Continuing to be cautious: Japanese contact patterns during the COVID-19 pandemic and their association with public health recommendations.

Despite implementing no lockdowns and having a large elderly population, Japan had a low mortality rate due to COVID-19 compared to Europe and North America. The extent to which policies impacted person-to-person contact remains unclear. In this study, we examined changes in contact patterns and their association with behaviors and governmental recommendations in Japan during the pandemic. Ten social contact surveys were conducted between 2021 and 2023 reaching over 1500 participants per survey in Osaka and Fukuoka prefectures where governmental recommendations were first implemented due to high COVID-19 incidence. Their contact patterns were assessed through their demographic characteristics, COVID-19 vaccination status, and individual disease mitigation measures. Generalized linear models were used to identify factors associated with increased contacts. The mean number of contacts during the pandemic declined by at least 49.8% (8.2 weekday contacts and 6.0 weekend contacts per individual, adjusted by age and sex) compared to a study conducted prior to 2020. Weekdays, occupation, larger household sizes, and mask wearing were associated with a higher number of contacts. The frequency and duration of contacts were negatively associated with the issuance of COVID-19 governmental measures, yet the relative change in contacts was not as prominent as pre- and post-lockdown situations in the United Kingdom. There was a gradual increase in contacts with time and less strict public health recommendations. Yet, contacts that did not increase with uptake of COVID-19 vaccination and continuous mask wearing depict cautious behavior across the survey population during the pandemic and into 2023. These results are in contrast with European countries where contacts largely increased among vaccinated individuals compared to the non-vaccinated. Social contacts are country and context specific, highlighting the need for data collection across different communities.