Taiaroa George, Matalavea Ben, Tafuna'i Malama, Lacey Jake A, Price David J, Isaia Lupeoletalalelei, Leaupepe Hinauri, Viali Satupaitea, Lee Darren, Gorrie Claire L, Williamson Deborah A, Jack Susan
Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia.
Faculty of Medicine, National University of Samoa, Apia, Samoa.
Lancet Reg Health West Pac. 2020 Dec 29;6:100081. doi: 10.1016/j.lanwpc.2020.100081. eCollection 2021 Jan.
Common infections of the skin such as impetigo and scabies represent a large burden of disease globally, being particularly prevalent in tropical and resource-limited settings. Efforts to address these infections through mass drug administrations have recently been shown as efficacious and safe. In Samoa, a Pacific Island nation, there is a marked lack of epidemiological data for these neglected tropical diseases, or appreciation of their drivers in this setting.
An observational, cross-sectional survey of children aged between 4 and 15 years attending primary schools in rural areas of Upolu Island, Samoa was carried out to assess the prevalence of impetigo and scabies in schoolchildren residing in rural Samoa, integrated with descriptive epidemiological and microbial genomic data. A phylogenetic assessment of local isolated from Samoan schoolchildren was performed to estimate putative community transmission.
In this survey, the prevalence of impetigo observed in Samoan schoolchildren was one of the highest described globally (57•1%, 95% CI [53•8-60•5%], 476/833). Associations between active impetigo and age and gender were noted, with younger children and males more commonly affected (aOR2•8 [1•8-4•7]and aOR1•8 [1•3-2•5], respectively). The prevalence of scabies was similar to that seen in other South Pacific island countries (14•4%, 95% CI [12•2-17•0%], 120/833). Transmission of was predicted, primarily between those children attending the same school. Carriage of was notably low, with pharyngeal carriage observed in less than 2% of schoolchildren, consistent with earlier studies from Samoa.
This study describes a considerable burden of disease attributed to impetigo and scabies in Samoa. These findings will be valuable in addressing the public health challenge posed by these conditions, providing baseline prevalence data and highlighting practical strategies to reduce transmission of relevant microbes and parasites in this setting.
O a'afiaga o le pa'u i fa'ama'i o le po'u (impetigo) ma le utu o le pa'u (scabies), ua tele naua le fanau ua maua ai i le pasefika, ma le lalolagi atoa. O fuafuaga vaai mamao ma polokalame e fofoina ai nei faafitauli, e aofia ai le inumaga o fualaau e tapeina ai nei fa'ama'i, ua aliali mai ai e mafai ona faatamaia nei fa'ama'i. E le o tele ni tusitusiga ma faamaumauga i totonu o Samoa, pe ta'atele nei fa'amai o le pa'u pe leai. Ona o le le faatauaina o nei fa'ama'i, e le o iloa fo'i ni mafuaga ma nisi tulaga e faateleina ai nei fa'ama'i o le pa'u i Samoa.
O le suesuega faasaenisi i le fanau aoga i le va o le 4 ma le 15 tausaga o loo ao'oga i le tulaga lua i nisi o nu'u i tua i Upolu, na faatinoina ai suesuega lea, ia suesueina ai le aotelega ma fainumera o le fanau ua maua i fa'ama'I o le po'u (impetigo) ma le utu o le pa'u (scabies). O lenei foi suesuega, na fia iloa ai fo'i po'o a ituaiga siama eseese o loo maua i luga o pa'u ma tino o le fanau aoga, ina ia iloa ai foi auala ua pipisi ai nei siama mai le isi tamaitiiti i le isi, ona mafua ai lea o nei fa'ama'i o le pa'u.
Ua faailoa mai i le suesuega, le ta'atele o le fa'ama'i o le po'u (impetigo) ua maua ai le fanau aoga (57%), i aoga na faia ai le suesuega. O se fainumera ua maualuga tele i le lalolagi atoa. E toatele atu nisi o le fanau laiti (younger) ma tama (male) e maua i le po'u nai lo isi tamaiti. O le fainumera o le utu o le pa'u (scabies) (14·4%) e tai tutusa lava ma isi motu o le Pasefika. O le feaveaina o le siama faapitoa (staph aureus) ua tupu lea i le fanau ua ao'oga i le aoga e tasi. E le toatele foi nisi o le fanau (2%) na maua i le siama faapitoa o le fa'ai (strep pyogenes) e ona mafua ai le fiva rumatika. O lenei fainumera ua tai tutusa ma suesuega faasaenisi na fai muamua i Samoa.
O le aotelega la o lenei suesuega faasaenisi, ua faailoaina mai ai le tele naua o le fa'ama'i o le pa'u, o po'u (impetigo) ma le utu o le pa'u (scabies) i Samoa nei. O nei foi suesuega o le a aoga tele ini polokalame ma ni fuafuaga mamao e fa'afoisia ai nei faafitauli i le soifua maloloina o le fanau i Samoa. O le a avea foi nei fainumera e faamaumauina mo le silafia e le atunuu ma le soifua maloloina, le ta'atele o nei fa'amai o le pa'u, mo le tapenaina o ni fofo talafeagai ise taimi o i luma, ina ia faaitiitina ai le pipisi o nei siami i fanau ao'oga i Samoa.
脓疱病和疥疮等常见皮肤感染在全球疾病负担中占比很大，在热带地区和资源有限地区尤为普遍。最近有研究表明，通过大规模药物给药来应对这些感染既有效又安全。在太平洋岛国萨摩亚，对于这些被忽视的热带疾病，明显缺乏流行病学数据，也不清楚其在当地的致病因素。
在萨摩亚乌波卢岛农村地区的小学对4至15岁儿童进行了一项观察性横断面调查，以评估萨摩亚农村学童中脓疱病和疥疮的患病率，并整合描述性流行病学和微生物基因组数据。对从萨摩亚学童中分离出的菌株进行系统发育评估，以估计可能的社区传播情况。
在本次调查中，萨摩亚学童中观察到的脓疱病患病率是全球报道中最高的之一（57.1%，95%置信区间[53.8 - 60.5%]，476/833）。活动性脓疱病与年龄和性别之间存在关联，年龄较小的儿童和男性更易受影响（调整后比值比分别为2.8[1.8 - 4.7]和1.8[1.3 - 2.5]）。疥疮患病率与其他南太平洋岛国相似（14.4%，95%置信区间[12.2 - 17.0%]，120/833）。预测主要在同一学校的儿童之间发生葡萄球菌传播。葡萄球菌携带率极低，不到2%的学童咽部携带该菌，这与萨摩亚早期研究结果一致。
本研究描述了萨摩亚脓疱病和疥疮造成的相当大的疾病负担。这些发现对于应对这些疾病带来的公共卫生挑战、提供基线患病率数据以及突出减少该环境中相关微生物和寄生虫传播的实用策略具有重要价值。
脓疱病（impetigo）和疥疮（scabies）这类皮肤疾病，在太平洋地区和全球范围内都造成了大量疾病负担。为解决这些问题所采取的远程和局部措施，包括使用药物治疗以减少这些疾病，已证明是可行的。在萨摩亚，对于脓疱病或疥疮这类疾病，缺乏足够的研究和了解。由于这些疾病的复杂性，尚未确定在萨摩亚导致脓疱病的多种因素和条件。
对居住在乌波卢岛农村地区4至15岁的在校儿童进行了观察性横断面研究，以调查脓疱病（impetigo）和疥疮（scabies）的发病率和流行情况。此外，该研究还旨在确定脓疱病在儿童中的不同类型和性别分布，以及这些因素如何导致脓疱病。
在本次研究中，脓疱病（impetigo）在在校儿童中的发病率为57%，这一数字在全球范围内处于较高水平。较年幼的儿童和男性比其他儿童更容易患脓疱病。疥疮（scabies）的发病率（14.4%）与其他太平洋岛屿国家相似。金黄色葡萄球菌（staph aureus）在同一学校儿童中传播。此外，不到2%的儿童感染了化脓性链球菌（strep pyogenes），这可能导致风湿热。这些数字与萨摩亚之前的研究结果一致。
本观察性研究表明了脓疱病（impetigo）和疥疮（scabies）在萨摩亚造成的大量疾病负担。这些研究对于了解萨摩亚儿童健康状况、脓疱病的发病率以及制定预防策略以减少萨摩亚在校儿童中的微生物传播具有重要意义。
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