Scabies-infested pregnant women: A critical therapeutic challenge

Weill, A.; Bernigaud, C.; Mokni, M.; Gil, Sophie; Eléfant, Élisabeth; Chosidow, Olivier

doi:10.1371/journal.pntd.0008929

Cited by 16 publications

(5 citation statements)

References 23 publications

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“…Topical treatment is recommended for those for whom ivermectin MDA is currently not approved (pregnant women, lactating mothers in the first week, and children weighing <15 kg or <90 cm height). Evaluation of the safety of ivermectin in these groups is a research priority ( Table 1 ) [ 14 – 16 ]. Permethrin 5% is the preferred topical treatment.…”

Section: A Framework For Scabies Controlmentioning

confidence: 99%

A framework for scabies control

et al. 2021

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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.

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Section: A Framework For Scabies Controlmentioning

confidence: 99%

A framework for scabies control

et al. 2021

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“…Permethrin 5% cream is recommended as the treatment in Australia for pregnant women and is categorized as B2 with limited human data; however, no fetal malformation in humans or animals have been observed [ 14 , 19 ]. In a small number of countries, such as France, oral ivermectin has been used in pregnant women with no demonstrated fetal adverse effects [ 20 ]. Additional management approaches for scabies include identifying and treating close contacts, washing linen, household cleaning, and treating for complications of scabies such as itch or dermatitis [ 4 ].…”

Section: Treatmentmentioning

confidence: 99%

“…The exclusion of oral ivermectin use in infants and pregnant women limits treatment and control in these population groups. Data from countries such as France that allow use in these populations should be closely monitored and reviewed to see if it is appropriate to expand Australian recommendations [ 20 , 24 ].…”

Section: Future Prevention and Control In Aboriginal And Torres Strait Islander Communitiesmentioning

confidence: 99%

Scabies in remote Aboriginal and Torres Strait Islander populations in Australia: A narrative review

Gramp

2021

PLoS Negl Trop Dis

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Scabies has recently gained international attention, with the World Health Organization (WHO) recognizing it as a neglected tropical disease. The International Alliance for the Control of Scabies recently formed as a partnership of more than 15 different countries, with an aim to lead a consistent and collaborative approach to preventing and controlling scabies globally. Scabies is most prevalent in low-resource and low socioeconomic areas that experience overcrowding and has a particularly high prevalence in children, with an estimated 5% to 10% in endemic countries. Scabies is widespread in remote Aboriginal and Torres Strait Islander communities in Australia with the prevalence of scabies in Aboriginal and Torres Strait Islander children in remote communities estimated to be as high as 33%, making it the region with the third highest prevalence in the world. This population group also have very high rates of secondary complications of scabies such as impetigo, poststreptococcal glomerulonephritis (PSGN), and rheumatic heart disease (RHD). This article is a narrative review of scabies in remote Aboriginal and Torres Strait Islander populations in Australia, including clinical manifestations of disease and current treatment options and guidelines. We discuss traditional approaches to prevention and control as well as suggestions for future interventions including revising Australian treatment guidelines to widen the use of oral ivermectin in high-risk groups or as a first-line treatment.

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“…Strongyloides hyper-infection may cause both maternal and neonatal death [38] and it has also been suggested that strongyloidiasis during pregnancy may impact the cognitive and motor functions of their children [39,40]. As ivermectin is the treatment of choice for strongyloidiasis, it has been suggested that ivermectin should be considered in Strongyloidesinfected pregnant women [41].…”

Section: Potential Other Advantages Of Treating O Volvulus Infected Pregnant Womenmentioning

confidence: 99%

“…Ivermectin, a very effective drug to treat scabies, has been proposed as second-line drug in scabies-infested pregnant women after the end of organogenesis (e.g., 10 weeks of amenorrhea). Indeed, in cases of scabies with eczematous or superinfected skin with risk of sepsis, oral ivermectin is the only alternative [41].…”

Section: Potential Other Advantages Of Treating O Volvulus Infected Pregnant Womenmentioning

confidence: 99%

Treatment of Pregnant Women with Ivermectin during Mass Drug Distribution: Time to Investigate Its Safety and Potential Benefits

et al. 2021

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To date, pregnant women are excluded from programmes delivering community-directed treatment of ivermectin (CDTI) for onchocerciasis and preventive chemotherapy of other helminthiases because of concerns over ivermectin safety during pregnancy. This systematic exclusion sustains an infection reservoir at the community level and deprives a vulnerable population from known benefits—there are indications that treating O. volvulus infected women may improve pregnancy outcomes and reduce the risk that their children develop onchocerciasis-associated morbidities. Furthermore, teratogenic effects are seen in non-clinical experiments at doses that far exceed those used in CDTI. Lastly, early, undetected and undeclared pregnancies are being systematically exposed to ivermectin in practice. Treatment of this population requires appropriate supporting evidence, for which we propose a three-pronged approach. First, to develop a roadmap defining the key steps needed to obtain regulatory clearance for the safe and effective use of ivermectin in all pregnant women who need it. Second, to conduct a randomised placebo-controlled double-blind clinical trial to evaluate the safety and benefits of ivermectin treatment in O. volvulus infected pregnant women. Such a trial should evaluate the possible effects of ivermectin in reducing adverse pregnancy outcomes and neonatal mortality, as well as in reducing the incidence of onchocerciasis-associated epilepsy. Third, to establish a pregnancy registry for women who inadvertently received ivermectin during pregnancy. This situation is not unique to ivermectin. Access to valuable therapies is often limited, delayed, or denied to pregnant women due to a lack of evidence. Concerns over protecting vulnerable people may result in harming them. We need to find acceptable ways to build robust evidence towards providing essential interventions during pregnancy.

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Scabies-infested pregnant women: A critical therapeutic challenge

Cited by 16 publications

References 23 publications

A framework for scabies control

A framework for scabies control

Scabies in remote Aboriginal and Torres Strait Islander populations in Australia: A narrative review

Treatment of Pregnant Women with Ivermectin during Mass Drug Distribution: Time to Investigate Its Safety and Potential Benefits

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