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 1970s
Humans are the reservoir
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
 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
 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
 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?
 DMR 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

 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
 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
 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
 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
 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
 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