title: Impact of an Ivermectin Mass Drug Administration on Scabies Prevalence in a Remote Australian Aboriginal Community.
abstract: BACKGROUND
  Scabies is endemic in many Aboriginal and Torres Strait Islander communities, with 69% of infants infected in the first year of life. We report the outcomes against scabies of two oral ivermectin mass drug administrations (MDAs) delivered 12 months apart in a remote Australian Aboriginal community.
  
  
  METHODS
  Utilizing a before and after study design, we measured scabies prevalence through population census with sequential MDAs at baseline and month 12. Surveys at months 6 and 18 determined disease acquisition and treatment failures. Scabies infestations were diagnosed clinically with additional laboratory investigations for crusted scabies. Non-pregnant participants weighing ≥15 kg were administered a single 200 μg/kg ivermectin dose, repeated after 2-3 weeks if scabies was diagnosed, others followed a standard alternative algorithm.
  
  
  RESULTS
  We saw >1000 participants at each population census. Scabies prevalence fell from 4% at baseline to 1% at month 6. Prevalence rose to 9% at month 12 amongst the baseline cohort in association with an identified exposure to a presumptive crusted scabies case with a higher prevalence of 14% amongst new entries to the cohort. At month 18, scabies prevalence fell to 2%. Scabies acquisitions six months after each MDA were 1% and 2% whilst treatment failures were 6% and 5% respectively.
  
  
  CONCLUSIONS
  Scabies prevalence reduced in the six months after each MDA with a low risk of acquisition (1-2%). However, in a setting where living conditions are conducive to high scabies transmissibility, exposure to presumptive crusted scabies and population mobility, a sustained reduction in prevalence was not achieved.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trial Register (ACTRN-12609000654257).
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors.forename: Thérèse M
authors.initials: TM
authors.lastname: Kearns
authors.affiliation: James Cook University, Townsville, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Speare
authors.affiliation: Monash University, Melbourne, Australia.
authors.forename: Allen C
authors.initials: AC
authors.lastname: Cheng
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, Australia.
authors.forename: James
authors.initials: J
authors.lastname: McCarthy
authors.affiliation: Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, Australia.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Carapetis
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors.forename: Deborah C
authors.initials: DC
authors.lastname: Holt
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Currie
authors.affiliation: Miwatj Health Aboriginal Corporation, Nhulunbuy, Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Page
authors.affiliation: La Trobe University, Bendigo, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Shield
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors.forename: Roslyn
authors.initials: R
authors.lastname: Gundjirryirr
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors.forename: Leanne
authors.initials: L
authors.lastname: Bundhala
authors.affiliation: Miwatj Health Aboriginal Corporation, Nhulunbuy, Australia.
authors.forename: Eddie
authors.initials: E
authors.lastname: Mulholland
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Chatfield
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
authors.forename: Ross M
authors.initials: RM
authors.lastname: Andrews
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D002648:Child; D065187:Controlled Before-After Studies; D004358:Drug Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007306:Insecticides / Q000627:therapeutic use*; D007559:Ivermectin / Q000627:therapeutic use*; D008297:Male; D011247:Pregnancy; D015995:Prevalence; D012532:Scabies / Q000188:drug therapy* / Q000453:epidemiology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007306:Insecticides; D007559:Ivermectin