Fact Check

Are Refugees Spreading Disease in the U.S.?

No, Syrian refugees aren't bringing a flesh-eating disease into the United States.

Published Dec 22, 2015

Syrian refugees are bringing a communicable flesh-eating disease into the United States.

On 20 December 2015, the web site Breitbart published an article titled "EXCLUSIVE - Syrian Refugees Bringing Flesh-Eating Disease into U.S.?", which held:

There is a risk that Middle Eastern refugees entering the U.​S​.​ could be infected with a flesh-eating disease that is sweeping across Syria.

Health agencies confirmed that Syrian refugees have transported leishmaniasis to Lebanon and Turkey, where it has been difficult to manage and treat.

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 leishmani​a​sis. Clearly, ​an attending doctor ​could easily spot a patient with obvious skin ulcers. However, leishmani​a​sis cannot be detected upon physical examination if the patient is asymptomatic, as can be the case for years.

On 21 December 2015, the web site Patriot Crier built upon the claim with an article titled "BREAKING: TERRIFYING NEW DISEASE ROCKS THE NATION as Syrian ‘REFUGEES’ ENTER AMERICA …" It began:

We’ve all been concerned that Syrian refugees were going to bring extremist beliefs and ideologies into the United States. But what about about leishmaniasis? You may have a puzzled look on your face right now…Don’t worry…you’re about to learn what that is.

Although that article didn't feature an image, it populated the above-reproduced photograph when the link was shared on Facebook. The appended image was unrelated; it appeared to depict a different infection known as amebiasis.

The articles referenced leishmaniasis, which according to the Centers for Disease Control and Prevention (CDC), has occurred in the United States, although rarely. A CDC FAQ addressed whether leishmaniasis is found in the United States, and explained:

Not usually. Almost all of the cases of leishmaniasis diagnosed in the United States are in people who became infected while traveling or living in other countries.

Occasional cases of cutaneous leishmaniasis have been acquired in Texas and Oklahoma. No cases of visceral leishmaniasis are known to have been acquired in the United States.

The CDC said that the disease is generally spread by a certain type of insect:

The main way is through the bite of infected female phlebotomine sand flies. Sand flies become infected by sucking blood from an infected animal or person. Some types (species) of Leishmania parasites also may be spread via contaminated needles (needle sharing) or blood transfusions. Congenital transmission (spread from a pregnant woman to her baby) has been reported.

On a separate page (subtitled "Epidemiology & Risk Factors"), the CDC added:

Leishmaniasis is found in people in focal areas of more than 90 countries in the tropics, subtropics, and southern Europe. The ecologic settings range from rain forests to deserts. Leishmaniasis usually is more common in rural than in urban areas, but it is found in the outskirts of some cities. Climate and other environmental changes have the potential to expand the geographic range of the sand fly vectors and the areas in the world where leishmaniasis is found.

Leishmaniasis is found on every continent except Australia and Antarctica.

fact sheet from the World Health Organization (WHO) further emphasized that the manner of transmission is overwhelmingly insect-to-human:

Leishmaniasis is caused by a protozoa parasite from over 20 Leishmania species and is transmitted to humans by the bite of infected female phlebotomine sandflies. Over 90 sandfly species are known to transmit Leishmania parasites. There are 3 main forms of the disease[.]

In an 18 December 2015 ScienceAlert article, University of Glasgow Professor of Biochemical Parasitology Michael Barrett described the concerns as a manifestation of epidemiologic xenophobia:

It is sandflies, not people, that transmit the disease and though they are found throughout the tropics and subtropics, they can’t survive in colder climates. The visceral form of leishmaniasis is already endemic in parts of southern Europe including Spain, Italy and the south of France, but the disease tends to only manifest itself in people with weak immune systems such as those infected with HIV. This highlights the fact that people in prosperous regions where nutrition and general health are good are at limited risk ... Although Turkey might be at risk of increased incidence of the cutaneous disease due to the flow of refugees from Syria, again it is worth highlighting that people with access to good nutrition and in generally good health are less vulnerable.

Concerns about imported germs, of course, are nothing new. Just last year, European airports were decorated with posters warning of Ebola, and those coming from West Africa were subjected to mandatory tests for signs of fever. But we should be careful of warnings of diseases spreading to developed countries, where healthcare systems and levels of public health are much more capable of preventing and treating infectious condition, even in instances where those diseases could spread. Plus the wider availability of treatments in Europe creates an opportunity to provide healthcare to incoming sick refugees.

Barrett was correct in his statement that opposition to immigration and asylum couched in terms disease is "nothing new."  For example, in mid-2014, unaccompanied minor immigrants from Central and South America were widely and baselessly blamed for an outbreak of Enterovirus D68. As the linked snopes.com page from 2014 noted, such claims were nearly identical in tenor and shape:

Media figures such as Schlafly and Pat Robertson have speculated that the EV-D68 outbreak started with immigrant children, with Robertson blaming minor migrants who have carried "with them viruses that we were not familiar with in the United States and haven't built up immunity to." Given that the particular strain of the virus now affecting Americans was recorded in the U.S. as far back as 1987, the claim that the current outbreak of Enterovirus D68 is due solely or primarily to that strain's being carried to the U.S. by immigrant children is a problematic one.

The "foreigners carrying disease" trope has, in fact, been present in American discourse for more than a century, and seems to reappear every time an immigrant or refugee population shows up in the United States.

In short, leishmaniasis infections in Syria increased due to a breakdown in the country's infrastructure during a larger, ongoing conflict. However, Syrian refugees are not known vectors of the illness. While human-to-human transmission is possible in rare circumstances, the disease's vector is the sandfly. Leishmaniasis has occurred in the United States, but again, it is rare due to the U.S.'s climate and its generally low-risk population.

Kim LaCapria is a former writer for Snopes.