Table 3. Authors’ recommendations to advance research or control agenda for NTDs in Japan.

NTD	Recommendations
Buruli ulcer	♦ Educate dermatologists and other physicians from relevant fields to promote early diagnosis and treatment. Diagnosis of Buruli ulcer is available in Japan but requires physicians’ ability to suspect the disease from the skin conditions.  ♦ Expand a physician-researcher network to improve reporting of Buruli ulcer. The current reporting system is managed by the Leprosy Research Center of the NIID and the expert group but is based on voluntary reporting from physicians leading to under-reporting.
Chagas disease	♦ Investigate access to diagnosis and treatment in Japan. Two unapproved drugs, benznidazole and nifurtimox, can be obtainable from WHO, but whether patients have access to them is not clearly understood.  ♦ Establish screening programs to detect infected persons before they develop symptoms. For instance, serological testing can be integrated into workplace medical checkups or prenatal checkups in municipalities with large Latino populations.
Cysticercosis	♦ Educate physicians to suspect cysticercosis when immigrants from endemic areas present central nervous system infections. Domestic transmission can be triggered by infected international travelers or agricultural workers.  ♦ Maintain the mandatory inspection of meat.
Dengue and chikungunya	♦ Monitor outbreaks of dengue and a new case of domestic transmission of chikungunya.  ♦ Pay attention to the trend of imported cases from overseas and continue to monitor mosquitoes in Japan to prevent new outbreaks.
Echinococcosis	♦ Investigate why transmission of E. multilocularis to humans is evidenced only in Hokkaido. The risk of its spread into the main islands was investigated in 2003 [310] but needs to be updated.
Foodborne trematodiases	♦ Establish a monitoring system to detect hot spots of clonorchiasis, fascioliasis, and paragonimiasis, for instance, by regular stool tests for school children in areas known to be endemic in the past. Since the transmission patterns of these diseases have varied due to increased immigration, changes in dietary habits, and heavy rains/flooding, it is necessary to monitor possible epidemic areas to understand the risks.
Leishmaniasis	♦ Educate physicians to address sporadically imported cases.  ♦ Consider adopting topical paromomycin for treatment of cutaneous leishmaniasis [311] to expand treatment options.
Leprosy	♦ Educate and organize dermatologists to manage leprosy patients. The repeal of the Leprosy Prevention Law in 1996 allowed patients to be managed at general hospitals or clinics, but dermatologists in general are not experienced in managing leprosy patients.  ♦ Surveillance of leprosy is continued at the LRC/NIID and the expert group, without any legal basis. The LRC can consider establishing integrated surveillance of skin NTDs that exist in Japan, to ensure the sustainability of the leprosy surveillance program.
Lymphatic filariasis	♦ Investigate whether patients found in Japan have access to treatment.
Mycetoma, chromoblastomycosis, and other deep mycoses	♦ Educate dermatologists to promote timely diagnosis.  ♦ Build a consensus among clinical researchers to report mycetoma, chromoblastomycosis, sporotrichosis, and paracoccidioidomycosis following international definitions of these diseases.
Rabies	♦ Consider revising the mandatory annual vaccination of domestic dogs, as this strategy is suggested to be no more cost beneficial. The risk of having rabies introduced to and spread in Japan is considerably low.  ♦ Secure access to rabies immune globulins (RIG). Since RIG is not approved in Japan, it should probably be provided through a research group.
Scabies	♦ Establish outbreak surveillance and control systems, since outbreaks of scabies have been regularly observed in Japan.  ♦ Evaluate the efficacy and safety of crotamiton and benzyl benzoate for treatment of scabies and consider obtaining PMDA approval.
Schistosomiasis	♦ Raise awareness and educate physicians to promote diagnosis of schistosomiasis, since obsolete cases and imported cases have been regularly found in Japan.  ♦ Consider obtaining PMDA approval of praziquantel for treatment of schistosomiasis, as this drug is only available for off-label use.
Snakebites	♦ Accumulate clinical cases to get the currently proposed treatment guideline updated and accepted by the medical community. Although mamushi and habu antivenoms are approved by PMDA, there is no consensus in the medical community on whether and when to administer antivenoms.  ♦ Guarantee government support for the production of yamakagashi antivenom. Yamakagashi antivenoms are voluntarily produced by a research group at the Japan Snake Center.  ♦ Establish information systems at all prefectural governments to collect and publish the number of mamushi bites, just as Okinawa and Kagoshima Prefectures do for habu bites. Although mamushi bites are frequently reported from all over Japan, there is no national surveillance system.  ♦ Collect data about the use of mamushi antivenoms to understand the demand for sustainable production and storage of antivenoms.
Soil-transmitted helminthiases	♦ Consider testing for Strongyloides infections to avoid hyper-infection syndrome and disseminated strongyloidiasis, particularly in patients over 50 years of age with a history of residence in Kagoshima and Okinawa Prefectures who will be treated with immunosuppressive drugs, anticancer drugs, or steroids.

Note: We have no specific recommendations for dracunculiasis, human African trypanosomiasis, onchocerciasis, trachoma, and yaws. We consider that these diseases are not Japan’s priority because we did not find any evidence of domestic transmission nor imported cases.