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      A framework for scabies control

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          Abstract

          Scabies is a neglected tropical disease (NTD) that causes a significant health burden, particularly in disadvantaged communities and where there is overcrowding. There is emerging evidence that ivermectin-based mass drug administration (MDA) can reduce the prevalence of scabies in some settings, but evidence remains limited, and there are no formal guidelines to inform control efforts. An informal World Health Organization (WHO) consultation was organized to find agreement on strategies for global control. The consultation resulted in a framework for scabies control and recommendations for mapping of disease burden, delivery of interventions, and establishing monitoring and evaluation. Key operational research priorities were identified. This framework will allow countries to set control targets for scabies as part of national NTD strategic plans and develop control strategies using MDA for high-prevalence regions and outbreak situations. As further evidence and experience are collected and strategies are refined over time, formal guidelines can be developed. The control of scabies and the reduction of the health burden of scabies and associated conditions will be vital to achieving the targets set in WHO Roadmap for NTDs for 2021 to 2030 and the Sustainable Development Goals.

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          Most cited references23

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          Effect of handwashing on child health: a randomised controlled trial.

          More than 3.5 million children aged less than 5 years die from diarrhoea and acute lower respiratory-tract infection every year. We undertook a randomised controlled trial to assess the effect of handwashing promotion with soap on the incidence of acute respiratory infection, impetigo, and diarrhoea. In adjoining squatter settlements in Karachi, Pakistan, we randomly assigned 25 neighbourhoods to handwashing promotion; 11 neighbourhoods (306 households) were randomised as controls. In neighbourhoods with handwashing promotion, 300 households each were assigned to antibacterial soap containing 1.2% triclocarban and to plain soap. Fieldworkers visited households weekly for 1 year to encourage handwashing by residents in soap households and to record symptoms in all households. Primary study outcomes were diarrhoea, impetigo, and acute respiratory-tract infections (ie, the number of new episodes of illness per person-weeks at risk). Pneumonia was defined according to the WHO clinical case definition. Analysis was by intention to treat. Children younger than 5 years in households that received plain soap and handwashing promotion had a 50% lower incidence of pneumonia than controls (95% CI (-65% to -34%). Also compared with controls, children younger than 15 years in households with plain soap had a 53% lower incidence of diarrhoea (-65% to -41%) and a 34% lower incidence of impetigo (-52% to -16%). Incidence of disease did not differ significantly between households given plain soap compared with those given antibacterial soap. Handwashing with soap prevents the two clinical syndromes that cause the largest number of childhood deaths globally-namely, diarrhoea and acute lower respiratory infections. Handwashing with daily bathing also prevents impetigo.
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            Prevalence of scabies and impetigo worldwide: a systematic review.

            Scabies is a skin disease that, through secondary bacterial skin infection (impetigo), can lead to serious complications such as septicaemia, renal disease, and rheumatic heart disease. Yet the worldwide prevalence of scabies is uncertain. We undertook a systematic review, searching several databases and the grey literature, for population-based studies that reported on the prevalence of scabies and impetigo in a community setting. All included studies were assessed for quality. 2409 articles were identified and 48 studies were included. Data were available for all regions except North America. The prevalence of scabies ranged from 0·2% to 71·4%. All regions except for Europe and the Middle East included populations with a prevalence greater than 10%. Overall, scabies prevalence was highest in the Pacific and Latin American regions, and was substantially higher in children than in adolescents and adults. Impetigo was common, particularly in children, with the highest prevalence in Australian Aboriginal communities (49·0%). Comprehensive scabies control strategies are urgently needed, such as a community-based mass drug administration approach, along with a more systematic approach to the monitoring of disease burden.
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              Mass Drug Administration for Scabies Control in a Population with Endemic Disease.

              Scabies is an underrecognized cause of illness in many developing countries. It is associated with impetigo, which can lead to serious systemic complications. We conducted a trial of mass drug administration for scabies control in Fiji.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS Negl Trop Dis
                PLoS Negl Trop Dis
                plos
                PLoS Neglected Tropical Diseases
                Public Library of Science (San Francisco, CA USA )
                1935-2727
                1935-2735
                2 September 2021
                September 2021
                : 15
                : 9
                : e0009661
                Affiliations
                [1 ] Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Australia
                [2 ] Melbourne Children’s Global Health, Royal Children’s Hospital, Melbourne, Australia
                [3 ] Department of Paediatrics, University of Melbourne, Melbourne, Australia
                [4 ] Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
                [5 ] Hospital for Tropical Diseases, London, United Kingdom
                [6 ] Communicable Diseases, Neglected Tropical Diseases, WHO Regional Office for Africa, Brazzaville, Congo
                [7 ] Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
                [8 ] Faculté de Santé de Créteil et Service de Dermatologie, APHP, Hôpital Henri-Mondor, Université Paris-Est, Créteil, France
                [9 ] Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d’Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
                [10 ] Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
                [11 ] College of Medicine, University of the Philippines, Manila, Philippines
                [12 ] Philippine Leprosy Mission, Inc., Manila, Philippines
                [13 ] Department of Dermatovenerology, Bahir Dar University, Medicine and Health Science College, Addis Ababa, Ethiopia
                [14 ] Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
                [15 ] University of Liberia, Monrovia, Liberia
                [16 ] Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
                [17 ] Division of Country Health Programmes, Malaria, Neglected Tropical Diseases and Other Vector-borne Diseases, WHO Regional Office for Europe, Copenhagen, Denmark
                [18 ] Independent Consultant, United Kingdom
                [19 ] Bridges to Development, Seattle, Washington, United States of America
                [20 ] Public Health Interventions Research Group, Kirby Institute University of New South Wales, Sydney, Australia
                [21 ] Dermatology Unit, EPS Institut d’Hygiéne Sociale de Dakar, Dakar, Senegal
                [22 ] University Cheikh Anta Diop of Dakar, Dakar, Senegal
                [23 ] Task Force for Global Health, Decatur, Georgia, United States of America
                [24 ] Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
                [25 ] Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
                [26 ] Infection Modelling, Murdoch Children’s Research Institute, Melbourne, Australia
                [27 ] Pacific Health Security & Communicable Diseases, Division of Pacific Technical Support, WHO, Suva, Fiji
                [28 ] Ministry of Health, Honiara, Solomon Islands
                [29 ] Tulane School of Public Health and Tropical Medicine, New Orleans, United States of America
                [30 ] School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
                [31 ] Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
                [32 ] Division of Communicable Diseases, Medicines, Vaccines and Pharmaceuticals, WHO Regional Office for the Western Pacific, Manila, Philippines
                [33 ] Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
                [34 ] Former Medical Officer, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
                Hitit University, Faculty of Medicine, TURKEY
                Author notes

                The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-4909-1287
                https://orcid.org/0000-0002-7585-4743
                https://orcid.org/0000-0001-7346-0196
                https://orcid.org/0000-0001-9627-349X
                https://orcid.org/0000-0002-4425-2264
                https://orcid.org/0000-0001-5494-9455
                https://orcid.org/0000-0002-0692-850X
                https://orcid.org/0000-0003-0257-7682
                https://orcid.org/0000-0002-3367-3231
                https://orcid.org/0000-0002-7530-1620
                https://orcid.org/0000-0003-2197-2549
                https://orcid.org/0000-0002-2986-7631
                https://orcid.org/0000-0001-5290-6849
                Article
                PNTD-D-21-00828
                10.1371/journal.pntd.0009661
                8412357
                34473725
                3fa7e876-0347-4c8d-b536-a0f99adc2621

                This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                History
                Page count
                Figures: 1, Tables: 2, Pages: 9
                Funding
                Funded by: international league of dermatological societies
                The expert meeting was partly supported by the International League of Dermatological Societies. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
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