A scabies outbreak in an inpatient rehabilitation setting

Background: Scabies is a skin infection transmitted by close person-to-person contact. Crusted scabies is a more severe type which is more contagious. Delayed diagnosis of scabies could lead to an outbreak.

Methods: The outbreak occurred at a 435-bed academic medical center with 76 inpatient rehabilitation beds. The index patient was incarcerated and admitted to our hospital in February 2022. The patient developed crusted scabies after steroids treatment.

Results: The patient was treated with oral ivermectin (200 mcg/kg, maximum dose 15 mg) and topical permethrin 5%. All units were followed for 6 weeks since diagnosis of the index patient. A total of 46 healthcare workers (20 nurses and 26 physical therapists) were exposed. Twenty-nine presented symptoms and were treated with ivermectin and permethrin or only ivermectin. No physicians, other patients, or prison guards were affected. There was no secondary household transmission of those exposed healthcare workers.

Conclusions: Scabies is highly contagious in high-risk patients. Early diagnosis and effective infection control are of vital importance.