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. 2020 Oct 18;59(4):264-272.
doi: 10.2478/sjph-2020-0033. eCollection 2020 Dec.

An Increasing Scabies Incidence in Croatia: A Call for Coordinated Action Among Dermatologists, Physicians and Epidemiologists

Liborija Lugović-Mihić  1   2 , Marija Delaš Aždajić  1 , Sanja Kurečić Filipović  3 , Iva Bukvić  1 , Ivana Prkačin  1 , Danijela Štimac Grbić  3   4 , Mirjana Lana Kosanović Ličina  5
Affiliations

An Increasing Scabies Incidence in Croatia: A Call for Coordinated Action Among Dermatologists, Physicians and Epidemiologists

Liborija Lugović-Mihić et al. Zdr Varst. .

Abstract
in English, Slovenian

Introduction: The aim of our study was to examine the scabies incidence in the Croatian population and to analyse potential related factors.

Methods: This mixed ecological study is based on a retrospective medical record review. National data from communicable disease reports was sourced and analysed for an 11-year period (2007-2017), with more focus on the period 2014-2017. Descriptive statistics were used to calculate trends. Differences between the groups were studied using Chi-square test and Kendall's tau (τ) correlation coefficient. Levels of significance were set at p<0.05 or p<0.01.

Results: From 2007 to 2017, scabies infestation in Croatia increased by 6-fold, particularly affecting children and young adults (19 years or younger). In the period 2014-2017, border counties which are part of migration flows were the counties with the highest average scabies incidences. A linear trend of increase in the number of tourists, immigrants and scabies infestations was noted on the national level for the analysed period, although a significant association was not observed. Regarding outbreaks of scabies within institutions, more than 80% of outbreaks occurred in institutions for adults. In the capital, Zagreb, the crude incidence rate increased 3-fold between 2014 and 2017.

Conclusions: The increased incidence of scabies, large disparities between counties, and prolonged outbreaks within families due to under-recognition and misdiagnoses points to a need for increased awareness among health practitioners. To the best of our knowledge, this is the first recent epidemiologic analysis on this topic, not only in Croatia but within the wider geographic region as well.

Uvod: Cilj naše študije je bil preučiti pojavnost skabiesa pri hrvaški populaciji in analizirati morebitne povezane dejavnike.

Metode: Ta mešana ekološka študija je temeljila na retrospektivnem pregledu zdravstvenih kartotek. Pridobili in analizirali smo nacionalne podatke iz poročil o nalezljivih boleznih za 11-letno obdobje (2007–2017), pri čemer smo se bolj osredotočili na obdobje 2014–2017. Za izračun trendov smo uporabili opisno statistiko. Razlike med skupinami smo preučili s testom hi-kvadrat in Kendallovim korelacijskim koeficientom tau (τ). Stopnja pomembnosti je bila nastavljena na p < 0,05 ali p < 0,01.

Rezultati: Od leta 2007 do 2017 se je pojavnost okužb s skabiesom na Hrvaškem povečala za šestkrat, pri čemer je bolezen prizadela zlasti otroke in mlajše odrasle (stare 19 let ali manj). V obdobju 2014–2017 so bila obmejna okrožja, ki so del migracijskih tokov, tista z najvišjo povprečno pojavnostjo skabiesa. V analiziranem obdobju je bil na nacionalni ravni opažen linearen trend povečevanja števila turistov, imigrantov in okužb s skabiesom, čeprav ni bilo opaziti pomembne povezanosti. Kar zadeva izbruhe skabiesa v zavodih, se jih je več kot 80 % zgodilo v zavodih za odrasle. V prestolnici Zagrebu se je groba incidenčna stopnja med letoma 2014 in 2017 povečala za trikrat.

Sklepi: Povečana incidenca skabiesa, velika neskladja med okrožji in dolgotrajni izbruhi v družinah zaradi premajhnega prepoznavanja in napačnih diagnoz kažejo na potrebo po večji ozaveščenosti zdravstvenih delavcev. Po naših podatkih je to prva epidemiološka analiza, ki je bila pred kratkim opravljena na to temo, ne samo na Hrvaškem, temveč tudi na širšem geografskem območju.

Keywords: Croatia; epidemiology; neglected tropical diseases; outbreaks; scabies.

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Figures

Figure 1
Figure 1
The scabies incidence rates in Croatia in the period 2007-2017.
Figure 2
Figure 2
The scabies incidence rates by month in the City of Zagreb, Croatia in the period 2014-2017.
Figure 3
Figure 3
Scabies incidence by county and migration flows, Croatia, 2017. Migration flows data available from Arsenijević et al. 2017 (20) and Arsenijević et al. 2018 (21).
Figure 4
Figure 4
Relative percental dynamics of number of tourists, immigrants, and scabies over the four-year period in Croatia.
See this image and copyright information in PMC

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