Mounsey K E, Murray H C, King M, Oprescu F
Inflammation and Healing Research Cluster,School of Health & Sport Sciences,University of the Sunshine Coast,Sippy Downs,Queensland,Australia.
Infectious Diseases Division,QIMR Berghofer Medical Research Institute,Herston,Queensland,Australia.
Epidemiol Infect. 2016 Aug;144(11):2462-71. doi: 10.1017/S0950268816000443. Epub 2016 Mar 28.
Scabies outbreaks can be disruptive in institutional settings, and are associated with considerable but under-researched morbidity, especially in vulnerable populations. In this paper, we describe key findings from a retrospective review of scabies outbreaks reported in the literature over the past 30 years. We undertook this review to gain insights into the impact of institutional outbreaks, the burden in terms of attack rates, economic costs, treatment trends, the types of index cases and outbreak progression. We found 84 reports over 30 years, with outbreaks most frequently reported in aged care facilities (n = 40) and hospitals (n = 33). On average, scabies outbreaks persisted for 3 months, and the median attack rate was 38%. While 1% lindane was once the most commonly employed acaricide, 5% permethrin and oral ivermectin are increasingly used. Crusted scabies represented the index case for 83% of outbreaks, and scabies was misdiagnosed in 43% outbreaks. The frequency of reported scabies outbreaks has not declined consistently over time suggesting the disease is still highly problematic. We contend that more research and practice emphasis must be paid to improve diagnostic methods, surveillance and control, health staff education and management of crusted scabies to prevent the development of scabies outbreaks in institutional settings.
疥疮暴发在机构环境中具有破坏性，并且与相当严重但研究不足的发病率相关，尤其是在弱势群体中。在本文中，我们描述了对过去30年文献中报道的疥疮暴发进行回顾性研究的主要发现。我们进行这项研究是为了深入了解机构性暴发的影响、发病率、经济成本、治疗趋势、首例病例类型以及暴发的发展过程。我们在30年里找到了84份报告，其中疥疮暴发最常发生在老年护理机构（40例）和医院（33例）。疥疮暴发平均持续3个月，中位发病率为38%。虽然1%林丹曾经是最常用的杀螨剂，但5%氯菊酯和口服伊维菌素的使用越来越多。结痂性疥疮是83%的暴发的首例病例，43%的暴发中疥疮被误诊。报告的疥疮暴发频率并未随时间持续下降，这表明该疾病仍然是一个严重问题。我们认为，必须更加重视研究和实践，以改进诊断方法、监测与控制、医护人员教育以及结痂性疥疮的管理，从而防止机构环境中疥疮暴发的发生。
