Scabies and risk of skin sores in remote Australian Aboriginal communities: A self-controlled case series study

• Published in: PLoS neglected tropical diseases 2018-07, Vol.12 (7), p.e0006668-e0006668
• Main Authors: Aung, Phyo Thu Zar, Cuningham, Will, Hwang, Kerry, Andrews, Ross M, Carapetis, Jonathan R, Kearns, Therese, Clucas, Danielle, McVernon, Jodie, Simpson, Julie Ann, Tong, Steven Y C, Campbell, Patricia Therese
• Format: Article
• Language: English
• Subjects: Age; Analysis; Bacterial infections; Children; Communities; Dermatology; Epidemiology; Funding; Health care; Health risk assessment; Hospitals; Infections; Infectious diseases; Laboratories; Medical research; Medicine and Health Sciences; Methods; Native peoples; Pediatric research; People and Places; Population; Product safety; Public health; Research and Analysis Methods; Research methodology; Risk factors; Scabies; Skin; Skin lesions; Software; Streptococcus infections; Studies; Supervision; Tropical diseases
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0006668

Skin sores caused by Group A streptococcus (GAS) infection are a major public health problem in remote Aboriginal communities. Skin sores are often associated with scabies, which is evident in scabies intervention programs where a significant reduction of skin sores is seen after focusing solely on scabies control. Our study quantifies the strength of association between skin sores and scabies among Aboriginal children from the East Arnhem region in the Northern Territory. Pre-existing datasets from three published studies, which were conducted as part of the East Arnhem Healthy Skin Project (EAHSP), were analysed. Aboriginal children were followed from birth up to 4.5 years of age. Self-controlled case series design was used to determine the risks, within individuals, of developing skin sores when infected with scabies versus when there was no scabies infection. Participants were 11.9 times more likely to develop skin sores when infected with scabies compared with times when no scabies infection was evident (Incidence Rate Ratio (IRR) 11.9; 95% CI 10.3-13.7; p1 year (IRR 0.8; 95% CI 0.7-0.9). The association between scabies and skin sores is highly significant and indicates a causal relationship. The public health importance of scabies in northern Australia is underappreciated and a concerted approach is required to recognise and eliminate scabies as an important precursor of skin sores.