People are fleeing certain African and Middle Eastern countries in large numbers and many are headed to the countries of Europe. In fact, one report notes that about 5,000 people flee Eritrea each month, according to the Office of the United Nations High Commissioner for Refugees (UNHCR), the UN refugee agency.

European Union/CIA
European Union/CIA

One of the things that can come from refugees and asylum seekers are infectious diseases contracted in their home country.

Europe is currently reporting cases of cutaneous diphtheria in asylum seekers to several countries to include Denmark, Sweden and Germany. To date, nine cases have been reported by the three nations.

The European Centre for Disease Prevention and Control (ECDC) say Denmark reported a case of toxigenic cutaneous diphtheria in an asylum seeker from Eritrea earlier this month. He presented to health services with a traumatic leg wound received in Libya two months earlier

At the same time, Sweden reported two confirmed cases of cutaneous diphtheria caused by toxigenic C. diphtheriae in asylum seekers from Eritrea.

As of 27 July, Germany has reported four cases of cutaneous diphtheria associated with asylum seekers in 2015. All infections were caused by toxigenic C. diphtheriae. One was in a refugee from Libya, one in a refugee from Ethiopia, one in a refugee from Eritrea, and one in a patient from Syria (refugee status unknown).

In addition, two cutaneous cases caused by C. diphtheriae and associated with asylum seekers or foreign visitors were reported to The European Surveillance System in 2014. The first case was a refugee from Somalia and the second case was a child from Angola who had come to Germany for medical care.

The information is limited about the vaccination status of these nine cases.

The ECDC says there is no indication that these cases represent a significant outbreak of diphtheria among refugees in Europe. However, health systems might not be able to detect cutaneous diphtheria outbreaks among refugees because refugees have limited access to health services.

Cutaneous diphtheria is endemic in tropical countries but is uncommon in Europe. Vaccination is the only effective protection against toxigenic diphtheria and unvaccinated people are at risk of developing potentially life threatening infection with toxigenic C. diphtheriae.

Most refugees who arrive in Europe are from endemic countries and have travelled under conditions that increase the risk of acquiring cutaneous diphtheria, and many of them continue to be exposed to over-crowding and poor hygiene once they have arrived in the EU. This may increase the risk of diphtheria.

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