Prevention of bacterial complications of scabies using mass drug administration: A population-based, before-after trial in Fiji, 2018-2020

Li Jun Thean; Lucia Romani; Daniel Engelman; Handan Wand; Adam Jenney; Jyotishna Mani; Jessica Paka; Tuliana Cua; Sera Taole; Maciu Silai; Komal Ashwini; Aalisha Sahukhan; Mike Kama; Meciusela Tuicakau; Joseph Kado; Matthew Parnaby; Natalie Carvalho; Margot Whitfeld; John Kaldor; Andrew C Steer

doi:10.1016/j.lanwpc.2022.100433

Prevention of bacterial complications of scabies using mass drug administration: A population-based, before-after trial in Fiji, 2018-2020

Lancet Reg Health West Pac. 2022 Mar 22:22:100433. doi: 10.1016/j.lanwpc.2022.100433. eCollection 2022 May.

Authors

Li Jun Thean^{1

2}, Lucia Romani³, Daniel Engelman^{1

2

4}, Handan Wand³, Adam Jenney⁵, Jyotishna Mani¹, Jessica Paka¹, Tuliana Cua¹, Sera Taole¹, Maciu Silai¹, Komal Ashwini¹, Aalisha Sahukhan⁶, Mike Kama⁶, Meciusela Tuicakau⁶, Joseph Kado^{6

7}, Matthew Parnaby¹, Natalie Carvalho⁸, Margot Whitfeld^{9

10}, John Kaldor⁵, Andrew C Steer^{1

2

4}

Affiliations

¹ Tropical Diseases Group, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia.
² Department of Paediatrics, University of Melbourne, Parkville, Victoria 3052, Australia.
³ Kirby Institute, University of New South Wales, Kensington, New South Wales 2052, Australia.
⁴ Melbourne Children's Global Health, Melbourne Children's Campus, The Royal Children's Hospital, Parkville, 3052 Australia.
⁵ College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
⁶ Ministry of Health and Medical Services, Suva, Fiji.
⁷ Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia 6009, Australia.
⁸ School of Population and Global Health, University of Melbourne, Carlton, Victoria 3053, Australia.
⁹ Department of Dermatology, St. Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia.
¹⁰ School of Medicine, University of New South Wales, Kensington, New South Wales 2052, Australia.

Abstract

Background: Scabies is an important predisposing factor of impetigo which can lead to serious bacterial complications. Ivermectin-based mass drug administration can substantially reduce scabies and impetigo prevalence in endemic settings, but the impact on serious bacterial complications is not known.

Methods: We conducted a before-after trial in the Northern Division of Fiji (population: 131,914) of mass drug administration for scabies control. Prospective surveillance was conducted from 2018 to 2020. Mass drug administration took place in 2019, involving two doses of oral ivermectin or topical permethrin, delivered alongside diethylcarbamazine and albendazole for lymphatic filariasis. The primary outcomes were incidence of hospitalisations with skin and soft tissue infections, and childhood invasive infections and post-streptococcal sequelae. Secondary outcomes included presentations to primary healthcare with skin infections and community prevalence of scabies and impetigo.

Findings: The incidence of hospitalisations with skin and soft tissue infections was 17% lower after the intervention compared to baseline (388 vs 467 per 100,000 person-years; incidence rate ratio 0.83, 95% CI, 0.74 to 0.94; P = 0.002). There was no difference in incidence of childhood invasive infections and post-streptococcal sequelae. Incidence of primary healthcare presentations with scabies and skin infections was 21% lower (89.2 vs 108 per 1000 person-years, incidence rate ratio, IRR 0.79, 95% CI, 0.78 to 0.82). Crude community prevalence of scabies declined from 14.2% to 7.7% (cluster-adjusted prevalence 12.5% to 8.9%; prevalence ratio 0.71, 95% CI, 0.28 to 1.17). Cluster-adjusted prevalence of impetigo declined from 15.3% to 6.1% (prevalence ratio 0.4, 95% CI, 0.18 to 0.86).

Interpretation: Mass drug administration for scabies control was associated with a substantial reduction in hospitalisations for skin and soft tissue infections.

Funding: National Health and Medical Research Council of Australia and Scobie and Claire Mackinnon Trust.

Keywords: Impetigo; Ivermectin; Mass drug administration; Scabies; Skin and soft tissue infections.