Scabies and Bacterial Superinfection among American Samoan Children, 2011–2012

Abstract

BackgroundScabies, a highly pruritic and contagious mite infestation of the skin, is endemic among tropical regions and causes a substantial proportion of skin disease among lower-income countries. Delayed treatment can lead to bacterial superinfection, and treatment of close contacts is necessary to prevent reinfestation. We describe scabies incidence and superinfection among children in American Samoa (AS) to support scabies control recommendations.Methodology/Principal FindingsWe reviewed 2011–2012 pharmacy records from the only AS pharmacy to identify children aged ≤14 years with filled prescriptions for permethrin, the only scabicide available in AS. Medical records of identified children were reviewed for physician-diagnosed scabies during January 1, 2011–December 31, 2012. We calculated scabies incidence, bacterial superinfection prevalence, and reinfestation prevalence during 14–365 days after first diagnosis. We used log binomial regression to calculate incidence ratios for scabies by age, sex, and county. Medical record review identified 1,139 children with scabies (incidence 29.3/1,000 children aged ≤14 years); 604 (53%) had a bacterial superinfection. Of 613 children who received a scabies diagnosis during 2011, 94 (15.3%) had one or more reinfestation. Scabies incidence varied significantly among the nine counties (range 14.8–48.9/1,000 children). Children aged <1 year had the highest incidence (99.9/1,000 children). Children aged 0–4 years were 4.9 times more likely and those aged 5–9 years were 2.2 times more likely to have received a scabies diagnosis than children aged 10–14 years.Conclusions/SignificanceScabies and its sequelae cause substantial morbidity among AS children. Bacterial superinfection prevalence and frequent reinfestations highlight the importance of diagnosing scabies and early treatment of patients and close contacts. Investigating why certain AS counties have a lower scabies incidence might help guide recommendations for improving scabies control among counties with a higher incidence. We recommend interventions targeting infants and young children who have frequent close family contact.

Skin bacterial colonizations and superinfections in immunocompetent patients with scabies

“…On the whole, scabies ranged from 14.3 to 20% . In American Samoan children with scabies, 53% of them had a bacterial superinfection . In the Solomon Islands, 41.1% of patients with impetigo also had scabies .…”

“…9,10 In American Samoan children with scabies, 53% of them had a bacterial superinfection. 11 In the Solomon Islands, 41.1% of patients with impetigo also had scabies. 13 The close relationship between scabies and skin bacterial colonizations and superinfections was demonstrated by two studies which were performed in an Australian Aboriginal community 6 and the Solomon Islands, 12 respectively.…”

Scabies –still current medical and social problem. A retrospective analysis of 193 cases

“…Scabies, as well as bacterial skin infections are associated with poverty, overpopulation, poor sanitary conditions, lack of hygiene and malnourishment (7,18). In a study carried out by Edison et al among 1139 in American Samoa, secondary bacterial infection was observed in 604 (53%) patients with scabies (19). In a study conducted by Esposito and Veraldi among 89 patients with scabies only 5 (5.6%) patients had positive bacterial culture from skin lesions (18).…”

“…W badaniu przeprowadzonym przez Edison i wsp. wśród 1139 dzieci na terenach Amerykańskich Wysp Samoa wtórne zakażenie bakteryjne opisano aż u 604 (53%) pacjentów ze świerzbem (19). W badaniu przeprowadzonym we Włoszech przez Esposito i Veraldi wśród 89 pacjentów ze świerzbem, jedynie u 5 (5,6%) pacjentów otrzymano dodatnie wyniki posiewów bakteryjnych (18).…”

How strong is the relationship between scabies and acute rheumatic fever? An analysis of neighbourhood factors

“…Permethrin is almost exclusively used for the treatment of scabies, and one study from the Pacific region (American Samoa) has shown high levels of agreement in the number of children with a permethrin prescription and with a scabies diagnosis . To explore whether scabies and ARF are correlated, we examined the spatial relationship between permethrin dispensing as an indicator of scabies prevalence and cases of ARF in Auckland.…”