Scabies in Spain? A comprehensive epidemiological picture

Abstract

Introduction: Scabies is a neglected disease stablished worldwide with a fairy well determined incidence. In high-income countries, it often causes outbreaks affecting the residents and staff of institutions and long-term facilities, usually hard to detect and control due to the difficult diagnosis and notification delay. This study aim at characterizing the affected population, geographical distribution, and evolution of scabies in Spain from 1997-2019 as well as to describe the main environments of transmission using different data sources.

Methods: We carried out a nationwide retrospective study using four databases, which record data from different perspectives: hospital admissions, patients attended at primary healthcare services, outbreaks, and occupational diseases. We described the main characteristics from each database and calculated annual incidences in order to evaluate temporal and geographical patterns. We also analyzed outbreaks and occupational settings to characterize the main transmission foci and applied Joinpoint regression models to detect trend changes.

Results: The elderly was the most frequent collective among the hospital admitted patients and notified cases in outbreaks, while children and young adults were the most affected according to primary care databases. The majority of the outbreaks occurred in homes and nursing homes; however, the facilities with more cases per outbreak were military barracks, healthcare settings and nursing homes. Most occupational cases occurred also in healthcare and social services settings, being healthcare workers the most common affected professional group. We detected a decreasing trend in scabies admissions from 1997 to 2014 (annual percentage change -APC- = -11.2%) and an increasing trend from 2014 to 2017 (APC = 23.6%). Wide geographical differences were observed depending on the database explored.

Discussion: An increasing trend in scabies admissions was observed in Spain since 2014, probably due to cutbacks in social services and healthcare in addition to worsen of living conditions as a result of the 2008 economic crisis, among other reasons. The main transmission foci were healthcare and social settings. Measures including enhancing epidemic studies and national registries, reinforcing clinical diagnosis and early detection of cases, hygiene improvements and training of the staff and wide implementation of scabies treatment (considering mass drug administration in institutions outbreaks) should be considered to reduce the impact of scabies among most vulnerable groups in Spain.

Fig 1. No. of outbreaks, no. of cases and average cases per outbreak by setting/place of occurrence by RENAVE outbreaks data.

Fig 2. Secondary attack rates and outbreaks length by setting/place of occurrence.

Fig 3. Work-related scabies cases by setting type and occupation.

Dot´s size represents the number work-related scabies cases. HCW: Healthcare workers.

Fig 4. Scabies annual admissions joinpoint regression model by HIV status and HIV+/HIV- scabies admissions ratio, from 1997–2017 in Spain.

APC: Annual percentage change.

Fig 5. Annual average scabies cases/million inhabitants, from 2011–2017 in Spain by CMBD, RENAVE (outbreaks), BDCAP and ODR.

*Cases according to each database: CMBD: Scabies related admissions/million inhabitants. RENAVE: Scabies cases detected in outbreaks/million inhabitants. BDCAP: Scabies cases diagnosed in Primary Care/million inhabitants. ODR: Occupational scabies cases/million active population.

Fig 6