Scabies Prevention and Control

These measures are targeted toward outbreaks of scabies within a community. A community can be defined, for the purpose of this site, as a group of people who have regular physical interaction. This can include institutions such as schools, daycare's, and other care facilities, or it can include broader communities such as towns.

For informational and protocols for controlling scabies in larger institutions such as prisons, hospitals, and other large care facilities, I recommend the "Scabies Prevention and Control Manual" produced by the Michigan Department of Public Health. This is the most comprehensive document of it's kind that I have found on the internet so far.

Co-ordinating scabies control

Because of the nature of the tasks required to effectively control a scabies outbreak within a community, an individual or team needs to take charge of the following tasks.

Communication and education of those affected by the outbreak

Getting rid of scabies in the community: It's much easier to organize scabies control in settings such as care facilities, where directions can be given and there's a reasonable chance that they will be carried out. In looser communities, such as schools, or in the general community, scabies control can be very, very, difficult. It can be difficult to convince people to treat for scabies, let alone have them treat in co-ordination with others. All too often treatment fails because somebody who has scabies is in some form of denial about it: they might believe they've gotten rid of it, when they haven't; or that the herbal treatment they're using is working, when it isn't; or they might treat, and then send they're kids to play with other children that they know might have scabies.

There are many ways treatment can fail, and reinfection occur. The primary purpose of this site, is to try to minimize these kinds of failures through sufficient and detailed information about scabies, and how to kill them.

• Receiving reports: Information, especially reports of new or suspected scabies cases need to be received during a scabies outbreak. A system for collecting such information needs to put in place. Contact information for receiving reports should appear on all information/notification publications.
Anyone reporting scabies symptoms should not come in to work or school until they have been treated or ruled out scabies as a cause of symptoms. Note: ruling out scabies is very difficult. Carefully question anyone who has determined they don't have scabies.
• Notification of outbreak and scabies information: As much effort as possible should be made to contact and inform everybody affected by the outbreak; this includes not only those directly exposed to scabies, but also the close contacts of anyone who has had significant exposure or hand contact with symptomatic individuals.
• In addition to notification of an outbreak, those affected by scabies need information about the symptoms of scabies, what scabies are, and detailed instructions about how to get rid of them. Notification and scabies information can be combined into one package to be distributed as a handout, email, or any other effective means.

Preliminary screening

Screening for symptoms of scabies, and determining who has been exposed to scabies, is required in order to determine the scope of an outbreak, and therefore the scope of treatment. Screening should start with close contacts/significant exposure of symptomatic cases, and proceed, if possible, by groups that symptomatic individuals belong to (class, team, etc.) and/or people who have been in locations where exposure may have occurred (floor, care unit, campus residence etc.). Begin screening as soon as possible in order to treat as soon as possible and give scabies less time to spread.

If screening uncovers enough cases of scabies, or possible cases of scabies, then it is probable mass treatments should be made (see...). If a decision to conduct mass treatments is made, screening must continue; if screening isn't thorough, contacts of unidentified symptomatic individuals could go untreated – especially family or sexual contacts, which often fall outside of a designated mass treatment group (class, floor, care unit etc.).

When screening, it's helpful to use a screening tool/form such as the one provided here*. This will help generate lists of those requiring treatment, as well as identifying further individuals and groups requiring screening.

Treatment

Treatment co-ordination requires setting a date for everybody who requires it, to actually carry out treatment. As well, it's an excellent idea to ensure that everybody who needs treatment has access to scabicide.

Post treatment questioning/screening

A check-back with symptomatic individuals that have been treated is required 7-10 days after treatment to ensure that the treatment has been successful. If the treatment has been successful, symptoms should have ceased, or gradually subsided over this period of time. Close contacts should also have check-backs to determine if they have developed symptoms.

If symptoms don't subside 7-10 days after treatment, or if treated close contacts develop symptoms, this indicates that treatment has probably failed; if this and treatment should be repeated. Case logs are helpful in ensuring check backs and recording other important information. They should be kept for symptomatic individuals and close contacts of those individual. An example case log can be found here