseases it covers into “Class A diseases” and “Class B diseases.” Influenza is Class B: Article 2, paragraph 3 of the Act lists “influenza” as item 1 of the “Class B diseases” (children’s measles, rubella, and the like are Class A). Who is covered is decided by the table in Article 3 of the Order for Enforcement of the Immunization Act.

Item 1: Persons aged sixty-five or older
Item 2: Persons aged sixty or older but under sixty-five who are specified by Ministry of Health, Labour and Welfare ordinance as having a disorder of heart, kidney, or respiratory function, or a disorder of immune function due to the human immunodeficiency virus

Order for Enforcement of the Immunization Act, Article 3, paragraph 1, table, entry for influenza (e-Gov Japanese Law Search, confirmed October 2026; translated from the Japanese, no official English text was confirmed)

For the degree of disability in item 2, Article 2-4 of the Ordinance for Enforcement of the Immunization Act sets “a degree that extremely restricts daily activities in looking after oneself” (heart, kidney, respiratory) and “a degree that makes daily life almost impossible” (immune function due to HIV), and the Ministry of Health, Labour and Welfare explains this as “generally equivalent to Grade 1 of the physical disability grades.”

Routine vaccination is carried out by the municipality where you are registered as a resident (住民票), once per fiscal year, using the injected “influenza HA vaccine” (the Ministry’s page and the Implementation Guidelines for Routine Vaccination). Resident registration is explained in our article on the words used in Japanese resident registration.

Class B Routine Vaccination Carries No “Duty to Make an Effort”

Article 9 of the Immunization Act, which says people “must endeavor to receive” a vaccination, applies only to Class A routine vaccination and to temporary vaccination. The same is true of Article 8, under which municipalities recommend vaccination. The Ministry of Health, Labour and Welfare’s Q&A tells those eligible for routine flu vaccination to “consult well with your regular doctor and decide whether to be vaccinated.” COVID-19 was also added to Class B by the Cabinet order amendment that took effect in April 2024 (Cabinet Order No. 116 of Reiwa 6), and the people covered are the same as for influenza.

Cost: Health Insurance Does Not Apply, and It Differs by Municipality

The Ministry of Health, Labour and Welfare’s Q&A says: “Because flu vaccination is not treatment for a disease, health insurance does not apply. In principle the whole cost is paid out of pocket, and the cost differs by medical institution.”

Routine vaccination is “in principle paid” (the Ministry’s influenza vaccine page), and Article 52 of the Immunization Act provides that the person who gave the vaccination may collect the actual cost (except where it is recognized that the person cannot bear it for economic reasons). How much is covered with public funds, and how much you pay yourself, differs by municipality. The same Q&A says that some municipalities independently subsidize people who are not covered by routine vaccination. Children’s medical expense subsidies subsidize the out-of-pocket share under health insurance, and in Yokohama’s example, anything not covered by insurance is outside the subsidy (our article on children’s medical expense subsidies).

Children: Optional Vaccination, and Two Doses Under Age 13

The Ministry of Health, Labour and Welfare’s Q&A says that the injected vaccine “is not covered by routine vaccination for infants and young children” and that “those who wish to be vaccinated receive it as optional vaccination.” The dose and number of doses are as follows.

For ages 13 and over, the Ministry of Health, Labour and Welfare cites a research report that one 0.5 mL dose raised antibody levels to about the same degree as two doses. The Japan Pediatric Society’s schedule (version of April 1, 2026) says “once or twice (in principle once),” and for two doses, an interval of 4 weeks (2 to 4 weeks).

The Nasal-Spray Vaccine

Besides the injection there is the “live attenuated nasal influenza vaccine.” According to the Ministry of Health, Labour and Welfare it was approved in 2023, and under its package insert (revised August 2026) it is for ages 2 to under 19, with 0.2 mL sprayed once per season (0.1 mL into each nostril). Sales began in October 2024, and it is not covered by health insurance benefits. The Japan Pediatric Society says it is “recommended on the same level as the inactivated influenza vaccine, except for people with asthma or immunodeficiency.” Consult a doctor on which to choose, and check with the medical institution before booking whether it offers it.

Where to Go for Compensation for Health Damage

According to the Ministry of Health, Labour and Welfare’s Q&A, health damage from routine vaccination is covered by the compensation system under the Immunization Act, and health damage from adverse reactions to a properly used vaccine given as optional vaccination is covered by the Pharmaceuticals and Medical Devices Agency (PMDA) Relief System for Adverse Drug Reactions and similar systems. For compensation for routine vaccination, consult the municipality where you were registered as a resident at the time of vaccination.

When to Get Vaccinated: The 2026 Season Started Early

The Ministry of Health, Labour and Welfare’s Q&A says that influenza usually “spreads from about December to March” and “peaks from the end of January to early March,” and that “it is desirable to be vaccinated before the epidemic arrives.” The guide to routine vaccination says it takes about 2 weeks for the effect to appear. The Implementation Guidelines for Routine Vaccination, which are addressed to municipalities, ask them to plan so that people can be vaccinated before the epidemic period begins (“usually by around mid-December”).

However, in 2026 the epidemic began early. According to JIHS (established in April 2025 through the merger of the National Institute of Infectious Diseases and the National Center for Global Health and Medicine), the number of reports per sentinel medical institution nationwide exceeded 1.00, at 1.11, in week 34 of 2026 (August 17 to 23), the second-earliest start of an epidemic after 2009 since the Infectious Diseases Control Act took effect in 1999. In the Ministry of Health, Labour and Welfare’s announcement of October 23, week 42 (October 12 to 18) was 9.08, above 3.26 for the same period last year. The period during which routine vaccination is offered differs by municipality, so check your municipality’s newsletter or website.

The Screening Questionnaire, and Vaccination Records From Ukraine

Before vaccination you fill in a “screening questionnaire” (予診票) on your health and the like. The Vaccination Research Center publishes Ukrainian translations of routine vaccination screening questionnaires, but the forms it has translated do not include the screening questionnaire for routine influenza vaccination (Form 5 of the Implementation Guidelines for Routine Vaccination) (confirmed October 2026). If you are unsure about the language, ask the medical institution or municipality when you book which languages the materials are in and whether an interpreter is available. Preparing for a medical visit is covered in our article on preparing before going to the hospital, and the handling of a child’s vaccination records from Ukraine is in our article on children’s vaccination records.

What to Check at the Counter

• Whether you are covered by routine vaccination (for ages 60 to 64, the degree of disability too), the period it is offered, the amount you pay yourself, and the medical institutions where you can be vaccinated (municipality)
• Whether there is a subsidy for children’s optional vaccination (municipality)
• Whether a booking is needed and the cost, and, for children, whether the institution offers the injection or the nasal spray (medical institution)
• The language of the screening questionnaire and explanations, and whether an interpreter can be arranged (medical institution and municipality)