Scabies management in institutions

Scabies is a particular problem in semi-closed institutions such as residential settings for elderly people, children, and those with learning disabilities; refugee camps and other settings for displaced persons; prisons; schools; hospitals; hostels. What many of these diverse places have in common is a range of transmission drivers which enable scabies to reach very high prevalence including: high densities of potential hosts, social behaviours involving prolonged contact, bed and clothes sharing, manual handling, reduced access to laundry facilities, and immunocompromise. We describe the epidemiology of institutional scabies outbreaks across settings, and based primarily on recent and longstanding evidence from adult health-care we draw out general strategic priorities for case management and outbreak control. The tools and information necessary to carry out an epidemiological assessment of an institutional scabies outbreak are provided, along with guidance on control measures. A summary checklist of the key steps to take in responding to an institutional outbreak concludes the chapter.