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A rampaging knifeman stormed a school bus line murdering a 12-year-old girl and man while screaming 'I will kill you' before slitting his own throat in Japan.

The attacker slashed 18 commuters, mostly primary school girls, before turning a blade on himself at rush hour on Tuesday morning in Kawasaki.

Kiyoshi Matsuda, deputy director of the Nippon Medical School Musashi Kosugi Hospital, told reporters that the 12-year-old schoolgirl and 39-year-old man had succumbed to their injuries.

Police have confirmed the suspect, believed to be in his 40s or 50s, died from his self-inflicted wounds.

A bus driver who witnessed the incident told officials the perpetrator had been holding a knife in each hand when he walked over to the bus stop and began cutting the children.    

The bloodshed came as Donald Trump wrapped up a state visit to Japan, and the US president offered his 'prayers and sympathy' to the victims as he met troops outside Tokyo.

Standing aboard a Japanese naval destroyer, he said that 'all Americans stand with the people of Japan and grieve for the victims and for their families'. 

Emergency service personnel swarm around victims at the scene - little girls can be seen being treated on the ground with blankets wrapped around them after they were attacked at around 8am on Tuesday while waiting for their bus in Kawasaki, Japan

Emergency crews rushed to the scene - the attacker had injured 16 victims and fatally wounded a 12-year-old girl and a man at the bus stop in Kawasaki on Tuesday morning

Emergency crews erect tents for carrying out treatment at the scene after the knifeman caused catastrophic injuries to at least two victims before killing himself

Emergency crews at the scene of the attack in Kawasaki, Japan - the attacker slashed the commuters, mostly primary school girls, before turning the blade on himself at the busy bus stop

Blood spatters the ground after the rush hour knife attack in Kawasaki on Tuesday morning - Kiyoshi Matsuda, deputy director of the Nippon Medical School Musashi Kosugi Hospital, told reporters that the 12-year-old schoolgirl and a 39-year-old man had succumbed to their injuries 

President Donald Trump and first lady Melania were visiting the Japanese navy on Tuesday morning in Kanagwa, close to Tokyo - he said: 'On behalf of the first lady and myself I want to take a moment to send our prayers and sympathy to the victims of the stabbing attack this morning in Tokyo'

'It is a very harrowing case. I feel strong anger,' Japan's Prime Minister Shinzo Abe said in televised remarks. 'I offer my heartfelt condolences to the victims and hope the injured recover quickly.' 

One witness told NHK the attacker was attempting to force his way onto the school bus. 

A local man living nearby, who identified himself as Matsumoto, 25, said he went outside after hearing screams.

'It's hard to describe what it was like, how it sounded. It wasn't girls having fun, it was a sound that was absolutely not normal,' he told AFP.

'I saw a man lying on the street. I also saw a girl hunched over on the ground. There were also five or six girls, maybe they were the ones who screamed... There was blood all over them.' 

The attack occurred during the busy early morning commute as workers headed to their offices and children to school.

Fire department officials said they received the first emergency calls shortly before 8am local time.

The scene of the attack was still swarming with emergency personnel hours later, with three police vans parked around the spot to block it from view.

Emergency workers set up an orange medical tent to treat the wounded, and ambulances and fire engines were parked nearby.

Officers were called to a stabbing at the bus stop in Kawasaki at around 8am, about nine miles southwest of downtown Tokyo

Police officers hose down the road and scrub blood away after the attack which has rocked Japan - 'It is a very harrowing case. I feel strong anger,' Japan's Prime Minister Shinzo Abe said in televised remarks. 'I offer my heartfelt condolences to the victims and hope the injured recover quickly'

A white school bus with blue stripes was parked at the site, with the name 'Caritas Gakuen (school)' written on the side close to the scene of the attack

An investigator holds plastic bags as he gathers evidence while making his way through the school bus on Tuesday

Rescue workers move equipment along a road close to the site of the mass stabbing - the scene of the attack was still swarming with emergency personnel hours later, with three police vans parked around the spot to block it from view

Forensics officers begin marking out evidence on the pavement on Tuesday after they cordoned off the horrific scene

A white school bus with blue stripes was parked at the site, with the name 'Caritas Gakuen (school)' written on the side, said an AFP correspondent at the scene. 

A local resident, who declined to give his name, said children attending the Caritas school lined up for the bus at the site every day.

'If you live in this neighbourhood, everybody knows that these kids are there,' the 66-year-old told AFP.

'I've been in this area for a long time, I cannot believe that somebody targeted this bus and targeted these small children.' 

An official at the St Marianna University School of Medicine said a 'woman in her forties and three girls... suffered serious injuries.'

'They will go through surgery for the injuries, mainly to their heads and necks. After that, they will be transferred to the ICU,' said Takehito Otsubo, the hospital's assistant director.

Police officers soak the tarmac in bleach as they scrub away blood left at the scene after the rampaging knife attack on Tuesday

Japan's Yasuko Atsukata, who witnessed the crime scene where a man stabbed school girls, lays flowers and pray at the site in Kawasaki

US President Donald Trump greets a naval officer while standing next to Japanese Prime Minister Shinzo Abe during a visit to the Japanese Navy destroyer J.S Kaga, in Yokosuka - Trump said aboard the vessel that 'all Americans stand with the people of Japan and grieve for the victims and for their families'

'I saw a man holding a knife... I couldn't see clearly, but he apparently stabbed himself in the neck,' one eyewitness told NHK.

The broadcaster said two knives were spotted at the scene, but there was no immediate confirmation.

Violent crime is extremely rare in Japan, and children often travel to and from schools alone.

The country has famously strict gun control regulations and gun crime is unusual, but there have been a few high-profile stabbing attacks.

In 2018, a man was arrested in central Japan after stabbing one person to death and injuring two others aboard a bullet train, an attack that prompted new security measures on the famed rail service.

And in 2016, a man stabbed 19 people to death at a disability centre south of Tokyo in what he described as a mission to rid the world of people with mental illness.  

Police and rescue workers work in the cordoned off scene - an official at the St Marianna University School of Medicine said a 'woman in her forties and three girls... suffered serious injuries'

Rescue workers and police investigators working at the scene of the attack on Tuesday - although Japan has one of the lowest crime rates in the world, it has had a series of high-profile killings, including in 2016 when a former employee at a home for the disabled was accused of going on a stabbing spree that killed 19 and wounded more than 20 others

The scene was packed with officials after the shocking attack during the morning rush hour in the Noborito area of Tokyo

Although Japan has one of the lowest crime rates in the world, it has had a series of high-profile killings, including in 2016 when a former employee at a home for the disabled was accused of going on a stabbing spree that killed 19 and wounded more than 20 others.

In 2008, seven people were killed by a man who slammed a truck into a crowd of people in central Tokyo's Akihabara electronics district and then stabbed passers-by.

In 2001, a man killed eight children and wounded 13 others in a knife attack at an elementary school in the city of Osaka. The incident shocked Japan and led to increased security at schools.   

With such a low crime rate, visitors to Japan are often surprised to see very young children travelling unaccompanied to school.

However, in 2018, a man was arrested in central Japan after stabbing one person to death and injuring two others aboard a bullet train, an attack that prompted new security measures on the famed rail service.

And in 2016, a man stabbed 19 people to death in a disability centre south of Tokyo in what he described as a mission to rid the world of people with mental illness.