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

Abstract

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.

Figure 1:

A child’s feet with skin manifestations of scabies infestation and secondary pyoderma Image credit: Millicent Osti.

Figure 2:

Prevalence of scabies in children and adolescents aged younger than 19 years Prevalence is shown at the country level, using available data from Romani and colleagues and updated with additional references.^– Subnational variation exists but is not represented in the map.

Figure 3:

Primary and secondary effects of scabies infestation