The global burden of scabies: a cross-sectional analysis from the Global Burden of Disease Study 2015

Abstract

SummaryBackgroundNumerous population-based studies have documented high prevalence of scabies in overcrowded settings, particularly among children and in tropical regions. We provide an estimate of the global burden of scabies using data from the Global Burden of Disease (GBD) Study 2015.MethodsWe identified scabies epidemiological data sources from an extensive literature search and hospital insurance data and analysed data sources with a Bayesian meta-regression modelling tool, DisMod-MR 2·1, to yield prevalence estimates. We combined prevalence estimates with a disability weight, measuring disfigurement, itch, and pain caused by scabies, to produce years lived with disability (YLDs). With an assumed zero mortality from scabies, YLDs were equivalent to disability-adjusted life-years (DALYs). We estimated DALYs for 195 countries divided into 21 world regions, in both sexes and 20 age groups, between 1990 and 2015.FindingsScabies was responsible for 0·21% of DALYs from all conditions studied by GBD 2015 worldwide. The world regions of east Asia (age-standardised DALYs 136·32), southeast Asia (134·57), Oceania (120·34), tropical Latin America (99·94), and south Asia (69·41) had the greatest burden of DALYs from scabies. Mean percent change of DALY rate from 1990 to 2015 was less than 8% in all world regions, except North America, which had a 23·9% increase. The five individual countries with greatest scabies burden were Indonesia (age-standardised DALYs 153·86), China (138·25), Timor-Leste (136·67), Vanuatu (131·59), and Fiji (130·91). The largest standard deviations of age-standardised DALYs between the 20 age groups were observed in southeast Asia (60·1), Oceania (58·3), and east Asia (56·5), with the greatest DALY burdens in children, adolescents, and the elderly.InterpretationThe burden of scabies is greater in tropical regions, especially in children, adolescents, and elderly people. As a worldwide epidemiological assessment, GBD 2015 provides broad and frequently updated measures of scabies burden in terms of skin effects. These global data might help guide research protocols and prioritisation efforts and focus scabies treatment and control measures.FundingBill & Melinda Gates Foundation.

A Review of Scabies: An Infestation More than Skin Deep

“…Using data from the Global Burden of Disease Study 2015, Karimkhani et al [3] provided for the first time a robust estimate of the global burden of scabies. They used prevalence estimates, weighted for disability, to calculate disability-adjusted life-years (DALYs), assuming a zero mortality for scabies.…”

“…Diagnosis is challenging and often delayed, and management of outbreaks is costly. Globally, more than 200 million people are affected, with a particularly high prevalence in resource-poor tropical regions [3]. This review describes recent advances in the understanding, diagnosis and treatment of scabies focusing on the global implications of the infestation across both resource-poor and -rich settings.…”

Tackling scabies: novel agents for a neglected disease

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Ivermectin Dosing Strategy to Achieve Equivalent Exposure Coverage in Children and Adults

“…Ivermectin is not approved in children weighing < 15 kg; hence, this age group is excluded from official treatment programs. The drug has been widely used off‐label in a single‐dose administration for various indications, and given that young children may have high prevalence of helminth infections and scabies and serve as an important reservoir of Plasmodium , there is a need to build an evidence base to determine safe and effective ivermectin doses in the pediatric population. Ivermectin pharmacokinetics (PK) in adults has been described in a small number of healthy volunteers and patients with onchocerciasis, Trichuris trichiura infection, or malaria .…”