Scabies Management in Institutions

Middleton, Jo; Cassell, Jackie A.; Walker, Stephen L.

doi:10.1007/978-3-031-26070-4_29

Cited by 1 publication

(3 citation statements)

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“…22 This suggestion is in line with prior studies which demonstrated that high density of potential hosts is a major transmission driver of scabies. 14 For a detailed overview of scabies transmission drivers in other semiclosed institutional settings where outbreaks are a regular occurrence (eg, residential settings for elderly people, children and those with learning disabilities; prisons; schools; hospitals and hostels), see Middleton et al 14 Many of these drivers were mentioned by our participants in some form while discussing their experiences of diagnosis, treatment, outbreak management and camp environments. Specifically of those discussed by Middleton et al, 14 the following were mentioned by our study participants: high densities of potential hosts; residents moving between semiclosed units; communication difficulties; reduced access to appropriate treatment; diagnostic error and/or delay; reduced access to laundry.…”

Section: The Meaning Of Common Scabies Occurrence In Camps In Europementioning

confidence: 99%

“…Even though improving WaSH facilities is unlikely to reduce skin-to-skin transmission, 3 it nevertheless would support treatment and control where transmission via Open access fomites may be a risk, when topical scabicides are used and to minimise secondary infections. 14 It could also be expected to reduce transmission of other diseases. It should however be noted that (primarily) ivermectinbased MDAs have achieved very good results in community intervention trials across Oceania (for a summary, see Middleton 53 ) without any environmental measures on hygiene, disinfection of bedding, etc (for example, see work in the Solomon Islands 54 ).…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

“…It is beyond the capacity of this study to determine the relative contribution of these factors to outbreak regularity and size, and indeed their contribution is likely to have been different in different camps and at different times. Clinicians and policymakers tasked with managing scabies in similar refugee settings may find it helpful to carry out site-specific assessment of scabies transmission drivers to guide intervention and treatment, using the guidance on how to do so provided by Middleton et al 14 More broadly, our view is that without support and coordination of all those responsible for care of refugees/migrants, successful scabies management will remain challenging, and the resource poor and overcrowded aspects of camp environments which enable outbreaks will remain unchanged. Indeed, in late 2020, a similar situation to those described in 2014-2017 was observed by coauthor CS in a formal camp on Lesvos (Greece).…”

Section: The Meaning Of Common Scabies Occurrence In Camps In Europementioning

confidence: 99%

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Scabies outbreak management in refugee/migrant camps in Europe 2014–2017: a retrospective qualitative interview study of healthcare staff experiences and perspectives

Richardson,

Cassell,

Head

et al. 2023

BMJ Open

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ObjectivesProvide insights into the experiences and perspectives of healthcare staff who treated scabies or managed outbreaks in formal and informal refugee/migrant camps in Europe 2014–2017.DesignRetrospective qualitative study using semistructured telephone interviews and framework analysis. Recruitment was done primarily through online networks of healthcare staff involved in medical care in refugee/migrant settings.SettingFormal and informal refugee/migrant camps in Europe 2014–2017.ParticipantsTwelve participants (four doctors, four nurses, three allied health workers, one medical student) who had worked in camps (six in informal camps, nine in formal ones) across 15 locations within seven European countries (Greece, Serbia, Macedonia, Turkey, France, the Netherlands, Belgium).ResultsParticipants reported that in camps they had worked, scabies diagnosis was primarily clinical (without dermatoscopy), and treatment and outbreak management varied highly. Seven stated scabicides were provided, while five reported that only symptomatic management was offered. They described camps as difficult places to work, with poor living standards for residents. Key perceived barriers to scabies control were (1) lack of water, sanitation and hygiene, specifically: absent/limited showers (difficult to wash off topical scabicides), and inability to wash clothes and bedding (may have increased transmission/reinfestation); (2) social factors: language, stigma, treatment non-compliance and mobility (interfering with contact tracing and follow-up treatments); (3) healthcare factors: scabicide shortages and diversity, lack of examination privacy and staff inexperience; (4) organisational factors: overcrowding, ineffective interorganisational coordination, and lack of support and maltreatment by state authorities (eg, not providing basic facilities, obstruction of self-care by camp residents and non-governmental organisation (NGO) aid).ConclusionsWe recommend development of accessible scabies guidelines for camps, use of consensus diagnostic criteria and oral ivermectin mass treatments. In addition, as much of the work described was by small, volunteer-staffed NGOs, we in the wider healthcare community should reflect how to better support such initiatives and those they serve.

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Section: The Meaning Of Common Scabies Occurrence In Camps In Europementioning

confidence: 99%