title: Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England.
abstract: Scabies is an important public health problem in residential care homes. Delayed diagnosis contributes to outbreaks, which may be prolonged and difficult to control. We investigated factors influencing outbreak recognition, diagnosis and treatment, and staff experiences of outbreak control, identifying areas for intervention. We carried out a semi-structured survey of managers, affected residents and staff of seven care homes reporting suspected scabies outbreaks in southern England over a 6-month period. Attack rates ranged from 2% to 50%, and most cases had dementia (37/39, 95%). Cases were diagnosed clinically by GPs (59%) or home staff (41%), none by dermatologists. Most outbreaks were attributable to avoidably late diagnosis of the index case. Participants reported considerable challenges in managing scabies outbreaks, including late diagnosis and recognition of outbreaks; logistically difficult mass treatment; distressing treatment processes and high costs. This study demonstrates the need for improved support for care homes in detecting and managing these outbreaks.
authors.affiliation: Division of Primary Care and Public Health,Brighton and Sussex Medical School,Brighton,UK.
authors.forename: K A
authors.identifier: http://orcid.org/0000-0003-3044-019X
authors.initials: KA
authors.lastname: Hewitt
authors.affiliation: Division of Primary Care and Public Health,Brighton and Sussex Medical School,Brighton,UK.
authors.forename: A
authors.initials: A
authors.lastname: Nalabanda
authors.affiliation: Division of Primary Care and Public Health,Brighton and Sussex Medical School,Brighton,UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Cassell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D004196:Disease Outbreaks / Q000517:prevention & control; D004739:England; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D009735:Nursing Homes; D011446:Prospective Studies; D012520:Sarcoptes scabiei / Q000502:physiology*; D012532:Scabies / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control; D011795:Surveys and Questionnaires
keywords: scabies