A proposal to reduce the amount of permethrin entering wastewater resultant from topical use to treat scabies

The incidence of scabies is rising in the last years. Subsequently, the use of pharmaceuticals to treat the disease has also increased. Treatment with topical permethrin is usually recommended as a first line agent. This substance is also an aquatic contaminant that is toxic for many non-target organisms, and has been included as a priority substance in the recently published proposal of the European Water Framework Directive. Current guidelines neglect the potential environmental impact of this drug, recommending that the cream should be applied head to toe and "washed off after 8-12 h". Recently, a wiping procedure before hand washing after application of the topical treatment resulted in a 66 % reduction of the amount of diclofenac released in wastewater. The authors suggested that this method could be explored for other topical treatments. In the case of scabiosis, a protocol implicating the whole body needs to be designed. The absorption of topical permethrin is low. Considering the growing incidence of scabies, the amount of the pyrethroid reaching the environment may also be increasing. Therefore, we believe that applying the wiping procedure to the case of topical permethrin deserves consideration. Other measures to minimize the amount of permethrin residues reaching wastewater by washing clothes and bed linen such as wearing single-use pijamas should also be explored. In conclusion, we need to apply a One Health approach in the treatment with scabies, without neglecting the environmental impact of pharmaceuticals. It is not rational to forget drugs once they go down the drain.

Eliminate all risks: A call to reexamine the link between canine scabies and rheumatic heart disease

Rheumatic heart disease (RHD) and acute rheumatic fever (ARF) disproportionately affect individuals in low-resource settings. ARF is attributed to an immune response to Group A Streptococcus (GAS) following GAS pharyngitis and potentially GAS impetigo in which infection can be initiated by scabies infestation. The burden of ARF and RHD in Aboriginal and Torres Strait Islander people in Australia is among the highest globally. Following recent calls to include dog management programs in ARF and RHD prevention programs, we believe it is timely to assess the evidence for this, particularly since previous recommendations excluded resources to prevent zoonotic canine scabies. While phylogenetic analyses have suggested that the Sarcoptes mite is host specific, they have differed in interpretation of the strength of their findings regarding species cross-over and the need for canine scabies control to prevent human itch. Given that there is also indication from case reports that canine scabies leads to human itch, we propose that further investigation of the potential burden of zoonotic canine scabies and intervention trials of canine scabies prevention on the incidence of impetigo are warranted. Considering the devastating impacts of ARF and RHD, evidence is required to support policy to eliminate all risk factors.

No secondary impact of ivermectin mass drug administration for onchocerciasis elimination on the prevalence of scabies in northwestern Ethiopia

BACKGROUND

Mass drug administration (MDA) is among the five major strategies that are currently in use to control, eliminate or eradicate Neglected Tropical Diseases (NTDs). Optimising MDA to control multiple NTDs maximises impact. The objective of this study is to estimate the secondary impact of ivermectin MDA for onchocerciasis on the prevalence of scabies.

METHODS

This quasi-experimental study was conducted in Ayu Guagusa district, northwestern Ethiopia. Scabies prevalence was estimated in surveys before the MDA, at 6 and 12 months afterwards. The sample size was 1437 people from a panel of 381 randomly selected study households. Multistage sampling was employed in randomly selecting six kebeles (the lowest administrative unit) with respective gotes (small villages) and households. All members of the selected households were invited to participate in the study and participants who were available in all three surveys formed a cohort.

RESULTS

Scabies prevalence was similar prior to the MDA (13.4%, 95% CI 11.7 to 15.2%) and 6 months after (11.7%, 95% CI 10.1 to 13.2%) but was substantially greater at 12 months (22.1%, 95% CI 20.1 to 24.1%). The 6-month incidence and disappearance rates were 10.8% (95% CI 8.8 to 13.2%) and 82.6% (95% CI 75.0 to 88.6%), respectively.

CONCLUSIONS

Ivermectin MDA for onchocerciasis was not observed to have a secondary impact on the prevalence of scabies over the follow-up period of 12 months.

Awareness and knowledge of scabies and ringworm among parents of school-age children in Calabar, Cross River State, Nigeria: Implications for prevention of superficial skin infestations

Context

Risk factors for the persistence of superficial skin infestations are prevalent in humid tropical environments, which are favorable for breeding of the causative vector mite Sarcoptes scabiei (ectoparasite) and dermatophyte fungi.

Aim

This study aimed at assessing the awareness and knowledge of childhood scabies and ringworm infestations among parents in Calabar, a highly humid rainforest tropical environment.

Settings and Design

Cross-sectional study design and systematic random sampling were used to recruit school-age children in selected primary schools in Calabar.

Materials and Methods

Researcher-driven administration of a structured questionnaire was conducted to obtain quantitative data from parents of recruited children.

Statistical Analysis Used

: Chi-square was used to assess factors associated with ever hearing or seeing scabies and ringworm infestations. Statistical significance was set at P < 0.05.

Results

One hundred and eighty-two (56.7%) and 218 (67.9%) of the respondents had heard of or seen scabies and ringworm infestation. Among respondents that were aware of scabies, 53.3% knew of the cause, 50.5% were aware of the risk factors while 68.1% and 78.0% knew their treatment and prevention, respectively; 98.6%, 60.6%, 76.6%, and 80.7% of respondents knew the cause, risk factors, treatment, and prevention of ringworm infestation, respectively. Fathers with at least secondary school literacy level and sharing beds were significantly associated with awareness of scabies.

Conclusion

There is a suboptimal level of awareness and knowledge of two of the most common superficial skin infestations among parents of primary school children in the study setting. There is a need to redouble our effort at sensitization of parents toward improved awareness of these common infestations.

Investigation of Malaria, Leishmaniasis, and Scabies Risk after Earthquakes and Recommendations for Prevention

This study examines the risk of malaria, leishmaniasis, and scabies following earthquakes in southeastern Türkiye. The focus is on the impact on the local population and Syrian immigrants. Recommendations for prevention include vector control measures such as indoor residual spraying and distribution of insecticidal nets. Surveillance and early detection through rapid diagnostic tests and active case finding are important. Public awareness campaigns and community engagement are crucial for promoting protective measures. Strengthening healthcare infrastructure, providing essential supplies, and capacity building is essential. For leishmaniasis, early detection and treatment, vector control, health education, and community engagement are vital. Scabies outbreaks affect the socioeconomically depressed local population and Syrian immigrants. Early detection, treatment, contact tracing, health education, hygiene promotion, and improved living conditions are necessary. Implementing these interventions and strategies can effectively prevent, control, and manage these diseases. Tailoring approaches to the specific context and needs of affected communities is crucial. By addressing these challenges, we can protect the health and well-being of the affected population.

Living in a large family and low daily water consumption substantially expose for human scabies in rural Ethiopia: a matched analysis

BACKGROUND

Scabies has been added to the neglected tropical diseases portfolio for large-scale disease control action since 2017 and is part of the WHO roadmap for NTDs 2021-2030, targeted at ending the neglect to achieve the sustainable development goals. Previous studies have not fitted matched analysis to identify predictors of scabies infestation in Ethiopia. Information is also scarce about predictors of scabies infestation in this area. Therefore, this study aimed to identify predictors of scabies infestation in rural Aneded District, northwest Ethiopia.

METHODS

A community-based matched case-control study involving 183 cases and 549 controls was undertaken from March 1 to May 31, 2021, in rural Aneded District. A two-stage sampling technique with a house-to-house census for the screening of scabies cases was employed. A structured questionnaire with questions on sociodemographics, behavior, water supply, sanitation, and hygiene, and delivery of scabies-specific interventions was used. Pretesting, training of data collectors and supervisors, and supervision were applied to keep the data quality. A multivariable conditional logistic regression model was fitted to identify predictors of scabies.

RESULTS

Unmarried individuals or those in separated families (adjusted matched odds ratio (AmOR = 2.71; 95% CI 1.30-5.65); those unable to read and write or in illiterate families (AmOR = 5.10; 95% CI 1.81-14.36); those in large families (AmOR = 6.67; 95% CI 2.83-15.73); households that had longer travel times for water collection (AmOR = 2.27; 95% CI 1.08-4.76); those that had low daily water consumption (AmOR = 6.69; 95% CI 2.91-15.37); households that disposed of solid wastes in open fields (AmOR = 5.60; 95% CI 2.53-12.40); and households that did not receive scabies-specific interventions (AmOR = 2.98; 95% CI 1.39-6.39) had increased odds of scabies.

CONCLUSIONS

Being unmarried, illiteracy, large family, long travel time for water collection, low daily water consumption, open dumping of solid wastes, and inaccessibility of scabies-specific interventions are predictors of scabies. This information is instrumental for redesigning improved scabies-specific interventions that consider educational status, marital status, family size, water collection time, daily water consumption, solid waste disposal, and equity and optimization in delivering existing interventions in rural Ethiopia.

Modelling mass drug administration strategies for reducing scabies burden in Monrovia, Liberia

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.

Beliefs, attitudes and practices towards scabies in central Ghana

BACKGROUND

Scabies commonly affects poor populations in low-middle-income countries. The WHO has advocated for country-driven and country-owned control strategies. Knowledge of context specific issues will be important for design and implementation of scabies control interventions. We aimed to assess beliefs, attitudes and practices towards scabies in central Ghana.

METHODOLOGY/PRINCIPAL FINDINGS

Data was collected via semi-structured questionnaires for people who had active scabies or scabies in the past year and people who never had scabies in the past. The questionnaire covered several domains: knowledge about the causes and risk factors; perceptions towards stigmatisation and consequences of scabies in daily life; and treatment practices. Out of 128 participants, 67 were in the (former) scabies group and had a mean age of 32.3 ± 15.6 years. Overall scabies group participants less often indicated a factor to predispose to scabies than community controls; only 'family/friends contacts' was more often mentioned in the scabies group. Scabies causation was attributed to poor hygiene, traditional beliefs, heredity and drinking water. Individuals with scabies delay care seeking (median time from symptom onset to visiting the health centre was 21 [14 - 30] days) and this delay is enhanced by their beliefs (like witchcraft and curses) and a perception of limited disease severity. Compared to past scabies participants in the dermatology clinic, participants with past scabies in the community tended to have a longer delay (median [IQR] 30 [14-48.8] vs 14 [9.5-30] days, p = 0.002). Scabies was associated with health consequences, stigma, and loss of productivity.

CONCLUSION/SIGNIFICANCE

Early diagnosis and effective treatment of scabies can lead to persons less frequently associating scabies with witchcraft and/ or curses. There is the need to enhance health education to promote early care seeking, enhance knowledge of communities on impact and dispel negative perceptions about scabies in Ghana.

Effects of ivermectin mass drug administration for malaria vector control on ectoparasites and soil-transmitted helminths: a cluster randomized trial

OBJECTIVES

Ivermectin, used to control several neglected tropical diseases, may also reduce malaria transmission. Mass drug administration (MDA) for malaria control therefore might have off-target impacts on neglected tropical diseases.

METHODS

In The Gambia, nested in a trial of ivermectin MDA, cross-sectional surveys measuring ectoparasites and soil-transmitted helminths in children aged 3 to 14 years took place in June and November 2019 and in November 2021.

RESULTS

After MDA, scabies prevalence was 41.2% (237/576) in the control and 38.2% (182/476) in the intervention arm (odds ratio [OR] 0.89 (95% confidence interval [CI] 0 67-1.2), P-value = 0.471) but by 2021, had rebounded to 38.8% (180/464) in the control and 53.2% (245/458) in the intervention arm. After MDA, prevalence of Strongyloides stercoralis was 16.8% (87/518) in the control and 9.1% (40/440) in the intervention arm (OR 0.4 (95% CI 0.16-0.94), P-value = 0.039). In 2021, it was 9.2% (38/413) in the control and 11.3% (45/399) in the intervention arm (OR 1.31 (95% CI 0.74-2.28), P-value = 0.35).

CONCLUSION

Scabies prevalence was similar between the two study arms. S. stercoralis prevalence was reduced. However, this effect did not last long: the prevalence 2 years after MDA was similar between study arms.

Community control strategies for scabies: A cluster randomised noninferiority trial

BACKGROUND

Scabies is a neglected tropical disease hyperendemic to many low- and middle-income countries. Scabies can be successfully controlled using mass drug administration (MDA) using 2 doses of ivermectin-based treatment. If effective, a strategy of 1-dose ivermectin-based MDA would have substantial advantages for implementing MDA for scabies at large scale.

METHODS AND FINDINGS

We did a cluster randomised, noninferiority, open-label, 3-group unblinded study comparing the effectiveness of control strategies on community prevalence of scabies at 12 months. All residents from 35 villages on 2 Fijian islands were eligible to participate. Villages were randomised 1:1:1 to 2-dose ivermectin-based MDA (IVM-2), 1-dose ivermectin-based MDA (IVM-1), or screen and treat with topical permethrin 5% for individuals with scabies and their household contacts (SAT). All groups also received diethylcarbamazine and albendazole for lymphatic filariasis control. For IVM-2 and IVM-1, oral ivermectin was dosed at 200 μg/kg and when contraindicated substituted with permethrin. We designated a noninferiority margin of 5%. We enrolled 3,812 participants at baseline (July to November 2017) from the 35 villages with median village size of 108 (range 18 to 298). Age and sex of participants were representative of the population with 51.6% male and median age of 25 years (interquartile range 10 to 47). We enrolled 3,898 at 12 months (July to November 2018). At baseline, scabies prevalence was similar in all groups: IVM-2: 11.7% (95% confidence interval (CI) 8.5 to 16.0); IVM-1: 15.2% (95% CI 9.4 to 23.8); SAT: 13.6% (95% CI 7.9 to 22.4). At 12 months, scabies decreased substantially in all groups: IVM-2: 1.3% (95% CI 0.6 to 2.5); IVM-1: 2.7% (95% CI 1.1 to 6.5); SAT: 1.1% (95% CI 0.6 to 2.0). The risk difference in scabies prevalence at 12 months between the IVM-1 and IVM-2 groups was 1.2% (95% CI -0.2 to 2.7, p = 0.10). Limitations of the study included the method of scabies diagnosis by nonexperts, a lower baseline prevalence than anticipated, and the addition of diethylcarbamazine and albendazole to scabies treatment.

CONCLUSIONS

All 3 strategies substantially reduced prevalence. One-dose was noninferior to 2-dose ivermectin-based MDA, as was a screen and treat approach, for community control of scabies. Further trials comparing these approaches in varied settings are warranted to inform global scabies control strategies.

TRIAL REGISTRATION

Clinitrials.gov NCT03177993 and ANZCTR N12617000738325.

A framework for scabies control

Scabies is a neglected tropical disease (NTD) that causes a significant health burden, particularly in disadvantaged communities and where there is overcrowding. There is emerging evidence that ivermectin-based mass drug administration (MDA) can reduce the prevalence of scabies in some settings, but evidence remains limited, and there are no formal guidelines to inform control efforts. An informal World Health Organization (WHO) consultation was organized to find agreement on strategies for global control. The consultation resulted in a framework for scabies control and recommendations for mapping of disease burden, delivery of interventions, and establishing monitoring and evaluation. Key operational research priorities were identified. This framework will allow countries to set control targets for scabies as part of national NTD strategic plans and develop control strategies using MDA for high-prevalence regions and outbreak situations. As further evidence and experience are collected and strategies are refined over time, formal guidelines can be developed. The control of scabies and the reduction of the health burden of scabies and associated conditions will be vital to achieving the targets set in WHO Roadmap for NTDs for 2021 to 2030 and the Sustainable Development Goals.

Kenneth Mellanby Commander of the Order of the British Empire (CBE) (1908-1993). The facts about scabies

Kenneth Mellanby was a distinguished biologist specialising in entomology. He helped to establish the first university in Nigeria and undertook pioneering work on the use of insecticides in agriculture. However, he will best be remembered for a series of experiments which he undertook on human volunteers during the Second World War. These experiments established the mechanism of transmission of scabies and allowed its effective control at a time when the condition had reached epidemic proportions, causing a significant adverse effect on public morale and military effectiveness. Mellanby's wartime monograph on scabies remains to this day the definitive work on the disease and is still studied by dermatologists. His subsequent book Human Guinea Pigs is a remarkable account of the privations to which wartime volunteers willingly submitted themselves in a way that would have never passed any current medical ethics committee.

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)

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.

Perceptions, attitudes and practices towards scabies in communities on the Bijagós Islands, Guinea-Bissau

BACKGROUND

Scabies is highly endemic among impoverished populations and has been recently included in the WHO's list of neglected tropical diseases (NTDs). Community support and behavioural changes are essential for the success of control interventions. This study aimed to explore beliefs, prevention attitudes and healthcare-seeking behaviours towards scabies in the Bijagós Archipelago of Guinea-Bissau.

METHODS

Data were collected through two methods. Community key informants (community members, community health workers, healthcare workers and traditional healers) were interviewed using snowball sampling. A questionnaire covering perceptions, attitudes and practices was administered to community members using random cluster sampling. Thematic analysis of qualitative data was applied to identify themes. Descriptive statistics were used for quantitative data analysis.

RESULTS

There was a satisfactory awareness about scabies, but perceptions about disease causation and transmission were imprecise. Misconceptions about personal hygiene as the primary measure for scabies prevention were recurrent. Some participants recognised the importance of early treatment to interrupt transmission. Treatment of close contacts was not considered important. Costs were the main determining factor for treatment choice between traditional healer and the local health centre. Late presentation and delayed treatment were common and associated with poverty and stigmatisation. Scabies impaired quality of life by affecting social interactions, health, fitness to work and school attendance.

CONCLUSIONS

There is a need to improve education, recognition, management and affordable access to treatment. Community education, healthcare workers' training and skin NTD integrated control programmes should address the challenges highlighted in this study.

The public health control of scabies: priorities for research and action

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.

A chitinase-like protein from Sarcoptes scabiei as a candidate anti-mite vaccine that contributes to immune protection in rabbits

BACKGROUND

Scabies is caused by Sarcoptes scabiei burrowing into the stratum corneum of the host's skin and is detrimental to the health of humans and animals. Vaccines are an attractive alternative to replace the acaricides currently used in their control.

METHODS

In the present study, the S. scabiei chitinase-like protein 5 (SsCLP5) was characterized and recombinant SsCLP5 (rSsCLP5) was evaluated as a candidate vaccine protein for anti-mite protection in rabbits. The expression, characterization and immunolocalization of SsCLP5 were examined. Vaccination experiments were performed on three test groups (n = 12 per group) immunized with purified rSsCLP5. Control groups (n = 12 per group) were immunized with PBS, QuilA saponin or empty vector protein. After challenge, the inflammatory reaction and skin lesions were graded and rSsCLP5 indirect ELISA was used to detect antibody IgG levels in serum samples at the time of vaccination and post-challenge.

RESULTS

The results showed that rSsCLP5 had high immunoreactivity and immunogenicity. In S. scabiei, SsCLP5 had a wide distribution in the chewing mouthpart, legs and exoskeleton, especially the outer layer of the exoskeleton. Vaccination with rSsCLP5 resulted in 74.3% (26/35) of rabbits showing no detectable lesions after challenge with S. scabiei.

CONCLUSIONS

Our data demonstrate that rSsCLP5 is a promising candidate for a recombinant protein-based vaccine against S. scabiei. This study also provides a method for studying scabies vaccine using rabbit as an animal model and a basis for screening more effective candidate proteins.

Feasibility and safety of mass drug coadministration with azithromycin and ivermectin for the control of neglected tropical diseases: a single-arm intervention trial

BACKGROUND

Mass drug administration has made a major contribution to the public health control of several important neglected tropical diseases. For settings with more than one endemic disease, combined mass drug administration has potential practical advantages compared with separate programmes but needs confirmation of feasibility and safety. We undertook a study of mass drug administration in the Solomon Islands for trachoma and scabies control using ivermectin and azithromycin, key drugs in the control of neglected tropical diseases worldwide.

METHODS

The entire population of Choiseul province, Solomon Islands, was eligible to participate. An azithromycin-based mass drug administration regimen was offered in line with standard recommendations for trachoma elimination (oral azithromycin or topical tetracycline). An ivermectin-based mass drug administration regimen was offered at the same time (oral ivermectin or topical permethrin), with a further dose 7-14 days later, using a modified version of a regimen demonstrated to be effective for scabies control. All participants underwent safety assessments 7-14 days later. Participants in ten randomly selected sentinel villages underwent a more detailed safety assessment. Routine health system reports of hospital or clinic admissions and deaths were also obtained to compare health outcomes in the 12 month period before and after the mass drug administration.

FINDINGS

The study enrolled 26 188 participants, 99·3% of the estimated resident population as determined at the 2009 census. Of those enrolled, 25 717 (98·2%) received the trachoma regimen and 25 819 (98·6%) received the first dose of the scabies regimen between Sept 1, and Oct 2, 2015. A second dose of the scabies regimen was received by 21 931 (83·7%) of participants. Adverse events, all mild and transient, were recorded in 571 (2·6%) of the entire study population and 58 (4·1%) of participants in the ten sentinel villages. In the 12 months before and after the mass drug administration the numbers of hospital admissions (1530 vs 1602) and deaths (73 vs 83) were similar. In the month after the mass drug administration, 84 individuals were admitted to hospital and two died, compared with a monthly median of 116 admissions (IQR 106-159) and six deaths (IQR 4-7) in the 12 months before and after the mass drug administration.

INTERPRETATION

In the largest trial so far involving coadministration of regimens based on ivermectin and azithromycin, the combination was safe and feasible in a population of more than 26 000 people. Coadministration of mass drug administration based on these two drugs opens up new potential for the control of neglected tropical diseases.

FUNDING

International Trachoma Initiative, Murdoch Children's Research Institute, Scobie and Claire Mackinnon Trust, Wellcome Trust.

Impact of Ivermectin Mass Drug Administration for Lymphatic Filariasis on Scabies in Eight Villages in Kongwa District, Tanzania

Scabies was recently added to the World Health Organization list of neglected tropical diseases. The ability to treat scabies with oral ivermectin makes a mass drug administration (MDA) campaign a feasible option for scabies control. Ivermectin MDA in communities endemic for lymphatic filariasis (LF) or onchocerciasis may already be having an impact on scabies. We examined the effect of ivermectin MDA for LF on scabies prevalence over 4 years in eight Tanzanian villages. At baseline, 4.4% (95% confidence interval [CI]: 3.7-5.4) of individuals tested positive for scabies, decreasing to 0.84% (95% CI: 0.51-1.4) after one round of ivermectin MDA but increased in Year 3 (2.5% [95% CI: 1.9-3.3]) and Year 4 (2.9% [95% CI: 2.2-3.8]). Most scabies cases were seen in children younger than 15 years. The data suggest that single-dose ivermectin MDA may not be effective in attaining long-term decreases when scabies prevalence is less than 5%.

A biological model of scabies infection dynamics and treatment informs mass drug administration strategies to increase the likelihood of elimination

Infections with Sarcoptes scabiei, or scabies, remain common in many disadvantaged populations. Mass drug administration (MDA) has been used in such settings to achieve a rapid reduction in infection and transmission, with the goal of eliminating the public health burden of scabies. While prevalence has been observed to fall substantially following such an intervention, in some instances resurgence of infection to baseline levels has occurred over several years. To explore the biology underpinning this phenomenon, we have developed a theoretical model of scabies life-cycle and transmission dynamics in a homogeneously mixing population, and simulate the impact of mass drug treatment strategies acting on egg and mite life cycle stages (ovicidal) or mites alone (non-ovicidal). In order to investigate the dynamics of the system, we first define and calculate the optimal interval between treatment doses. We calculate the probability of eradication as a function of the number of optimally-timed successive treatment doses and the number of years over which a program is run. For the non-ovicidal intervention, we first show that at least two optimally-timed doses are required to achieve eradication. We then demonstrate that while more doses over a small number of years provides the highest chance of eradication, a similar outcome can be achieved with fewer doses delivered annually over a longer period of time. For the ovicidal intervention, we find that doses should be delivered as close together as possible. This work provides a platform for further research into optimal treatment strategies which may incorporate heterogeneity of transmission, and the interplay between MDA and enhancement of continuing scabies surveillance and treatment strategies.

Scabies in residential care homes: Modelling, inference and interventions for well-connected population sub-units

In the context of an ageing population, understanding the transmission of infectious diseases such as scabies through well-connected sub-units of the population, such as residential care homes, is particularly important for the design of efficient interventions to mitigate against the effects of those diseases. Here, we present a modelling methodology based on the efficient solution of a large-scale system of linear differential equations that allows statistical calibration of individual-based random models to real data on scabies in residential care homes. In particular, we review and benchmark different numerical methods for the integration of the differential equation system, and then select the most appropriate of these methods to perform inference using Markov chain Monte Carlo. We test the goodness-of-fit of this model using posterior predictive intervals and propagate forward the resulting parameter uncertainty in a Bayesian framework to consider the economic cost of delayed interventions against scabies, quantifying the benefits of prompt action in the event of detection. We also revisit the previous methodology used to assess the safety of treatments in small population sub-units-in this context ivermectin-and demonstrate that even a very slight relaxation of the implicit assumption of homogeneous death rates significantly increases the plausibility of the hypothesis that ivermectin does not cause excess mortality based upon the data of Barkwell and Shields.

Incidental mosquitocidal effect of an ivermectin mass drug administration on Anopheles farauti conducted for scabies control in the Solomon Islands

Background

The Solomon Islands is targeting elimination of malaria by 2030. The dominant vector is the predominantly exophagic, exophilic Anopheles farauti sensu strictu. This biting behaviour limits the efficacy of conventional vector control tools and highlights the need for new strategies. When administered to humans ivermectin has been shown to have a mosquitocidal effect. Mass drug administration (MDA) with ivermectin is an emerging strategy in the control of scabies. In this study we explored any incidental effect of ivermectin MDA conducted for scabies control on mosquitoes.

Methods

MDA for scabies was conducted in three villages. We performed human landing catches and measured 5-day mortality amongst Anopheles mosquitoes caught before and after MDA. Cox regression was used to calculate hazard ratios (HR) for mortality between mosquitoes caught before and after MDA.

Results

There was a significant increase in 5-day mortality in anopheline mosquitoes caught post-MDA which was highest on the day of MDA itself (HR 4.2 95% CI 1.8 to 10.1, p=0.001) and the following day (HR 4.4 95% CI 1.8 to 10.8, p=0.002) compared to mosquitoes caught before MDA.

Conclusions

This study shows a possible mosquitocidal effect of ivermectin MDA conducted for scabies control. Studies with a larger sample size with clinical as well as entomological outcomes should be conducted in this population.

Vaccination of rabbits with immunodominant antigens from Sarcoptes scabiei induced high levels of humoral responses and pro-inflammatory cytokines but confers limited protection

BACKGROUND

Vaccination is an attractive ecological alternative to the use of acaricides for parasite control. However, effective anti-parasite vaccines against sarcoptic mange have not yet been developed. The purpose of this study was first to identify Sarcoptes scabiei immunodominant antigens and second to evaluate them as vaccine candidates in a rabbit/S. scabiei var. cuniculi model.

METHODS

The S. scabiei Ssλ15 immunodominant antigen was selected by immunoscreening of a S. scabiei var. hominis cDNA. The full-length cDNA was sequenced and cloned into the pGEX vector and the recombinant protein expressed in BL21 (DE3) cells and purified. A vaccination trial was performed consisting of a test group (n = 8) immunised with recAgs (a mix of two recombinant antigens, Ssλ15 and the previously described Ssλ20∆B3) and a control group (n = 8) immunised with PBS. All analyses were performed with R Statistical Environment with α set at 0.050.

RESULTS

The full-length open reading frame of the 1,821 nt cloned cDNA encodes a 64 kDa polypeptide, the sequence of which had 96 % identity with a hypothetical protein of S. scabiei. Ssλ15 was localised by immunostaining of skin sections in the tegument surrounding the mouthparts and the coxa in the legs of mites. Rabbit immunisation with recAgs induced high levels of specific IgG (P < 0.010) and increased levels of total IgEs. However, no significant clinical protection against S. scabiei challenge was detected. Unexpectedly, the group immunised with the recAgs mix had significantly higher lesion scores (P = 0.050) although lower mean mite densities than those observed in the control group. These results might indicate that the lesions in the recAgs group were due not only to the mites density but also to an exacerbated immunological response after challenge, which is in agreement with the specific high levels of pro-inflammatory cytokines (IL-1 and TNFα) detected after challenge in this group.

CONCLUSIONS

The selected antigens delivered as recombinant proteins had no clinical protective efficacy against S. scabiei infestation although immunisation reduced mite density. However, these results pave the way for future studies on alternative production systems, adjuvants, delivery methods and combinations of antigens in order to manage stimulation of clinical protective immune responses.

Long Term Control of Scabies Fifteen Years after an Intensive Treatment Programme

INTRODUCTION

Scabies is a major public health problem in the Pacific and is associated with an increased risk of bacterial skin infections, glomerulonephritis and rheumatic fever. Mass drug administration with ivermectin is a promising strategy for the control of scabies. Mass treatment with ivermectin followed by active case finding was conducted in five communities in the Solomon Islands between 1997 and 2000 and resulted in a significant reduction in the prevalence of both scabies and bacterial skin infections.

METHODS

We conducted a prospective follow-up study of the communities where the original scabies control programme had been undertaken. All residents underwent a standardised examination for the detection of scabies and impetigo.

RESULTS

Three hundred and thirty eight residents were examined, representing 69% of the total population of the five communities. Only 1 case of scabies was found, in an adult who had recently returned from the mainland. The prevalence of active impetigo was 8.8% overall and 12.4% in children aged 12 years or less.

DISCUSSION

We found an extremely low prevalence of scabies 15 years after the cessation of a scabies control programme. The prevalence of impetigo had also declined further since the end of the control programme. Our results suggest that a combination of mass treatment with ivermectin and intensive active case finding may result in long term control of scabies. Larger scale studies and integration with other neglected tropical disease control programmes should be priorities for scabies control efforts.

Immune response induced by candidate Sarcoptes scabiei var. cuniculi DNA vaccine encoding paramyosin in mice

Sarcoptes scabiei is the causal agent of the highly contagious disease sarcoptic mange (scabies) that affects animals and humans worldwide. An increasing number of cases of treatment failure is being reported because of drug resistance. The development of a specific vaccine would be a sustainable option for control of this disease. In this study, we cloned and expressed a S. scabiei gene encoding paramyosin (PAR) and investigated the immune response elicited by DNA encoding PAR in mice. The ability of the DNA vaccine to express antigen in COS-7 cells was confirmed by RT-PCR and IFA. The immune response induced by DNA vaccine was investigated by ELISA, splenocyte proliferation assay, and cytokine production assay. Compared to the pVAX1 control group, the PAR DNA vaccination group showed the higher levels of IgG, IgG1, IgG2a, IgE, IgM, stronger lymphocyte proliferation in mouse spleen, and larger production of IL-2, IL-4, IL-5, and IFN-γ in the supernatant of cultures from splenocytes. These results indicated that the PAR DNA vaccine induced a mixed Th1/Th2 response in mice. In conclusion, our results revealed that the S. scabiei PAR DNA vaccine induced both a humoral and cellular immune response, which would provide basic data for the further study to develop an effective vaccine against sarcoptic mange.

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.

Interventions for preventing the spread of infestation in close contacts of people with scabies

BACKGROUND

Scabies, caused by Sarcoptes scabiei variety hominis or the human itch mite, is a common parasitic infection. While anyone can become infected, it causes significant morbidity in immunocompromised hosts and it spreads easily between human hosts where there is overcrowding or poor sanitation. The most common symptom reported is itch which is worse at night. As the symptoms are attributed to an allergic reaction to the mite, symptoms usually develop between four to six weeks after primary infection. Therefore, people may be infected for some time prior to developing symptoms. During this time, while asymptomatic, they may spread infection to others they are in close contact with. Consequently, it is usually recommended that when an index case is being treated, others who have been in close contact with the index case should also be provided with treatment.

OBJECTIVES

To assess the effects of prophylactic interventions for contacts of people with scabies to prevent infestation in the contacts.

SEARCH METHODS

We searched electronic databases (Cochrane Occupational Safety and Health Review Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE (Ovid), Pubmed, EMBASE, LILACS, CINAHL, OpenGrey and WHO ICTRP) up to November 2013.

SELECTION CRITERIA

Randomised controlled trials (RCTs) or cluster RCTs which compared prophylactic interventions which were given to contacts of index cases with scabies infestation. Interventions could be compared to each other, or to placebo or to no treatment. Both drug treatments and non-drug treatments were acceptable.

DATA COLLECTION AND ANALYSIS

Two authors intended to extract dichotomous data (developed infection or did not develop infection) for the effects of interventions and report this as risk ratios with 95% confidence intervals. We intended to report any adverse outcomes similarly.

MAIN RESULTS

We did not include any trials in this review. Out of 29 potentially-relevant studies, we excluded 16 RCTs as the data for the contacts were either not reported or were reported only in combination with the outcomes for the index cases. We excluded a further 11 studies as they were not RCTs. We also excluded one study as not all subjects were examined at baseline and follow-up, and another as it was a case study.

AUTHORS' CONCLUSIONS

The effects of providing prophylactic treatments for contacts of people with scabies to prevent infestation are unknown. We need well-designed RCTs of the use of prophylactic measures to prevent the transmission of scabies conducted with people who had the opportunity for prolonged skin contact with an index case, such as family members, healthcare workers or residential care personnel, within the previous six weeks.

Nurse-led school-based clinics for skin infections and rheumatic fever prevention: results from a pilot study in South Auckland

AIM

To assess the acceptability and feasibility of delivering targeted primary health care in a decile one primary school setting.

METHOD

A pilot public health nurse (PHN)-led clinic was set up in a South Auckland primary school (roll approximately 400). The clinic was based on a previous sore throat clinic model with modifications aimed at improving programme feasibility and effectiveness. The timely identification and treatment of Group A Streptococcal (GAS) throat infections to prevent rheumatic fever (RF), and the prevention and treatment of four skin infections (cellulitis, impetigo, infected eczema and scabies) were the focus. The pilot ran for 15 weeks from April to July 2011. Evaluation included documentation review, key school and healthcare stakeholder interviews and parent questionnaires.

RESULTS

The consent rate was 92.2%. Of a total 722 throat swabs taken from 337 students, 94 were GAS positive. Ninety-eight assessments of skin conditions were completed at which 76 had a skin infection diagnosed, the most common infection being impetigo (n=46). Thirty-one skin infections were diagnosed in the first week of the pilot. PHN workload was high with a total of 539 phone calls, 137 home visits and 51 school-based parent consultations. The approach was highly acceptable to the majority of key stakeholders. Extrapolating pilot costs results in an estimated annual cost of $510 per student for the programme.

CONCLUSION

It is likely to be both acceptable and feasible to take this model of delivering targeted primary health care to school aged children and use it on a larger scale. The complexity of providing this type of service should not be underestimated and it is essential that robust processes are in place to ensure smooth, safe running of such a programme. Long-term outcome evaluation will be vital to assess programme effectiveness.

Management of scabies

Scabies is a common contagious parasitic dermatosis. Transmission of the mite Sarcoptes scabiei var hominis generally occurs by skin-to-skin contact, but with crusted scabies it may also occur through fomites, such as infected clothing or bedding. Diagnosis is usually clinical. A 2010 updated Cochrane review concluded that management of scabies is based on topical scabicides, mainly 5% permethrin. However, oral ivermectin, although not licensed in many countries, may be useful, particularly for patients who cannot tolerate or comply with topical therapy and in institutional scabies epidemics. Patients should also receive detailed information about the infestation to limit further spreading. Cases resulting from close physical or sexual contact, even without symptoms, should be systematically treated. Hygienic measures should be taken after treatment is completed. Patients should be followed to confirm cure, including resolution of itching, which may take up to 4 weeks or longer.

Treatment and control of ectoparasites in sheep

Ectoparasites are a major concern in sheep flocks, wherever sheep are kept. Techniques to control and eradicate lice, ked, or scab have been available since the beginning of the 20th century, but the parasites still exist. Sheep scab (Psoroptes ovis) was eradicated from Australia in the late 1800s, before many of the more effective chemicals were available, and sheep ked is believed to also have been eradicated. Sheep scab has also been eradicated from North America. This article provides an overview of the common ectoparasites of sheep, effective products to control these parasites, and management factors that affect the success of these treatments.

Control strategies for endemic childhood scabies

Human scabies is a major global public health issue, with an estimated 300 million cases per year worldwide. Prevalence rates are particularly high in many third-world regions and within various indigenous communities in developed countries. Infestation with Sarcoptes Scabiei is associated with group-A streptococcal pyoderma which in turn predisposes to rheumatic fever, acute glomerulonephritis and their respective long-term sequelae: rheumatic heart disease and chronic renal insufficiency. The documented difficulties inherent in achieving scabies control within affected communities have motivated us to develop a network-dependent Monte-Carlo model of the scabies contagion, with the dual aims of gaining insight into its dynamics, and in determining the effects of various treatment strategies. Here we show that scabies burden is adversely affected by increases in average network degree, prominent network clustering, and by a person-to-person transmissibility of greater magnitude. We demonstrate that creating a community-specific model allows for the determination of an effective treatment protocol that can satisfy any pre-defined target prevalence. We find frequent low-density treatment protocols are inherently advantageous in comparison with infrequent mass screening and treatment regimes: prevalence rates are lower when compared with protocols that administer the same number of treatments over a given time interval less frequently, and frequent low-density treatment protocols have economic, practical and public acceptance advantages that may facilitate their long-term implementation. This work demonstrates the importance of stochasticity, community structure and the heterogeneity of individuals in influencing the dynamics of the human scabies contagion, and provides a practical method for investigating the outcomes of various intervention strategies.

Prevention, control and treatment of scabies

Scabies is a common, but neglected, skin condition that is becoming increasingly prevalent globally. It causes distress and is frequently regarded as a stigmatising condition, although it can affect anyone of any age or social class. Understanding the epidemiology and life cycle of the mite Sarcoptes scabiei which causes scabies, is the key to effective prevention and control.

Risk factors for scabies among male soldiers in Pakistan: case-control study

Being a preventable disease, good control of scabies can be achieved by identification of risk factors. During the 3-month period February 2006-April 2006 we carried out a case-control study on 200 patients with scabies and 200 controls to identify risk factors for scabies among male soldiers in Pakistan. We identified risk factors for the infestation using logisitic regression analysis. Itching in family/dormitory mates, infrequent bathing, infrequent changing of clothes, low education, sharing beds and being away from the barracks were identified as significant risk factors for scabies, while overcrowding, large family size and sharing of towels and hospitalisation were not.

A persistent problem with scabies in and outside a nursing home in Amsterdam: indications for resistance to lindane and ivermectin

An ongoing outbreak of scabies in and outside a nursing home in Amsterdam is described. Despite standard treatment with lindane and ivermectin, many recurrences were observed which suggested resistance to these drugs. After treatment with 5% permethrine, the patients were finally cured.

[Prediction of the effectiveness of a health care organization system for Muscovites in case of scab]

The present paper gives data on prediction of the number of Muscovites and homeless individuals who suffered from scab in 1998-2005. As of 2005, the difference in the expected and actual number of scab patients among the Muscovites and the homeless was 4.3 and 13% less than the expected values, respectively. At the same time the authors show that over 6 years (2005-2010) the incidence of scab will be able to reduce by 43.5 and 48.7% among the Muscovites and the homeless, respectively. Due to the extensive use of the inexpensive, safe, and most effective drugs medifox and medifox-super to treat scab and disinfect its foci, the efficiency of the treatment and prevention of scab has considerably increased. The above and other measures implemented by a dermatovenereological service and the concerned organizations improved the rating of Moscow: if it occupied the tenth place in the incidence of scab in 1999, then in 2003 it ranked third among the subjects of the Russian Federation.

[Lice, fleas and other beasts]

Bedbugs, lice, fleas and mites are blood-sucking ectoparasites whose bites cause allergic skin reactions. Diagnosis of bites is based on the morphology of the skin eruptions and the pattern of involved skin areas. Confirmation of the diagnosis often requires detection of the causal parasite. The main reservoir for ectoparasites (e.g., bedbugs, fleas, lice and scabies mites) are humans, but animals are also known to harbor ectoparasites (e.g., certain fleas and mites). Fleas, body lice and certain mite larvae in the tropics can transmit infectious diseases, but bedbugs, headlice, pubic lice and scabies mites cannot. Therapy is primarily directed against itching and bacterial superinfections. Pediculosis and scabies are additionally treated with t0pical insecticides. In order to kill freshly hatched larvae, topical treatmentmust be repeated after one week. In the case of pediculosis, people who have come into contact with symptomatic individuals also need to be treated, whereas with scabies, all contact persons must undergo treatment in order toprevent further transmission. Topicalinsecticides, in combination with anti-itch treatment, is usually sufficientto immediately relieve the symptoms and promote permanent healing of the skin lesions.

Safety of benzyl benzoate lotion and permethrin in pregnancy: a retrospective matched cohort study

OBJECTIVE

To assess the safety of benzyl benzoate lotion (BBL) and permethrin, topical treatments for scabies, during pregnancy.

DESIGN

A retrospective controlled cohort study.

POPULATION

Refugee and migrant women attending antenatal clinics (ANC) on the Thai-Burmese border between August 1993 and April 2006.

METHODS

Women treated with either BBL (25%) or permethrin (4%) were identified from a manual search of antenatal records. Each case of scabies was matched with four scabies-free controls for gravidity, age, smoking status, malaria, period of treatment and gestational age at treatment. Conditional Poisson regression was used to estimate risk ratios for outcomes of pregnancy (proportion of abortions, congenital abnormalities, neonatal deaths, stillbirths and premature babies), mean birthweight and estimated median gestational age, for scabies and scabies-free women, independently for BBL and permethrin.

RESULTS

There were no statistically significant differences in pregnancy outcomes between women who were treated with either BBL (n = 444) compared with their matched controls (n = 1,776) or permethrin (n = 196) treated women and their matched controls (n = 784). Overall, only 10.9% (n = 66) of treatments were in the first trimester. Retreatment rates were higher with BBL 16.4%, than permethrin 9.7%, P = 0.038. Scabies was more common during cooler periods.

CONCLUSION

We found no evidence of adverse effects on pregnancy outcome due to topical 25% BBL or 4% permethrin.

Nosocomial scabies

Scabies is a parasitic dermatosis with a worldwide distribution. This infestation affects millions of people annually and may cause large nosocomial outbreaks with considerable morbidity among patients and healthcare workers. Immunocompromised or elderly institutionalized patients admitted with unrecognized crusted scabies are the main source of nosocomial transmission. Factors that facilitate the development of hospital-acquired scabies and nosocomial epidemics are: poor knowledge of scabies epidemiology, unfamiliarity of healthcare workers with atypical presentations, long incubation period, diagnostic delay and incomplete monitoring. Within hospitals, containment of an outbreak relies on the strict implementation of appropriate infection control measures and treatment administration to contacts. It is associated with a considerable working and economic burden.

Recent immunologic considerations regarding the itch and treatment of scabies

Scabies continues to be a major public health problem. Recent findings reveal that these mites produce substances that modulate the host's immune response resulting in the latency period prior to symptoms. In terms of treatment, two cases of ivermectin resistance have come to fore in Australia in patients treated over fifty times with the agent. Additionally, work in the development of vaccination of hosts with antigenic midgut proteins of mites to control ectoparasitic infestations continues.

A scabies outbreak in a further education college in Gloucestershire

Scabies outbreaks in England have been reported in hospitals, long-stay wards, acquired immune deficiency syndrome (AIDS) units and residential homes for the elderly. This paper describes the control of an outbreak in a further education college for persons with learning disabilities. In March 2004, four confirmed cases of scabies were reported among a subset of 108 students and 41 staff members. Staff had considerable physical contact with the students who were housed in five groups of homes, individual homes and support centres. Mass prophylaxis was offered to all staff and students, through 39 general practice surgeries. Challenges overcome were: ensuring complete case ascertainment, accessing of up-to-date information about students and staff, achieving a coordinated approach to treatment, securing informed consent and media management. No further outbreaks have been reported. The college has revised its information request form for new students.

[Sarcoptes scabiei var. suis in a closed pig breeding and fattening herd and control possibilities after treatment]

On an Austrian pig breeding and finishing farm containing 13,000 pigs a mange prevalence of 38.7% according to the results of the skin scraping and 28.2% based on serology was determined. Due to the insufficient treatment (single treatment of the sows using Phoxim [Sebacil pour on]), sustainable control was impossible. That could be confirmed by the high number of mange positive gilts and finishing pigs. Before eradication started the following prevalences of mange could be found: sows 6.74% (skin scrapings), respectively 6.18% (serologically), gilts 18.18% resp 28.67%, finishing pigs 54.35% and 38.58%. The breeding stock for eradication was treated with doramectin (Dectomax) injectable solution and the finishing pigs with Ivomec-praemix, both applied twice. The success of treatment of the different farm units and of different age groups was controlled for the following ten months by combined diagnostic methods. In addition to skin scrapings, serum and colostral samples were carried out using a commercially available ELISA licensed for investigation of blood serum and colostrum. After treatment antibodies in the serum of the sows and gilts and Sarcoptes mites in their skin scrapings were detectable for up to four months after treatment. In serum samples of piglets and colostrum samples antibodies against Sarcoptes mites were detectable up to five months after final treatment. Due to the higher level and longer verifiability of antibodies in blood samples of piglets for five months after treatment and high prevalences their use as a diagnostic tool can be recommended. In contrast the use of colostral samples for routine diagnosis should be investigated more thoroughly. The comparison of the results of different diagnostic methods showed that for reliable mange diagnosis combined methods are recommended.