Scabies Control

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

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 

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

Scabies Transmission
•	Direct, prolonged, skin–to-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 
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)

Scabies Rash 
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

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.

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

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

DDS 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?

DDS Protocol for
Suspect 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

DDS 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

DDS 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

DDS Follow-up Protocol
•	Isolation of treated, confirmed cases at home is determined by physician 
•	For confirmed or suspect cases – signed doctor’s 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

DDS 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

DDS 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

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!

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

References
•	American Academy of Pediatrics. Summaries of Infectious Diseases. In:Pickering LK, ed. Red Book: 2006 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:584-587.

•	Heymann, DL, Control of Communicable Diseases Manual. Washington DC: American Public Health Association; 2004:473-476. 

•	Isada, C. et al. Infectious Diseases Handbook. 6th ed. Hudson, Ohio: Lexi-Comp, Inc.; 2006:293-294.

•	http://www.cdc.gov/ncidod/dpd/parasites/scabies/default.htm