Scabies outbreak in paediatric malignancy patients: clinical and healthcare burden

Scabies is a highly contagious parasitic skin infestation with increased severity in immunocompromised individuals. Paediatric oncology patients represent a uniquely vulnerable population, where delayed diagnosis and atypical presentations can complicate management. This study aimed to evaluate the clinical outcomes and institutional burden of a scabies outbreak in a paediatric haematology-oncology unit.

This retrospective study included paediatric malignancy patients diagnosed with scabies between January 2020 and January 2024 in a tertiary paediatric oncology centre. Diagnosis was based on clinical evaluation by dermatologists. Data collected included demographics, underlying malignancy, treatment modalities, duration of infection, complications and impact on healthcare services. Statistical analyses included t-tests, Chi-squared tests and univariable regression.

Among 1483 unique inpatients over 4 years, 23 (1.55%) were diagnosed with scabies, with 78% of cases occurring within a 6-month period. The mean ± standard deviation (SD) age was 12.7 ± 5.95 years; 82.6% were male. The mean ± SD duration from symptom onset to resolution was 3.26 ± 2.47 months. Complications occurred in 43.5% of patients, including secondary bacterial infections, chemotherapy delays and one catheter-related event. A prolonged infection duration was significantly associated with complications (P = 0.008). All caregivers were affected, and 11 healthcare workers developed symptoms, leading to workforce shortages and single-room isolation that halved bed capacity.

This outbreak underscores the diagnostic and therapeutic challenges of scabies in immunosuppressed paediatric patients. The involvement of caregivers and healthcare staff, coupled with operational disruptions, highlights the need for early recognition, standardised treatment protocols and proactive infection control strategies in high-risk hospital settings.