Outbreak Of Scabies Research Articles

Factors associated with scabies outbreaks in primary schools in Ethiopia: a case-control study.

BackgroundScabies is a neglected tropical disease affecting more than 200 million people worldwide every year. Scabies in school adolescents and young adults could affect their school performance. The current study investigates the factors associated with an outbreak of scabies at primary schools in southern Ethiopia.MethodA team of health professionals investigated an outbreak of scabies that occurred in primary schools from May 1 to 30, 2018. An unmatched case–control study was employed to assess factors which predisposed for the scabies outbreak. Cases of scabies were individuals having a skin lesion compatible with the WHO case definitions of scabies. Controls were from the same locality with no skin lesions. Data on sociodemographic and behavioral variables were collected using questionnaires. Data on clinical presentations of scabies among cases were recorded by two trained and experienced health professionals. Factors associated with scabies were assessed using bivariate and multivariate logistic regression, and strength of association was described using odds ratio (OR) and 95% confidence intervals (CIs).ResultsA total of 711 (237 cases and 474 controls) study subjects participated in the study. The mean age of study participants was 17.56±2.66 years. Poor knowledge about scabies, adjusted odds ratio (AOR)=4.32 (95% CI: 2.93, 6.36); male sex, AOR=2.69 (95% CI: 1.82, 3.96); and parental illiteracy, AOR =3.49 (95% CI: 2.06, 5.94) predicted scabies infestation. Additionally, socioeconomic variables like sharing clothes/beds or contact with others, AOR=3.12 (95% CI: 2.12, 4.59); low household annual income, AOR=2.13 (95% CI: 1.32, 3.44); and family size greater than five, AOR=1.77 (95% CI: 1.04, 3.01) were significantly associated with scabies infestation. Inaccessibility and poor utilization of water, AOR=1.64 (95% CI: 1.12, 2.40) and poor personal hygiene, AOR=1.69 (95% CI: 1.14, 2.51) were also factors independently associated with scabies.ConclusionModifiable risk factors such as personal hygiene and literacy level were found to be independent predictors of scabies infestation. Access to and utilization of water were also important predictors. Strategies for poverty alleviation and awareness creation on personal hygiene and efficient use of water are recommended for effective prevention of scabies infestation in closed institutions.

Scabies polymerase chain reaction with standardized dry swab sampling: an easy tool for cluster diagnosis of human scabies.

Expert visualization of Sarcoptes scabiei remains essential for diagnosing human scabies, but access to said experts can be difficult. Polymerase chain reaction (PCR) is a specific tool for the detection and confirmation of S. scabiei but has poor sensitivity. To evaluate PCR as a diagnostic method for scabies using nonexpert-dependent standardized sampling. The dry swab was systematically rubbed across the front of both wrists, the eight interdigital spaces and on any suspected scabies lesions in all patients referred for scabies. A new PCR-based diagnostic test was run on the samples. All patients underwent clinical and dermoscopic examination. Scabies diagnosis was confirmed when dermoscopic examination was positive or the patient had typical clinical signs of scabies. Of 183 suspected cases of scabies, 164 patients were sampled, 87 had confirmed scabies (dermoscopy positive n = 87, typical clinical signs n = 1) and 77 did not. Of the 87 patients with proved scabies, 33 patients had positive scabies PCR, resulting in a 37·9% [95% confidence interval (CI) 28·4-48·4%] sensitivity and a 61·7% (95% CI 52·4-72·7%) negative predictive value. None of the 77 patients ruled out for scabies had a positive PCR result. This method is nontraumatic, repeatable and non-expert-dependent. It shows sensitivity similar to previous studies involving expert skin scraping. However, this method facilitates the multiplication of sampling, which increased the sensitivity for cluster scabies diagnosis. This method may be suitable as a first-line diagnosis tool where a large cluster scabies outbreak is suspected. What's already known about this topic? Scabies diagnosis requires expertise. Scabies polymerase chain reaction (PCR) is specific but has poor sensitivity. Poor sensitivity is the consequence of the low efficiency of sampling methods. What does this study add? This PCR-based diagnostic method based on nontraumatic standardized skin sampling is not expert-dependent and is reproducible. This diagnostic method may be relevant as a non-expert sentinel diagnosis tool in large clusters where a scabies outbreak is suspected.

Clinical presentation and risk factors of increased scabies cases in the Western region of Saudi Arabia in 2016-2018.

Objectives:To describe the clinical characteristics of scabies in the Makkah province and analyze risk factors associated with the outbreak.Methods:A cross-sectional study was conducted between June 2016 and June 2018 by collecting the data of patients reported to have infestations at King Abdulaziz Medical City, Makkah, Saudi Arabia. A comparative analysis was conducted of patients reported before and during the outbreak of scabies.Results:Of the 352 patients identified, the range of cases was 0-24 cases per month before the months of the outbreak (March to April 2018). However, the actual number of cases reported increased 2.8 times the expected maximum in April 2018. Saudi nationals were 2.5 times more affected than non-Saudi nationals during the outbreak period compared to before the outbreak (95% CI: 1.02, 6.05, p=0.045). Symptoms involving upper arms, axillae (53.7% versus 68.7%, p=0.048), and torso (50% versus 66.4%, p=0.033) were significantly under-represented among outbreak patients. The presence of additional comorbidities was reported more frequently in patients diagnosed with scabies before versus during the outbreak months (25.8% versus 8.2%, p=0.014). Permethrin prescriptions increased (75.6% versus 41%), crotamiton prescriptions decreased (13.5% versus 48%), and the hospitalization was lower (3.8% versus 13.5%) during the outbreak.Conclusion:The clinical presentation and risk factors of scabies change significantly with scabies outbreaks, and consequently so do the lines of treatment in Saudi Arabia. The present study highlights the importance of adopting strategies related to community infection control and prevention.

A Large Scabies Outbreak at a Prison in Southern Thailand, April – August 2017

Scabies is a neglected contagious skin disease and mostly occurs in crowded environment. After an increase in scabies cases at a prison, an investigation team was deployed. The objectives were to describe the epidemiological characteristics of cases, identify risk factors for infection and implement control measures. We defined a scabies confirmed case as a person with at least one itchy skin lesion, and diagnosed as scabies by both a physician and a dermatologist. We inspected the prison environment and observed sanitation practices. A case-control study was conducted among male inmates to identify risk factors for scabies. The overall attack rate was 29.4% among inmates. All 251 confirmed cases were typical scabies and 250 were male. The environmental inspection revealed poor hygiene and overcrowded at men’s zones. Sharing a bedroom (Adjusted odds ratio AOR = 9.72, 95% CI = 5.33-17.73) and sharing clothes with cases (AOR = 3.61, 95% CI = 1.66-7.84) were significantly associated with having scabies. After interventions of setting scabies surveillance, separation of new comers, universal treatment for all inmates, and disinfection of bedrooms, bedding and clothes with detergents, no more new cases were found. Improving sanitation especially in bedrooms, enhancing scabies detection, and early interventions after case detection could help prevent scabies outbreak in prisons.

Outbreak of scabies among preschool children, Accra, Ghana, 2017

BackgroundScabies occurs worldwide with a prevalence between 0.3 and 46.0%. In Ghana, even though a 5.1% proportion of scabies was reported in a retrospective review of skin diseases at the Korle Bu Teaching Hospital, the nationwide prevalence of scabies is unknown. Overall, its burden is higher in tropical regions. Scabies outbreaks mostly occur among children, the elderly in nursing homes, and prison inmates. Even though primary scabies hardly results in mortalities, the pain, itch, and systemic complications from secondary bacterial infections account for about 1.5 million years lived with disabilities. We investigated a scabies outbreak among school children in Ghana to determine its magnitude, stop the outbreak, and institute preventive measures to minimize risks of future outbreaks.MethodsThe investigation was conducted between March 14 and May 17, 2017 among pupils of Presbyterian Secondary Staff Basic School in Accra. We defined a case as a school child who on clinical examination, had an intensely pruritic rash on at least one typical predilection site with or without a burrow, or positive skin scrapings on microscopy. We screened and line listed cases, performed laboratory investigations on skin scrapings and wound swaps, and conducted an environmental assessment. We performed descriptive statistics on data, and calculated attack rate ratios (ARR) at 95% confidence level.ResultsOf 823 preschool children screened, 92 were cases. Median age of cases was 4 years (range 2–7 years) and their modal age was 3 years. The overall attack rate was 11.2% (92/823). The sex specific attack rate was 11.5% for males, and 10.8% for females (ARR: 0.93; CI: 0.67–1.28). Compared with the least affected class (crèche), the nursery one class was worst affected (ARR: 5.14; CI: 3.44–7.50). On microscopy, all skin scrapings were negative for scabies. Staphylococcus aureus and Streptococcus spp. were isolated from secondarily infected scabies lesions.ConclusionsA scabies outbreak with a propagated source occurred among preschool children. The 3-year-old pupils were most affected. It was controlled by mass treatment with benzyl benzoate and health education. Classrooms and sleeping mats were disinfected. We recommended the decongestion of classrooms and discouraged sharing of sleeping mats.

Epidemiology of scabies in relation to socio-economic and selected climatic factors in north-east Poland.

Scabies is a contagious parasitic disease, a skin infestation caused by Scaroptes scabieri, tiny mites that burrow under the skin. Outbreaks of scabies can be difficult to control and require the implementation of appropriate control programme. The purpose of the study was to analyze the epidemiology of scabies in north-east Poland, considering socio-economic and selected climatic factors. The analysis was based on data reports (n=26,362) obtained from the Polish National Health Fund (NFZ) for the period 2007-2014. Monthly climate data were collected from the Institute of Meteorology and Water Management/National Research Institute (IMGW-PIB) in Warsaw, including data on temperature and relative humidity. Additionally, the influence of socio-economic factors on the prevalence of scabies was analyzed. Data on population size, medical staff, and unemployment rate were obtained from the Central Statistical Office (GUS) in Warsaw, and analyzed using SPSS Statistics 24.0 programme. The age group of 10-19 years showed the highest infestation rates. Seasonality of scabies was demonstrated. The highest numbers of cases were reported during the autumn and winter months. There was a significant negative correlation (rho = -0.499; p<0.001) between air temperature and the incidence of scabies, and a positive correlation (r = 0.532; p<0.001) between relative humidity and the number of cases reported. A rise in the unemployment rate also caused an increase in the scabies incidence rate (r = 0.294; p<0.001). The results suggest that an improvement of socio-economic conditions may contribute to a reduction in the number of scabies infections. The possibility should be considered of monitoring the parameters, such as air temperature and humidity, particularly when scabies outbreaks occur.

Implementation and evaluation of an algorithm for the management of scabies outbreaks

BackgroundInfestations with scabies mites are a global burden affecting individuals of all ages, classes and ethnicities. As poor sanitation and overcrowding favor the transmission of this highly contagious disease, epidemic outbreaks are frequently observed among displaced persons and asylum seekers. Due to the growing influx of refugees during the last years, public health authorities in host countries are frequently confronted with the challenge to treat individuals with diagnosed or suspected scabies promptly and effectively to avoid further spreading of the infestation.This study aimed to establish a straightforward and efficient algorithm for rapid screening and treatment of large numbers of patients with confirmed or suspected scabies infestations.MethodsForty-eight individuals (58% males, mean age 22.4 yrs.) from Syria with suspected scabies infestation were allocated to 3 colour-coded groups: (1) no signs or symptoms of infestation, (2) itch only, and (3) itch and typical skin lesions. Patients were treated with a single (group 1) or two doses of oral ivermectin at an interval of 7 days (group 2), or with a combination of 2 doses of ivermectin plus 2 applications of permethrin ointment at an interval of 7 days (group 3). Follow-ups were performed 4 weeks after initial treatments.ResultsAll individuals with signs and/or symptoms of infestation had improved skin lesion; in 10/11 (90.9%) lesion had completely resolved. All individuals with initial itch only (n = 32) reported improvement of its intensity or complete resolution. None of the patients of group 1 developed itch or skin lesions. The algorithm was reapplied in 4 individuals (8.3%) after 4 weeks and the outbreak was completely controlled after 8 weeks. Colour-coding ensured fast flow of information between health-care providers at the interfaces of the algorithm.ConclusionsOur algorithm proved to be both highly efficient for treatment of large numbers of patients with suspected or diagnosed scabies infestation as well as for prevention of spreading of the disease. Hence, this algorithm is well suited for the management of scabies mass outbreaks.

The Outbreak of Classic and Norwegian Type Scabies, in Mentally Handicapped Persons in a Rehabilitation Centre-Iran

Introduction: Scabies is an ectoparasitic infection caused in humans by the scabies mite Sarcoptes scabiei variety hominis. Aim: The aim of this study was to detect early disease scabies, finding its risk factors, and prevention of epidemic diseases among the people who are susceptible to scabies, because of disability and mental retardation. Materials and Methods: This was a descriptive cross-sectional study which was managed in a rehabilitation centre, which is responsible for the care of disabled and mentally retarted in Iran for a period of two months from July 27, 2018 until September 28, 2018. This centre had five units (A, B, C, D and E) comprising of 46 employers (34 staff; 2 nurses and 10 service personnel) who were catering to 110 handicapped persons. The index case of scabies in disability centre was a 16-year-old child with Down Syndrome, who was in contact with the patients in Unit E. On July 27, 2018, it reported one outbreak of scabies in this rehabilitation dormitory to one Centre Care Health (CCH) of Iran. All of 19 patients had symptom including: skin itching; papule on testis and penis and generalised rash on the body and two patients had thick crust on skin in armpit and anal area. Four service personnels had itching and papule on the neck. The patients were examined by a team including entomologists and dermatologists and demographic information of the patients was collected by completing the questionnaire (with regard to the principles of medical ethics). Mentally retarded persons were treated with 5% permethrin cream and for staff; nurses and service personnel 10% crotamiton cream was given except for pregnant women who used 10% sulfur ointment. Results: A total of 110 individuals with mental and physical disorders (23.6% males and 76.4% females) were resident in five units out of which 19% of individuals were exposed and 81% unexposed. The sex ratio of male to female was 1:3.2. The mean age of patients was 27 years (SD=7.09, Range 14-48 years) that most affected age group was 21-30 years (45.4%), 92% of exposed group was females and 8% were males. Using of sharing towels (odds ratio: 23.25, 95% CI: 8.91-60.64), sharing bathroom supplies (odds ratio: 3.31, 95% CI: 1.03- 10.64), sleeping in a common bed (odds ratio: 23.25, 95% CI: 8.91-60.64) and sharing glove (odds ratio: 0.86, 95% CI: 0.28- 2.18) were the most important risk factors of the scabies. Conclusion: It is an urgent need that in social places, including hospitals, centres for the care of the elderly and mentally handicapped people, the nurses and service personnel get trained about the importance of urgent report of epidemic diseases especially scabies to Health care centres.

A Survey on the Scabies Outbreak and Infection Control

A Survey on the Scabies Outbreak and Infection Control

Do we know how scabies outbreaks in residential and nursing care homes for the elderly should be managed? A systematic review of interventions using a novel approach to assess evidence quality.

Currently no national guidelines exist for the management of scabies outbreaks in residential or nursing care homes for the elderly in the United Kingdom. In this setting, diagnosis and treatment of scabies outbreaks is often delayed and optimal drug treatment, environmental control measures and even outcome measures are unclear. We undertook a systematic review to establish the efficacy of outbreak management interventions and determine evidence-based recommendations. Four electronic databases were searched for relevant studies, which were assessed using a quality assessment tool drawing on STROBE guidelines to describe the quality of observational data. Nineteen outbreak reports were identified, describing both drug treatment and environmental management measures. The quality of data was poor; none reported all outcome measures and only four described symptom relief measures. We were unable to make definitive evidence-based recommendations. We draw on the results to propose a framework for data collection in future observational studies of scabies outbreaks. While high-quality randomised controlled trials are needed to determine optimal drug treatment, evidence on environmental measures will need augmentation through other literature studies. The quality assessment tool designed is a useful resource for reporting of outcome measures including patient-reported measures in future outbreaks.

How Telehealth Stopped A Contagious Outbreak At A School.

A school-based telehealth program helps identify a disease outbreak before it gets out of hand.

Investigation of a Scabies Outbreak in Drought-Affected Areas in Ethiopia.

The impact of the severe drought in Ethiopia, attributed to El Niño weather conditions, has led to high levels of malnutrition that have, in turn, increased the potential for disease outbreaks. In 2015, Ethiopia faced a scabies outbreak in drought-affected areas where there was a shortage of safe water for drinking and personal hygiene. Following a house-to-house census to assess the prevalence of scabies, a detailed study was conducted looking at the disease burden. Following the outbreak report, training was provided on scabies identification and management for zonal and district health officials from administrative districts affected by the drought (nutritional hot-spot woredas). The training was cascaded down to the health extension workers in the affected areas. Screening and management guidelines and protocols were also distributed. House-to-house data collection was undertaken by 450 health extension workers (HEWs) to assess the prevalence of scabies. The HEWs used a simplified reporting tool. Subsequently, data were collected and validated in two zones and six woredas from 474 participants who had been diagnosed with scabies using a standardized questionnaire. This was designed to look at the specificity of the diagnosis of scabies, age distribution, severity, duration of illness, secondary infection and other sociodemographic variables as preparation for mass drug administration (MDA). The HEWs screened 1,125,770 people in the 68 districts in Amhara Region and a total of 379,000 confirmed cases of scabies was identified. The prevalence in the different districts ranged from 2% to 67% and the median was 33.5% [interquartile range (IQR) 19–48%]. 49% of cases were school-aged children. The detailed study of 474 individuals who were recorded as scabies cases revealed that the specificity of the diagnosis of scabies by the HEWs was 98.3%. The mean duration of illness was 5 months (SD of ± 2.8). One third of patients were recorded as having severe illness, 75.1% of cases had affected family members, and 30% of affected children were noted to have secondary bacterial infection. Eleven percent of the students had discontinued school due to scabies or/and drought and 85% of these had secondary bacterial infection. These community-based data serve as reliable proxy indicators for community-based burden assessment of the scabies epidemic. This study will also provide a good basis for advocating the use of a community-level clinical diagnostic scheme for scabies using an algorithm with a simple combination of signs and symptoms in resource-poor settings.

Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes

SummaryBackgroundScabies outbreaks in residential and nursing care homes for elderly people are common, subject to diagnostic delay, and hard to control. We studied clinical features, epidemiology, and outcomes of outbreaks in the UK between 2014 and 2015.MethodsWe did a prospective observational study in residential care homes for elderly people in southeast England that reported scabies outbreaks to Public Health England health protection teams. An outbreak was defined as two or more cases of scabies (in either residents or staff) at a single care home. All patients who provided informed consent were included; patients with dementia were included if a personal or nominated consultee (ie, a family member or nominated staff member) endorsed participation. Dermatology-trained physicians examined residents at initial clinical visits, which were followed by two mass treatments with topical scabicide as per local health protection team guidance. Follow-up clinical visits were held 6 weeks after initial visits. Scabies was diagnosed through pre-defined case definitions as definite, probable, or possible with dermatoscopy and microscopy as appropriate.Findings230 residents were examined in ten outbreaks between Jan 23, 2014, and April 13, 2015. Median age was 86·9 years (IQR 81·5–92·3), 174 (76%) were female, and 157 (68%) had dementia. 61 (27%) residents were diagnosed with definite, probable, or possible scabies, of whom three had crusted scabies. Physical signs differed substantially from classic presentations. 31 (51%) of the 61 people diagnosed with scabies were asymptomatic, and only 25 (41%) had burrows. Mites were visualised with dermatoscopy in seven (11%) patients, and further confirmed by microscopy in three (5%). 35 (57%) cases had signs of scabies only on areas of the body that would normally be covered. Dementia was the only risk factor for a scabies diagnosis that we identified (odds ratio 2·37 [95% CI 1·38–4·07]). At clinical follow-up, 50 people who were initially diagnosed with scabies were examined. No new cases of scabies were detected, but infestation persisted in ten people.InterpretationClinical presentation of scabies in elderly residents of care homes differs from classic descriptions familiar to clinicians. This difference probably contributes to delayed recognition and suboptimal management in this vulnerable group. Dermatoscopy and microscopy were of little value. Health-care workers should be aware of the different presentation of scabies in elderly people, and should do thorough examinations, particularly in people with dementia.FundingPublic Health England and British Skin Foundation.

Diagnosis, treatment, and control of scabies: can we do better?

In 2017, the Department of Control of Neglected Tropical Diseases of WHO recommended that scabies be added to the neglected tropical disease portfolio and called for action to improve control efforts. Scabies affects around 200 million people at any one time, 1 Karimkhani C Colombara DV Drucker AM et al. The global burden of scabies: a cross-sectional analysis from the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017; 17: 1247-1254 Summary Full Text Full Text PDF PubMed Scopus (130) Google Scholar causes an intensely itchy rash, and leads to bacterial infection and autoimmune disease. 2 Engelman D Kiang K Chosidow O et al. Toward the global control of human scabies: introducing the International Alliance for the Control of Scabies. PLoS Negl Trop Dis. 2013; 7: e2167 Crossref PubMed Scopus (123) Google Scholar Although the greatest burden is in disadvantaged populations in resource-limited and tropical settings, scabies also causes a substantial health-care burden via institutional outbreaks in high-income and temperate settings. Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomesClinical presentation of scabies in elderly residents of care homes differs from classic descriptions familiar to clinicians. This difference probably contributes to delayed recognition and suboptimal management in this vulnerable group. Dermatoscopy and microscopy were of little value. Health-care workers should be aware of the different presentation of scabies in elderly people, and should do thorough examinations, particularly in people with dementia. Full-Text PDF Open Access

Scabies Outbreak Investigation and Risk Factors in East Badewacho District, Southern Ethiopia: Unmatched Case Control Study.

Introduction Scabies is one of the common public health problem but neglected parasitic diseases caused by Sarcoptes scabiei var. Methods A community-based unmatched case control (1 : 2 ratios) study was conducted in East Badewacho District, using collected scabies line listed data and face-to-face interview to assess risk factors during October 23–30, 2016. The data were collected using structured questionnaire, and then the data were coded, entered, cleaned, and analyzed using SPSS statistical software, whereas, line listed data was entered into Microsoft excel for descriptive analyses. Odds ratios (OR) and 95% confidence interval (CI) were computed to determine associated factors. Results A total of 4,532 scabies cases line listed with overall attack rate of 110/1,000 population. The mean age was 12 years, and most affected age group was 5–14 years. Independent risk factors found to be statistically associated with scabies infestation were age less than 15 years (AOR = 2.62, 95% CI: 1.31–5.22), family size greater than 5 members (AOR = 2.63, 95% CI: 1.10–6.27), bed sharing with scabies cases (AOR = 12.47, 95% CI: 3.05–50.94), and home being affected by flooding (AOR = 22.32, 95% CI: 8.46–58.90). Conclusion Outbreak of scabies occurred in East Badewacho District. Age less than 15 years, family size greater than five members, sleeping with others, and home being affected by flooding are the risk factors. Providing risk factors related health education on prevention and controls especially, at community level and schools, is recommended.

Management of a family outbreak of scabies with high risk of spread to other community and hospital facilities

In developed countries, scabies is observed sporadically or as institutional outbreaks in hospitals and other health facilities. In the family context, outbreaks generally involve a limited number of cases. A local health authority in Emilia-Romagna (Northern Italy) carried out an epidemiologic investigation on a family outbreak of scabies that included an unusually high number of cases. Its possible connection with a nosocomial case in a long-term care facility (LTCF) and outbreak management are discussed. Among the household members, 8 confirmed cases occurred (attack rate, 87.5%). Another case was reported in a patient of an LTCF where one of the family cases worked as a sociosanitary operator. In total, 244 contacts were placed under surveillance. The control strategy focused on a mass information campaign addressed to all contacts and the training of health care personnel. In addition, specific prophylaxis (permethrin 5%) was performed in 108 high-risk contacts and LTCF patients and staff. The control measures were successful in preventing the spread of the outbreak. However, misdiagnosis and the tendency of people to hide the symptoms caused the late recognition and underestimation of the cases, contributing to delayed control measures and increasing the economic and human resources required for outbreak management.

Outbreak of scabies among school pupils, Accra, Ghana, 2017

Introduction : though ubiquitous, scabies presents a major public health threat to developing countries. Post-infective complications from secondary infections cause renal and cardiovascular morbidities. Globally, its prevalence varies from 0.3% to 46%; with an estimated 1.5 million years lived with disability. Its prevalence in Ghana is estimated at 5.1%. We report the findings of a scabies outbreak investigation among schoolchildren in Ghana that aimed at stopping the outbreak and instituting preventive measures to minimize the risk of future outbreaks. Methods : between March 14 and May 17, 2017, we conducted an outbreak investigation of scabies in Presec Staff Basic School situated in an urban community in Accra. A case was defined as a schoolchild who on clinical examination, had an intensely pruritic rash on at least one typical predilection site with or without a burrow or positive skin scrapings on microscopy. We line listed cases and captured data which included socio-demographic and other risk factors, body parts affected and complications of scabies. We conducted an environmental assessment and performed descriptive statistics on the data. Results : a total of 823 school children were screened. Overall attack rate was 11.2% (92/823). The attack rate among the nursery category was 25.1% (52/207). Their ages ranged from one to seven years; with a modal age of 3 years. Males affected were 51% and frequently affected body parts were: face (77.2%) and neck (54.3%). Nearly 10.0% of cases had pyoderma from secondary infection. Pupils sat close together in pairs and share sleeping mats. Conclusion : a scabies outbreak affecting mostly children aged 3 years occurred in a basic school in Accra. We recommend avoidance of sharing of sleeping mats by school children. Benzyl benzoate mass treatment, disinfecting of classrooms and sleeping mats, and health education were done.

Scabies outbreak among healthcare workers in a German acute care hospital

This article reports on a scabies outbreak among healthcare workers (HCW) in an acute care hospital. The outbreak was associated with a patient suffering from a chronic skin disease that was later diagnosed as crusted scabies. The objective was to determine the outbreak drivers and define a prevention strategy against future outbreaks. All staff that had contact with the patient were treated with 5% permethrin ointment. An interdisciplinary outbreak investigation team was established. The team conducted a questionnaire-based case-control study. After the permethrin treatment, no further case was found. Twenty-seven HCWs who had contact with the index patient answered the questionnaire (response rate 73%). The outbreak questionnaire revealed 13 cases of secondary scabies among HCWs. In the multivariable analysis, a lack of glove use (odds ratio [OR], 9.8; P value = 0.036) and frequent close physical contact (OR, 8.151; P value = 0.038) were associated with increased risk of scabies acquisition. The scabies outbreak was most likely driven by three factors: an index patient with crusted scabies; a delayed diagnosis of this patient; and close physical contact without gloves during his hospital stay. The use of disposable gloves for patients with unclear dermatological diagnosis have the potential to limit future scabies outbreaks.

Nosocomial crusted scabies outbreak: Important infection prevention lessons learned from a small case series

• Crusted scabies is a highly infectious hyperkeratotic dermatosis caused by an ectoparasite S. scabiei variety hominis .

A scabies outbreak in a diabetic and collagen disease ward: Management and prevention.

Scabies is an infection caused by Sarcoptes scabiei. In developed countries, scabies remains an important public health problem in hospitals and care facilities among elderly or immunocompromised patients. There are a number of medical providers who have not experienced scabies and there has been confusion surrounding its management and prevention. Therefore, the aim of the present study was to identify the optimal approach for the management and prevention of scabies. A scabies outbreak occurred between June 2014 and October 2014 in the Toho University School of Medicine, Omori Hospital (Tokyo, Japan), and the current study investigates factors concerning the outbreak, such as disease recognition, diagnostic strategy, medical staff experience and correspondence after the outbreak occurred. Six patients were newly diagnosed with scabies including patients, medical staff and family of the medical staff. An infection control committee was implemented and required a follow-up survey of 181 people (144 patients and 37 medical staff). It took ~4 months to resolve the outbreak. Scabies is highly infectious, and sufficient knowledge is required to care for the patients and prevent the infection of healthy people. In this example, the spread of infection was controlled by prompt action.