Crusted scabies in remote Australia, a new way forward: Lessons and outcomes from the east arnhem scabies control program

Buddhi Lokuge, Alex Kopczynski, Angela Woltmann, Faye Alvoen, Christine Connors, Terrence Guyula, Eddie Mulholland, Samantha Cran, Tim Foster, Kamalini Lokuge, Tanya Burke, Sam Prince

    Research output: Contribution to journalArticlepeer-review

    24 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)644-648
    Number of pages5
    JournalMedical Journal of Australia
    Volume200
    Issue number11
    DOIs
    Publication statusPublished - 16 Jun 2014

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