Outbreak of scabies among preschool children, Accra, Ghana, 2017

Abstract

Background Scabies occurs worldwide with a prevalence between 0.3 and 46.0%. In Ghana, even though a 5.1% proportion of scabies was reported in a retrospective review of skin diseases at the Korle Bu Teaching Hospital, the nationwide prevalence of scabies is unknown. Overall, its burden is higher in tropical regions. Scabies outbreaks mostly occur among children, the elderly in nursing homes, and prison inmates. Even though primary scabies hardly results in mortalities, the pain, itch, and systemic complications from secondary bacterial infections account for about 1.5 million years lived with disabilities. We investigated a scabies outbreak among school children in Ghana to determine its magnitude, stop the outbreak, and institute preventive measures to minimize risks of future outbreaks. Methods The investigation was conducted between March 14 and May 17, 2017 among pupils of Presbyterian Secondary Staff Basic School in Accra. We defined a case as a school child who on clinical examination, had an intensely pruritic rash on at least one typical predilection site with or without a burrow, or positive skin scrapings on microscopy. We screened and line listed cases, performed laboratory investigations on skin scrapings and wound swaps, and conducted an environmental assessment. We performed descriptive statistics on data, and calculated attack rate ratios (ARR) at 95% confidence level. Results Of 823 preschool children screened, 92 were cases. Median age of cases was 4 years (range 2–7 years) and their modal age was 3 years. The overall attack rate was 11.2% (92/823). The sex specific attack rate was 11.5% for males, and 10.8% for females (ARR: 0.93; CI: 0.67–1.28). Compared with the least affected class (crèche), the nursery one class was worst affected (ARR: 5.14; CI: 3.44–7.50). On microscopy, all skin scrapings were negative for scabies. Staphylococcus aureus and Streptococcus spp. were isolated from secondarily infected scabies lesions. Conclusions A scabies outbreak with a propagated source occurred among preschool children. The 3-year-old pupils were most affected. It was controlled by mass treatment with benzyl benzoate and health education. Classrooms and sleeping mats were disinfected. We recommended the decongestion of classrooms and discouraged sharing of sleeping mats. Electronic supplementary material The online version of this article (10.1186/s12889-019-7085-6) contains supplementary material, which is available to authorized users.

Scabies Among High School Students in Accra, Ghana: Risk Factors and Health Literacy

“…Rosenbaum et al in 2016 reported a prevalence rate of 5.1% in dermatology clinics (13). Kaburi et al in 2017 reported a prevalence rate of 11.2% in primary school students and 25.1% in kindergarten children (14). Our different findings with the Kaburi study can be explained by the high education level and age of our participants, leading them to pay more attention to their personal hygiene.…”

A scabies outbreak in the North East Region of Ghana: The necessity for prompt intervention

“…A scabies rate of 17.6% with peak infection occurring in children 5–9 years was reported when villagers in a community in the Ashanti region of Ghana were studied over 3 decades ago [ 25 ]. More recently, two hospital based studies and one school based study conducted in Accra and Kumasi, the two largest cities of Ghana, reported rates of 5.1%, 12.4% and 11.5% respectively [ 9 , 17 , 18 ]. A degree of selection bias may have impacted the high prevalence found in the present study as the study was conducted among communities where the local health authorities had reported a high scabies burden at the onset of the outbreak.…”

“…Although less common, contact with infested fomites including clothing, bedding and towels have been thought to play a role [ 5 , 7 ]. Outbreaks of scabies have occurred during wars, refugees/migration crisis [ 8 ] and in situations of overcrowding such as in schools [ 9 – 11 ], prisons and care homes [ 12 ]. Scabies has been reported to be associated with household size, low socioeconomic status and poor access to healthcare [ 13 – 15 ].…”

Untitled

“…A scabies rate of 17.6% with peak infection occurring in children 5-9 years was reported when villagers in a community in the Ashanti region of Ghana were studied over 3 decades ago [25]. More recently, two hospital based studies and one school based study conducted in Accra and Kumasi, the two largest cities of Ghana, reported rates of 5.1%, 12.4% and 11.5% respectively [9,17,18]. A degree of selection bias may have impacted the high prevalence found in the present study as the study was conducted among communities where the local health authorities had reported a high scabies burden at the onset of the outbreak.…”

“…Although less common, contact with infested fomites including clothing, bedding and towels have been thought to play a role [5,7]. Outbreaks of scabies have occurred during wars, refugees/migration crisis [8] and in situations of overcrowding such as in schools [9][10][11], prisons and care homes [12]. Scabies has been reported to be associated with household size, low socioeconomic status and poor access to healthcare [13][14][15].…”