Scabies Control

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Scabies Control

• Massachusetts Department of Public Health
• Presented by Elizabeth Land, MS
• November 2006

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Presentation Objectives

• Provide an overview of scabies
• Description
• Transmission
• Symptoms
• Diagnosis and treatment
• Control measures
• Examine the Department of Mental Retardation
  (DMR) protocols for scabies prevention and
  control

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Scabies Description

• Contagious infestation of the skin
• Caused by human mites (Sarcoptes scabiei subsp.
  hominis)
• Distributed worldwide
• Reported incidence increasing in US since 1970s
• Humans are the reservoir

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Scabies Infestation Mites burrow under skin to
feed and lay eggs Can burrow beneath skin in 2.5
minutes Adult female mite .3 - .4 mm long
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Scabies Transmission

• Direct, prolonged, skinto-skin contact
• Sexual contact
• Household contact
• Indirect transfer from clothing, towels and
  bedding, only if contaminated immediately before
  contact
• Communicable
• while infested and untreated
• during incubation period

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Scabies Symptoms

• Symptoms caused by reaction to mites
• Pimple-like rash or burrows between fingers, on
  wrist, elbows, armpits, belt line, navel,
  abdomen, and/or buttocks
• Intense itching over most of the body, especially
  at night
• Sores on the body caused by scratching
• Incubation period
• 2-6 weeks without previous exposure
• 1-4 days after re-infestation (usually milder)

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Scabies Rash
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Scabies Diagnosis

• Confirmed by skin scrapings of papules or intact
  burrows
• Burrows and mites may be few in number (only
  10-12) and difficult to find

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Scabies Treatment

• Applicaton of scabicide over entire body below
  head
• 5 permethrin cream (wash after 8-14 hrs)
• 1 lindane cream (wash after 8-12 hrs)
• Ivermectin, single dose, orally
• Itching may continue for several weeks despite
  successful treatment
• In 5 of cases, 2nd treatment may be necessary
  after 7-10 days.

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Applying Prescription Creams

• Follow package insert
• Apply thin layer over whole body from neck down,
  paying particular attention to folds in skin
• Trim fingernails and toenails, apply under nails
• Reapply after handwashing
• Leave on for at least 8 hours, but not longer
  than maximum time recommended for product
• Wash off with warm, soapy water and dry skin

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Scabies Control

• Prompt diagnosis and treatment of patients
• Simultaneous, prophylactic therapy
• household members,
• sexual contacts, and
• caregivers with prolonged skin-to skin contact
• Launder all clothing worn within 48-72 hrs. of
  treatment in hot water and dry in hot dryer
• Thorough vacuuming of carpets and upholstered
  furniture

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DMR Protocols for Scabies

• Who should be treated?
• Who should be prophylaxed?
• Who should be notified?
• Who should be isolated and for how long?
• Who should be monitored and for how long?
• What environmental treatment is needed?
• Who is responsible for follow-up?

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DMR Protocol forSuspect Scabies Case

• Staff reports suspect scabies case to their
  supervisor
• Primary care physician or dermatologist is
  contacted for appointment
• Case remains at home to minimize exposure to
  others until medical clearance is obtained
• Physician completes the Scabies MD Treatment Form

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DMR Notification Protocol for Confirmed Scabies
Case

• Day and residential program directors, as
  applicable
• Area office nurse
• Day program and/or residential program nurse
• Primary care physician for all others living in
  household of confirmed case
• Family/guardian
• Residential staff, if applicable
• Transportation staff, if applicable

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DMR Treatment Protocol

• Confirmed case
• All people living in the household of a confirmed
  case
• All residential staff
• Exposed day program individuals and staff do not
  need to be treated, but will be monitored for
  rash for 6 weeks

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DMR Follow-up Protocol

• Isolation of treated, confirmed cases at home is
  determined by physician
• For confirmed or suspect cases signed doctors
  note is required to return to any day program
• For exposed individuals - family members and
  residential staff may sign note that treatment
  has been completed or is not indicated
• Exposed individuals are monitored for 6 weeks
• Area office nurse tracks additional cases

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DMR Environmental Protocol

• Wash all bedding and towels used by case during
  last 4 days in hot water and dry on hot cycle
• Wear gloves to launder and discard after
• Store items that cannot be washed in plastic bag
  for 14 days
• Clean all washable surfaces
• Vacuum rugs, furniture, and mattresses
• Clean and vacuum all vehicles

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DMR Scabies Control

• Educate clients about personal hygiene, including
  handwashing
• Increase awareness and surveillance for scabies
  with program staff
• Report any suspect cases promptly to program
  nurse or area office nurse
• Seek medical visit as soon as possible, if
  indicated
• Conduct contact investigation as soon as
  possible, if indicated

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Prevention and Handwashing

• Germs are everywhere
• People carry millions of germs on their hands.
• Germs are on also on objects that we touch every
  day (doorknobs, handrails)
• 30 second solution
• Least expensive way to stay healthy
• Forming good habits early in life keeps us
  healthy
• Biggest factor in preventing spread of infectious
  diseases!

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How to Wash Your Hands

• Use warm running water
• Lather with soap (liquid preferred)
• Scrub, including between fingers, for 20 seconds
• Rinse with water
• Dry thoroughly with a clean dry towel or paper
  towel
• Turn off faucet with towel

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References

• American Academy of Pediatrics. Summaries of
  Infectious Diseases. InPickering LK, ed. Red
  Book 2006 Report of the Committee on Infectious
  Diseases. 26th ed. Elk Grove Village, IL
  American Academy of Pediatrics 2003584-587.
• Heymann, DL, Control of Communicable Diseases
  Manual. Washington DC American Public Health
  Association 2004473-476. 
• Isada, C. et al. Infectious Diseases Handbook.
  6th ed. Hudson, Ohio Lexi-Comp, Inc.
  2006293-294.
• http//www.cdc.gov/ncidod/dpd/parasites/scabies/de
  fault.htm