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Mass Drug Administration for Scabies Control in a Population with Endemic Disease
Lucia Romani1, Margot J Whitfeld, Josefa Koroivueta
1From Kirby Institute, University of New South Wales (L.R., H.W., J.M.K.), and the Department of Dermatology, St. Vincent's Hospital (M.J.W.), Sydney, Menzies School of Health Research, Charles Darwin University, Darwin, NT (R.A.), and the Centre for International Child Health, University of Melbourne (A.C.S.), Group A Streptococcal Research Group, Murdoch Children's Research Institute (A.C.S.), and Department of General Medicine, Royal Children's Hospital (A.C.S.), Melbourne, VIC - all in Australia; and the Ministry of Women, Children, and Poverty Alleviation (J.K.) and the Ministry of Health (M.K., L.T., M.T., A.K.) - both in Suva, Fiji.
Background:
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.
Methods:
We randomly assigned three island communities to one of three different interventions for scabies control: standard care involving the administration of permethrin to affected persons and their contacts (standard-care group), mass administration of permethrin (permethrin group), or mass administration of ivermectin (ivermectin group). The primary outcome was the change in the prevalence of scabies and of impetigo from baseline to 12 months.
Results:
A total of 2051 participants were enrolled; 803 were in the standard-care group, 532 in the permethrin group, and 716 in the ivermectin group. From baseline to 12 months, the prevalence of scabies declined significantly in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 36.6% to 18.8% in the standard-care group (relative reduction in prevalence, 49%; 95% confidence interval [CI], 37 to 60), from 41.7% to 15.8% in the permethrin group (relative reduction, 62%; 95% CI, 49 to 75), and from 32.1% to 1.9% in the ivermectin group (relative reduction, 94%; 95% CI, 83 to 100). The prevalence of impetigo also declined in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 21.4% to 14.6% in the standard-care group (relative reduction, 32%; 95% CI, 14 to 50), from 24.6% to 11.4% in the permethrin group (relative reduction, 54%; 95% CI, 35 to 73), and from 24.6% to 8.0% in the ivermectin group (relative reduction, 67%; 95% CI, 52 to 83). Adverse events were mild and were reported more frequently in the ivermectin group than in the permethrin group (15.6% vs. 6.8%).
Conclusions:
Mass drug administration, particularly the administration of ivermectin, was efficacious for the control of scabies and impetigo. (Funded by the Australian National Health and Medical Research Council; Australian New Zealand Clinical Trials Registry number, ACTRN12613000474752.).
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