Distribution of tick-borne diseases in Japan: Past patterns and implications for the future

The rapid geographical spread of tick-borne diseases (TBDs) worldwide has recently provoked significant concerns amongst public health authorities. Tick-borne pathogens are maintained in enzootic cycles involving ticks and wild animal hosts, with epizootic spread to other mammals, including livestock and humans. Despite the increasing public health concern, current TBD diagnostic tests and treatments are inadequate, and predictive models of future risks posed by TBDs are limited by the heterogeneity of environmental, vector, and host factors, even in neighboring regions. In recent years, infections resulting in severe fever with thrombocytopenia syndrome (SFTS), Japanese spotted fever, and the scrub typhus pathogens have been reported frequently in addition to traditional TBDs in Japan. The Japanese archipelago is extremely elongated from north to south and its climate varies considerably, creating remarkable regional differences in tick species. The importance of continuous surveillance of TBDs has been growing in terms of geopathology - studies dealing with the relationships between geographic factors and the causes of specific diseases - in Japan and neighboring areas among eastern Asian countries, including China and Korea. In this review, we summarize detailed information regarding the history and epidemic status of human TBDs in Japan.