TY - JOUR
T1 - Prevention of bacterial complications of scabies using mass drug administration
T2 - A population-based, before-after trial in Fiji, 2018–2020
AU - Thean, Li Jun
AU - Romani, Lucia
AU - Engelman, Daniel
AU - Wand, Handan
AU - Jenney, Adam
AU - Mani, Jyotishna
AU - Paka, Jessica
AU - Cua, Tuliana
AU - Taole, Sera
AU - Silai, Maciu
AU - Ashwini, Komal
AU - Sahukhan, Aalisha
AU - Kama, Mike
AU - Tuicakau, Meciusela
AU - Kado, Joseph
AU - Parnaby, Matthew
AU - Carvalho, Natalie
AU - Whitfeld, Margot
AU - Kaldor, John
AU - Steer, Andrew C.
PY - 2022/5
Y1 - 2022/5
N2 - Background: Scabies is an important predisposing factor of impetigo which can lead to serious bacterial complications. Ivermectin-based mass drug administration can substantially reduce scabies and impetigo prevalence in endemic settings, but the impact on serious bacterial complications is not known. Methods: We conducted a before-after trial in the Northern Division of Fiji (population: 131,914) of mass drug administration for scabies control. Prospective surveillance was conducted from 2018 to 2020. Mass drug administration took place in 2019, involving two doses of oral ivermectin or topical permethrin, delivered alongside diethylcarbamazine and albendazole for lymphatic filariasis. The primary outcomes were incidence of hospitalisations with skin and soft tissue infections, and childhood invasive infections and post-streptococcal sequelae. Secondary outcomes included presentations to primary healthcare with skin infections and community prevalence of scabies and impetigo. Findings: The incidence of hospitalisations with skin and soft tissue infections was 17% lower after the intervention compared to baseline (388 vs 467 per 100,000 person-years; incidence rate ratio 0.83, 95% CI, 0.74 to 0.94; P = 0.002). There was no difference in incidence of childhood invasive infections and post-streptococcal sequelae. Incidence of primary healthcare presentations with scabies and skin infections was 21% lower (89.2 vs 108 per 1000 person-years, incidence rate ratio, IRR 0.79, 95% CI, 0.78 to 0.82). Crude community prevalence of scabies declined from 14.2% to 7.7% (cluster-adjusted prevalence 12.5% to 8.9%; prevalence ratio 0.71, 95% CI, 0.28 to 1.17). Cluster-adjusted prevalence of impetigo declined from 15.3% to 6.1% (prevalence ratio 0.4, 95% CI, 0.18 to 0.86). Interpretation: Mass drug administration for scabies control was associated with a substantial reduction in hospitalisations for skin and soft tissue infections. Funding: National Health and Medical Research Council of Australia and Scobie and Claire Mackinnon Trust.
AB - Background: Scabies is an important predisposing factor of impetigo which can lead to serious bacterial complications. Ivermectin-based mass drug administration can substantially reduce scabies and impetigo prevalence in endemic settings, but the impact on serious bacterial complications is not known. Methods: We conducted a before-after trial in the Northern Division of Fiji (population: 131,914) of mass drug administration for scabies control. Prospective surveillance was conducted from 2018 to 2020. Mass drug administration took place in 2019, involving two doses of oral ivermectin or topical permethrin, delivered alongside diethylcarbamazine and albendazole for lymphatic filariasis. The primary outcomes were incidence of hospitalisations with skin and soft tissue infections, and childhood invasive infections and post-streptococcal sequelae. Secondary outcomes included presentations to primary healthcare with skin infections and community prevalence of scabies and impetigo. Findings: The incidence of hospitalisations with skin and soft tissue infections was 17% lower after the intervention compared to baseline (388 vs 467 per 100,000 person-years; incidence rate ratio 0.83, 95% CI, 0.74 to 0.94; P = 0.002). There was no difference in incidence of childhood invasive infections and post-streptococcal sequelae. Incidence of primary healthcare presentations with scabies and skin infections was 21% lower (89.2 vs 108 per 1000 person-years, incidence rate ratio, IRR 0.79, 95% CI, 0.78 to 0.82). Crude community prevalence of scabies declined from 14.2% to 7.7% (cluster-adjusted prevalence 12.5% to 8.9%; prevalence ratio 0.71, 95% CI, 0.28 to 1.17). Cluster-adjusted prevalence of impetigo declined from 15.3% to 6.1% (prevalence ratio 0.4, 95% CI, 0.18 to 0.86). Interpretation: Mass drug administration for scabies control was associated with a substantial reduction in hospitalisations for skin and soft tissue infections. Funding: National Health and Medical Research Council of Australia and Scobie and Claire Mackinnon Trust.
KW - Impetigo
KW - Ivermectin
KW - Mass drug administration
KW - Scabies
KW - Skin and soft tissue infections
UR - http://www.scopus.com/inward/record.url?scp=85126880921&partnerID=8YFLogxK
U2 - 10.1016/j.lanwpc.2022.100433
DO - 10.1016/j.lanwpc.2022.100433
M3 - Article
C2 - 35345391
AN - SCOPUS:85126880921
SN - 2666-6065
VL - 22
JO - The Lancet Regional Health - Western Pacific
JF - The Lancet Regional Health - Western Pacific
M1 - 100433
ER -
