Prevalence of Scabies in the Covid-19 Pandemic Period and Determination of Risk Factors for Scabies: a Hospital-Based Cross-Sectional Study in Northeast Turkey

Prevalence and determinants of scabies: A global systematic review and meta-analysis

OBJECTIVES

Scabies is a neglected skin disease that disproportionately affects people from resource poor and overcrowded countries. Global data on prevalence and risk factors are limited. This article aims to estimate the global burden of scabies and identifies the risks associated with it.

METHODS

Databases (PubMed, Scopus and Cochrane Reviews) were accessed to identify studies of scabies prevalence published between 2000 and 2024. Results were pooled to estimate prevalence and identify factors, which explained between-study heterogeneity. Odds ratios (ORs), risk of bias, subgroup analyses and meta-regression were used to describe variation in effect size and heterogeneity based on country-level demographic and economic variables.

RESULTS

Seventy studies yielded a pooled prevalence of 11.9% (95% confidence interval [CI]: 9.60-14.7) with substantial heterogeneityI 2 = 100 % τ 2 = 1.04 . Prevalence was highest in Oceania (17.9%; 95% CI: 13.9-22.8) compared to other regions. Pooled risk factors for scabies showed significant associations for demographic and behavioural factors including contact history with household members with itch (OR 11.3; 95% CI 4.82-26.51;I 2 = 96 % ; n = 7), lack of soap use (OR 3.41; 95% CI: 2.56-4.54;I 2 = 44 % ; n = 7), bed-sharing (OR 2.64; 95% CI: 1.50-4.63;I 2 = 76 % ; n = 7), sharing of clothes (OR 2.52; 95% CI: 1.58-4.03;I 2 = 85 % ; n = 7), infrequent bathing (OR 2.13; 95% CI: 1.41-3.22;I 2 = 77 % ; n = 6), presence of pets (OR 1.76; 95% CI: 1.08-2.87;I 2 = 84 % ; n = 4) and being a male (OR = 1.19; 95% CI: 1.04-1.37;I 2 = 83 % ; n = 22). Socioeconomic factors were not convincingly associated with scabies prevalence.

CONCLUSION

Prevalence of scabies is associated with geographic location and behavioural factors, but not between-country socioeconomic status. In addition to mass drug administration, risk factors are identified which may be included in health promotion programmes to reduce scabies prevalence and its sequelae in the long term.

Clinical practice guidelines for the diagnosis and treatment of scabies

Scabies, caused by the Sarcoptes scabiei var hominis mite burrowing into the skin, is a highly contagious disease characterized by intense nocturnal itching. Its global impact is considerable, affecting more than 200 million individuals annually and posing significant challenges to healthcare systems worldwide. Transmission occurs primarily through direct skin-to-skin contact, contributing to its widespread prevalence and emergence as a substantial public health concern affecting large populations. This review presents consensus-based clinical practice guidelines for diagnosing and managing scabies, developed through the fuzzy Delphi method by dermatology, parasitology, pediatrics, pharmacology, and public health experts. The presence of burrows containing adult female mites, their eggs, and excreta is the diagnostic hallmark of scabies. Definitive diagnosis typically involves direct microscopic examination of skin scrapings obtained from these burrows, although dermoscopy has become a diagnostic tool in clinical practice. Treatment modalities encompass topical agents, such as permethrin, balsam of Peru, precipitated sulfur, and benzyl benzoate. In cases where topical therapy proves inadequate or in instances of crusted scabies, oral ivermectin is recommended as a systemic treatment option. This comprehensive approach addresses the diagnostic and therapeutic challenges associated with scabies, optimizing patient care, and management outcomes.

The impact of scabies in tent cities in Kahramanmaraş after the Turkish earthquakes: oral pharmacologic treatment efficacy

Background

Our study was conducted to determine the impact of scabies in people living in collective living areas such as tent cities and container cities after the February 6 Kahramanmaraş earthquakes and to show the effectiveness of oral ivermectin treatment on scabies cases because topical treatments could not be used in this period when access to water was limited.

Methods

Among 233 patients diagnosed and treated with scabies in tent and container cities, 192 patients who met the criteria were included in the study. Descriptive statistics were given as number (n), percentage (%), mean, median, standard deviation (SD). In the comparison of categorical data, the chi-square test was applied; in the comparison of numerical data ANOVA analyses was applied.

Results

A total of 192 scabies patients (82.4%), 47.9% (N:92) of whom were women, were included in the study. The frequency of scabies in the total population in tent cities and container cities was found to be at least 0.54%. The most common symptoms were pruritis (99.0%) and rash (97.9%). The most common sites of lesion involvement were the umbilicus (87.0.%), forearm (75.0%), and back (70.3%). After the first dose of ivermectin, 159 (82.8%) patients showed complete recovery, while 30 (15.6%) patients showed partial recovery. 3 (1.6%) patients showed no improvement. After the second dose of ivermectin, 173 (90.1%) patients showed complete recovery. There were two (1.0%) patients who did not show improvement after two doses. Due to the deterioration of urban infrastructure after devastating earthquakes, the irregularity of mass living areas, the lack of hygiene conditions, and the difficulty of accessing clean, usable water, oral ivermectin may be the first choice for treatment in terms of ease of use and effectiveness.

Dermatology Quality of Life and Depression, Anxiety, and Stress Scale-42 in Scabies Patients

INTRODUCTION

Scabies is a pruritic skin infestation with a globally increasing prevalence. Sleep problems and impaired social and personal interactions, mainly due to itching, have been reported.

OBJECTIVES

We aimed to determine the influence of scabies on quality of life and psychosocial health using Dermatology Life Quality Index (DLQI) and Depression Anxiety and Stress Scale-42 (DASS-42) and analyze whether there is a correlation between the two scales and any sociodemographic and clinical characteristic.

METHODS

Scabies patients (>16 years) who presented to our outpatient clinics were enrolled. Age, sex, occupation, marital status, and education level and clinical features were recorded. DLQI and DASS-42 were used. Possible influence of demographic and clinical characteristics on total scores were analyzed. The Spearman coefficient analysis was performed to determine whether there is a correlation between these scores.

RESULTS

Of 92 patients (mean age:37.76±15.355, Female/Male: 1.09/1), 63% were married and 35.9% were high-school graduates; 27.2% and 23.9% were housewives and officers, respectively. Disease was generalized in 57.6% and duration of disease was mostly <4 weeks. Mean DLQI and DASS-42 scores were 13.16±7.638 and 42.10±30.644, respectively. Symptoms/feelings were affected predominantly. DLQI was affected 'severely' in 41.3% of patients.

CONCLUSIONS

Impairment of DLQI is a significant predictive parameter for higher DASS levels. Scabies is not only associated with impairment in DLQI but may also lead to psychosocial problems. All scabies patients should be evaluated and consulted-if needed-for possible problems of psychosocial status, including depression, anxiety, and stress, as well as clinical symptoms and secondary complications.

Risk factors for scabies in hospital: a systematic review

BACKGROUND

Annually, 175.4 million people are infected with scabies worldwide. Although parasitic infections are important nosocomial infections, they are unrecognized compared to bacterial, fungal, and viral infections. In particular, nonspecific cutaneous manifestations of scabies lead to delayed diagnosis and frequent nosocomial transmission. Hospital-based studies on the risk factors for scabies have yet to be systematically reviewed.

METHODS

The study followed the PRISMA guidelines and was prospectively registered in PROSPERO (CRD42023363278). Literature searches were conducted in three international (PubMed, Embase, and CINAHL) and four Korean (DBpia, KISS, RISS, and Science ON) databases. We included hospital-based studies with risk estimates calculated with 95% confidence intervals for risk factors for scabies infection. The quality of the studies was assessed using the Joanna Briggs Institute critical appraisal tools. Two authors independently performed the screening and assessed the quality of the studies.

RESULTS

A total of 12 studies were included. Personal characteristics were categorized into demographic, economic, residential, and behavioral factors. The identified risk factors were low economic status and unhygienic behavioral practices. Being a patient in a long-term care facility or institution was an important factor. Frequent patient contact and lack of personal protective equipment were identified as risk factors. For clinical characteristics, factors were categorized as personal health and hospital environment. People who had contact with itchy others were at higher risk of developing scabies. Patients with higher severity and those with a large number of catheters are also at increased risk for scabies infection.

CONCLUSIONS

Factors contributing to scabies in hospitals range from personal to clinical. We emphasize the importance of performing a full skin examination when patients present with scabies symptoms and are transferred from settings such as nursing homes and assisted-living facilities, to reduce the transmission of scabies. In addition, patient education to prevent scabies and infection control systems for healthcare workers, such as wearing personal protective equipment, are needed.

Scabies in the Philippines: A Secondary Analysis of Local Patient Registries

Background

Scabies is the second most common cause of disability among skin diseases in the Philippines as of 2019. There is no large nationwide study describing the epidemiologic profile of scabies in the country.

Objective

This study aimed to describe the demographic, seasonal, and geographic profile of scabies in the Philippines.

Methods

We compared secondary data of two local patient registries (Philippine Dermatological Society, PDS, 2010 to 2021; and Philippine Pediatric Society, PPS, 2009 to 2021) for reported cases of scabies in the Philippines. We reported the frequency and percentage distribution according to age, sex, month, year, and type of diagnosis, and region.

Results

The median annual frequency of scabies cases (mostly outpatient) for PDS (from year 2010) was 4087 (range ([QR], 342-6422 [3271.5]), while it was 183 (range [IQR], 64-234 [96.5]) (all inpatient) for PPS (from year 2009). There was a reduction to one-third (PDS) and one-fourth (PPS) of pre-pandemic numbers during the pandemic years (2020-2021). The peak months for scabies cases were the cooler months: January (median, 12.1% of annual cases; range [IQR], 2.6%-31.4% [3.6%]) to February (median, 10.0% of annual cases; range [IQR], 1.5%-27.8% [2.5%]) based on PDS data, and November (median, 10.0% of annual cases; range [IQR], 0.0%-24.3% [7.0%]) to January (median, 9.0% of annual cases; range [IQR], 0.0%-24.3% [6.6%]) for PPS data. Overall, for PDS, age 1-4 years is the most affected age group (median, PDS, 17.5% of annual cases; range [IQR], 11.9%-25.4% [8.1%]), while it was the less than 1-year-olds (median annual cases, 48.9%; range [IQR], 29.1%-67.3% [13.20%]) among PPS pediatric population aged 0 to 18 years. Males (median, 53.9% of annual cases; range [IQR], 45.0%-67.2% [8.8%]) were more affected than females in PPS. While for PDS during earlier years (prior to 2015), males (median, 51.6% of annual cases from 2010 to 2014; range [IQR], 47.4%-52.9% [0.2%]) were more affected than females. However, males became less affected than females with median, 44.7% of annual cases from 2015 onwards (range [IQR], 43.4%-46.5% [1.2%]). NCR was the region with the highest frequency of cases in PPS (median, 52.6% of annual cases; range [IQR], 22.7%-75.0% [20.4%]). The 2nd most affected regions were Central/Eastern Visayas (34.2%, 2009-2013; range [IQR], 17.9%-54.1% [5.3%]), Bicol region (12%; 2014 to 2018; range [IQR], 17.9%-54.1% [7.4%]), Central Luzon (18%; 2019), Central/Eastern Visayas (29%, 2020), and Northern/Central Mindanao (17%, 2021).

Conclusion

Scabies was commonly seen in the younger age group, slightly more in females in the PDS, while slightly more among males in the PPS, in the cooler months of the year, and in the urbanized NCR.

Analysis of the Scabies Incidence at As'ad Islamic Boarding School, Jambi City

Scabies is an infectious disease. Based on preliminary observations, numerous scabies sufferers have been found among students living in As'ad Islamic Boarding School, Jambi City, Indonesia. Scabies disease develops in humans and can be influenced by both human factors and the environment. This study aims to identify factors associated with scabies incidence at the As'ad Islamic Boarding School. This analytical observational research was conducted using a cross-sectional study design. The variables measured were scabies symptoms, knowledge, personal hygiene, contact history, humidity, and room occupancy density. The research samples consisted of 178 students at the As'ad Islamic Boarding School in Jambi City, who were selected randomly. The required data were collected by questionnaires and analyzed by Chi-square test and logistic regression. Most of the students had crowded living conditions (94.4%), low room humidity (80.8%), poor personal hygiene (66.3%), a low level of knowledge about scabies (70.8%), contact with scabies sufferers (61.8%), and symptoms of scabies (60.7%). Symptoms of scabies were related to knowledge (P=0.000), personal hygiene (P=0.000), contact history (P=0.000), humidity (P=0.000), and room occupancy density (P=0.001). The incidence of scabies in students at the As'ad Islamic Boarding School was influenced by insufficient knowledge, poor personal hygiene, history of contact, low humidity, and overcrowding.

Infection Control among Healthcare Workers and Management of a Scabies Outbreak in a Large Italian University Hospital

This retrospective observational study describes the results of an ad-hoc designated prevention protocol aimed at containing the spread of the scabies infestation among healthcare workers (HCWs) of a large University Hospital in Italy. The outbreak started on October 2022 and a preventive protocol was set up thanks to a multidisciplinary approach. HCWs at high scabies risk were defined as subjects working in Operative Units with a scabies prevalence higher than 2%, close contacts of a confirmed case of scabies, or HCWs with signs and symptoms of the disease. All cases at high scabies risk underwent a dermatological examination, and the infested HCWs were suspended from work until definitive healing. Mass drug administration was established for all HCWs working in Operative Units with a scabies prevalence higher than 2%. Until March 2023, out of 183 screening dermatological examinations, 21 (11.5%) were diagnostic for scabies. Between 11 October 2022 (date of the first diagnosed scabies case) and 6 March 2023 (the end of incubation period related to the last case detected), the frequency of scabies was 0.35% (21 scabies cases/6000 HCWs). The duration of the outbreak in our hospital was 14.7 weeks. Statistical analysis shows a significant association between scabies and being a nurse and having an allergy to dust mites. We obtained a low frequency of scabies infection, limiting the duration of the outbreak and the related economic burden.