Some diseases are more likely to be seen than others. COVID-19 dominated public discourse in 2020, while cancer and AIDS are high-profile diseases that are attracting significant scientific and media attention. You can safely discuss these diseases at the dining table. Other diseases like scabies not so much.
Scabies is classified as a neglected tropical disease. It’s out of sight and out of mind. But that doesn’t mean it isn’t there – there will be an infestation somewhere near you – take my word for it.
Scabies is caused by microscopic mites (Sarcoptes scabiei) that burrow under human skin and lay their eggs. The skin does not take this infestation well, resulting in an angry, itchy rash.
There are an estimated 455 million cases of scabies worldwide each year. This burden is unevenly distributed and poorer countries bear the brunt of the infestation. However, even in affluent countries, where most neglected tropical diseases are unknown outside of travel clinics, scabies does develop and is a common outbreak in institutional settings such as nursing homes for the elderly.
It goes anywhere. While it’s treatable, it’s also stigmatized, underreported, often misdiagnosed, and the itching can be seriously uncomfortable to endure.
My team and I recently conducted research on scabies in Ghana and described how patients with scabies and other skin infections would travel farther than necessary to report to a health center. They bypassed their nearest center and often walked several kilometers away in clinics over difficult terrain.
The reasons for this are unclear. Colleagues in rural Ghana suggested that the day of the week the patient reported to a clinic coincide with market day so that the patient could combine a visit to the clinic and shopping in the nearest city during one visit. Our statistical analysis did not confirm this, and we could not rule out the possibility that patients would bypass their nearest health center for reasons of stigma.
Scabies is sometimes perceived as an “unclean” condition even in published literature, and the idea that washing is a remedy is widespread. Bathing won’t rid a patient of scabies – but there are treatments that can clear it up.
In 2019, there was a massive outbreak of more than 6,000 cases of scabies in northeastern Ghana. The media reported that there was widespread local fear of rash transmission between villagers. A combination of misdiagnosis and misinformation resulted in some infected people being temporarily banned from their homes.
Local journalists met some of the patients and described them as “bloody open wounds all over their bodies from excessive scratches”. The outbreak was later correctly diagnosed and treated. However, transmission to thousands of people shows the potential for large outbreaks. One Ethiopian outbreak included 379,000 confirmed cases of scabies.
In developed countries, the actual prevalence is often unknown, but the institutional outbreaks can have significant health, social and economic implications.
Our study in The Lancet showed that nursing home residents with dementia were more likely to develop scabies than those without dementia. Even in these vulnerable populations environments, inequalities persist regarding those most affected by infectious disease outbreaks.
Outbreak management in nursing homes is difficult and different from management in other facilities such as hospitals. An infirmary is designed for infection control, but nursing homes literally are that – people’s homes.
The COVID-19 pandemic has put these issues in a very harsh light, with thousands of deaths in nursing homes in countries like the UK, Sweden and more. Treatment of scabies in the elderly is also not supported by unfounded safety concerns related to one of the main oral medicines, ivermectin.
1997 correspondence in The Lancet reported an increased mortality rate among nursing home residents being treated for scabies. It was immediately criticized for insufficient consideration of confounding factors (other factors that may have influenced the resident’s death, such as the severity of dementia), and other outbreak reports failed to confirm this association.
The WHO has recognized ivermectin as a safe and essential medicine, however it is not licensed in the UK for the treatment of scabies and is rarely used despite its safety and effectiveness. And as an oral medicine, it’s easier to use than skin creams like permethrin.
Scabies doesn’t kill many people or attract headlines, but don’t underestimate the power of itching. It makes life seriously uncomfortable for those affected and can lead to stigma and poor quality of life. Multiply that one case that you think of by 455 million and there you have the global picture of the year.
Do you have scabies The following is provided by The Conversation
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