“Scabies remains a scourge of remote Indigenous communities although new strategies are promising.
In the light of recent research, crusted scabies was now managed not simply as an infectious disease, but as a chronic condition,
“So as for diabetes or kidney disease, if you have ever been diagnosed with crusted scabies you’ll now be on a recall list, You get monitored every month or so to make sure you’re not infecting everyone else.
Before ivermectin was introduced in the Northern Territory, around half of people with crusted scabies died within five years”
Dr Thérèse Kearns of the Menzies School of Health Research.
Seven out of 10 children in such communities are thought to be affected with scabies, and infection with Group A streptococcus bacteria can lead to sepsis, rheumatic fever, acute kidney disease and rheumatic heart disease.
Posted byMic Cavazzini In the Medical Republic
A trial in Fiji found treating entire communities with a single dose of oral ivermectin, whether individuals were infected or not, reduced rates of scabies by 95%. This compared with a 62% reduction in a neighbouring island community randomly assigned to mass administration of topical permethrin.
The prevalence of impetigo also declined, from 21% to 8% in the ivermectin group, and from 25% to 11% in the permethrin group.
But the same strategy was not as effective for an ivermectin trial in the Northern Territory, which saw infection rates bounce back after 12 months.
An Australian expert said crusted scabies was of particular concern, where people were infested with thousands of mites compared with a more usual infection where a person might about 10 mites.
In the light of recent research, crusted scabies was now managed not simply as an infectious disease, but as a chronic condition, said Dr Thérèse Kearns of the Menzies School of Health Research.
“So as for diabetes or kidney disease, if you have ever been diagnosed with crusted scabies you’ll now be on a recall list,” Dr Kearns said. “You get monitored every month or so to make sure you’re not infecting everyone else.”
“But there will be some people that don’t show strong symptoms though they have a mite burrowing into the skin,” she explained. “In our ivermectin interventions, we go household to household and treat the entire household, whether they show scabies or not.”
These public health responses are implemented when prevalence reaches 5% or higher.
Before ivermectin was introduced in the Northern Territory, around half of people with crusted scabies died within five years, she said.
Thorough screening of visitors for crusted scabies to indigenous communities for crusted scabies was also essential, Dr Kearns said.
Individuals with crusted scabies were extremely contagious and could be hard to track as they often covered up out of embarrassment, however, the arrival of one or two individuals with crusted scabies in an Aboriginal community could spark a widespread outbreak, she told The Medical Republic.
The population approach was supported by the finding of a 15-year follow-up of mass ivermectin in the Solomon Islands, which found only one case of scabies out of around 1500 people, as reported in PLoS Neglected Tropical Medicines.
Further food for thought comes from recent Australian research on the genetics of scabies mites in indigenous communities, which found a patient was infected with mites more similar to those typically found on pigs.
“This suggests it may be possible for certain animal strains of mites to infect humans, which we did not previously know was possible. This could have major implications for disease control programs,” said author Dr Katja Fischer of the Queensland Institute of Medical Research.
NEJM 2015 Dec 10;373(24):2305-13
PLoS Negl Trop Dis. 2015 Dec 1;9(12):e0004246
PLoS Negl Trop Dis. 2015 Oct 30;9(10):e0004151
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