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Migrant Induced Biological Health Hazard – Scabies Outbreak: Paris, Pas de Calais, France

2017/06/16

SCABIES – FRANCE: (PARIS) MIGRANTS
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Published Date: 2017-06-16 12:48:07
Subject: PRO/AH/EDR> Scabies – France: (Paris) migrants
Archive Number: 20170616.5109528

Date: Sun 11 Jun 2017 8:05 CEST
Source: FranceTVinfo [in French, trans. Sr.Tech.Ed.MJ, edited]

The living conditions of homeless migrants in the vicinity of the Chapelle camp in the 18th arrondissement of Paris make it impossible to eradicate scabies, which persists despite the efforts of the health services and associations.

It was believed that scabies belonged to another age, but it is present in the streets of Paris. Migrants in precarious conditions suffer from this very contagious disease of promiscuity. But without housing solutions that would allow medical follow-up under proper hygiene conditions, it is impossible to eradicate the problem. Faced with this situation, Médecins Sans Frontières [MSF] has sounded the alarm.

Even if there are no official statistics on this disease, the High Council for Public Health has already estimated from data of the sale of drugs a 10 percent increase in cases detected between 2002 and 2010. In the “jungle” of Calais, the French Institute for Public Health Surveillance also estimated that scabies accounted for 20 percent of the diagnoses between the end of 2015 and mid-2016. With the dismantling of the “jungle” and the influx of new waves of migrants, this problem moved to Paris, where it is worrisome.

Significant health monitoring needs
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“We will not succeed in taking everyone. It’s not possible, we can not.” In front of the camp of migrants Porte de la Chapelle, on Thu 8 Jun 2017, Corinne Torre, head of the France mission of Médecins sans Frontières, said that the mobile clinic of MSF posted there [on 11 Jun 2017] will only make 25 to 30 consultations. Since the dismantling of the “jungle” of Calais, MSF, which closed its operations in France, has re-launched a mobile clinic project to meet the health needs in Paris.

At Porte de la Chapelle, in the vicinity of the reception center for migrants, many people sleep outside in deplorable conditions of hygiene. Some have just arrived, others say they have been there for a month, without a shower or any spare clothing.

A Somali migrant has been there for 20 days and is suffering from itching, especially in the neck, thighs, and lower abdomen. “He scratches all night,” describes his companion, who shares with him the piece of cardboard on which they sleep every night. A little further on, another 18-year-old Somali, scratches as soon as he rolls up his sleeves; his arms are covered with cutaneous lesions.

More and more cases of scabies
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However, a medical diagnosis is necessary to prove a case of scabies . “Anyone who scratches does not have scabies,” says Dr Abdon Goudjo, director of the Samu [emergency medical services] social health teams in Paris. “It is necessary to distinguish between scabies and infected dermatoses because of a very irritated skin, either by the cold in winter or by hypersudation in summer […] The majority of the people with skin irritations we see, actually have infected dermatoses.”

But scabies remains a persistent problem, especially since, unlike dermatoses, it is very contagious. Its transmission is by frequent and repeated physical contact, either “skin against skin”, or by the linen and bedding. The health center, located inside the 1st reception center of the Porte de la Chapelle, has detected 157 cases of scabies since its opening in November 2016, according to Bruno Morel, CEO of Emmaus Solidarity. Among the migrants who sleep outside, the MSF mobile clinic detected 164 of the approximately 1300 consultations carried out since the end of December [2016]. If, on average, more than 1/10 of the consultations lead to a diagnosis of scabies, health professionals say they count more and more. “Today, this corresponds to 1/3 of the consultations,” says the general practitioner Mondane Berthault, who carries out all consultations at the mobile clinic.

Despite its very bad reputation, “scabies today heals well,” says Dr Goudjo. “It’s like lice, everyone has caught lice, it’s not a drama.” Moreover, in order to ensure that foreign patients can be properly cared for, a telephone interpreting service is provided during the consultations, explains Barbara Bertini, Coordinator of permanence of access to health care (Pass — hospital-based units providing primary care services to patients who lack health care coverage) activities of Ile-de-France.

An impossible treatment without hosting solutions
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In the reception center the health center has a medical shower and, in case of scabies, “they are given clean clothes, if they have already been housed, they change their sheets and are given medical treatment,” says Bruno Morel, Emmaus Solidarity. These devices are effective, provided that people are accommodated. For migrants on the streets, that’s another story.

“To cure a itch on the street is illusory,” says Dr Goudjo. First, because the treatment of scabies requires 2 cures, to make sure that the disease does not reappear. “It’s a very mobile population, very complicated for medical follow-up,” explains Dr Berthault. “The only thing that can be done is to give them the double dose of drugs and explain to them to resume the treatment after 8 days.”

Effective treatment of scabies also assumes that patients completely change clothes. But often they only possess the clothes they are wearing. “Ideally they could wash their clothes, boil their sheets … but under these conditions, it’s utopian,” says Dr Berthault.

A bad, or badly treated scabies can cause serious complications due to scratching. Especially when, as Dr Berthault points out, “they have not been able to wash for days and they can not cut their nails, which become long and dirty.” Once such infections are installed, it is essential to use antibiotics, without which one is exposed to a superinfection, staphylococcal in particular.

Volunteers from Utopia 56 or the vestry of the church of Saint-Bernard de la Chapelle try to remedy the problem by providing new clothes to the needy. But even if a patient manages to get rid of the itch, if he returns to a wild camp where the parasite is circulating, he/she will be exposed again.

Without the prospect of a reduction in the number of homeless migrants, the scabies problem will last. On 9 May 2017, 1609 people were evacuated from the 18th arrondissement, but wild encampments again swelled with migrants. “For the last month, it has gone from worse to worse,” says Corinne Torre; “today there are 500 people sleeping around the door of the church. […] With the summer, it will be multiplied I am quite worried about the situation,” she adds, looking at the camp from the opposite pavement.

[Byline: Louise Hemmerlé]

Communicated by:
ProMED-mail
<promed@promedmail.org>

[As pointed out in the post, scabies in itself is not dangerous. The rise in scabies, however, point to the general unhygienic conditions of these refugees and pose a risk of outbreaks of lice borne infections like _Borrelia recurrentis_ (relapsing fever), _Bartonella quintana_ (trench fever) and _Rickettsia prowazekii_ (lice borne or epidemic typhus).

There are already 3 reports in 2017 of relapsing fever in immigrants from Africa to Europe:
– Cutuli SL et al. Lice, rodents, and many hopes: a rare disease in a young refugee. Crit Care. 2017; 21(1): 81. doi: 10.1186/s13054-017-1666-5; https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1666-5.
– Grecchi C et al. Louse-borne relapsing fever in a refugee from Mali. Infection. 2017; 45(3): 373-6. doi: 10.1007/s15010-017-0987-2; abstract available at https://www.ncbi.nlm.nih.gov/pubmed/28161771.
– Hytönen J et al. Louse-borne relapsing fever in Finland in two asylum seekers from Somalia. APMIS. 2017; 125(1): 59-62; http://onlinelibrary.wiley.com/doi/10.1111/apm.12635/full.

Lice infestation is common in Africa, with reports of both trench fever and epidemic typhus:
– Drali R et al. A new clade of African body and head lice infected by _Bartonella quintana_ and _Yersinia pestis_ – Democratic Republic of the Congo. Am J Trop Med Hyg. 2015; 93(5): 990-3. doi: 10.4269/ajtmh.14-0686; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4703253/.
– Umulisa I et al. A mixed outbreak of epidemic typhus fever and trench fever in a youth rehabilitation center: risk factors for illness from a case-control study, Rwanda, 2012. Am J Trop Med Hyg. 2016; 95(2): 452-6. doi: 10.4269/ajtmh.15-0643); http://www.ajtmh.org/content/journals/10.4269/ajtmh.15-0643.
And a review from 2006 (Parola P. Rickettsioses in sub-Saharan Africa. Ann N Y Acad Sci. 2006; 1078: 42-7; http://onlinelibrary.wiley.com/doi/10.1196/annals.1374.005/abstract) estimates that louse borne epidemic typhus is endemic in tropical and North Africa.

Relapsing fever, trench fever, and epidemic typhus were last seen in a major scale during WWII, but scabies is a signal that the next wave of infestations will be lice and with _Borrelia recurrentis_, _Bartonella quintana_, and _Rickettsia prowazekii_ endemic in the countries of origin of many of the migrants, emphasizing the need to provide hygienic conditions during their stay in Europe. – Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/1871.]

See Also

Scabies – USA: (TN) jail outbreak: 20170613.5102668

2016
—-
Scabies – Spain: (AN) hospital acquired: 20161024.4581347
Scabies, varicella – Nigeria: (ED) IDP camp: 20160723.4364149

2015
—-
Chickenpox – Antigua & Barbuda: prison inmates 20151217.3869311
Louse-borne relapsing fever – Italy: asylum seekers, poss local transmission 20151110.3779157
Louse-borne relapsing fever – Germany (02): asylum seekers 20150911.3638819
Scabies – France: (PC) illegal immigrants, skin infections 20150808.3566562
Louse-borne relapsing fever – Netherlands: asylum seekers, ex Eritrea 20150731.3549645

2013
—-
Spotted fever rickettsiosis – USA: (CA) new species 20131101.2033025
Tick-borne borreliosis – USA (03): B. miyamotoi, comment 20130705.1808032
Tick-borne borreliosis – USA (02): (MA,NJ) B. miyamotoi 20130703.1805219
Tick-borne borreliosis – USA: (South. New Engl., NY) B. miyamotoi 20130118.1504740

2011
—-
Scabies, nursing home – Spain: (La Rioja) 20111231.3716
Scabies, hospital acquired – Spain (Canary Islands) 20111225.3673
Scabies – Mexico (02): (VE) background 20111216.3612
Scabies – Mexico: (VE) 20111214.3595
Tick-borne relapsing fever – Russia: (SV) Borrelia miyamotoi 20110920.2858
Tick-borne relapsing fever – USA (02): discussion 20110824.2580

2007
—-
Scabies, nursing home – Sweden 20071125.3815
Scabies, nosocomial – Russia (Tambov) 20070719.2318

2000
—-
Borreliosis, relapsing fever, soldiers – Israel: 20000423.0602

1999
—-
Borreliosis, relapsing fever – Sudan (south) 19990429220242
Borreliosis, relapsing fever – Sudan (south) (04) 19990511135434
………………………………………….sb/ep/mj/dk

Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases


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