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§ 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.
§ Some doctors say the actual number of cases of tuberculosis is far
higher than the official figures suggest and have accused the RKI of
downplaying the threat in an effort to avoid fueling anti-immigration
sentiments.
§ "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?" — Carsten Boos, orthopedic
surgeon, interview with Focus magazine.
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.
Soeren Kern is
a Senior Fellow at the New York-based Gatestone Institute. Follow him on Facebook and on Twitter.
