A prospective study of scabies outbreaks in ten residential care facilities for the elderly in South-East England, 2014-15

Cassell, Jackie, Nalabanda, Ananth, Lanza, Stefania, Middleton, Jo, Head, Michael G, Bostock, Jennifer, Hewitt, Kirsty, Jones, Christopher, Darley, Charles, Karir, Simran and Walker, Stephen L (2016) A prospective study of scabies outbreaks in ten residential care facilities for the elderly in South-East England, 2014-15. In: Public Health England Annual Conference 2016, 13-14 Sept 2016, University of Warwick, UK.

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Abstract

Introduction
Scabies is a significant problem in UK elderly residential care facilities (RCF); outbreaks are common and difficult to control. Clinical presentations in the elderly are poorly understood. We studied scabies outbreaks in RCFs to investigate the clinical signs and risk factors in this population.

Methods
We visited RCFs with suspected scabies outbreaks. We examined residents, performed dermoscopy and skin scrapings, and classified their scabies diagnosis as definite (mite visualised)/probable (compatible symptoms, mite not visualised)/possible (non-specific rash + contact with case) or non-scabies. All residents were treated twice with a topical scabicide, and a second visit conducted.

Results
We examined 230 residents at 10 RCFs between 03/02/2014-11/02/2015. Their median age was 87 years, 76% were female, and 68% had dementia. 61 (27%) had scabies (13% definite); 41% with burrows, 51% had not reported symptoms. Dermoscopy identified the mite in 7 cases (11.5%), skin scrapings in 3. We diagnosed a median 6 cases/RCF. Dementia was strongly associated with scabies (OR=2.4, 95% CI 1.4-4.1). No new cases were identified at the second visit (median interval 44 days), 10 cases still had scabies (2 probable, 8 possible).

Discussion
Scabies diagnosis is difficult in this population; half of cases were asymptomatic, and dermoscopy and skin scrapings were of limited diagnostic value. Our study is the first to confirm that dementia is a risk factor for scabies in this group. Careful examination of elderly residents of RCFs with suspected scabies outbreaks is important, particularly those with dementia, as they may have no obvious clinical signs.

Item Type: Conference or Workshop Item (Poster)
Schools and Departments: Brighton and Sussex Medical School > Primary Care and Public Health
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0639 Transmission of disease
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0643 Communicable diseases and public health
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0645.3 Home health care services
R Medicine > RB Pathology > RB127 Manifestations of disease
R Medicine > RC Internal medicine > RC0109 Infectious and parasitic diseases
R Medicine > RC Internal medicine > RC0581 Specialties of internal medicine > RC0952 Geriatrics
R Medicine > RL Dermatology
R Medicine > RL Dermatology > RL0760 Diseases due to parasites
Depositing User: Jo Middleton
Date Deposited: 05 Oct 2016 08:43
Last Modified: 20 Oct 2016 15:03
URI: http://sro.sussex.ac.uk/id/eprint/63725

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Project NameSussex Project NumberFunderFunder Ref
PHE Scabies Research ProjectUnsetPublic Health England South EastUnset
UnsetUnsetBritish Skin FoundationUnset