TY - JOUR
T1 - Crusted scabies in remote Australia, a new way forward
T2 - Lessons and outcomes from the east arnhem scabies control program
AU - Lokuge, Buddhi
AU - Kopczynski, Alex
AU - Woltmann, Angela
AU - Alvoen, Faye
AU - Connors, Christine
AU - Guyula, Terrence
AU - Mulholland, Eddie
AU - Cran, Samantha
AU - Foster, Tim
AU - Lokuge, Kamalini
AU - Burke, Tanya
AU - Prince, Sam
PY - 2014/6/16
Y1 - 2014/6/16
N2 - Crusted scabies is a highly infectious, debilitating and disfi guring disease, and remote Aboriginal communities of northern Australia have the highest reported rates of the condition in the world. We draw on monitoring data of the East Arnhem Scabies Control Program to discuss outcomes and lessons learnt through managing the condition in remote communities. Using active case fi nding, we identifi ed seven patients with crusted scabies in three communities and found most had not presented to health services despite active disease. We compared presentations and hospitalisations for a cumulative total of 99 months during a novel preventive program with 99 months immediately before the program for the seven cases and seven sentinel household contacts. Our preventive long-term case management approach was associated with a signifi cant 44% reduction in episodes of recurrent crusted scabies (from 36 to 20; P = 0.025) in the seven cases, and a non-signifi cant 80% reduction in days spent in hospital (from 173 to 35; P = 0.09). It was also associated with a signifi cant 75% reduction in scabies-related presentations (from 28 to 7; P = 0.017) for the seven sentinel household contacts. We recommend active surveillance and wider adoption of this preventive case management approach, with ongoing evaluation to refi ne protocols and improve effi ciency. Contacts of children presenting with recurrent scabies should be examined to exclude crusted scabies. In households where crusted scabies is present, a diagnosis of parental neglect due to recurrent scabies and weight loss in children should be made with extreme caution. Improved coordination of care by health services, and research and development of new therapies including immunotherapies for crusted scabies, must be a priority.
AB - Crusted scabies is a highly infectious, debilitating and disfi guring disease, and remote Aboriginal communities of northern Australia have the highest reported rates of the condition in the world. We draw on monitoring data of the East Arnhem Scabies Control Program to discuss outcomes and lessons learnt through managing the condition in remote communities. Using active case fi nding, we identifi ed seven patients with crusted scabies in three communities and found most had not presented to health services despite active disease. We compared presentations and hospitalisations for a cumulative total of 99 months during a novel preventive program with 99 months immediately before the program for the seven cases and seven sentinel household contacts. Our preventive long-term case management approach was associated with a signifi cant 44% reduction in episodes of recurrent crusted scabies (from 36 to 20; P = 0.025) in the seven cases, and a non-signifi cant 80% reduction in days spent in hospital (from 173 to 35; P = 0.09). It was also associated with a signifi cant 75% reduction in scabies-related presentations (from 28 to 7; P = 0.017) for the seven sentinel household contacts. We recommend active surveillance and wider adoption of this preventive case management approach, with ongoing evaluation to refi ne protocols and improve effi ciency. Contacts of children presenting with recurrent scabies should be examined to exclude crusted scabies. In households where crusted scabies is present, a diagnosis of parental neglect due to recurrent scabies and weight loss in children should be made with extreme caution. Improved coordination of care by health services, and research and development of new therapies including immunotherapies for crusted scabies, must be a priority.
UR - http://www.scopus.com/inward/record.url?scp=84904479797&partnerID=8YFLogxK
U2 - 10.5694/mja14.00172
DO - 10.5694/mja14.00172
M3 - Article
SN - 0025-729X
VL - 200
SP - 644
EP - 648
JO - Medical Journal of Australia
JF - Medical Journal of Australia
IS - 11
ER -