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. 2025 Jul 1;25(1):846.
doi: 10.1186/s12879-025-11208-7.

An outbreak of scabies in a fishing community in Hoima District, Uganda, February - June, 2022

Rebecca Akunzirwe  1 , Brian Agaba  2 , Saudah Namubiru Kizito  2 , Lilian Bulage  2 , Benon Kwesiga  2 , Richard Migisha  2 , Robert Kaos Majwala  3   4 , Peter Chris Kawungezi  2 , Jane Frances Zalwango  2 , Daniel Kadobera  2 , Alex Riolexus Ario  2   5
Affiliations

An outbreak of scabies in a fishing community in Hoima District, Uganda, February - June, 2022

Rebecca Akunzirwe et al. BMC Infect Dis. .

Abstract

Background: Scabies, an infectious parasitic disease, is endemic in most resource-poor tropical areas, including Uganda. On May 21, 2022, the Ugandan Ministry of Health was notified of > 1,000 cases of scabies in Hoima District. We investigated to assess the scope of the outbreak, identify associated factors, and recommend interventions.

Methods: We defined a suspected scabies case as the onset of an itchy pimple-like skin rash or crusting from January 2021 to July 2022 in a resident of Hoima District. We reviewed medical records, performed active community case-finding, and computed attack rates by age, sex, and village per 1,000 population. Using logistic regression, we compared exposures among 101 case persons and 99 unmatched controls living in Rwentale Landing Site in Hoima during June 2022.

Results: We line listed 2,236 suspected cases in Hoima District. Children aged 5-14 years were more affected (AR = 64/1,000) than persons aged ≥ 15 years (AR = 8/1,000) (p < 0.001). Males (AR = 27/1,000) were more affected than females (AR = 15/1,000) (p < 0.001). Of the 54 affected villages, Rwentale Village had the highest attack rate (AR = 233/1,000 population). Rwentale Village includes a fishing area known as Rwentale Landing Site where 1,119 (50%) cases in Hoima District were identified. At this landing site, cases began in April 2022 shortly after the end of the peak fishing and trading season. Being aged 5-14 years (AOR = 4.9, 95%CI: 2.0-12), being male (AOR = 2.4, 95%CI 1.1-5.1), living with another case (AOR = 3.1, 95%CI: 1.5-6.2), and sharing three or more personal care items (towel, beddings, clothes, or sponges) (AOR = 2.2, 95%CI: 1.1-4.6) were associated with scabies.

Conclusion: This scabies outbreak was likely initiated by person-to-person interactions during peak fishing and trading months at a landing site and propagated by close household interactions. Community sensitization on scabies, especially before fishing and trading seasons is recommended for prevention and early control of scabies in the region. Additionally, establishing a surveillance system for scabies, in high-risk areas such as fishing communities may facilitate timely detection and control of future outbreaks.

Keywords: Sarcoptes scabiei; Outbreak; Scabies; Uganda.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: This study, conducted in response to a national public health emergency, was approved under a memorandum of understanding and an umbrella protocol (project ID: 0900f3eb81f96394); the study was waived the full Institutional Review Board (IRB) review. The Uganda Public Health Fellowship Program, part of the National Rapid Response Team, was authorized by the Ministry of Health to access and analyze surveillance data from the District Health Information System-2, along with other relevant data, to inform outbreak control and public health programs. The Ministry also granted permission for the dissemination of findings through scientific publications. In agreement with the International Guidelines for Ethical Review of Epidemiological Studies by the Council for International Organizations of Medical Sciences (1991) [58] and the Office of the Associate Director for Science, CDC/Uganda, it was determined that this activity was not human subject research and that its primary intent was public health practice or disease control activity (specifically, epidemic or endemic disease control activity). The authors sought administrative clearance to conduct the investigation from the District Health authorities of Hoima District. Clearance was also sought from the administrators of the health facilities to access data about patients who had visited the facility or been admitted with a scabies diagnosis. Verbal informed consent was obtained from the participants before the start of each interview. Parental/legal guardian verbal informed consent was obtained on behalf of all the children before the start of each interview since they were aged less than 10 years. Data which was collected did not contain individual personal identifiers as a way of ensuring confidentiality. Individuals who were clinically diagnosed with scabies were given benzyl benzoate lotion 25% to apply to the whole body from the scalp to the soles of the feet as per Uganda clinical guidelines [59]. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of scabies cases by month of onset, Hoima District, Uganda, January 2021 to June 2022
Fig. 2
Fig. 2
Distribution of scabies cases by date of onset, Rwentale Village, Buseruka sub-county, Hoima District, Uganda, July 2022
Fig. 3
Fig. 3
A: Location of Hoima District in Uganda highlighted in brown. B: Attack rates per 1,000 persons by sub county, Hoima District, January 2021?June 2022
See this image and copyright information in PMC

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