Abstract
BackgroundCrusted scabies is endemic in some remote Aboriginal communities in the Northern Territory (NT) of Australia and carries a high mortality risk. Improvement in active case detection (ACD) for crusted scabies is hampered by a lack of evidence about best practice. We therefore conducted a systematic review of ACD methods for leprosy, a condition with similar ACD requirements, to consider how findings could be informative to crusted scabies detection.Methods and principle findingsWe conducted systematic searches in MEDLINE, CINAHL, Scopus and the Cochrane Database for Systematic Reviews for studies published since 1999 that reported at least one comparison rate (detection or prevalence rate) against which the yield of the ACD method could be assessed. The search yielded 15 eligible studies from 511. Study heterogeneity precluded meta-analysis. Contact tracing and community screening of marginalised ethnic groups yielded the highest new case detection rates. Rapid community screening campaigns, and those using less experienced screening personnel, were associated with lower suspect confirmation rates. There is insufficient data to assess whether ACD campaigns improve treatment outcomes or disease control.ConclusionThis review demonstrates the importance of ACD campaigns in communities facing the highest barriers to healthcare access and within neighbourhoods of index cases. The potential benefit of ACD for crusted scabies is not quantified, however, lessons from leprosy suggest value in follow-up with previously identified cases and their close contacts to support for scabies control and to reduce the likelihood of reinfection in the crusted scabies case. Skilled screening personnel and appropriate community engagement strategies are needed to maximise screening uptake. More research is needed to assess ACD cost effectiveness, impact on disease control, and to explore ACD methods capable of capturing the homeless and highly mobile who may be missed in household centric models.
Highlights
Caused by Sarcoptes scabiei, the same mite that causes simple scabies, crusted scabies is a severe, progressive and debilitating form of scabies that occurs in individuals with reduced immune competence to control mite replication [1]
This review demonstrates the importance of active case detection (ACD) campaigns in communities facing the highest barriers to healthcare access and within neighbourhoods of index cases
The potential benefit of ACD for crusted scabies is not quantified, lessons from leprosy suggest value in follow-up with previously identified cases and their close contacts to support for scabies control and to reduce the likelihood of reinfection in the crusted scabies case
Summary
Caused by Sarcoptes scabiei, the same mite that causes simple scabies, crusted scabies is a severe, progressive and debilitating form of scabies that occurs in individuals with reduced immune competence to control mite replication [1]. People with crusted scabies are highly infectious core transmitters of scabies, known to cause scabies outbreaks and contribute to scabies endemicity [3,6], making early detection of crusted scabies an important component of scabies control. This is so given the increasing use of Mass Drug Administration (MDA) programs for scabies control in scabies endemic communities globally [6], as even a single crusted scabies case risks reducing MDA program efficacy and subsequently, acceptability [7]. We conducted a systematic review of ACD methods for leprosy, a condition with similar ACD requirements, to consider how findings could be informative to crusted scabies detection
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