Germany: Infectious Diseases Spreading as Migrants Settle In

A failed asylum seeker from Yemen who was given sanctuary at a church in northern Germany to prevent him from being deported has potentially infected more than 50 German children with a highly contagious strain of tuberculosis.

The man, who was sheltered at a church in Bünsdorf between January and May 2017, was in frequent contact with the children, some as young as three, who were attending a day care center at the facility. He was admitted to a hospital in Rendsburg in June and subsequently diagnosed with tuberculosis — a disease which only recently has reentered the German consciousness.

Local health authorities say that in addition to the children, parents and teachers as well as parishioners are also being tested for the disease, which can develop months or even years after exposure. It remains unclear if the man received the required medical exams when he first arrived in Germany, or if he is one of the hundreds of thousands of migrants who have slipped through the cracks.

The tuberculosis scare has cast a renewed spotlight on the increased risk of infectious diseases in Germany since Chancellor Angela Merkel allowed in around two million migrants from Africa, Asia and the Middle East.

A new report by the Robert Koch Institute (RKI), the federal government’s central institution for monitoring and preventing diseases, confirms an across-the-board increase in disease since 2015, when Germany took in an unprecedented number of migrants.

The Infectious Disease Epidemiology Annual Report — which was published on July 12, 2017 and provides data on the status of more than 50 infectious diseases in Germany during 2016 — offers the first glimpse into the public health consequences of the massive influx of migrants in late 2015.

The report shows increased incidences in Germany of adenoviral conjunctivitis, botulism, chicken pox, cholera, cryptosporidiosis, dengue fever, echinococcosis, enterohemorrhagic E. coli, giardiasis, haemophilus influenza, Hantavirus, hepatitis, hemorrhagic fever, HIV/AIDS, leprosy, louse-borne relapsing fever, malaria, measles, meningococcal disease, meningoencephalitis, mumps, paratyphoid, rubella, shigellosis, syphilis, toxoplasmosis, trichinellosis, tuberculosis, tularemia, typhus and whooping cough.

Germany has — so far at least — escaped the worst-case scenario: most of the tropical and exotic diseases brought into the country by migrants have been contained; there have no mass outbreaks among the general population. More common diseases, however, many of which are directly or indirectly linked to mass migration, are on the rise, according to the report.

The incidence of Hepatitis B, for example, has increased by 300% during the last three years, according to the RKI. The number of reported cases in Germany was 3,006 in 2016, up from 755 cases in 2014. Most of the cases are said to involve unvaccinated migrants from Afghanistan, Iraq and Syria. The incidence of measles in Germany jumped by more than 450% between 2014 and 2015, while the number of cases of chicken pox, meningitis, mumps, rubella and whooping cough were also up. Migrants also accounted for at least 40% of the new cases of HIV/AIDS identified in Germany since 2015, according to a separate RKI report.

The RKI statistics may be just the tip of the iceberg. The number of reported cases of tuberculosis, for example, was 5,915 in 2016, up from 4,488 cases in 2014, an increase of more than 30% during that period. Some doctors, however, believe that the actual number of cases of tuberculosis is far higher and have accused the RKI of downplaying the threat in an effort to avoid fueling anti-immigration sentiments.

In an interview with Focus, Carsten Boos, an orthopedic surgeon, warned that German authorities have lost track of hundreds of thousands of migrants who may be infected. He added that 40% of all tuberculosis pathogens are multidrug-resistant and therefore inherently dangerous to the general population:

“When asylum seekers come from countries with a high risk for tuberculosis infections, the RKI, as the highest German body for infection protection, should not downplay the danger. Is a federal institute using political correctness to conceal the unpleasant reality?

“The media reports that in 2015, the federal police registered about 1.1 million refugees. Around 700,000 to 800,000 applications for asylum were submitted and 300,000 refugees have disappeared. Have they been checked? Do they come from the high risk countries?

“One has the impression that in the RKI the left hand does not know what the right one is doing.”

German newspapers have published a flurry of articles about the public health dimension of the migrant crisis. The articles often quote medical professionals with first-hand experience of treating migrants. Many admit that mass migration has increased the risk of infectious diseases in Germany. Headlines include:

“Refugees Often Bring Unknown Diseases to the Host Country“; “Refugees Bring Rare Diseases to Berlin“; Refugees in Hesse: Return of Rare Diseases“; “Refugees Often Bring Unknown Diseases to Germany“; “Experts: Refugees Bring ‘Forgotten’ Diseases“; “Three Times More Hepatitis-B Cases in Bavaria“; “Cases of Tapeworm in Germany Increased by More than 30%“; “Infectious Disease: Refugees Bring Tuberculosis“; “Tuberculosis in Germany is on the Rise Again, Especially in the Big Cities: Caused by Migration and Poverty“; “Refugees Are Bringing Tuberculosis“; More Diseases in Germany: Tuberculosis is Back“; “Medical Practitioner Fears Tuberculosis Risk due to Refugee Wave“; “Significantly More Tuberculosis in Baden-Württemberg: Migrants often Affected“; “Expert: Refugee Policy to Blame for Measles Outbreak“; “Scabies on the Rise in North Rhine-Westphalia“; “Almost Forgotten Diseases Like Scabies Return to Bielefeld“; “Do You Come into Contact with Refugees? You Should Pay Attention“; and “Refugees: A Wide Range of Disorders.”

At the height of the migrant crisis in October 2015, Michael Melter, the chief physician at the University Hospital Regensburg, reported that migrants were arriving at his hospital with illnesses that are hardly ever seen in Germany. “Some of the ailments I have not seen for 20 or 25 years,” he said, “and many of my younger colleagues have actually never seen them.”

Marc Schreiner, director of international relations for the German Hospital Federation (Deutschen Krankenhausgesellschaft), echoed Melter’s concerns:

“In the clinics, it is becoming increasingly common to see patients with diseases that were considered to have been eradicated in Germany, such as scabies. These diseases must reliably be diagnosed, which is a challenge.”

Christoph Lange, a tuberculosis expert at the Research Center Borstel, said that German doctors were unfamiliar with many of the diseases imported by migrants: “It would be useful if tropical diseases and other diseases that are rare in our lives played a bigger role in the training of physicians.”

The German Society for Gastroenterology, Digestive and Metabolic Diseases recently held a five-day symposium in Hamburg to help medical practitioners diagnose diseases which are rarely seen in Germany. Those include:

• Louse-borne relapsing fever (LBRF): During the past two years, at least 48 people in Germany were diagnosed with LBRF, a disease that was unheard of in the country before the migration crisis in 2015, according to the RKI report. The disease, which is transmitted by clothing lice, has been prevalent among migrants from East Africa who have been travelling for months to reach Germany on a single set of clothes. “We had all forgotten about LBRF,” said Hans Jäger, a Munich-based doctor. “It has a mortality rate of up to 40% if it is not recognized and not treated with antibiotics. The symptoms are like in malaria: fever, headache, skin rash.”
• Lassa fever: In February 2016, a patient who had been infected in Togo, West Africa, was treated and died in Germany. After his death, a Lassa virus infection was confirmed in another person who had professional contact with the corpse of the deceased. The person was treated at an isolation facility and survived the disease. This was the first documented transmission of the Lassa virus in Germany.
• Dengue fever: Nearly a thousand people were diagnosed with dengue fever, a mosquito-borne tropical disease, in Germany during 2016. This is up 25% from 2014, when 755 people were diagnosed with the disease.
• Malaria: The number of people diagnosed with malaria jumped sharply in 2014 (1,007) and 2015 (1,063), but declined slightly in 2016 (970). Most of those affected contracted the disease in Africa, particularly from Cameroon, Ghana, Nigeria and Togo.
• Echinococcosis: Between 2014 and 2016, more than 200 people in Germany have been diagnosed with echinococcosis, a tapeworm infection. This represents in an increase of around 30%. Those affected contracted the disease in Afghanistan, Bulgaria, Greece, Kosovo, Iraq, Macedonia, Morocco, Syria and Turkey.
• Diphtheria: Between 2014 and 2016, more than 30 people in Germany have been diagnosed with diphtheria. Those affected contracted the disease in Ethiopia, Eritrea, Libya, Sri Lanka and Thailand.
• Scabies: Between 2013 and 2016, the number of people diagnosed with scabies in North Rhine-Westphalia jumped by nearly 3,000%.

Meanwhile, Germany currently is in the throes of a measles outbreak that health authorities have linked to immigration from Romania. Around 700 people in Germany have been diagnosed with measles during the first six months of 2017, compared with 323 cases in all of 2016, according to the Robert Koch Institute. The measles outbreak has spread to all of Germany’s 16 federal states except one, Mecklenburg-Vorpommern, a state with a very low migrant population.

The epicenter of the measles crisis is in North Rhine-Westphalia (NRW), Germany’s most populous state and also the state with the highest number of migrants. Nearly 500 people have been diagnosed with measles in NRW during the first six months of 2017; most of the cases have been reported in Duisburg and Essen, where a 37-year-old mother of three children died from the disease in May. Outbreaks of measles have also been reported in Berlin, Cologne, Dresden, Hamburg, Leipzig, Munich and Frankfurt, where a nine-month-old baby was diagnosed with the disease.

On June 1, 2017, the German Parliament approved a controversial new law that requires kindergartens to inform German authorities if parents fail to provide evidence that they have consulted a doctor about vaccinating their children. Parents who refuse to comply face a fine of €2,500 ($2,850). “We cannot be indifferent to the fact that people are still dying of measles,” said German Health Minister Hermann Gröhe. “That’s why we are tightening up regulations on vaccination.”

Some say the new law does not go far enough; they are calling for vaccinations to be made compulsory for everyone in Germany. Others say the law goes too far and infringes on privacy protections guaranteed by the German constitution; they add that parents, not the government, should decide what is best for their children. The fallout from Chancellor Merkel’s open-door migration policy continues.

H/t reader kevin a.