A framework for scabies control

Abstract

Scabies is a neglected tropical disease (NTD) that causes a significant health burden, particularly in disadvantaged communities and where there is overcrowding. There is emerging evidence that ivermectin-based mass drug administration (MDA) can reduce the prevalence of scabies in some settings, but evidence remains limited, and there are no formal guidelines to inform control efforts. An informal World Health Organization (WHO) consultation was organized to find agreement on strategies for global control. The consultation resulted in a framework for scabies control and recommendations for mapping of disease burden, delivery of interventions, and establishing monitoring and evaluation. Key operational research priorities were identified. This framework will allow countries to set control targets for scabies as part of national NTD strategic plans and develop control strategies using MDA for high-prevalence regions and outbreak situations. As further evidence and experience are collected and strategies are refined over time, formal guidelines can be developed. The control of scabies and the reduction of the health burden of scabies and associated conditions will be vital to achieving the targets set in WHO Roadmap for NTDs for 2021 to 2030 and the Sustainable Development Goals.

Estimation of scabies prevalence using simplified criteria and mapping procedures in three Pacific and southeast Asian countries

“…Simplified criteria defining ‘typical lesions in a typical distribution, with or without itch’ as scabies cases, were proposed by the 2019 WHO Informal Consultation on a Framework for Scabies Control as an alternative, based on the assumption that these criteria would be more efficient and feasible for rapid mapping purposes as they utilised an abbreviated examination and omitted assessment of contact history [ 16 ]. However, the accuracy of prevalence estimates using these simplified criteria is not known, and an evaluation was identified as an operational research priority by the WHO Informal Consultation [ 16 , 17 ]. A high scabies prevalence has previously been identified in several Pacific and southeast Asian countries, including Fiji, Solomon Islands and Timor-Leste [ 5 ].…”

Can ivermectin mass drug administrations to control scabies also reduce skin and soft tissue infections? Hospitalizations and primary care presentations lower after a large-scale trial in Fiji

“…These are major health burdens in the global south, with sequelae including glomerulonephritis, rheumatic fever and chronic kidney disease. 1 , 2 , 3 In a major step forward Li Jun Thean and colleagues 4 report in The Lancet Regional Health Western Pacific on the impact on skin infections of an oral ivermectin MDA targeting scabies in Fiji. Importantly, they show in the largest before-after trial of its kind that not only did scabies and impetigo prevalence reduce, but so too did hospitalisations with severe skin and soft tissue infections and attendance at primary care with scabies and skin infections.…”

“…It is classed by WHO as a Neglected Tropical Disease (NTD) in recognition of its high burden and the health risks associated with secondary infections of impetigo (i.e., cellulitis, necrotising fascittis, skin abscesses, rheumatic fever, chronic kidney disease). 1 , 2 , 3 Evidence indicates prevalence is not influenced by personal washing. 5 Neglected tropical skin diseases are significant health problems across Oceania.…”

“…Influenced by these developments in Oceania, similar interventions are increasingly being conducted elsewhere. 1 The largest adoption of this approach has been in Ethiopia where a 2018 scabies MDA involved over nine million people, 15 and the secondary impacts on scabies of an ivermectin MDA targeting onchocerciasis is also being assessed. 16…”

“…Given resource scarcity such synergistic integrations are important clinically not only in Oceania 6 , but worldwide. 1 …”