Active case detection methods for crusted scabies and leprosy: A systematic review.

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Crusted scabies is a high-mortality endemic disease in remote Australian Aboriginal communities.
• Current active case detection (ACD) methods for crusted scabies lack evidence-based best practices.
• A systematic review of leprosy ACD methods was conducted due to similar detection requirements.

Purpose of the Study:

• To systematically review active case detection (ACD) methods for leprosy.
• To inform best practices for crusted scabies case detection by adapting findings from leprosy research.
• To identify effective strategies for improving ACD in remote, high-risk populations.

Main Methods:

• Systematic searches of major databases (MEDLINE, CINAHL, Scopus, Cochrane) for studies since 1999.
• Inclusion of studies reporting comparison rates for ACD method yield assessment.
• Qualitative synthesis of 15 eligible studies due to heterogeneity, precluding meta-analysis.

Main Results:

• Contact tracing and community screening of marginalized ethnic groups showed the highest new case detection rates.
• Rapid screening campaigns and those with less experienced personnel had lower suspect confirmation rates.
• Insufficient data exists to evaluate the impact of ACD campaigns on treatment outcomes or disease control.

Conclusions:

• ACD campaigns are vital for communities with healthcare access barriers and near existing cases.
• Lessons from leprosy highlight the value of follow-up with cases and contacts to prevent reinfection.
• Skilled personnel, community engagement, and further research on cost-effectiveness and specific populations are essential for effective crusted scabies control.