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Meyersburg D, Hoellwerth M, Brandlmaier M, Handisurya A, Kaiser A, Prodinger C, Bauer JW. Comparison of topical permethrin 5% vs. benzyl benzoate 25% treatment in scabies: a double-blinded randomized controlled trial. Br J Dermatol 2024; 190:486-491. [PMID: 38112640 DOI: 10.1093/bjd/ljad501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/21/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Scabies is a pruritic parasitic infestation of the skin. High-income countries have reported an increasing incidence over the last few years. Studies have indicated a reduction in the sensitivity of scabies mites to the standard treatment of choice, topical permethrin 5%. OBJECTIVES To evaluate in a head-to-head manner the efficacy of two topical scabicides [permethrin 5% and benzyl benzoate 25% (BB)] in the treatment of scabies using the same administration modality; and to address potential confounding factors such as incorrectly performed treatment and hygiene measures. METHODS In total, 110 patients with dermoscopy-verified scabies infestation were enrolled and randomized into two equally sized groups in a double-blinded manner. Fifty-five received topical permethrin 5% and 55 received topical BB 25%, both for daily use over a period of three consecutive days. Treatment outcome was evaluated by dermoscopy at a 3-week follow-up visit. RESULTS Treatment resulted in a dermoscopy-verified cure rate of 27% in the permethrin group and 87% in the BB group. The tolerability and safety profile of permethrin 5% cream was excellent, while the BB emulsion produced a burning sensation in 43% of patients. CONCLUSIONS Topical permethrin demonstrated a lack of efficacy in the majority of scabies cases, whereas BB demonstrated an excellent cure rate and reasonable tolerability. Considering the reduced sensitivity of scabies mites to permethrin 5%, our results suggest that BB is an appropriate first-line therapy in the treatment of scabies.
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Affiliation(s)
- Damian Meyersburg
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Magdalena Hoellwerth
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Matthias Brandlmaier
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Andreas Kaiser
- Department of Psychosomatics and Inpatient Psychotherapy, University Hospital of Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
| | - Christine Prodinger
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Johann W Bauer
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University Salzburg, Salzburg, Austria
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Hansmann A, Wamba Lékémo G, Fomba C, Kaddoura J, Toure R, Diop A, Ndiaye M, Chosidow O, Marks M, Ly F. Low prevalence of scabies and impetigo in Dakar/Senegal: A cluster-randomised, cross-sectional survey. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002942. [PMID: 38417092 PMCID: PMC10901544 DOI: 10.1371/journal.pgph.0002942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/25/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Scabies, a parasitic infection caused by Sarcoptes scabiei var. hominis, is a public health problem with significant morbidity worldwide, particularly in low-resource countries. Impetigo, a complication of scabies infection, is a risk factor for sepsis, glomerulonephritis and possibly acute rheumatic fever. Currently, the majority of epidemiological data has been collected in rural populations in the Pacific with limited applicability to urban populations in sub-Saharan Africa, where scabies is also believed to be a problem. To inform future public health programs, more reliable information about the burden of disease is required. METHODOLOGY/PRINCIPAL FINDINGS In July/August 2022, we conducted a cross sectional, cluster-randomised, household survey in Pikine/Dakar using the 'International Association for the Control of Scabies (IACS)' criteria to diagnose scabies and impetigo. All participants underwent a standardised clinical examination by post-graduate dermatology students. For those diagnosed with scabies, an age-adapted 'Dermatology Life Quality Index (DLQI)' questionnaire was filled. We recruited and examined 1697 participants to detect 27 cases of scabies (prevalence: 1.6%, 95% CI 0.8-3.2), mostly in school aged children. Ten participants suffered from impetigo (prevalence: 0.6%, 95% CI 0.3-1.3), 5 of which were dually infected with scabies. Risk factors for scabies infection were young age, male gender and Koranic school attendance. Of those found to have scabies, in 7 out of 22 cases (31.8%) it had a large effect on their lives according to the DLQI questionnaires filled. CONCLUSIONS/SIGNIFICANCE This study adds to the mapping of the burden of scabies across Africa to support public health action. With a low prevalence of scabies that is concentrated amongst poor households and children attending Koranic schools, a focused public health approach targeting Koranic schools and poor households seems to be most appropriate in this community.
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Affiliation(s)
- Andreas Hansmann
- Department of Neonatology and Paediatric Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Genevia Wamba Lékémo
- Service de Dermatologie, Institut d’Hygiène Sociale, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Chiaka Fomba
- Service de Dermatologie, Institut d’Hygiène Sociale, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Jade Kaddoura
- Service de Dermatologie, Institut d’Hygiène Sociale, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Ramatoullaye Toure
- Service de Dermatologie, Institut d’Hygiène Sociale, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Assane Diop
- Service de Dermatologie, Institut d’Hygiène Sociale, Université Cheikh Anta Diop, Dakar, Sénégal
| | | | - Olivier Chosidow
- Service de Dermatologie, Henri Mondor Hospital, Université Paris-Est, Créteil, Paris, France
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fatimata Ly
- Service de Dermatologie, Institut d’Hygiène Sociale, Université Cheikh Anta Diop, Dakar, Sénégal
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Tellioglu N, Chisholm RH, Campbell PT, Collinson S, Timothy J, Kollie K, Zayzay S, Devine A, McVernon J, Marks M, Geard N. Modelling mass drug administration strategies for reducing scabies burden in Monrovia, Liberia. Epidemiol Infect 2023; 151:e153. [PMID: 37593956 PMCID: PMC10548539 DOI: 10.1017/s0950268823001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/29/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023] Open
Abstract
Scabies is a parasitic infestation with high global burden. Mass drug administrations (MDAs) are recommended for communities with a scabies prevalence of >10%. Quantitative analyses are needed to demonstrate the likely effectiveness of MDA recommendations. In this study, we developed an agent-based model of scabies transmission calibrated to demographic and epidemiological data from Monrovia. We used this model to compare the effectiveness of MDA scenarios for achieving scabies elimination and reducing scabies burden, as measured by time until recrudescence following delivery of an MDA and disability-adjusted-life-years (DALYs) averted. Our model showed that three rounds of MDA delivered at six-month intervals and reaching 80% of the population could reduce prevalence below 2% for three years following the final round, before recrudescence. When MDAs were followed by increased treatment uptake, prevalence was maintained below 2% indefinitely. Increasing the number of and coverage of MDA rounds increased the probability of achieving elimination and the number of DALYs averted. Our results suggest that acute reduction of scabies prevalence by MDA can support a transition to improved treatment access. This study demonstrates how modelling can be used to estimate the expected impact of MDAs by projecting future epidemiological dynamics and health gains under alternative scenarios.
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Affiliation(s)
- Nefel Tellioglu
- School of Computing and Information Systems, The University of Melbourne, Melbourne, VIC, Australia
| | - Rebecca H. Chisholm
- Department of Mathematical and Physical Sciences, La Trobe University, Bundoora, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Patricia Therese Campbell
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Shelui Collinson
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Joseph Timothy
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Angela Devine
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Jodie McVernon
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Nicholas Geard
- School of Computing and Information Systems, The University of Melbourne, Melbourne, VIC, Australia
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Meyersburg D, Welponer T, Kaiser A, Selhofer S, Tatarski R, Handisurya A, Bauer JW. Comparison of topical benzyl benzoate vs. oral ivermectin in treating scabies: A randomized study. J Eur Acad Dermatol Venereol 2023; 37:160-165. [PMID: 36097258 PMCID: PMC10087012 DOI: 10.1111/jdv.18573] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 08/18/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Scabies is an itchy, parasitic infection of the skin. Recent reports indicate there is a decreasing efficacy of the standard treatment of choice, topical 5% permethrin cream. OBJECTIVE To evaluate the comparative efficacy, safety and tolerability of topical benzyl benzoate (BB) with oral ivermectin in the treatment of scabies. METHODS Patients with dermoscopy-verified scabies visiting the dermatologic outpatient clinic were assessed for enrolment in the study. In total, 224 patients were enrolled and sequentially randomized into two equally sized groups. Group A received topical 25% or 10% BB for the daily use over a period of three consecutive days, group B received oral ivermectin (200 μg/kg body weight) twice, 1 week apart. Treatment outcome was evaluated by dermoscopy at a 3-week follow-up visit. RESULTS Treatment resulted in a cure rate of 87% in group A and 86% in group B. After initial therapy failure in group A, six out of eight patients showed treatment response upon repeated application of BB, five of five when retreated with ivermectin and two of two with BB plus ivermectin, respectively. In group B, successful retreatment was observed in three out of three patients with ivermectin, two of two patients with BB and 11 of 11 patients with the combination of BB plus ivermectin, respectively. Tolerability and safety profile of oral ivermectin was excellent, while BB produced short burning sensations in 14%. CONCLUSION Topical BB and oral ivermectin have shown comparable good therapeutic efficacy. Therefore, both agents constitute an adequate first-line therapy in the treatment of scabies. A combination of both agents may be considered in recalcitrant and extensively infested cases, additionally to crusted scabies.
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Affiliation(s)
- Damian Meyersburg
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University, Salzburg, Austria
| | - Tobias Welponer
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University, Salzburg, Austria
| | - Andreas Kaiser
- Department of Psychosomatics and Inpatient Psychotherapy, University Hospital of Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
| | - Sylvia Selhofer
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University, Salzburg, Austria
| | - Rafaella Tatarski
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University, Salzburg, Austria
| | | | - Johannes Wolfgang Bauer
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University, Salzburg, Austria
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5
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Tsoi SK, Lake SJ, Thean LJ, Matthews A, Sokana O, Kama M, Amaral S, Romani L, Whitfeld M, Francis JR, Vaz Nery S, Marks M, Kaldor JM, Steer AC, Engelman D. Estimation of scabies prevalence using simplified criteria and mapping procedures in three Pacific and southeast Asian countries. BMC Public Health 2021; 21:2060. [PMID: 34758806 PMCID: PMC8579609 DOI: 10.1186/s12889-021-12039-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Scabies causes considerable morbidity in disadvantaged populations. The International Alliance for the Control of Scabies (IACS) published consensus criteria in 2020 to standardize scabies diagnosis. However, these criteria are complex, and a WHO informal consultation proposed simplified criteria for mapping, to identify regions of high prevalence as targets for mass drug administration. We aimed to investigate the accuracy of simplified criteria in determining scabies prevalence, compared to the 2020 IACS criteria. Methods We obtained data relating to demographics, relevant history and skin lesions from all-age prevalence surveys from Fiji (n = 3365) and Solomon Islands (n = 5239), as well as school-aged children in Timor-Leste (n = 1043). We calculated prevalence using the 2020 IACS criteria and simplified criteria and compared these disease estimates. Results There was no significant difference in the pooled prevalence using the two methods (2020 IACS criteria: 16.6%; simplified criteria: 15.6%; difference = 0.9, [95% CI -0.1, 2.0]). In Timor-Leste, the prevalence using simplified criteria was lower (26.5% vs 33.8%). Simplified criteria had a sensitivity of 82.3% (95% CI 80.2, 84.2) and specificity of 97.6% (95% CI 97.2, 97.9) compared to the 2020 IACS criteria. Conclusions The scabies prevalence estimation using simplified criteria was similar to using the 2020 IACS criteria in high prevalence, tropical countries. The prevalence estimation was lower in the school-based survey in Timor-Leste. Mapping using simplified criteria may be a feasible and effective public health tool to identify priority regions for scabies control. Further work assessing use of simplified criteria for mapping in a field setting should be conducted. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12039-2.
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Affiliation(s)
- Shu Ki Tsoi
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Susanna J Lake
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Royal Children's Hospital, Melbourne, Australia
| | - Li Jun Thean
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Mike Kama
- Ministry of Health, Dinem House, Suva, Republic of Fiji
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Lucia Romani
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Margot Whitfeld
- St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Hospital for Tropical Diseases, University College London Hospital, London, UK
| | - John M Kaldor
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew C Steer
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Royal Children's Hospital, Melbourne, Australia
| | - Daniel Engelman
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, Australia. .,Melbourne Children's Global Health, Royal Children's Hospital, Melbourne, Australia.
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6
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Joshi V, Dimri U, Gopalakrishnan A, Bhanuprakash AG, Gupta VK. Porcine scabies induces marked apoptosis, increased pro-inflammatory cytokines IL-1, TNF-α and shedding of ICAM-1. Parasite Immunol 2021; 43:e12878. [PMID: 34559899 DOI: 10.1111/pim.12878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/05/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Scabies is one of the leading causes of morbidity in pigs worldwide. Limited data are available regarding the role of immune reactions in the development of porcine scabies. MATERIALS AND METHODS The aim of this study was to investigate key pro-inflammatory cytokines (IL-1, TNF-α), soluble variant of adhesion molecule ICAM-1 and mite-mediated apoptosis of peripheral leukocytes in 20 pigs with scabies, in addition to 10 healthy controls. The pigs with at least three typical clinical signs and found positive for Sarcoptes scabiei var. suis in microscopy were recruited for the present study. RESULTS IL-1 acted as the major pro-inflammatory cytokine as serum IL-1 concentrations showed significantly (p < .05) higher levels (7-fold increase) in cases than in controls. The minor cytokine TNF-α was 4-fold higher during scabies, and its mean serum concentration was significantly increased (p < .05) in cases when compared to healthy controls. Soluble ICAM-1 levels were significantly higher (p < .05) in all the pigs of infested group compared with the controls. The percentage of apoptotic and necrotic leukocytes was found to be significantly higher (p < .05) in scabies positive pigs as compared to the healthy controls. CONCLUSION It is concluded that systemic elevation in pro-inflammatory cytokines IL-1 and TNF-α, shedding of soluble ICAM-1 variant in peripheral blood and increased rate of host-cell apoptosis in peripheral leukocytes might be implicated in the immunopathology of naturally acquired porcine scabies.
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Affiliation(s)
- Vivek Joshi
- Division of Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India.,Animal Health Section, ICAR-National Research Centre on Mithun, Medziphema, Dimapur, Nagaland, India
| | - Umesh Dimri
- Division of Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Arumugam Gopalakrishnan
- Division of Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India.,Resident Veterinary Services Section, Madras Veterinary College, Chennai, Tamil Nadu, India
| | | | - Vinod Kumar Gupta
- Division of Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
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Abstract
Scabies is an infestation of the skin caused by the mite Sarcoptes scabiei. In 2017, scabies was recognised by the World Health Organisation as a disease of public importance and was consequently added to the list of neglected tropical diseases. An estimated 200 million people currently have scabies worldwide. Scabies is endemic in many developing countries, with the highest prevalence being in hot, humid climates such as the Pacific and Latin American regions. Scabies causes a host immune response which is intensely itchy. Scratching of the lesions can lead to secondary bacterial infections of the skin, such as impetigo, most commonly caused by Streptococcus pyogenes or Staphylococcus aureus. This can have fatal consequences, such as septicaemia, glomerulonephritis, and rheumatic heart disease. Advances over the past 5 years indicate that mass drug administration is an effective strategy to treat scabies. This review will outline advances in the mite biology, epidemiological understanding, diagnosis, and treatment of scabies.
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Affiliation(s)
- Emily Welch
- St Vincent’s Hospital, University of New South Wales, Sydney, Australia
| | | | - Margot J Whitfeld
- St Vincent’s Hospital, University of New South Wales, Sydney, Australia
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8
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Lake SJ, Engelman D, Sokana O, Nasi T, Boara D, Grobler AC, Osti MH, Andrews R, Marks M, Whitfeld MJ, Romani L, Kaldor JM, Steer AC. Defining the need for public health control of scabies in Solomon Islands. PLoS Negl Trop Dis 2021; 15:e0009142. [PMID: 33617544 PMCID: PMC7932527 DOI: 10.1371/journal.pntd.0009142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/04/2021] [Accepted: 01/14/2021] [Indexed: 01/22/2023] Open
Abstract
Pacific Island countries have a high burden of scabies and impetigo. Understanding of the epidemiology of these diseases is needed to target public health interventions such as mass drug administration (MDA). The aim of this study is to determine the prevalence of scabies and impetigo in Solomon Islands as well as the relationship between them and their distribution. We conducted a prevalence study in 20 villages in Western Province in Solomon Islands. All residents of the village were eligible to participate. Nurses conducted clinical assessments including history features and skin examination. Diagnosis of scabies was made using the 2020 International Alliance for the Control of Scabies diagnostic criteria. Assessments were completed on 5239 participants across 20 villages. Overall scabies prevalence was 15.0% (95%CI 11.8-19.1). There was considerable variation by village with a range of 3.3% to 42.6%. There was a higher prevalence of scabies in males (16.7%) than females (13.5%, adjusted relative risk 1.2, 95%CI 1.1-1.4). Children aged under two years had the highest prevalence (27%). Overall impetigo prevalence was 5.6% (95%CI 4.2-7.3), ranging from 1.4% to 19% by village. The population attributable risk of impetigo associated with scabies was 16.1% (95% CI 9.8-22.4). The prevalence of scabies in our study is comparable to previous studies in Solomon Islands, highlighting a persistent high burden of disease in the country, and the need for public health strategies for disease control.
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Affiliation(s)
- Susanna J. Lake
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne Children’s Global Health, Melbourne, Australia
| | - Daniel Engelman
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne Children’s Global Health, Melbourne, Australia
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara Solomon Islands
| | - Titus Nasi
- Ministry of Health and Medical Services, Honiara Solomon Islands
| | - Dickson Boara
- Ministry of Health and Medical Services, Honiara Solomon Islands
| | - Anneke C. Grobler
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Millicent H. Osti
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Ross Andrews
- Australian National University, Canberra, Australia
| | - Michael Marks
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
| | | | - Lucia Romani
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - John M. Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew C. Steer
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne Children’s Global Health, Melbourne, Australia
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The prevalence of scabies in Monrovia, Liberia: A population-based survey. PLoS Negl Trop Dis 2020; 14:e0008943. [PMID: 33284821 PMCID: PMC7746289 DOI: 10.1371/journal.pntd.0008943] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/17/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022] Open
Abstract
Scabies is known to be a public health problem in many settings but the majority of recent data is from rural settings in the Pacific. There is a need for high quality data from sub-Saharan Africa and peri-urban settings to inform scale up of scabies control efforts. There have been anecdotal reports of scabies being a public health problem in Liberia but robust data are lacking. We conducted a cross-sectional cluster-randomised prevalence survey for scabies in a peri-urban community in Monrovia, Liberia in February-March 2020. Participants underwent a standardised examination conducted by trained local health care workers. Health related quality of life (HRQoL) was assessed using age-appropriate versions of the dermatology life quality index (DLQI). Prevalence estimates were calculated accounting for clustering at community and household levels and associations with key demographic variables assessed through multivariable random-effects logistic regression. 1,318 participants from 477 households were surveyed. The prevalence of scabies was 9.3% (95% CI: 6.5–13.2%), across 75 (19.7%) households; impetigo or infected scabies prevalence was 0.8% (95% CI: 0.4–1.9%). The majority (52%) of scabies cases were classified as severe. Scabies prevalence was lower in females and higher in the youngest age group; no associations were found with other collected demographic or socio-economic variables. DLQI scores indicated a very or extremely large effect on HRQoL in 29% of adults and 18% of children diagnosed with scabies. Our study indicates a substantial burden of scabies in this peri-urban population in Liberia. This was associated with significant impact on quality of life, highlighting the need for action to control scabies in this population. Further work is needed to assess the impact of interventions in this context on both the prevalence of scabies and quality of life. Scabies is an infestation with a microscopic mite which affects many people living in low-resource tropical countries. It causes intense itching, which can lead to complications through bacterial infection and poor quality of life. To help develop global scabies control programmes, we need a better understanding of how common it is across different tropical settings. We conducted a survey to assess the burden of scabies and bacterial skin infection in a random sample of people living in a community in Monrovia, Liberia. Information about participants and their household were collected and their skin was examined; those with skin conditions were asked about its impact on quality of life. We examined 1,318 participants and found that almost 10% of people had scabies. Scabies was more common in young children and more common in male children than female children. We found that there was a large impact on quality of life due mostly to the itching that scabies causes and to people feeling embarrassed or sad because of their skin condition. This scabies survey is one of the first conducted across all age groups in recent years in sub-Saharan Africa and indicates a substantial burden and impact on quality of life. More work is needed to understand how common scabies is in different settings and the impact that different treatment strategies may have.
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Engelman D, Yoshizumi J, Hay R, Osti M, Micali G, Norton S, Walton S, Boralevi F, Bernigaud C, Bowen A, Chang A, Chosidow O, Estrada‐Chavez G, Feldmeier H, Ishii N, Lacarrubba F, Mahé A, Maurer T, Mahdi M, Murdoch M, Pariser D, Nair P, Rehmus W, Romani L, Tilakaratne D, Tuicakau M, Walker S, Wanat K, Whitfeld M, Yotsu R, Steer A, Fuller L. The 2020 International Alliance for the Control of Scabies Consensus Criteria for the Diagnosis of Scabies. Br J Dermatol 2020; 183:808-820. [PMID: 32034956 PMCID: PMC7687112 DOI: 10.1111/bjd.18943] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Scabies is a common parasitic skin condition that causes considerable morbidity globally. Clinical and epidemiological research for scabies has been limited by a lack of standardization of diagnostic methods. OBJECTIVES To develop consensus criteria for the diagnosis of common scabies that could be implemented in a variety of settings. METHODS Consensus diagnostic criteria were developed through a Delphi study with international experts. Detailed recommendations were collected from the expert panel to define the criteria features and guide their implementation. These comments were then combined with a comprehensive review of the available literature and the opinion of an expanded group of international experts to develop detailed, evidence-based definitions and diagnostic methods. RESULTS The 2020 International Alliance for the Control of Scabies (IACS) Consensus Criteria for the Diagnosis of Scabies include three levels of diagnostic certainty and eight subcategories. Confirmed scabies (level A) requires direct visualization of the mite or its products. Clinical scabies (level B) and suspected scabies (level C) rely on clinical assessment of signs and symptoms. Evidence-based, consensus methods for microscopy, visualization and clinical symptoms and signs were developed, along with a media library. CONCLUSIONS The 2020 IACS Criteria represent a pragmatic yet robust set of diagnostic features and methods. The criteria may be implemented in a range of research, public health and clinical settings by selecting the appropriate diagnostic levels and subcategories. These criteria may provide greater consistency and standardization for scabies diagnosis. Validation studies, development of training materials and development of survey methods are now required. What is already known about this topic? The diagnosis of scabies is limited by the lack of accurate, objective tests. Microscopy of skin scrapings can confirm the diagnosis, but it is insensitive, invasive and often impractical. Diagnosis usually relies on clinical assessment, although visualization using dermoscopy is becoming increasingly common. These diagnostic methods have not been standardized, hampering the interpretation of findings from clinical research and epidemiological surveys, and the development of scabies control strategies. What does this study add? International consensus diagnostic criteria for common scabies were developed through a Delphi study with global experts. The 2020 International Alliance for the Control of Scabies (IACS) Criteria categorize diagnosis at three levels of diagnostic certainty (confirmed, clinical and suspected scabies) and eight subcategories, and can be adapted to a range of research and public health settings. Detailed definitions and figures are included to aid training and implementation. The 2020 IACS Criteria may facilitate the standardization of scabies diagnosis.
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11
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Walker SL, Collinson S, Timothy J, Zayzay SK, Kollie KK, Candy N, Lebas E, Halliday K, Pullan R, Fallah M, Marks M. A community-based validation of the International Alliance for the Control of Scabies Consensus Criteria by expert and non-expert examiners in Liberia. PLoS Negl Trop Dis 2020; 14:e0008717. [PMID: 33017426 PMCID: PMC7732067 DOI: 10.1371/journal.pntd.0008717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/11/2020] [Accepted: 08/14/2020] [Indexed: 11/09/2022] Open
Abstract
Background The International Alliance for the Control of Scabies (IACS) recently published expert consensus criteria for scabies diagnosis. Formal validation of these criteria is needed to guide implementation. We conducted a study to provide detailed description of the morphology and distribution of scabies lesions as assessed by dermatologists and validate the IACS criteria for diagnosis by both expert and non-expert examiners. Methods Participants from a community in Monrovia, Liberia, were independently assessed by two dermatologists and six non-expert examiners. Lesion morphology and distribution were documented based on the dermatologist examination. Diagnoses were classified by IACS criteria and the sensitivity and specificity of non-expert examiner assessments calculated. Results Papules were the most common lesions (97.8%). Burrows were found in just under half (46.7%) and dermatoscopy was positive in a minority (13.3%). Scabies lesions were found in all body regions but more than 90% of patients could have been diagnosed by an examination of only the limbs. Severity of itch was associated with lesion number (p = 0.003). The sensitivity of non-expert examiners to detect typical scabies ranged between 69–83% and specificity 70–96%. The sensitivity of non-expert examiners was higher in more extensive disease (78–94%). Conclusions The IACS criteria proved a valid tool for scabies diagnosis. For the purposes of implementation papules and burrows represent truly ‘typical’ scabies lesions. Non-expert examiners are able to diagnose scabies with a high degree of accuracy, demonstrating they could form a key component in population-level control strategies. Scabies is a very common skin condition in both high- and low-income settings with hundreds of millions of people affected each year. Recently standardised criteria have been proposed to help improve the quality of scabies diagnosis, in particular in low income settings where the access to a skin specialist is very limited. In this study, conducted in Liberia, expert examiners conducted a thorough examination and recorded what different types of skin problems they found in participants with and without scabies. We then compared the accuracy of a diagnosis of scabies made by dermatologists to that made by non-specialist healthcare workers who had received a short training course over three days. We found that papules were the most common type of scabies lesion and were found in almost every single patient with scabies. A second type of skin lesion called a burrow was the next most common and was found in just under half of the participants. Other types of scabies lesions which have been described were rare in this study. We found that after the short training course the non-specialists were able to detect the majority of the cases of scabies correctly. Our study has helped provide detailed data on exactly what types of skin changes are typical of scabies and demonstrated how short training programmes can help improve the skill of non-specialist examiners in diagnosing scabies.
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Affiliation(s)
- Stephen L. Walker
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases and Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- * E-mail: (SLW); (MM)
| | - Shelui Collinson
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joseph Timothy
- Disease Control Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Neima Candy
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Eglantine Lebas
- Department of Dermatopathology, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Katherine Halliday
- Disease Control Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel Pullan
- Disease Control Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mosoka Fallah
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail: (SLW); (MM)
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12
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Lake SJ, Phelan SL, Engelman D, Sokana O, Nasi T, Boara D, Gorae C, Schuster T, Grobler AC, Osti MH, Andrews R, Marks M, Whitfeld MJ, Romani L, Kaldor J, Steer A. Protocol for a cluster-randomised non-inferiority trial of one versus two doses of ivermectin for the control of scabies using a mass drug administration strategy (the RISE study). BMJ Open 2020; 10:e037305. [PMID: 32868360 PMCID: PMC7462236 DOI: 10.1136/bmjopen-2020-037305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Scabies is a significant contributor to global morbidity, affecting approximately 200 million people at any time. Scabies is endemic in many resource-limited tropical settings. Bacterial skin infection (impetigo) frequently complicates scabies infestation in these settings. Community-wide ivermectin-based mass drug administration (MDA) is an effective control strategy for scabies in island settings, with a single round of MDA reducing population prevalence by around 90%. However, current two-dose regimens present a number of barriers to programmatic MDA implementation. We designed the Regimens of Ivermectin for Scabies Elimination (RISE) trial to investigate whether one-dose MDA may be as effective as two-dose MDA in controlling scabies in high-prevalence settings. METHODS AND ANALYSIS RISE is a cluster-randomised non-inferiority trial. The study will be conducted in 20 isolated villages in Western Province of Solomon Islands where population prevalence of scabies is approximately 20%. Villages will be randomly allocated to receive either one dose or two doses of ivermectin-based MDA in a 1:1 ratio. The primary objective of the study is to determine if ivermectin-based MDA with one dose is as effective as MDA with two doses in reducing the prevalence of scabies after 12 months. Secondary objectives include the effect of ivermectin-based MDA on impetigo prevalence after 12 and 24 months, the prevalence of scabies at 24 months after the intervention, the impact on presentation to health facilities with scabies and impetigo, and the safety of one-dose and two-dose MDA. ETHICS AND DISSEMINATION This trial has been approved by the ethics review committees of the Solomon Islands and the Royal Children's Hospital, Australia. Results will be disseminated in peer-reviewed publications and in meetings with the Solomon Islands Ministry of Health and Medical Services and participating communities. TRIAL REGISTRATION DETAILS Australian New Zealand Clinical Trials Registry: ACTRN12618001086257. Date registered: 28 June 2018.
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Affiliation(s)
- Susanna J Lake
- Tropical Disease Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sophie L Phelan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel Engelman
- Tropical Disease Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Titus Nasi
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Dickson Boara
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Christina Gorae
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Tibor Schuster
- Clinical Epidemiology and Biostatistics Unit, McGill University, Montreal, Quebec, Canada
| | - Anneke C Grobler
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Millicent H Osti
- Tropical Disease Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Ross Andrews
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michael Marks
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, London, UK
| | - Margot J Whitfeld
- Department of Dermatology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Lucia Romani
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Steer
- Tropical Disease Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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13
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Callum J, McDiarmid D, Gao Y, Armstrong M, Iavro E, Steer A. Prevalence of scabies in Sanma Province, Vanuatu. Trans R Soc Trop Med Hyg 2020; 113:500-502. [PMID: 31185078 DOI: 10.1093/trstmh/trz045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/23/2019] [Accepted: 05/05/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Scabies is a common, under-reported condition in the Pacific with acute and chronic complications. In this study we explored the prevalence of scabies in Sanma Province, Vanuatu. METHODS We randomly selected 30 villages from nine government zones across three islands and examined residents present within these villages for scabies. Bivariate analysis and multilevel models were conducted to investigate associated demographic and household factors. RESULTS Of 1879 participants examined, 563 had scabies (30%, 95% CI 27.9 to 32.1) with the highest prevalence in children aged 6-10 y (38.8%, 95% CI 33.9 to 44). CONCLUSIONS Scabies is a significant issue in Sanma with very high prevalence in children.
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Affiliation(s)
- Jack Callum
- Medical Santo, Luganville, Vanuatu.,School of Medicine, University of Queensland, St Lucia, Qld, Australia
| | - Duin McDiarmid
- School of Medicine, University of Queensland, St Lucia, Qld, Australia
| | - Yu Gao
- Mater Research Institute & School of Nursing, Midwifery and Social Work, University of Queensland, Raymond Terrace, South Brisbane, Qld, Australia
| | - Mark Armstrong
- Pathology Queensland, Townsville Hospital, 100 Angus Smith Dr, Douglas, Qld, Australia
| | - Edna Iavro
- Department of Rural Health, Ministry of Health, Sanma Province, Vanuatu
| | - Andrew Steer
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, Australia
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14
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Meyersburg D, Kaiser A, Bauer JW. 'Loss of efficacy of topical 5% permethrin for treating scabies: an Austrian single-center study'. J DERMATOL TREAT 2020; 33:774-777. [PMID: 32495666 DOI: 10.1080/09546634.2020.1774489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Scabies is a contagious, itchy, parasitic infection of the skin. It is transmitted by skin-to-skin contact or by contact with contaminated material. Recent observations, especially in the outpatient setting, suggest there is decreasing efficacy of the standard treatment of choice, topical 5% permethrin cream.Objectives: To assess the efficacy and safety of topical permethrin for scabies treatment in patients.Methods: Patients visiting the Dermatology outpatient clinic with dermatoscopy-assured scabies were assessed for enrollment in the study. In total, 55 patients were enrolled and sequentially randomized into three groups. Group (A) received permethrin 5% cream on two occasions within a one-week interval, while (intensive) group (B) received the same administration of permethrin 5% cream plus the daily application of the cream on dermatoscopically verified affected sites (hands and/or genitals and/or feet). The treatment was evaluated at 3 weeks by dermatoscopy. Group A patients who failed to respond were allowed to repeat the treatment according to the group B scheme and were again evaluated after 3 weeks (group C).Results: Two applications of permethrin 5% cream (group A) produced a cure rate of 29% at follow-up. The intense application of permethrin 5% cream (group B) was not superior at follow-up (cure rate 31%). Patients who were retreated according to the intense scheme (group C) did not benefit at all.Conclusion: Mite populations with reduced susceptibility to permethrin exist in Austria and necessitate the evaluation of alternative treatment regimens.Key MessagesHuman scabies is a rising major public health issue worldwide and has been designated as a neglected tropical disease by the World Health Organization.Resistance to permethrin, the most widely prescribed first-line therapy for scabies is to date underreported.At present, treatment recommendations remain controversially discussed as official guidelines do not address current development of resistances, and therefore their clinical applicability is limited.
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Affiliation(s)
- Damian Meyersburg
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Kaiser
- Department of Psychosomatics and Inpatient Psychotherapy, University Hospital of Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
| | - Johann Wolfgang Bauer
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University Salzburg, Salzburg, Austria
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15
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Abstract
The morphology of scabies, a mite infestation of worldwide proportion, is characterized by a variety of cutaneous lesions. Patients with classic scabies present with characteristic burrows often located on the web spaces of the fingers and toes. Scabies surrepticius refers to the non-classic atypical presentation of scabies; establishing the diagnosis of scabies in these individuals can be difficult. To facilitate the diagnosis of scabies, criteria have been proposed by the International Alliance for the Control of Scabies (IACS). These criteria are intended for scabies research; however, they can be utilized by clinicians to establish either a confirmed diagnosis, a clinical diagnosis or a suspected diagnosis of scabies. Visualization of mites, eggs or feces is necessary for a confirmed diagnosis of scabies. A clinical diagnosis can be established by observation of either genital lesions in men or burrows or classically distributed classical lesions in individuals with two historic features: pruritus and close contact with an individual who itches and has classically distributed classical scabetic lesions. The clinical features and management of a woman residing in an assisted living environment with a confirmed diagnosis of scabies and a man with a clinical diagnosis of scabies are described. The criteria for the suspected diagnosis of scabies require either one historic feature and typical lesions in a typical distribution or both historic features and the presence of atypical lesions or an atypical distribution of the skin lesions. Once the diagnosis of scabies is established, not only the patient but also close contacts should receive treatment with either a topical medication (such as permethrin 5% cream) or a systemic drug (ivermectin) or both. The number and frequency of treatments are variable; classic scabies typically is managed with a total of two treatments performed weekly to biweekly. Patients with crusted scabies usually require multiple topical and oral antiscabetic treatments in addition to topical keratolytic therapy. Bacterial impetiginization or infection (most commonly by Staphylococcus aureus or Streptococcus pyogenes) can complicate scabies infestation and potentially result in cellulitis, abscess, sepsis, rheumatic fever, rheumatic heart disease and post-streptococcal glomerulonephritis; therefore, in some patients, systemic antimicrobial therapy may be necessary in addition to scabies-directed treatment. In addition to systemic antihistamines, oral and/or topical corticosteroids may be used to provide symptomatic pruritus relief once the diagnosis of scabies has been established and mite-directed treatment has been initiated. The clinician should consider several potential causes (such as inadequate treatment, reinfection, mite resistance, delusions of parasitosis and the development of a new non-scabetic dermatosis) in scabies patients who fail to respond to treatment with a topical or oral scabicide therapy.
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Affiliation(s)
- Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
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16
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Osti MH, Sokana O, Phelan S, Marks M, Whitfeld MJ, Gorae C, Kaldor JM, Steer AC, Engelman D. Prevalence of scabies and impetigo in the Solomon Islands: a school survey. BMC Infect Dis 2019; 19:803. [PMID: 31519153 PMCID: PMC6743115 DOI: 10.1186/s12879-019-4382-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/15/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Scabies, a parasitic disease of the skin, is a major public health problem, largely affecting children. Scabies is often complicated by impetigo which can result in serious complications including invasive infections and immune mediated diseases. Scabies and impetigo are reported to have high prevalence in tropical settings including the Solomon Islands. METHODS We conducted a cross-sectional prevalence survey at Gizo Primary School in the Western Province of the Solomon Islands in August 2018. The diagnosis of scabies was based on criteria developed by the International Alliance for the Control of Scabies in 2018. Population attributable risk was calculated to determine the effect of scabies on the prevalence of impetigo, and both adjusted and unadjusted risk ratios were calculated to identify differences between sexes and age groups. RESULTS A total of 324 students were assessed (47.5% of those enrolled at the school). The prevalence of scabies was 54.3% (95% confidence interval [CI] 48.7-59.8) and most disease was mild (68.8%). The prevalence was higher in males (63.5%; adjusted risk ratio [ARR] 1.4, 95% CI 1.1-1.7), and in those aged 10-12 years (61.4%; ARR 1.8, 95% CI 1.1-2.9 when compared to those aged 4-6 years). The prevalence of impetigo was 32.1%, with males more likely to be affected (41.7%, ARR 1.7, 95% CI 1.2-2.4) but with no significant differences between age groups. 63.5% of those with impetigo had scabies, corresponding to a population attributable risk of 11.8%. CONCLUSIONS There is a very high burden of scabies and impetigo among primary school students in Gizo. There is a critical need for the development and implementation of control programs in areas where scabies is endemic.
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Affiliation(s)
- Millicent H Osti
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Melbourne, Australia
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Sophie Phelan
- Kirby Institute, University of New South Wales, Sydney, Australia.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Margot J Whitfeld
- St Vincent's Hospital, Sydney, Australia.,Department of Medicine, University of New South Wales, Sydney, Australia
| | - Christina Gorae
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Melbourne, Australia
| | - Daniel Engelman
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, Australia. .,Melbourne Children's Global Health, Melbourne, Australia.
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17
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Engelman D, Cantey PT, Marks M, Solomon AW, Chang AY, Chosidow O, Enbiale W, Engels D, Hay RJ, Hendrickx D, Hotez PJ, Kaldor JM, Kama M, Mackenzie CD, McCarthy JS, Martin DL, Mengistu B, Maurer T, Negussu N, Romani L, Sokana O, Whitfeld MJ, Fuller LC, Steer AC. The public health control of scabies: priorities for research and action. Lancet 2019; 394:81-92. [PMID: 31178154 PMCID: PMC11257500 DOI: 10.1016/s0140-6736(19)31136-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/14/2019] [Accepted: 04/25/2019] [Indexed: 12/16/2022]
Abstract
Scabies is a parasitic disease of the skin that disproportionately affects disadvantaged populations. The disease causes considerable morbidity and leads to severe bacterial infection and immune-mediated disease. Scientific advances from the past 5 years suggest that scabies is amenable to population-level control, particularly through mass drug administration. In recognition of these issues, WHO added scabies to the list of neglected tropical diseases in 2017. To develop a global control programme, key operational research questions must now be addressed. Standardised approaches to diagnosis and methods for mapping are required to further understand the burden of disease. The safety of treatments for young children, including with ivermectin and moxidectin, should be investigated. Studies are needed to inform optimum implementation of mass treatment, including the threshold for intervention, target, dosing, and frequency. Frameworks for surveillance, monitoring, and evaluation of control strategies are also necessary.
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Affiliation(s)
- Daniel Engelman
- Tropical Diseases Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, VIC, Australia.
| | - Paul T Cantey
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Aileen Y Chang
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Olivier Chosidow
- Department of Dermatology, Hôpital Henri-Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France; Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Wendemagegn Enbiale
- Department of Dermatovenerology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Dirk Engels
- Uniting to Combat Neglected Tropical Diseases, Switzerland
| | - Roderick J Hay
- Department of Dermatology, King's College London, London, UK
| | - David Hendrickx
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John M Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - James S McCarthy
- QIMR Berghoefer Medical Research Institute, Brisbane, QLD, Australia
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Toby Maurer
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | | | - Lucia Romani
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Margot J Whitfeld
- Department of Dermatology, St Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia
| | - L Claire Fuller
- Chelsea and Westminster Healthcare National Health Service Foundation Trust, London, UK; International Foundation for Dermatology, London, UK
| | - Andrew C Steer
- Tropical Diseases Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, VIC, Australia
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18
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Tripathi R, Knusel KD, Ezaldein HH, Bordeaux JS, Scott JF. Emergency Department Visits due to Scabies in the United States: A Retrospective Analysis of a Nationally Representative Emergency Department Sample. Clin Infect Dis 2019; 70:509-517. [DOI: 10.1093/cid/ciz207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 03/08/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Limited information exists regarding the burden of emergency department (ED) visits due to scabies in the United States. The goal of this study was to provide population-level estimates regarding scabies visits to American EDs.
Methods
This study was a retrospective analysis of the nationally representative National Emergency Department Sample from 2013 to 2015. Outcomes included adjusted odds for scabies ED visits, adjusted odds for inpatient admission due to scabies in the ED scabies population, predictors for cost of care, and seasonal/regional variation in cost and prevalence of scabies ED visits.
Results
Our patient population included 416 017 218 ED visits from 2013 to 2015, of which 356 267 were due to scabies (prevalence = 85.7 per 100 000 ED visits). The average annual expenditure for scabies ED visits was $67 125 780.36. The average cost of care for a scabies ED visit was $750.91 (±17.41). Patients visiting the ED for scabies were most likely to be male children from lower income quartiles and were most likely to present to the ED on weekdays in the fall, controlling for all other factors. Scabies ED patients that were male, older, insured by Medicare, from the highest income quartile, and from the Midwest/West were most likely to be admitted as inpatients. Older, higher income, Medicare patients in large Northeastern metropolitan cities had the greatest cost of care.
Conclusion
This study provides comprehensive nationally representative estimates of the burden of scabies ED visits on the American healthcare system. These findings are important for developing targeted interventions to decrease the incidence and burden of scabies in American EDs.
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Affiliation(s)
- Raghav Tripathi
- Case Western Reserve University School of Medicine
- University Hospitals Cleveland Medical Center, Department of Dermatology, Ohio
| | - Konrad D Knusel
- Case Western Reserve University School of Medicine
- University Hospitals Cleveland Medical Center, Department of Dermatology, Ohio
| | - Harib H Ezaldein
- Case Western Reserve University School of Medicine
- University Hospitals Cleveland Medical Center, Department of Dermatology, Ohio
| | - Jeremy S Bordeaux
- Case Western Reserve University School of Medicine
- University Hospitals Cleveland Medical Center, Department of Dermatology, Ohio
| | - Jeffrey F Scott
- Case Western Reserve University School of Medicine
- University Hospitals Cleveland Medical Center, Department of Dermatology, Ohio
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