Mass Drug Administration for Scabies Control in a Population with Endemic Disease

Lucia Romani, Margot Whitfeld, Josefa Koroivueta, Mike Kama, Handan Wand, Lisi Tikoduadua, Meciusela Tuicakau, Aminiasi Koroi, Ross Andrews, John Kaldor, Andrew Steer

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    BACKGROUND: Scabies is an underrecognized cause of illness in many developing countries. It is associated with impetigo, which can lead to serious systemic complications. We conducted a trial of mass drug administration for scabies control in Fiji.

    METHODS: We randomly assigned three island communities to one of three different interventions for scabies control: standard care involving the administration of permethrin to affected persons and their contacts (standard-care group), mass administration of permethrin (permethrin group), or mass administration of ivermectin (ivermectin group). The primary outcome was the change in the prevalence of scabies and of impetigo from baseline to 12 months.

    RESULTS: A total of 2051 participants were enrolled; 803 were in the standard-care group, 532 in the permethrin group, and 716 in the ivermectin group. From baseline to 12 months, the prevalence of scabies declined significantly in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 36.6% to 18.8% in the standard-care group (relative reduction in prevalence, 49%; 95% confidence interval [CI], 37 to 60), from 41.7% to 15.8% in the permethrin group (relative reduction, 62%; 95% CI, 49 to 75), and from 32.1% to 1.9% in the ivermectin group (relative reduction, 94%; 95% CI, 83 to 100). The prevalence of impetigo also declined in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 21.4% to 14.6% in the standard-care group (relative reduction, 32%; 95% CI, 14 to 50), from 24.6% to 11.4% in the permethrin group (relative reduction, 54%; 95% CI, 35 to 73), and from 24.6% to 8.0% in the ivermectin group (relative reduction, 67%; 95% CI, 52 to 83). Adverse events were mild and were reported more frequently in the ivermectin group than in the permethrin group (15.6% vs. 6.8%).

    CONCLUSIONS:
    Mass drug administration, particularly the administration of ivermectin, was efficacious for the control of scabies and impetigo.
    Original languageEnglish
    Pages (from-to)2305-2313
    Number of pages9
    JournalNew England Journal of Medicine
    Volume373
    Issue number24
    DOIs
    Publication statusPublished - 2015

    Fingerprint

    Scabies
    Endemic Diseases
    Ivermectin
    Permethrin
    Impetigo
    Pharmaceutical Preparations
    Confidence Intervals
    Population
    Fiji
    Islands
    Developing Countries

    Cite this

    Romani, L., Whitfeld, M., Koroivueta, J., Kama, M., Wand, H., Tikoduadua, L., ... Steer, A. (2015). Mass Drug Administration for Scabies Control in a Population with Endemic Disease. New England Journal of Medicine, 373(24), 2305-2313. https://doi.org/10.1056/NEJMoa1500987
    Romani, Lucia ; Whitfeld, Margot ; Koroivueta, Josefa ; Kama, Mike ; Wand, Handan ; Tikoduadua, Lisi ; Tuicakau, Meciusela ; Koroi, Aminiasi ; Andrews, Ross ; Kaldor, John ; Steer, Andrew. / Mass Drug Administration for Scabies Control in a Population with Endemic Disease. In: New England Journal of Medicine. 2015 ; Vol. 373, No. 24. pp. 2305-2313.
    @article{52e02575b40c44da85ae73caf4064fba,
    title = "Mass Drug Administration for Scabies Control in a Population with Endemic Disease",
    abstract = "BACKGROUND: Scabies is an underrecognized cause of illness in many developing countries. It is associated with impetigo, which can lead to serious systemic complications. We conducted a trial of mass drug administration for scabies control in Fiji. METHODS: We randomly assigned three island communities to one of three different interventions for scabies control: standard care involving the administration of permethrin to affected persons and their contacts (standard-care group), mass administration of permethrin (permethrin group), or mass administration of ivermectin (ivermectin group). The primary outcome was the change in the prevalence of scabies and of impetigo from baseline to 12 months. RESULTS: A total of 2051 participants were enrolled; 803 were in the standard-care group, 532 in the permethrin group, and 716 in the ivermectin group. From baseline to 12 months, the prevalence of scabies declined significantly in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 36.6{\%} to 18.8{\%} in the standard-care group (relative reduction in prevalence, 49{\%}; 95{\%} confidence interval [CI], 37 to 60), from 41.7{\%} to 15.8{\%} in the permethrin group (relative reduction, 62{\%}; 95{\%} CI, 49 to 75), and from 32.1{\%} to 1.9{\%} in the ivermectin group (relative reduction, 94{\%}; 95{\%} CI, 83 to 100). The prevalence of impetigo also declined in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 21.4{\%} to 14.6{\%} in the standard-care group (relative reduction, 32{\%}; 95{\%} CI, 14 to 50), from 24.6{\%} to 11.4{\%} in the permethrin group (relative reduction, 54{\%}; 95{\%} CI, 35 to 73), and from 24.6{\%} to 8.0{\%} in the ivermectin group (relative reduction, 67{\%}; 95{\%} CI, 52 to 83). Adverse events were mild and were reported more frequently in the ivermectin group than in the permethrin group (15.6{\%} vs. 6.8{\%}). CONCLUSIONS: Mass drug administration, particularly the administration of ivermectin, was efficacious for the control of scabies and impetigo.",
    keywords = "ivermectin, permethrin, antiinfective agent, insecticide, skin cream, adolescent, adult, Article, child, clinical feature, comparative effectiveness, controlled study, dose response, drug administration, drug efficacy, drug safety, endemic disease, female, Fiji, follow up, human, impetigo, infection control, major clinical study, male, mass drug administration, practice guideline, prevalence, priority journal, randomized controlled trial, scabies, school child, single drug dose, treatment outcome, unspecified side effect, comparative study, complication, intradermal drug administration, preschool child, young adult, Administration, Cutaneous, Adolescent, Adult, Anti-Bacterial Agents, Child, Child, Preschool, Endemic Diseases, Female, Humans, Impetigo, Insecticides, Ivermectin, Male, Permethrin, Prevalence, Scabies, Skin Cream, Young Adult",
    author = "Lucia Romani and Margot Whitfeld and Josefa Koroivueta and Mike Kama and Handan Wand and Lisi Tikoduadua and Meciusela Tuicakau and Aminiasi Koroi and Ross Andrews and John Kaldor and Andrew Steer",
    year = "2015",
    doi = "10.1056/NEJMoa1500987",
    language = "English",
    volume = "373",
    pages = "2305--2313",
    journal = "New England Journal of Medicine",
    issn = "0028-4793",
    publisher = "Massachusetts Medical Society",
    number = "24",

    }

    Romani, L, Whitfeld, M, Koroivueta, J, Kama, M, Wand, H, Tikoduadua, L, Tuicakau, M, Koroi, A, Andrews, R, Kaldor, J & Steer, A 2015, 'Mass Drug Administration for Scabies Control in a Population with Endemic Disease', New England Journal of Medicine, vol. 373, no. 24, pp. 2305-2313. https://doi.org/10.1056/NEJMoa1500987

    Mass Drug Administration for Scabies Control in a Population with Endemic Disease. / Romani, Lucia; Whitfeld, Margot; Koroivueta, Josefa; Kama, Mike; Wand, Handan; Tikoduadua, Lisi; Tuicakau, Meciusela; Koroi, Aminiasi; Andrews, Ross; Kaldor, John; Steer, Andrew.

    In: New England Journal of Medicine, Vol. 373, No. 24, 2015, p. 2305-2313.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Mass Drug Administration for Scabies Control in a Population with Endemic Disease

    AU - Romani, Lucia

    AU - Whitfeld, Margot

    AU - Koroivueta, Josefa

    AU - Kama, Mike

    AU - Wand, Handan

    AU - Tikoduadua, Lisi

    AU - Tuicakau, Meciusela

    AU - Koroi, Aminiasi

    AU - Andrews, Ross

    AU - Kaldor, John

    AU - Steer, Andrew

    PY - 2015

    Y1 - 2015

    N2 - BACKGROUND: Scabies is an underrecognized cause of illness in many developing countries. It is associated with impetigo, which can lead to serious systemic complications. We conducted a trial of mass drug administration for scabies control in Fiji. METHODS: We randomly assigned three island communities to one of three different interventions for scabies control: standard care involving the administration of permethrin to affected persons and their contacts (standard-care group), mass administration of permethrin (permethrin group), or mass administration of ivermectin (ivermectin group). The primary outcome was the change in the prevalence of scabies and of impetigo from baseline to 12 months. RESULTS: A total of 2051 participants were enrolled; 803 were in the standard-care group, 532 in the permethrin group, and 716 in the ivermectin group. From baseline to 12 months, the prevalence of scabies declined significantly in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 36.6% to 18.8% in the standard-care group (relative reduction in prevalence, 49%; 95% confidence interval [CI], 37 to 60), from 41.7% to 15.8% in the permethrin group (relative reduction, 62%; 95% CI, 49 to 75), and from 32.1% to 1.9% in the ivermectin group (relative reduction, 94%; 95% CI, 83 to 100). The prevalence of impetigo also declined in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 21.4% to 14.6% in the standard-care group (relative reduction, 32%; 95% CI, 14 to 50), from 24.6% to 11.4% in the permethrin group (relative reduction, 54%; 95% CI, 35 to 73), and from 24.6% to 8.0% in the ivermectin group (relative reduction, 67%; 95% CI, 52 to 83). Adverse events were mild and were reported more frequently in the ivermectin group than in the permethrin group (15.6% vs. 6.8%). CONCLUSIONS: Mass drug administration, particularly the administration of ivermectin, was efficacious for the control of scabies and impetigo.

    AB - BACKGROUND: Scabies is an underrecognized cause of illness in many developing countries. It is associated with impetigo, which can lead to serious systemic complications. We conducted a trial of mass drug administration for scabies control in Fiji. METHODS: We randomly assigned three island communities to one of three different interventions for scabies control: standard care involving the administration of permethrin to affected persons and their contacts (standard-care group), mass administration of permethrin (permethrin group), or mass administration of ivermectin (ivermectin group). The primary outcome was the change in the prevalence of scabies and of impetigo from baseline to 12 months. RESULTS: A total of 2051 participants were enrolled; 803 were in the standard-care group, 532 in the permethrin group, and 716 in the ivermectin group. From baseline to 12 months, the prevalence of scabies declined significantly in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 36.6% to 18.8% in the standard-care group (relative reduction in prevalence, 49%; 95% confidence interval [CI], 37 to 60), from 41.7% to 15.8% in the permethrin group (relative reduction, 62%; 95% CI, 49 to 75), and from 32.1% to 1.9% in the ivermectin group (relative reduction, 94%; 95% CI, 83 to 100). The prevalence of impetigo also declined in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 21.4% to 14.6% in the standard-care group (relative reduction, 32%; 95% CI, 14 to 50), from 24.6% to 11.4% in the permethrin group (relative reduction, 54%; 95% CI, 35 to 73), and from 24.6% to 8.0% in the ivermectin group (relative reduction, 67%; 95% CI, 52 to 83). Adverse events were mild and were reported more frequently in the ivermectin group than in the permethrin group (15.6% vs. 6.8%). CONCLUSIONS: Mass drug administration, particularly the administration of ivermectin, was efficacious for the control of scabies and impetigo.

    KW - ivermectin

    KW - permethrin

    KW - antiinfective agent

    KW - insecticide

    KW - skin cream

    KW - adolescent

    KW - adult

    KW - Article

    KW - child

    KW - clinical feature

    KW - comparative effectiveness

    KW - controlled study

    KW - dose response

    KW - drug administration

    KW - drug efficacy

    KW - drug safety

    KW - endemic disease

    KW - female

    KW - Fiji

    KW - follow up

    KW - human

    KW - impetigo

    KW - infection control

    KW - major clinical study

    KW - male

    KW - mass drug administration

    KW - practice guideline

    KW - prevalence

    KW - priority journal

    KW - randomized controlled trial

    KW - scabies

    KW - school child

    KW - single drug dose

    KW - treatment outcome

    KW - unspecified side effect

    KW - comparative study

    KW - complication

    KW - intradermal drug administration

    KW - preschool child

    KW - young adult

    KW - Administration, Cutaneous

    KW - Adolescent

    KW - Adult

    KW - Anti-Bacterial Agents

    KW - Child

    KW - Child, Preschool

    KW - Endemic Diseases

    KW - Female

    KW - Humans

    KW - Impetigo

    KW - Insecticides

    KW - Ivermectin

    KW - Male

    KW - Permethrin

    KW - Prevalence

    KW - Scabies

    KW - Skin Cream

    KW - Young Adult

    U2 - 10.1056/NEJMoa1500987

    DO - 10.1056/NEJMoa1500987

    M3 - Article

    VL - 373

    SP - 2305

    EP - 2313

    JO - New England Journal of Medicine

    JF - New England Journal of Medicine

    SN - 0028-4793

    IS - 24

    ER -

    Romani L, Whitfeld M, Koroivueta J, Kama M, Wand H, Tikoduadua L et al. Mass Drug Administration for Scabies Control in a Population with Endemic Disease. New England Journal of Medicine. 2015;373(24):2305-2313. https://doi.org/10.1056/NEJMoa1500987