ICEH Resources Information Sheet

SCABIES

Pronunciation: Skay-bees

What is Scabies?

Scabies is an environmental health problem as well as a medical one. It is an infestation of skin with the parasitic mite Sarcoptes scabiei.

It is a communicable disease – person to person, house to house, community to community. You get scabies from people with scabies.

What does the Scabies mite look like?

The scabies mite is a very, very small animal from the family called mites; three can easily fit on the tip of a ball point pen. It is oval and straw-coloured, measuring 0.2-0.4mm in length.

Scabies in Australia

Where does it occur?

Sarcoptes scabiei is found worldwide in all socio-economic groups. Scabies is associated with close living conditions and is not an indication of poor hygiene.

Australian / Indigenous Significance

Scabies is endemic in many remote Aboriginal communities with up to 50% of children and 25% of adults infected (CDC NT, 2003). It causes 50-70% of streptococcal skin infections which can lead to complications.

Symptoms: What to look out for?

The main symptoms are intense itching which is worse at night and a red, lumpy rash. The severe itching and scratching can lead to sores on the body which are then secondary bacterial infections.

How do you diagnose (confirm) a case?

The usual sign is burrows between the fingers and on the inside of the wrist. These can also be found on elbows, armpits, waist, penis, breasts, and with children on the palms of the hands and soles of the feet. The burrows appear as greyish pencil marks on the skin surface; in darker skin these are paler.

Skin scrapings may be taken to confirm a case but it is easy to miss with only 10-12 mites on the entire body. The rash will not (or rarely) be where the infestation is.

How does it reproduce?

The adult mite can live a month on a human. Newly mated females burrow into the skin and excavate a tunnel. The female lays eggs singly, 2-3 per day in the tunnel. After 48 hours the eggs hatch and the small mites dig their way to the skin's surface. The fertilised females then seek a permanent burrow on the skin and at this stage can be transferred to a new host.

How infectious is it?

Transmission of the scabies mites occurs with prolonged and close direct contact with an infected person or bedding. It is transmissible as long as a person is infested with mites. Mites can live only 2-3 days away from the human body.

The typical infestation is 12 scabies mites unless the scabies is the type known as crusted scabies where there can be thousands of mites.

Mites can burrow in 2.5 minutes into the skin. 90% of mites that hatch die and if removed from the host can live only a short time.

How long does it take for symptoms to appear?

It can take a month for the itch to start for a first time infestation. Reinfected people will develop symptoms 1-4 days after re-exposure.

Who is most at risk?

People living in crowded conditions, in poverty, with poor hygiene, malnutrition, or multiple serial sexual partners are most at risk. The elderly and people with weakened immune systems are at risk for the most severe form - crusted scabies.

How do we prevent it from occurring?

Prevention is a job for the whole community and all the community must work together. The Healthy Skin Program from the Northern Territory promotes a well-planned, coordinated and committed community approach for success. It identifies 3 requirements for a successful community scabies program:

• Community support and education to treat all residents at the same time
• A maintenance program involving a simple screen of all children less than 15 years old, three times a year, to check for scabies
• An ongoing community education and evaluation of the program.

A reliable water supply is a priority to prevent scabies. Regular washing of children needs to be promoted and the maintenance of health hardware needs to be considered a priority. Hot water and a washing machine are essential.

To get rid of scabies, you need a:

• sunny day
• washing machine and hot water
• washing line or fence
• vacuum cleaner or broom
• shower, soap and nail brush
• scabies cream for everyone in the house which is put on when you are cool and dry.

There must be clean sheets and blankets and clean clothes for everyone so the scabies cannot spread again. Strip beds and wash everything in hot water and soap and hang in sun. Air the mattresses, pillows and floor mats in the sun and give the house a good clean. Shower and put the cream all over the body and then put clean clothes on. All the people you are close to will need to do the same.

How can it be controlled?

A scabicide cream (5% permethrin) from the health clinic or chemist will kill the scabies mites. The itching and lesions will disappear within 3-4 weeks after treatment which must be applied following directions provided. These are usually to:

• Apply to clean body from the neck down to the toes, avoiding eyes and mouth, and leave 8 hours or overnight
• Take a bath or shower to wash the scabicide off
• Put on clean clothes that have been washed in hot, soapy water and dried in the sun or a hot dryer
• Wash all clothes, bedding, towels used by the infected person for 2 days before the treatment in hot soapy water and dried in the sun or in a hot dryer
• Seal items that can't be washed in a plastic bag for 4 days to kill any mites or eggs
• Repeat in 7 days if needed to ensure all mites are killed - no new rashes or burrows should appear 2-3 days after effective treatment.

The treatment must be applied to all members of the family or persons in close contact, even if they have no sign of scabies. Pregnant women and children are often treated with a milder scabicide and babies should never be treated with some varieties - read the label and ask for advice.

But, as it can spread again from contact, a thorough disinfection of clothes and bedding must also take place. It is a whole community problem.

Thanks to Money, J 2001 Scabies & Sores, multimedia CD, Northern Territory for the Sarcoptes scabiei and Transmission graphics on this page.

Case Studies

Scabies Control in a Remote Aboriginal Community in the Northern Territory, Australia
(Tindall, 2001)

A scabies program was run in a small community outside Katherine, NT. First a community survey was undertaken which highlighted issues such as overcrowding and the lack of hot water. The health team then prepared to conduct a week-long scabies treatment program. Aboriginal Health Workers attended in-house education sessions. Posters were put up depicting basic hygiene practices and pet care.

15 Aboriginal Health Workers and two Medical Officers attended the community on a daily basis for 4 days to screen people from the community. Any person diagnosed with scabies was given permethrin 5% cream (Lyclear) and taught how to apply and when to remove the cream. Family members were treated as a preventative measure.

Problems encountered were the inability of the health team to ensure all community members used the cream. Full tubes of the cream were found, unused, days after the program finished. Lack of resources prevented the Health Centre from providing any followup and so none of the recommended maintenance occurred. Data was not collated and reported back to the community about the success.

A medical officer involved said that the program was minimally successful in the short term and it did not reduce the number of people presenting with scabies. There is a problem in conducting a program in a small community where there can be shame in having your lifestyle criticised. Overcrowding is still an issue that has not been addressed to ensure that scabies will remain under control.

Report of the "Bo Bo Scabies Day" at Oenpelli, September 18, 2001
(Yee, 2002)

This report details how a Northern Territory community focused on scabies education and control.

In Oenpelli, NT community organisations were greatly involved in the Scabies Day, including the Council, Council CDEP project, Council and private stores, social club, school, and local band. Prizes, T-shirts and balloons were donated and organisations closed down to allow people to attend the screening. In the morning the CDEP organised the cleaning up of the houses, inside and out. Washing machines were manned and the garbage truck went around. The Council store sold mattresses, pillows and sheets at a special subsidised rate. At night the Club held a celebration with free food and dancing. Prizes were awarded to winners of the T-shirt design and poster competitions. Lucky draw tickets were given for the return of empty tubes from the cream (to help determine the number actually used). Towels were given away.

Screening of the 0-3 year olds took place 6 weeks later. The estimated prevalence of scabies had decreased from 33% to 12%. There was a marked increase in community involvement in the Scabies Day from the previous year.

The clinic manager and the doctor did most of the negotiations and planning and this took a significant amount of time. The lack of human resources meant that the health message did not get advertised widely enough. However, the project did have a strong sense of community ownership.

Glossary

Scabies in animals

Insecticides which kill scabies mites

Resources

Centre for Disease Control, Northern Territory 2003. Healthy Skin Program: Guidelines for Community Control of Scabies, Skin Sores and Crusted Scabies in the Northern Territory. Department of Health and Community Services, Northern Territory Government.
Available from:
www.nt.gov.au/health/cdc/treatment_protocol/scabies.pdf
[Detailed resource (28pg) for running a community awareness and eradication program, includes sample worksheets and work flow]

Chin, J., 2000, Control of Communicable Disease Manual, 17th edn, American Public Health Association, Washington DC, pp. 135-137.
[Book on infectious diseases that is often referred to in health departments (technical language)]

Commens, C 2000. The treatment of scabies web page
Available from: www.australianprescriber.com/magazines/vol23no2/scabies.html
[Guide for practitioners treating scabies (clear language)]

Department of Medical Entomology Website. Scabies, University of Sydney. Available from:
medent.usyd.edu.au/fact/scabies.html
[Gives natural history of mite along with suggested treatment of scabies}

Fernando, R.L., Fernando, S.E. & Leong, A.S.Y. 2001, Tropical Infectious Diseases: Epidemiology, Investigation, Diagnosis and Management, Greenwich Medical Media Ltd, London, pp. 65-67.
[Book that focuses on infectious diseases in Australia (technical language)]

Money, J 2001 Scabies & Sores, multimedia CD, Northern Territory
[gives a good account of scabies in an indigenous community with great graphics and language for communities. Also in Kriol, it can be purchased by contacting PJMoney@bigpond.com]

Parasitic Disease Information Website 1999, Fact Sheet - Scabies, Centre for Disease Control. Available: www.cdc.gov/ncidod/dpd/parasites/scabies/factsht_scabies.htm
[Fact sheet giving general advice on Scabies, ideal for general community]

Public Health Fact Sheets: Scabies, 2002. Queensland Health, Brisbane.
Available: www.health.qld.gov.au/phs/Documents/cdu/690.pdf
[Fact sheet (2pg) giving general advice on crpto, ideal for general community]

Tindal, Helen 2001. 'Scabies Control in a Remote Aboriginal Community in the Northern Territory, Australia', in Canyon DV, Speare RS. (eds) Rural and Remote Environmental Health I.
The Australasian College of Tropical Medicine, Brisbane. Available at: www.tropmed.org/rreh/vol1_5.htm
[Case study of a community scabies program with evaluation of success/failure (not too academic)]

Wallman, Noel 2002.Healthy Skin, part of a powerpoint presentation given at the 3rd Environmental Health Forum, Adelaide, Nov 2002
Available at: iceh.uws.edu.au/pdf_files/wadeye_healthy_skin.pdf
[Samples of the poster campaign used in Wadeye Environmental Health Unit (20pg - 3MB)]

Yee, Theresa (2001) Report of the "Bo Bo Scabies Day" at Oenpelli, September 18, 2001. Available from: www.tedgp.asn.au/resdoc/final1_formatted.pdf (10pg)
[Case study of a community scabies program (easy to read)]

Revised November 2003