High burden and seasonal variation of paediatric scabies and pyoderma prevalence in The Gambia: a cross-sectional study

Armitage, Edwin P.; Senghore, Elina; Darboe, Saffiatou; Barry, Momodou; Camara, Janko; Bah, Sulayman; Marks, Michael; Cerami, Carla; Roca, Anna; Antonio, Martín; Turner, Claire E.; Silva, Thushan I. de

doi:10.1101/591537

Cited by 9 publications

(17 citation statements)

References 34 publications

(25 reference statements)

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“…The prevalence of scabies in our survey was found to be higher in younger age groups, which is consistent with other studies [10,24]. The highest burden was found in children under 5 years of age (16.6%), which is at the higher end of prevalence figures seen among this age group in other West African studies [27–31]. However, whilst the highest prevalence was seen among children, the results of our survey indicate that scabies carries a substantial burden across all age groups.…”

Section: Discussionsupporting

confidence: 92%

“…We did not find a high burden of secondary bacterial infection among the study population, suggesting that this may not be a substantial risk arising from scabies in this setting. We conducted out study in the dry season, and in other West African settings impetigo has been shown to increase markedly in the wet season and we may therefore have underestimated the true burden of impetigo in this setting [27,28]. Regardless, the impact of scabies itself appears to be significant.…”

Section: Discussionmentioning

confidence: 99%

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The prevalence of scabies in Monrovia, Liberia: a population-based survey

Collinson

Timothy

Zayzay

et al. 2020

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Background Scabies is known to be a public health problem in many settings but the majority of recent data is from rural settings in the Pacific. There is a need for high quality data from sub-Saharan Africa and peri-Urban settings to inform scale up of scabies control efforts. There have been anecdotal reports of scabies being a public health problem in Liberia but robust data are lacking. Methods We conducted a cross-sectional cluster-randomised prevalence survey for scabies in a peri-urban community in Monrovia, Liberia in February-March 2020. Participants underwent a standardised examination conducted by trained local health care workers. Health related quality of life (HRQoL) was assessed using age-appropriate dermatology life quality indices (DLQIs). Prevalence estimates were calculated accounting for clustering at community and household levels and associations with key demographic variables assessed through multivariable random-effects logistic regression. Results 1,318 participants from 477 households were surveyed. The prevalence of scabies prevalence was 9.3% (95% CI: 6.5-13.2%), across 75 (19.7%) households; impetigo or infected scabies prevalence was 0.8% (95% CI: 0.4-1.9%). The majority (52%) of scabies cases were classified as severe. Scabies prevalence was lower in females and higher in the youngest age group; no associations were found with other collected demographic or socio-economic variables. DLQI scores indicated a very or extremely large effect on HRQoL in 29% of adults and 18% of children diagnosed with scabies. Conclusions Our study indicates a substantial burden of scabies in this peri-Urban population in Liberia. This was associated with significant impact on quality of life, highlighting the need for action to control scabies in this population. Further work is needed to assess the impact of interventions in this context on both the prevalence of scabies and quality of life.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

The prevalence of scabies in Monrovia, Liberia: a population-based survey

Collinson

Timothy

Zayzay

et al. 2020

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“…In addition, most individuals received only a single dose of ivermectin limiting the efficacy of treatment for individual patients. All three visits were conducted during the dry season, so differences in prevalence seem unlikely to be related to seasonality [23]. Unlike research interventions that have been carried out in islands or confined populations and have maintained the effects for years [13], the activities reported here were carried out as part of a long term dermatological assistance programme and the patients in our target area, are surrounded by neighbouring communities with potentially high scabies rates.…”

Section: Methodsmentioning

confidence: 99%

A facility and community-based assessment of scabies in rural Malawi

Mitjà

Esteban-Terradillos²,

Kafulafula³

et al. 2020

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Background: Scabies is a neglected tropical disease of the skin, causing severe itching, stigmatizing skin lesions and systemic complications. Since 2015, the DerMalawi project provides an integrated skin diseases clinics and Tele-dermatology care in Malawi. Clinic-based data suggested a progressive increase in scabies cases observed. To better identify and treat individuals with scabies in the region, we shifted from a clinic-based model to a community-based outreach programme. Methods: From May 2015, DerMalawi project provide integrated skin diseases and Tele-dermatological care in the Nkhotakota and Salima health districts in Malawi. Demographic and clinical data of all patients personally attended are recorded. Due to a progressive increase in the number of cases of scabies the project shifted to a community-based outreach programme. For the community outreach activities, we conducted three visits between 2018 to 2019 and undertook screening in schools and villages of Alinafe Hospital catchment area. Treatment was offered for all the cases and school or household contacts. Results: Scabies increased from 2.9% to 39.2% of all cases seen by the DerMalawi project at clinics between 2015 to 2018. During the community-based activities approximately 50% of the population was assessed in each of three visits. The prevalence of scabies was similar in the first two rounds, 15.4% (2392) at the first visit and 17.2% at the second visit. The prevalence of scabies appeared to be lower (2.4%) at the third visit. The prevalence of impetigo appeared unchanged and was 6.7% at the first visit and 5.2% at the final visit. Conclusions: Prevalence of scabies in our study setting was very high suggesting that scabies is a major public health problem in parts of Malawi. Further work is required to more accurately assess the burden of disease and develop appropriate public health strategies for its control.

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“…It is estimated that more than 162 million children have impetigo/pyoderma at any given time, predominantly in LMICs, although data for Europe, South-East Asia and North America is very limited (14). A recent study in The Gambia, West Africa, identified a 17.4% prevalence of pyoderma in children, with S. pyogenes as a leading infection cause (15). This was higher than the estimated global prevalence of 12.3% (14).…”

Section: Introductionmentioning

confidence: 98%

Comparative genomic analysis of skin and soft tissue Streptococcus pyogenes isolates from low- and high-income settings

Bah

Keeley

Armitage

et al. 2021

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Streptococcus pyogenes is a leading cause of human morbidity and mortality, especially in resource limited settings. The World Health Organisation has recently made a vaccine for S. pyogenes a global health priority to reduce the burden of the post-infection rheumatic heart disease. For a vaccine to be active against all relevant strains in each region, molecular characterisation of circulating S. pyogenes isolates is needed. We performed extensive comparative whole genome analyses of S. pyogenes isolates from skin and soft tissue infections in The Gambia, West Africa, where there is a high burden of such infections. To act as a comparator to this low-income country (LIC) collection of isolates, we performed genome sequencing of isolates from skin infections in Sheffield, UK, as representative high-income country (HIC) isolates. LIC isolates from The Gambia were genetically more diverse (46 emm-types in 107 isolates) compared to HIC isolates from Sheffield (23 emm-types in 142 isolates), with only 7 overlapping emm-types and with diverse genetic backgrounds. Characterisation of other molecular markers indicated some shared features, including a high prevalence of the skin infection-associated emm-pattern D and the variable fibronectin-collagen-T antigen (FCT) types FCT-3 and FCT-4. A previously unidentified FCT (FCT-10) was identified in the LIC isolates, belonging to two different emm-types. A high proportion (79/107; 73.8%) of LIC isolates carried genes for tetracycline resistance, compared to 53/142 (37.3%) HIC isolates. There was also evidence of different circulating prophages, as very few prophage-associated DNases and lower numbers of superantigens were detected in LIC isolates. Our study provides much needed insight into the genetics of circulating isolates in a LIC (The Gambia), and how they differ from those circulating in HICs (Sheffield, UK). Common molecular features may act as bacterial drivers for specific infection types, regardless of the diverse genetic background.

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High burden and seasonal variation of paediatric scabies and pyoderma prevalence in The Gambia: a cross-sectional study

Cited by 9 publications

References 34 publications

The prevalence of scabies in Monrovia, Liberia: a population-based survey

The prevalence of scabies in Monrovia, Liberia: a population-based survey

A facility and community-based assessment of scabies in rural Malawi

Comparative genomic analysis of skin and soft tissue Streptococcus pyogenes isolates from low- and high-income settings

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