Responses to the outbreak of novel influenza A (H1N1) in Japan: risk communication and shimaguni konjo.

In Japan, national outbreak of novel influenza A (H1N1) triggered serious social disruption. The public perceived overwhelming fear and their behaviors were severely affected. Countless events were put off, with massive economic losses due to activity cancellations. The heightened fear may have been a mixture of risk communication consequences, geographic characteristics (island nation), and culture-bound fear related to shimaguni konjo, or "island mentality"; according to a Japanese cultural norm, the "outside" is considered "impure" and is often covered-up, criticized, and avoided. These consequences shed light on cultural effects on collective behaviors, along with the importance of risk communication strategies.