Gestion d’une épidémie de gale aux Hôpitaux universitaires de Strasbourg

Infection Control among Healthcare Workers and Management of a Scabies Outbreak in a Large Italian University Hospital

This retrospective observational study describes the results of an ad-hoc designated prevention protocol aimed at containing the spread of the scabies infestation among healthcare workers (HCWs) of a large University Hospital in Italy. The outbreak started on October 2022 and a preventive protocol was set up thanks to a multidisciplinary approach. HCWs at high scabies risk were defined as subjects working in Operative Units with a scabies prevalence higher than 2%, close contacts of a confirmed case of scabies, or HCWs with signs and symptoms of the disease. All cases at high scabies risk underwent a dermatological examination, and the infested HCWs were suspended from work until definitive healing. Mass drug administration was established for all HCWs working in Operative Units with a scabies prevalence higher than 2%. Until March 2023, out of 183 screening dermatological examinations, 21 (11.5%) were diagnostic for scabies. Between 11 October 2022 (date of the first diagnosed scabies case) and 6 March 2023 (the end of incubation period related to the last case detected), the frequency of scabies was 0.35% (21 scabies cases/6000 HCWs). The duration of the outbreak in our hospital was 14.7 weeks. Statistical analysis shows a significant association between scabies and being a nurse and having an allergy to dust mites. We obtained a low frequency of scabies infection, limiting the duration of the outbreak and the related economic burden.

[Scabies as an occupational disease]

Scabies is an infectious skin disease caused by the human itch mite (Sarcoptes scabiei var. hominis). It is mainly transmitted by direct skin-to-skin contact. The spread of scabies can cause major difficulties in healthcare institutions, particularly in residential homes for the elderly. The disease is characterized by intense nocturnal itching, erythematous papules arranged in a linear order, and scratching resulting in excoriations. The diagnosis is confirmed by identification of the mite or by finding one or more mite tunnels in the skin. An individually occurring case does not need to be reported. If two or more cases occur in the same institution, the company physician and the appropriate public health department are to be informed in Germany. In case of a suspected scabies infection in medical personnel due to exposure in their work setting, medical notification to the statutory occupational accidents' insurance (Nr. 3101) is to be issued in accordance with § 202, Volume VII of the German Social Code. First line treatment is topical therapy with 5 % permethrin. If scabies control is required in an institution, systemic treatment with ivermectin may be considered. In the case of a scabies outbreak, all patients, contact persons, and staff must be treated simultaneously.

Scabies

Scabies is a contagious skin infestation caused by a mite. It causes significant global morbidity, with an estimated 300 million cases annually. Although it can affect individuals at any socioeconomic level, individuals who live in poverty or in overcrowded conditions are at much higher risk for scabies. Lack of local expertise can result in failure to recognize scabies, leading to delayed diagnosis and inadequate treatment of cases and contacts. Scabies disproportionately affects many Indigenous (First Nations, Inuit, Métis) communities where risk factors are present. Scabies risk is also higher in young children, the elderly and immunocompromised individuals. Institutional outbreaks of scabies have also been reported. Apart from a very itchy rash, scabies can lead to secondary bacterial infections and related complications, as well as to stigmatization, depression, insomnia and significant financial costs. Topical antiscabies lotions are still the mainstay of treatment, but oral ivermectin has also proven effective under certain circumstances. Asymptomatic and symptomatic household members should all be treated at the same time. In Canada and globally, the presence of scabies is usually a symptom of poor living conditions and a sign that basic necessities need improvement. Clinicians who work with Indigenous communities can improve their ability to diagnose and treat scabies, and should advocate for better living conditions where scabies is prevalent.

Topical ivermectin versus crotamiton cream 10% for the treatment of scabies

Scabies, known colloquially as the 7-year itch, is a contagious skin infection that occurs among humans and other animals. The treatment of choice is still controversial. The aim of this study was to compare the efficacy and safety of topical ivermectin vs. crotamiton cream 10% for the treatment of scabies. In total, 340 patients with scabies were enrolled, and randomized into two groups. The first group received 1% ivermectin applied topically to the affected skin. The dose employed was 400 μg/kg, repeated once the following week, and the second group received crotamiton 10% cream and were told to apply this twice daily for five consecutive days. Treatment was evaluated at intervals of two and four weeks, and if there was treatment failure at the 2-week follow-up, treatment was repeated. Two applications of topical ivermectin provided a cure rate of 64.7% at the 2-week follow-up, which increased to 82.3% at the 4-week follow-up after repeating the treatment. Treatment with single applications of crotamiton cream 10% was effective in 41.2% of patients at the 2-week follow-up, which increased to 64.7% at the 4-week follow-up after this treatment was repeated. Ivermectin was quite safe in our cases. Two applications of ivermectin were as effective as single applications of crotamiton 10% cream at the 2-week follow-up. After repeating the treatment, ivermectin was superior to crotamiton cream 10% at the 4-week follow-up.

Control of scabies outbreaks in an Italian hospital: an information-centered management strategy

BACKGROUND

Scabies is a dermatologic infestation caused by Sarcoptes scabiei. In industrialized countries, hospitals and other health structures can sometimes be hit. The optimal management of scabies outbreaks still has to be established, mass prophylaxis being one possible option.

METHODS

To identify the optimal approach to containing this re-emerging disease, a local health authority in Lombardy, Northern Italy, carried out an epidemiologic study into 2 scabies epidemics that took place from September to December 2012 in a 600-bed hospital with 26,000 admissions a year.

RESULTS

Over a 3-month period, there were 12 cases of scabies on 4 wards; 43 contacts received prophylaxis. When the first cases were identified, an information campaign involving all hospital personnel was immediately set up. Regular staff meetings were organized, and information leaflets were distributed to patients. Family doctors of discharged patients were informed of the outbreak.

CONCLUSION

A management model based on an information-centered strategy was used in place of mass prophylaxis to deal with scabies epidemics. The success of this approach was confirmed by the managers of the hospital involved (reduced expenditure for prophylactic drugs) and by hospital staff who did not have to deal with potential drug adverse effects.

[Interest of emergency dermatological consultation in a regional hospital]

INTRODUCTION

Dermatologists, both as hospital and as resident practitioners, are often requested to see emergencies of their discipline, although appointment planning are already fully booked months in advance. Orleans Regional Hospital (ORH) has opened a department of dermatological emergency consultation to try to help with this issue. A prospective, descriptive and consecutive study on patient characteristics was conducted during its first year operating.

METHOD

In September 2011, we opened a department of dermatological emergency consultation. Reception is skin disorders evaluated by physicians or nurses as "emergencies", according to predefined criteria. Follow-up visits are performed in the afternoon.

RESULTS

Within one year, 2209 medical visits were conducted, with an average of 8,7 emergency visits per day. The maximum numbers of patients treated by our dermatological emergency unit in one single morning was 19. Mondays were the busiest day of the week. The average age of a patient attending the department was 33 years, with 29% of pediatric patients (under 15 years old). The majority of patients presented spontaneously (43%), or were referred by general practitioners (25%). Adult and pediatric emergency departments sent 8% of patients. The two main reasons for consultation were rash (48%) and pruritus (16%). Diagnoses observed were mainly infections (24%) and eczema (14%). Scabies accounted for 9% of all diagnoses. In the aftermath of an emergency dermatological consultation, 84 patients were hospitalized, including 74 in the dermatology department of Orleans hospital totalling 505 days of hospitalization.

CONCLUSION

The value of a dermatological emergency consultation is well demonstrated in areas where more medical services are available (such as cities with University hospitals available). It is even more justified in areas with a deficit of healthcare service availability such as Central France.

Epidemiology of scabies

PURPOSE OF REVIEW

Scabies is a common skin infestation globally, particularly in the developing world. With the launch of the International Alliance for the Control of Scabies (IACS) in 2012, this review aims to present the recent evidence of the current epidemiological situation for scabies across the globe. Mindful of the fact that the downstream complications of scabies infestations, pyoderma, streptococcal glomerulonephritis and subsequent chronic renal impairment and rheumatic fever, have been recognized as being more significant to global health than previously acknowledged, the review focusses also on the epidemiological evidence from developing countries.

RECENT FINDINGS

Scabies occurrence rates vary in the recent literature from 2.71 per 1000 to 46%. Although it is responsible for larger disease burdens and complications such as pyoderma and renal and heart disease in the tropics, scabies outbreaks in the developed world amongst vulnerable communities and health institutions contribute a significant cost to the health services managing them.

SUMMARY

Scabies remains common across the world, but is such a health issue in the developing world that the suggestion that it be considered a neglected tropical disease is a pertinent one. Standardized diagnostic criteria and even a point-of-care diagnostic test would be a major contribution to the understanding of this epidemic.