Abstract
Scabies is a skin infestation with the mite Sarcoptes scabiei causing itch and rash and is a major risk factor for bacterial skin infections and severe complications. Here, we evaluated the treatment outcome of 2866 asylum seekers who received (preventive) scabies treatment before and during a scabies intervention programme (SIP) in the main reception centre in the Netherlands between January 2014 and March 2016. A SIP was introduced in the main national reception centre based on frequent observations of scabies and its complications amongst Eritrean and Ethiopian asylum seekers in the Netherlands. On arrival, all asylum seekers from Eritrea or Ethiopia were checked for clinical scabies signs and received ivermectin/permethrin either as prevention or treatment. A retrospective cohort study was conducted to compare the reinfestations and complications of scabies in asylum seekers who entered the Netherlands before and during the intervention and who received ivermectin/permethrin. In total, 2866 asylum seekers received treatment during the study period (January 2014 –March 2016) of which 1359 (47.4%) had clinical signs of scabies. During the programme, most of the asylum seekers with scabies were already diagnosed on arrival as part of the SIP screening (580 (64.7%) of the 897). Asylum seekers with more than one scabies episode reduced from 42.0% (194/462) before the programme to 27.2% (243/897) during the programme (RR = 0.64, 95% CI = 0.55–0.75). Development of scabies complications later in the asylum procedure reduced from 12.3% (57/462) to 4.6% (41/897). A scabies prevention and treatment programme at start of the asylum procedure was feasible and effective in the Netherlands; patients were diagnosed early and risk of reinfestations and complications reduced. To achieve a further decrease of scabies, implementation of the programme in multiple asylum centres may be needed.
Highlights
In 2015, several outbreaks of scabies amongst asylum seekers at refugee camps and reception centres in Europe were reported [1,2,3]
The high number of asylum seekers arriving in Europe between 2014 and 2016 emphasized the importance to expand knowledge on best practice regarding health care provision and control of infectious diseases that may come with migration
This study shows that a scabies prevention and treatment programme at start of the asylum procedure is feasible and effective in the Netherlands
Summary
In 2015, several outbreaks of scabies amongst asylum seekers at refugee camps and reception centres in Europe were reported [1,2,3]. Scabies is an infestation of the skin with the mite Sarcoptes scabiei. SIP was effective in the prevention of scabies outbreaks. The few scabies manifestations amongst asylum seekers from countries other than Ethiopia and Eritrea suggests that the target group of the SIP was well chosen. Newly developed scabies episodes were mainly seen in asylum health centres other than the national reception centres Ter Apel and Budel. These centres did not have a scabies prevention and treatment programme. This indicates that to achieve a further decrease of scabies, implementation of the programme in multiple asylum centres may be needed
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