Scabies outbreak in an intensive care unit with 1,659 exposed individuals--key factors for controlling the outbreak.
OBJECTIVE
To investigate a large outbreak of scabies in an intensive care unit of a university hospital and an affiliated rehabilitation center, and to establish effective control measures to prevent further transmission.


METHODS
Outbreak investigation.


METHODS
The intensive care unit of a 750-bed university hospital and an affiliated 92-bed rehabilitation center.


METHODS
All exposed individuals were screened by a senior staff dermatologist. Scabies was diagnosed on the basis of (1) identification of mites by skin scraping, (2) identification of mites by dermoscopy, or (3) clinical examination of patients without history of prior treatment for typical burrows. During a follow-up period of 6 months, the attack rate was calculated as the number of symptomatic individuals divided by the total number of exposed individuals.


METHODS
All exposed healthcare workers (HCWs) and their household members underwent preemptive treatment. Initially, the most effective registered drug in Switzerland (ie, topical lindane) was prescribed, but this prescription was switched to topical permethrin or systemic ivermectin as a result of the progression of the outbreak. Individuals with any signs or symptoms of scabies underwent dermatological examination.


RESULTS
Within 7 months, 19 cases of scabies were diagnosed, 6 in children with a mean age of 3.1 years after exposure to the index patient with HIV and crusted scabies. A total of 1,640 exposed individuals underwent preemptive treatment. The highest attack rate of 26%-32% was observed among HCWs involved in the care of the index patient. A too-restricted definition of individuals at risk, noncompliance with treatment, and the limited effectiveness of lindane likely led to treatment failure, relapse, and reinfestation within families.


CONCLUSIONS
Crusted scabies resulted in high attack rates among HCWs and household contacts. Timely institution of hygienic precautions with close monitoring and widespread, simultaneous scabicide treatment of all exposed individuals are essential for control of an outbreak.
Buehlmann
Manuela
M
Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
Beltraminelli
Helmut
H
Strub
Christoph
C
Bircher
Andreas
A
Jordan
Xavier
X
Battegay
Manuel
M
Itin
Peter
P
Widmer
Andreas F
AF
D000328:Adult; D000818:Animals; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000635:transmission; D004196:Disease Outbreaks / Q000517:prevention & control*; D005191:Family Characteristics; D005260:Female; D006282:Health Personnel; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017758:Infectious Disease Transmission, Patient-to-Professional; D007306:Insecticides / Q000008:administration & dosage; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007559:Ivermectin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D026023:Permethrin / Q000008:administration & dosage; D012047:Rehabilitation Centers; D012520:Sarcoptes scabiei / Q000187:drug effects*; D012532:Scabies / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000635:transmission
D007306:Insecticides; D026023:Permethrin; D007559:Ivermectin