Long Term Control of Scabies Fifteen Years after an Intensive Treatment Programme

Abstract

IntroductionScabies is a major public health problem in the Pacific and is associated with an increased risk of bacterial skin infections, glomerulonephritis and rheumatic fever. Mass drug administration with ivermectin is a promising strategy for the control of scabies. Mass treatment with ivermectin followed by active case finding was conducted in five communities in the Solomon Islands between 1997 and 2000 and resulted in a significant reduction in the prevalence of both scabies and bacterial skin infections.MethodsWe conducted a prospective follow-up study of the communities where the original scabies control programme had been undertaken. All residents underwent a standardised examination for the detection of scabies and impetigo.ResultsThree hundred and thirty eight residents were examined, representing 69% of the total population of the five communities. Only 1 case of scabies was found, in an adult who had recently returned from the mainland. The prevalence of active impetigo was 8.8% overall and 12.4% in children aged 12 years or less.DiscussionWe found an extremely low prevalence of scabies 15 years after the cessation of a scabies control programme. The prevalence of impetigo had also declined further since the end of the control programme. Our results suggest that a combination of mass treatment with ivermectin and intensive active case finding may result in long term control of scabies. Larger scale studies and integration with other neglected tropical disease control programmes should be priorities for scabies control efforts.

A Review of Scabies: An Infestation More than Skin Deep

“…The SHIFT trial, conducted in Fiji, showed that MDA with oral ivermectin (single dose, 200 µg/kg body weight) led to a significantly greater reduction in prevalence of both scabies and impetigo, compared with permethrin and standard approach to care [28]. In addition, it has been shown in the Solomon Islands that intensive scabies control using this strategy has long-lasting effects, with very low levels of scabies and associated bacterial skin infections maintained 15 years after cessation of control activities [71]. A higher dose of ivermectin (400 µg/kg) may offer improved efficacy over the standard dose (200 µg/kg), particularly for the treatment of crusted scabies, although this has not been confirmed.…”

European guideline for the management of scabies

“…Ten new clinical trials on scabies treatment have been published since the previous guideline in 2010 . Recent data are focused on mass population treatment, usually with ivermectin.…”

“… Mass population treatment is recommended for the control of scabies in endemic areas, for example remote communities or mass population displacements, and in the management of epidemics in closed communities such as nursing homes or jails. All individuals should be treated irrespective of symptoms. Oral ivermectin is easier to administer than traditional topical scabicides, thus facilitating treatment of large populations. A single dose of oral ivermectin 200 micrograms/kg of bodyweight is effective Ivermectin may not sterilize scabies eggs, and a second dose given after one week has been shown to increase the response .…”

“…1) Ten new clinical trials on scabies treatment have been published since the previous guideline in 2010. [24][25][26][27][28][29][30][31][32][33] Recent data are focused on mass population treatment, usually with ivermectin. Based on the existing comparative studies addressing the efficacy of different antiscabetic treatments, a distinction was made only between 'recommended' and 'alternative' treatments.…”

Österreichweite Kampagne gegen Skabies

“…Die generelle Empfehlung für die Verordnung von oralem Ivermectin beruht auf publizierten Erfahrungen in der Bekämpfung von Skabiesausbrüchen in unterschiedlichen Weltregionen die gezeigt haben, dass die „Mass Drug Administration“ (MDA) von Ivermectin der alleinigen topischen Behandlung überlegen, sinnvoll und sicher ist . Ein offensichtlicher Vorteil der oralen Therapie mit Ivermectin ist die geringere Abhängigkeit der Wirksamkeit von der Compliance und eine vermutlich höhere Akzeptanz, vor allem bei Behandlung (asymptomatischer) Kontaktpersonen zu sein.…”