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5 tips for staying healthy while traveling in Japan this winter

By Amy Chavez

I spent two winter seasons working in the hospital emergency room (as a translator) in Niseko, a popular Hokkaido snow holiday destination for foreigners. While we had our share of broken bones from ski and boarding accidents, what impressed upon me most was the number of people who get ill while on vacation. There were just as many sudden illnesses as snow-related accidents – everything from gastrointestinal disorders to ear infections and first-time asthma attacks which too many times put people in the emergency room.

The good news is that most of these illnesses can be avoided, but different cultures pose different health risks and knowing what to watch out for beforehand can be tricky, if not impossible. In this article, I’ll share some tips on how to stay healthy while traveling in Japan in wintertime, based on my experience working with hundreds of foreigners who ended up in hospital on their vacations.

Many foreigners who come to Hokkaido to ski or snowboard are coming to Japan for the first time. Since the foremost attraction for them is some of the most awesome skiing in the world (waist-deep powder, off-piste skiing–say no more!), it’s understandable that such guests may not have thought much about the actual culture they’ll be skiing into.

Let’s start at the beginning then, booking your accommodation.

1. Japanese minshuku and ryokan

Staying in family-run minshuku and ryokan is a quintessential Japanese experience that everyone should partake in. Such places have several advantages over a hotel room, including a traditional Japanese ambiance (tatami mat rooms, futons, etc), home-cooked meals, and witnessing Japanese hospitality at its finest.

But other than some top-of-the-line ryokan, most traditional style Japanese accommodation involves shared bathing and washing facilities. This is fine as long as you’re prepared for it. But if you’re not careful, these communal facilities (showers, sinks, etc) can be like a super highway for the spread of bacteria and viruses, least not when they’re being used by people coming from all over the world. Dr. Wuthrich, an American doctor who works out of Jackson Hole, Wyoming says that staying safe from viruses can be as simple as carrying antibacterial wipes with you. “Wipe down faucets, flush toilet knobs, and towel hooks before using them,” she says. “The antibacterial wipes won’t kill all the germs, but most of them.”

But since many minshuku and ryokan are family-run (although not all), you’re subjecting yourself to the hygiene standards of the owners, not a professional cleaning staff.

During my tenure in the Niseko emergency room, I had quite a few patients who had contracted the dreaded Norovirus. One of these patients told me, “I know exactly when I got it. I put down my toothbrush, turned on the water faucet, cupped the water and drank from my hands to rinse my mouth.” Unfortunately, the person who had used the sink before him had the virus. Within days, it had spread to over half the guests and the accommodation was shut down by the health department to be sanitized. Wow, right?!

I’ve never gotten sick at such a place myself, but if you catch colds easily or if you’re paranoid about getting sick, choose a studio apartment, rental condo or hotel room where the only people you share facilities with are those who you know don’t have a virus.

2. Asthma and respiratory illnesses

While in Niseko, I saw an inordinate number of cases of adults suddenly afflicted with asthma attacks, either on the slopes or while in their accommodation. When the doctor asked these patients if they had a history of asthma, most of them said they had had it as a child, but hadn’t suffered an attack since. A few patients said they’d never experienced an asthma attack before.

What would prompt a sudden onset of asthmatic symptoms, or a recurrence, years later? The only thing I could see that connected these patients was that they were all staying in budget accommodation that wasn’t very clean. Maybe you know the places I mean–they haven’t changed the tatami mats in years, the bedding is ancient, the fusuma doors are stained and no one has bothered to wash the curtains or upholstery since smoking became prohibited in public places.

“Old accommodation is fine as long as it’s clean,” says Dr. Wuthrich, a previous resident of Japan. “Mites live in dirty bedding and carpet. Curtains are generally okay, but smoke and dust can still be a problem for those susceptible to asthma.”

Aging minshuku and ryokan are especially prevalent in Japan’s countryside but it’s surprising how many can still be found even in tourist areas. If you’re traveling around Japan on a two-week to one-month vacation and hit one of these places by mistake, it’s not as big a deal if you only have to suffer through one night. But on a ski trip, where people tend to stay in the same place for a week or longer, the monetary savings may not be worth the cost to your health.

It’s easier to make this mistake than you’d think. I once called to make a reservation at a minshuku I had stayed at before, but since they were fully booked, they gave me the number of the only other place in town. Another time I unexpectedly ended up somewhere for the night and had to take the only place available. You get my drift, right? These places fill up last. Get your reservations in early so you’ll still have a choice of where to stay.

Rather than going for cheap, go for clean. Think of those ’60s-style motels with the neon signs along roadsides in the U.S. They’re cheap, they’re retro, but ..oh…um, well, maybe you shouldn’t stay there.

In situations like this, it’s probably best to follow the advice of the Japanese: You’re on holidays – treat yourself.

3. Slippers are okay if…

Upon entering any minshuku or ryokan, you’re likely to be met by a line of slippers set out for guests to easily slide their feet into after having taken off their shoes. Yes, they’re plastic and yes, they’re yucky! Most foreigners envision nasty fungal spores living inside these slippers, eagerly waiting to attach themselves to our vulnerable foreign toes. But wait, it turns out their actually okay, according to Dr. Wuthrich, “…as long as you wear socks.” Socks will protect you from most of the nasties.

Of course, the Japanese know this which is why its considered polite to wear socks when you go to someone’s house. So keep those feet covered, whether it be summer or winter.

4. In the Onsen

Now that you’ve settled in to your nice, clean minshuku, ryokan, condo or apartment, and are lounging around in cute socks, it’s probably about time to hit the hot springs.

While everyone should try Japan’s legendary onsen hot springs, make sure you don’t dunk your head under the water. Not only is this considered rude, it can lead to ear infections and gastrointestinal problems (should you accidentally drink the water) and a week of lost skiing topped with a general feeling of misery. Japanese people would never put their heads under the water, but children getting into an onsen for the first time are likely to treat such a large body of water like a swimming pool. Also, do not enter the water if you have open cuts, sores, or lesions. And of course, bathe thoroughly using the showers before you get in.

5. Wash your hands

Yeah, we know. No, seriously, wash your hands!

Bacterial hand wash is everywhere in Japan. All public buildings have them and most places where money is exchanged will have a bottle sitting just ready to be squirted onto your filthy digits. Don’t just look at the bottles and marvel at how clean the Japanese are – use the hand wash! Use it before and after you handle money.

Many Japanese wash their hands immediately after coming indoors just to make sure that any germs aren’t brought inside and spread around the house. Now that’s thinking!

Bonus tips for skiers and snowboarders:

In addition to the above, Dr. Wuthrich recommends that when at ski areas, use your gloved hands to open and close doors. If you have a choice, use sinks with sensor faucets. And if you really must touch a nasty curtain in that dirty minshuku booked by your spouse who hasn’t read this article, make a fist with your hand and slide the curtain to the side (or even use an elbow) rather than using your hands.

And lastly, she’s all for bowing rather than shaking hands.

Some of this advice may seem a bit extreme, but the worst that can happen by following it is – not getting sick. After all, this is your vacation, so treat yourself.

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Great article! Nice to put together some common sense that seems less and less common, reading about the consequences of not "wasting" a minute or two with extra precautions might get people more willing to use those preventive measures.

1 ( +1 / -0 )

It is interesting that the main problem seems to be a lack of cleanliness and hygeine , which contradicts what every Japanese tells you about Japan.

I always think that where I get sick in winter in Japan is on the train. Travelling on a crowded train with sick people on it makes it hard to avoid germs. As it is usually hard to avoid travelling by train, just try not to be close to people who are coughin or look sick.

3 ( +6 / -4 )

It is interesting that the main problem seems to be a lack of cleanliness and hygiene , which contradicts what every Japanese tells you about Japan.

I agree, I thought this article was going to be about avoiding collisions on the slopes. When I first came to Japan I caught every bug, germ and virus going around until my system toughened up and became immune, a process that took more than two years, not two weeks!

Rather than going for cheap, go for clean.

One of my pen-pals visited Japan just to stay at a ryokan in Kyoto. She was shocked to find dust all over the place and bloodstains on the bedding. It wasn't one of those budget places, either.

Bacterial hand wash is everywhere in Japan.

Does the writer mean those squirt bottles filled with weak alcohol solution that I've never seen anyone using? How effective can that stuff be anyway? I'd gladly exchange it for hot water, soap, and paper towels in all restrooms. Unfortunately, those seem to be about as rare as men who don't spit, or people who actually think to cover their mouths before sneezing.

6 ( +10 / -4 )


Wear a mask. (I'd recommend a biohazard suit but that would be facetious)

Fish oil helps too. Some people apparently have side effects. I'm lucky to have none.

-1 ( +2 / -3 )

According to this article, then, to remain healthy you should avoid minshiku and family-run ryokan.

7 ( +7 / -0 )

The viruses and bacteria in 'foreign' places are different strains than the ones people are resistant to at home. Just ask any family which has traveled to visit relatives in another town and suddenly the kids get colds and the like. You don't have to go abroad to get sick. Therefore, the author's suggestion to wipe down faucets, knobs and the like is a good one. (Just don't do that at your mother-in-law's house and let her catch you doing it!)

Generally, when travelling in Japan I have noted that the locals do not practise good hygiene etiquette in public. They don't cover their coughs or sneezes. If they do it's with their hands (which immediately touch the rails and straps on trains, doorknobs and so on). The better habit is to cough into the elbow/sleeve--or if wearing a short sleeve, down the inside of a t-shirt.

Soap and water is anti-bacterial. However, many people don't scrub well enough and bacteria remains on their hands. I've seen many barely wet their fingers before drying them on a small towel they carry with them. I can't imagine the bacterial count on those damp rags percolating in purses and pockets.

Another thing to look out for is mold. I stayed in a room that had a dark circle of mold on the ceiling (as well as ancient bedding and dusty tatami). I not only suffered an allergic reaction, but got the first and only asthma attack I've ever had after staying there for 7 nights. I didn't see the mold. Didn't think to look up. However, on the last night I happened to have my eyeglasses still on when I tucked into the futon. No wonder I felt better every time I left the building.

Unless it's a luxury one--and even then the grossly hot AC in the chilly non-insulated rooms drives me nuts--I find the ryokan experience over-rated and not that comfortable. I prefer a business hotel where the thermostat can keep a small room at a reasonable temperature without drying the skin and mucus membranes. There are chains which are fastidiously clean, offer great amenities like free WiFi, computers, coin laundries and include breakfast, coffee and newspapers at a reasonable price. I'll choose one of those every time. Never got sick from staying in one of those.

6 ( +7 / -1 )

6th tip...stay home, heat up some sake, draw your own bath, get in, relax, and enjoy!

0 ( +2 / -2 )

I'm glad to see so many others have shared my experiences in ryokans. No matter how "traditional" and "authentic" an experience they're billing you for, I've found a lot of these places to be dusty, grimy and conducive to setting off allergies. It's amazing how people are prepared to turn a blind eye to this in the name of culture.

I will also never understand how an entire nation got duped into believing that sitting immersed in hot water in which countless pensioners have been simmering for decades could possibly be anything other than a seething petri dish of bacteria. For a nation which prides itself so greatly in being clean, there is a remarkable degree of selective amnesia when it comes to sneezes, coughs and shared surfaces.

Don’t just look at the bottles and marvel at how clean the Japanese are

That's a very unlikely reaction for anyone who's lived in Tokyo for any length of time.

2 ( +8 / -6 )


For toilets without soap I alway carry a small bottle of spray to clean my hands.

Thanks for raising that point. Why would any developed country have a toilet without soap? How can that be considered an option? It's one thing to have to remind people to wash their hands, but quite another for it to be entirely predictable that you won't be able to even if you do have the sanitation awareness of a six-year-old.

Yet go to most public parks, hiking trails or train stations and you suddenly have to hope that a ritual sprinkling of cold water will have a magical cleansing power. (The subways have introduced soap dispensers within the last year in inner-city stations, but get beyond NishiNippori and you'll be lucky to get beyond the ceremonial cold water talisman.)

It really is astounding DoubleThink that a place where soap is considered optional in lavatories can consider itself such an epitome of cleanliness.

3 ( +7 / -4 )

It really is astounding DoubleThink that a place where soap is considered optional in lavatories can consider itself such an epitome of cleanliness.

And don't forget the charming custom of carrying around toilet paper (well, what do you think those free tissue packets are really used for?), and for the ladies, cotton hand towels that are kept in the handbag to be used over and over again in the course of a day, not just for hand wiping but for mopping up sweat, spilled drinks, etc.

2 ( +5 / -3 )

"....a seething petri dish of bacteria."

Another thing to consider is that many onsen advertise the supposed curative benefits of the water. That means they are catering to people who are sick or otherwise suffering from diseases.

1 ( +2 / -1 )

On that note, I actually find that most toilets in Japan do have soap, and and there are many restrooms that have auto-dispensers, as well as sensors for the taps, and no doors to the restroom, meaning you don't have to touch anything.

Japanese public restrooms are for the most part usable. Which is more than I can say for many countries.

-2 ( +2 / -4 )

No one in Japan carries a handkerchief more than a day, so I'd not call the one in their handbag a "petri dish". We've stayed in hotels, ryokan and hostels; only one, in Miyajima near Hiroshima, was at all questionable in the cleanliness department. In fact, hostels use crisp clean linens and have plentiful soap & hot water even in the dining areas.

1 ( +2 / -1 )

Good for you, zichi. You are being proactive rather than whine and moan about how Japan is a third world country.

2 ( +5 / -3 )

Personally, I find the toilets here in general brilliant, especially the handicap toilets. Super clean in general. Privacy with doors down to the floors, rather than letting everyone see your clothes and shoes is a plus too. Plus there is usually toilet paper available where as in many public toilets in America it was long gone stolen, or the seat stolen and just disgusting.

Germs are important for survival. You need them to flourish to live and grow. If you are so paranoid as to constantly go to the doctor and get antibiotics for every little bacterial infection, you are doing your body a big disservice.

Yes, door hand knobs can be contaminated . You can use a simple tissue to open it. Go with the flow.

I am definitely not a Ryokan fan, and find the mildew in general to be asthma inducing, and that really does not do me well. I also find that athlete's foot here is a killer for the public bath areas, beach showers etc. That annoys me more than just fake cleaning.

So much her looks pretty but is superficially washed. Watch how most Izakaya clean their tables. The cloths are never sterilized and wipe away. The people picking up the dirty dishes on their way back are delivering food...did they clean those hands? Heck no way.

You need dirt kids. Get over it. If you have asthma, keep away from Ryokans and old hotels. If you got other probs, keep away too.

I do.

4 ( +5 / -1 )

"This is not done in the countries with public swimming pools."

The water at swimming pools is filtered by an extensive array of sophisticated hi-tech equipment, which must confirm to health and safety regulations. The water is tested regularly and frequently, usually by staff with degrees or diplomas in subjects like sports science.

Any evidence of contamination must be immediately reported to authorities.

The standards at rural Japanese inns doesn't even come close to this.

1 ( +3 / -2 )

Asthma and allergies have always bugged me here. House dust and mold spores.

Wearing a mask with a tissue inside will filter the air long enough for me to calm down after getting a sudden fit of the giganto-sneezes.

0 ( +1 / -1 )

Probably don't do what I did, I mistakenly used the "toilet seat cleaning" dispenser in the conbini toilet, instead of the hand wash. Stings a lot, but my hands may never need cleaning again.

2 ( +2 / -0 )

Don’t just ... marvel at how clean the Japanese are

I considered this comment at the station this morning when the gentleman waiting next to me performed a loud dredging of his sinus cavities, hacked up a bolus of phlegm and gobbed it on the platform, where disembarking passengers would be treading moments later.

He then spent much of the following forty-minute journey alternating which hand grabbed the handrail and which one explored the depths of his nostrils.

Now that’s thinking!

-2 ( +3 / -5 )

It's all very well saying that people need a healthy amount of bacteria when they are young to build up their immune system - but it doesn't change the fact people need to wash their hands to avoid spreading the norovirus during winter months. I certainly never touch any handstraps on the trains, precisely for the reasons that other posters mentioned - lack of handwashing etiquette among much of Japan's male population. People will generally give their hands a 1 second sprinkle under the water, and often only one hand at that. In many cases no contact with water at all occurs. True - if you go to department stores and convenience stores you will generally find hand soap. JR however seems to consider it optional for it's toilets. Japan has some work to do before the 2020 olympics, and in reducing the spread of germs during winter as well

3 ( +3 / -0 )

This article states opinion as fact and is misleading:

"Japanese people would never put their heads under the water"

I go to the same onsen at least once a week and I see Japanese men of all ages do this a few times each time I go.

"Bacterial hand wash is everywhere in Japan. All public buildings have them and most places where money is exchanged will have a bottle sitting just ready to be squirted onto your filthy digits. "

-Absurd, absurd, absurd. I can't tell you how many places, especially in the countryside where every toilet/ restaurant/ hotel/ nature restroom/ etc. is quite old and has no hand wash, or a watered-down substitute or the bacterial wash container is dirtier than my hand is.

And lets be honest, most men have seen this, too, and its an international problem, but so many dudes never wash their hands after pee-pee time.

And a ryokan is a case by case thing: There are well-run establishments with clean kitchens and showers and there ryokans that are on par with a truck-stop toilet next to a strip club.

In general, just be careful when you go to any country, look up any precautions you should take and get travel health insurance.

4 ( +4 / -0 )

And lets be honest, most men have seen this, too, and its an international problem, but so many dudes never wash their hands after pee-pee time.

Speaking as a female, I've seen similar behaviour in women's lavatories. At the most, they run their hands under a cold water tap (often the only thing available) for a few seconds, and then wipe their hands on a worn cotton towel that they keep in their handbag. Many women brush their teeth in the same sinks, spitting their saliva everywhere. And when they pull out the full make-up kit and primp and preen themselves for half an hour ... well, don't get me started on the nasty stray hairs, used Q-tips, tissues, blotting papers, and face powder trails that they leave around the basin.

by the way, I used to teach at a women's college that had a problem with students vomiting so much into the toilets that they got blocked up (eating disorders?), but somehow I don't think that's a problem unique to Japan.

0 ( +2 / -2 )

Wash your hands and, equally important, dry them properly. Cold and thunderstorms can trigger asthma and worsen other respiratory problems. Don't stay in filthy accommodation. Unfortunately this is a problem in Japan. The worse hotel I've ever stayed in was a business hotel in Shiga, the rooms were so dirty we refused to stay. Wash your hands. People don't do this enough.

0 ( +1 / -1 )

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