Scabies in Spain? A comprehensive epidemiological picture

Abstract

Introduction Scabies is a neglected disease stablished worldwide with a fairy well determined incidence. In high-income countries, it often causes outbreaks affecting the residents and staff of institutions and long-term facilities, usually hard to detect and control due to the difficult diagnosis and notification delay. This study aim at characterizing the affected population, geographical distribution, and evolution of scabies in Spain from 1997–2019 as well as to describe the main environments of transmission using different data sources. Methods We carried out a nationwide retrospective study using four databases, which record data from different perspectives: hospital admissions, patients attended at primary healthcare services, outbreaks, and occupational diseases. We described the main characteristics from each database and calculated annual incidences in order to evaluate temporal and geographical patterns. We also analyzed outbreaks and occupational settings to characterize the main transmission foci and applied Joinpoint regression models to detect trend changes. Results The elderly was the most frequent collective among the hospital admitted patients and notified cases in outbreaks, while children and young adults were the most affected according to primary care databases. The majority of the outbreaks occurred in homes and nursing homes; however, the facilities with more cases per outbreak were military barracks, healthcare settings and nursing homes. Most occupational cases occurred also in healthcare and social services settings, being healthcare workers the most common affected professional group. We detected a decreasing trend in scabies admissions from 1997 to 2014 (annual percentage change -APC- = -11.2%) and an increasing trend from 2014 to 2017 (APC = 23.6%). Wide geographical differences were observed depending on the database explored. Discussion An increasing trend in scabies admissions was observed in Spain since 2014, probably due to cutbacks in social services and healthcare in addition to worsen of living conditions as a result of the 2008 economic crisis, among other reasons. The main transmission foci were healthcare and social settings. Measures including enhancing epidemic studies and national registries, reinforcing clinical diagnosis and early detection of cases, hygiene improvements and training of the staff and wide implementation of scabies treatment (considering mass drug administration in institutions outbreaks) should be considered to reduce the impact of scabies among most vulnerable groups in Spain.

Increasing incidence of reported scabies infestations in the Netherlands, 2011–2021

“…The observed increase in incidence corresponds with the trend in other European countries, such as Germany, Norway, Croatia, Poland, and Spain [1][2][3][4]11]. Although each country has slightly different surveillance systems in place or used other data sources than our study, they all still reported an increase in the last years.…”

“…The increasing trends were most striking in adolescents and (young) adults and was also timed roughly similarly. It is remarkable that these countries observed a comparable seasonal trend in autumn and winter season [1][2][3][4]11,12]. It can be suggested that the seasonal trend is caused by more contact during cold and dry seasons [12].…”

“…Scabies is officially categorized as a neglected tropical disease. In recent years scabies manifestations are increasing in numbers in Europe [1][2][3][4]. Global epidemiological data is rather scarce as it is not notifiable in many countries [5].…”

“…In the past years, the general practitioners (GPs) observed a gradual increase of scabies diagnoses in the Netherlands. Other (neighbouring) European countries also reported an increase of scabies infestations in their countries in recent years [1][2][3][4]. Individual cases of scabies in the general population are not notifiable in the Netherlands.…”

Scabies affects quality of life in correlation with depression and anxiety

“…Recently, scabies outbreaks have been reported in many countries [17][18][19][20]. In a study conducted in distinct geographic regions of Turkey, a 7-fold increase was found comparing 2017 and 2018, and a 30-fold increase was found and 2017 and 2019 [4].…”