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TEL AVIV – The Syrian refugee crisis has precipitated a “catastrophic outbreak” of a flesh-eating disease that is spreading across the Middle East and North Africa, according to research published on Thursday in the scientific journal PLOS.
Largely missing from news media coverage is that the same news-making scientific report warned the ongoing violence in Syria has “created a setting in which we have seen the re-emergence of polio and measles, as well as tuberculosis, hepatitis A, and other infections in Syria and among displaced Syrian refugees.”
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Indeed, in 2013 the World Health Organization documented new cases of vaccine-preventable diseases such as measles, reporting that year alone the number of confirmed measles cases in Syria reached 139, as compared to no documented cases in 2010 and 2011.
The WHO reported that 2013 saw Syria’s first outbreak of polio since 1999. According to an April 2015 WHO report, 35 children were subsequently paralysed by polio before the start of a new vaccine campaign.
In November, 2014 PLOS documented the spread of measles from among the Syrian refugee population:
Measles has swept through Syria, including Aleppo and the northern regions, with over 7,000 confirmed cases. This epidemic has not spared refugees in neighboring countries, even among highly vaccinated populations. In Jordan, 24 cases of measles were reported in 2012, while over 200 cases were reported in 2013. In Lebanon, nine reported cases of measles in 2012 increased to 1,760 cases in 2013, only 13.2% of which were among Syrian refugees.
Regarding the flesh-eating disease, leishmaniasis, PLOP warned in its latest report, “We may be witnessing an epidemic of historic and unprecedented proportions, but it has largely been hidden due to lack of specific information.”
The PLOP journal reported leishmaniasis is now affecting hundreds of thousands of refugees and has spread to Iraq, Lebanon, Jordan, Libya and Yemen. In Yemen alone, 10,000 new cases have been reported annually, the journal reported.
“Additionally, the number of cases of CL (cutaneous leishmaniasis) has most likely been severely underreported” due in part to constraints on collecting data from violence-torn regions, PLOP warned.
“Few countries have mandated reporting of CL and the resultant weak reporting system promotes a lack of disease awareness and public policies for treatment and prevention,” the report added.
“Due to the violence, Syrians have been forced to flee from their homes and seek refuge across the Middle East, North Africa, and, more recently, Europe,” the journal documented.
Leishmaniasis, meanwhile, is a disease caused by protozoan parasites. It is spread almost entirely by sandflies, including those present in the U.S.
There are three main types of the disease: cutaneous, mucocutaneous, and visceral leishmaniasis.
Cutaneous is the most common form among Syrians. It manifests in skin sores that typically develop within a few weeks or months from a sand fly bite. The sores can initially appear as bumps or nodules and may evolve into volcano-like ulcers.
Mucocutaneous leishmaniasis causes skin ulcers like the cutaneous form, as well as mucosal ulcers that usually damage the nose and mouth.
Visceral leishmaniasis, which has also been found among Syrian refugees, is the most serious form and can be fatal. It damages internal organs, usually the spleen and liver, and also affects bone marrow.
Threat to U.S.?
Refugees who enter the U.S. must undergo medical screening according to protocols established by the Centers for Disease Control and Prevention, or CDC. Each refugee must submit to a physical examination, including a skin test and possibly a chest x-ray to check for tuberculosis,as well as a blood test for syphilis.
The blood tests do not currently look for leishmaniasis. Clearly, an attending doctor could easily spot a patient with obvious skin ulcers. However, leishmaniasis cannot be detected upon physical examination if the patient is asymptomatic, as can be the case for years.
In December, Dr. Heather Burke, an epidemiologist from the CDC’s Immigrant, Refugee, and Migrant Health Branch, explained to Breitbart Jerusalem that there is generally a window of three to six months from the initial physical examination until a refugee departs for the U.S.
She said a medical examination is valid for six months, and explained that patients undergo a second examination just prior to departure – a quicker “fitness to fly” screening. While she conceded that this final examination is not thorough, she said it would pick up any visible skin lesions. Burke told Breitbart Jerusalem that she is not aware of a single case of leishmaniasis entering the U.S. via Syrian refugees.
Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, warned that “most doctors in the U.S. know nothing about leishmaniasis.”
“We’d all need to refer patients to tropical diseases specialists,” she told Breitbart Jerusalem in December. “The treatments are toxic and expensive, and some are not widely available.”
For Orient, the only sensible public health policy is “for all refugees to pass through a quarantined place like Ellis Island.”
“Officials need to know where they’ve been and what diseases occur there. We need sophisticated, reliable screening methods and excellent vector control in any areas where refugees stay.”
With research by Brenda J. Elliott.
Aaron Klein is Breitbart’s Jerusalem bureau chief and senior investigative reporter. He is a New York Times bestselling author and hosts the popular weekend talk radio program, “Aaron Klein Investigative Radio.” Follow him on Twitter @AaronKleinShow. Follow him on Facebook.