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. 2019 Feb 28;19(1):200.
doi: 10.1186/s12879-019-3818-5.

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

Simon M Mueller  1 , Stefan Gysin  2 , Michael Schweitzer  2 , Simon Schwegler  2 , Peter Haeusermann  2 , Peter Itin  2 , Thomas Bart  3 , Ruth Spieler Denz  3 , Thomas Steffen  3 , Richard Kuehl  4 , Andreas F Widmer  4 , Oliver Brandt  2
Affiliations

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

Simon M Mueller et al. BMC Infect Dis. .

Abstract

Background: Infestations 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.

Methods: Forty-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.

Results: All 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.

Conclusions: Our 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.

Keywords: Epidemic outbreak; Infection control; Ivermectin; Permethrin; Scabies infestation.

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Conflict of interest statement

Ethics approval and consent to participate

The Ethics Committee of Northwest and Central Switzerland (EKNZ) approved the study and granted a consent waiver status. Informed consent from the patient was not required in this case due to non-interventional nature of the study, indicating that the research presents no more than minimal risk of harm to subjects and does not involve any additional interventions besides those in the regular therapeutic regimen.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Algorithm used for the treatment of patients with suspected and confirmed scabies infestations. Four separate areas (check-in/ triage area, examination area, treatment area, and check-out area) involving different health-care providers were used at the different steps of the algorithm. Patients with neither symptoms nor signs were assigned a green label, those with itch only a blue label and patients with itch and skin lesion typical for scabies infestation a red label
Fig. 2
Fig. 2
Localisation of itch (blue bars) and scabies lesions (green bars) in 16 patients
Fig. 3
Fig. 3
Distribution of patients (n = 48) according to their signs and symptoms at baseline (visit 1), after 4 (visit 2) and 8 weeks (visit 3). Individuals were assigned to the following groups and treated as described in the Methods section: neither itch nor signs (group I, green parts of columns), itch without skin lesions (group II, blue parts of columns), itch and skin lesions (group III, red parts of columns). Figures in columns represent numbers of patients of each group at the different time points
See this image and copyright information in PMC

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