Increasing trend of scabies in Belgium, 2000-2023

Abstract

Background: Several European countries have reported an increasing trend of human scabies in the past twenty years. In Belgium, scabies' clusters hinted at a similar trend despite individual cases not being notifiable. We aimed to describe scabies' trends between 2000 and 2023 in Belgium.

Methods: We described the evolution of scabies during 2000-2023 in Belgium using a variety of available data sources. Using generalized linear models, we analysed yearly trends and seasonality of scabies diagnoses at general practitioners (GPs) in Flanders, occupational health services in Belgium, nationwide asylum seekers' shelters and consultations for people with precarious housing, and student medical facilities in Flanders. Additionally, we analysed national reimbursement and sales data for first-line scabies treatments in Belgium.

Results: Scabies diagnoses significantly increased at all investigated levels (p-value < 0.001): primary care (15% yearly increase, 2011-2023), occupational health services (16% yearly increase, 2011-2022, temporary decrease in 2020-2021), asylum seekers' shelters (41% yearly increase, 2016-2022), consultations for people in precarious living situations (41% yearly increase, 2019-2022), and pharmaceutical sales (15% yearly increase in permethrin sales, 2012-2022). In primary care, those 15-24 years-old were most affected (13.2/1,000 compared to 4.1/1,000 for all ages in 2023), as were urban areas (6.7/1,000 compared to 2.7/1,000 in rural areas in 2022). Incidence was overall higher in males (p-value 0.016).

Conclusions: Our study shows a strong increasing trend of scabies in Belgium since 2011, with higher incidences in younger age groups, urban areas and during colder months. We recommend further studies to better quantify the increase and investigate the underlying drivers.

Keywords: Sarcoptes scabiei; Belgium; Mite infestations; Scabies; Skin diseases.

Fig. 1

Incidence of scabies diagnoses in a GP network, all ages versus 15–19 and 20–24 years old, 2000–2023, with fitted trend since 2011 (start increase), Flanders (data source: INTEGO, Reference 1 in Table 1)

Fig. 2

Incidence of scabies in a network of general practitioners, per place of residence of patients, 2017–2022, Flanders (data source: INTEGO, Reference 3 in Table 1)

Fig. 3

Number of scabies diagnoses per 1,000 employees with at least one consultation at IDEWE during that year, with fitted trend, 2011–2022, Belgium (data source: IDEWE, Reference 4 in Table 1)

Fig. 4

Yearly number of scabies cases per mean number of people sheltered in refugee centers of Fedasil with fitted trend, 2016–2022, Belgium (data source: Fedasil, Reference 5 in Table 1)

Fig. 5

Yearly number of scabies diagnoses per 1,000 consultations per age group among patients of Doctors of the World, 2019–2022, Belgium. Age groups of 0–14 and 75 plus are left out because of very low numbers (data source: Doctors of the World, Reference 6 in Table 1)

Fig. 6

Number of packages of permethrin sold in community pharmacies with fitted trend, 2012–2022, Belgium (data source: IQVIA, Reference 9 in Table 1)

Fig. 7

Number of reimbursed permethrin packages per month November 2019– March 2023 with fitted trend, Belgium (data source: NIHDI, Reference 10 in Table 1)

Fig. 8

Boxplot of the number of reimbursed permethrin packages per month, November 2019 - March 2023, Belgium (horizontal lines denote lower quartile, median and upper quartile, with dots showing outliers) (data source: NIHDI, Reference 10 in Table 1)

Fig. 9

Number of benzyl benzoate preparations dispensed in pharmacies per month with fitted trend, January 2019– February 2023, Belgium (data source: Algemene Pharmaceutische Bond, Reference 11 in Table 1)