Mass ivermectin administration reduces scabies, impetigo

Key takeaways:

• Scabies and impetigo can cause severe skin reactions as well as soft tissue infections.
• Prevalence of both conditions were significantly reduced following mass ivermectin administration in four Indian villages.

Scabies and impetigo prevalence was reduced significantly with mass administration of ivermectin or permethrin in small Indian communities, according to a study.

“Scabies infestation predisposes to secondary bacterial infection (impetigo), which in turn can lead to severe skin and soft tissue infection, septicemia and immune-mediated conditions including rheumatic fever and post-streptococcal glomerulonephritis,” Daniel Engelman, PhD, of Murdoch Children’s Research Institute, and colleagues wrote.

All residents of four villages (n = 1,211) in Uttarakhand, India, were enrolled in a single-arm, community intervention trial and were each given two doses of oral ivermectin (approximately 200 g/kg). For those who were pregnant, breastfeeding in the first week after birth, diagnosed with severe illness, taking warfarin, allergic to ivermectin or weighing less than 15 kg, topical 5% permethrin was offered as an alternative.

Doses were administered 7 days apart and the prevalence of scabies was evaluated before treatment and 12 months after treatment.

At least one dose was completed by 99.4% of the population, whereas 97.2% completed the second dose.

At baseline, 91 people had scabies, with 31.9% being moderate and 29.7% being severe. Suspected scabies was found in 55 patients. Impetigo was found in 15 participants, with nine cases considered very mild or mild.

At 12 months post-treatment, 11 individuals had scabies, meaning the absolute prevalence was reduced by 6.6% and the relative prevalence was reduced by 87.7%.

Five individuals had impetigo at 12 months with the absolute prevalence reduced by 0.8% and the relative prevalence reduced by 66.1%.

“These results are highly significant for scabies control efforts in India and globally,” the authors wrote. “The near-complete [mass drug administration] coverage likely contributed to the effectiveness of the intervention. This coverage reflects the benefits of community engagement in research and public health planning and the benefits of partnering with community health workers such as [Accredited Social Health Activist] workers.”