Research Article: Efficacy of ivermectin mass-drug administration to control scabies in asylum seekers in the Netherlands: A retrospective cohort study between January 2014 – March 2016

Date Published: May 17, 2018

Publisher: Public Library of Science

Author(s): Dorien T. Beeres, Sofanne J. Ravensbergen, Annelies Heidema, Darren Cornish, Machiel Vonk, Leonie D. Wijnholds, Jessica J. H. Hendriks, Johanneke Kleinnijenhuis, Till F. Omansen, Ymkje Stienstra, Pamela L. C. Small.

Abstract: Scabies is a skin infestation with the mite Sarcoptes scabiei causing itch and rash and is a major risk factor for bacterial skin infections and severe complications. Here, we evaluated the treatment outcome of 2866 asylum seekers who received (preventive) scabies treatment before and during a scabies intervention programme (SIP) in the main reception centre in the Netherlands between January 2014 and March 2016. A SIP was introduced in the main national reception centre based on frequent observations of scabies and its complications amongst Eritrean and Ethiopian asylum seekers in the Netherlands. On arrival, all asylum seekers from Eritrea or Ethiopia were checked for clinical scabies signs and received ivermectin/permethrin either as prevention or treatment. A retrospective cohort study was conducted to compare the reinfestations and complications of scabies in asylum seekers who entered the Netherlands before and during the intervention and who received ivermectin/permethrin. In total, 2866 asylum seekers received treatment during the study period (January 2014 –March 2016) of which 1359 (47.4%) had clinical signs of scabies. During the programme, most of the asylum seekers with scabies were already diagnosed on arrival as part of the SIP screening (580 (64.7%) of the 897). Asylum seekers with more than one scabies episode reduced from 42.0% (194/462) before the programme to 27.2% (243/897) during the programme (RR = 0.64, 95% CI = 0.55–0.75). Development of scabies complications later in the asylum procedure reduced from 12.3% (57/462) to 4.6% (41/897). A scabies prevention and treatment programme at start of the asylum procedure was feasible and effective in the Netherlands; patients were diagnosed early and risk of reinfestations and complications reduced. To achieve a further decrease of scabies, implementation of the programme in multiple asylum centres may be needed.

Partial Text: In 2015, several outbreaks of scabies amongst asylum seekers at refugee camps and reception centres in Europe were reported [1–3]. Scabies is an infestation of the skin with the mite Sarcoptes scabiei. The mites are transmitted by close and prolonged skin to skin contact. Individuals with a severe form of scabies, such as crusted scabies, may harbour millions of mites and are highly contagious [4]. A manifestation of scabies mostly results in skin burrows, erythematous papules and generalized itching [5]. Secondary infections can lead to life-threatening complications including sepsis [6]. In 2017, the WHO recognized scabies as a neglected tropical disease [7]. Crowded conditions and frequently poor access to health care are major risk factors for scabies outbreaks and most likely gave rise to its recent emergence and spread in refugee camps [8].

Frequent observations of scabies and its complications were reported amongst Eritrean and Ethiopian asylum seekers arriving in the Netherlands. Introduction of a scabies prevention and treatment programme on arrival was feasible and resulted in early detection of asylum seekers with scabies. Itch and burrows were the most common clinical manifestations. Atypical scabies presentations in the face and neck were also noticed. The number of scabies reinfestations after treatment and the number of complicated forms of scabies reduced after introduction of the programme. Asylum seekers who received ivermectin/permethrin on arrival but developed scabies in other asylum centres across the Netherlands, presented after a median of 2.5 months after arrival.